Géraldine Andrieux introduced the Financing Health Innovation (FHI) program as an initiative led by BLUMORPHO to accelerate the adoption and financing of impactful innovations. BLUMORPHO positions itself as a strategic innovation partner, supporting startups, corporates, and public organizations to access the right projects, financing, and innovation frameworks needed to scale what truly matters. Since 2016, the company has contributed to mobilizing over €1 billion to support innovation programs across sectors, with health as one of its key focus areas. The objective is not only to fund innovation but also to understand why and how to act effectively, ensuring alignment between technological solutions, societal needs, and sustainable health outcomes.

Géraldine then welcomed Dr. Iñaki Gutiérrez-Ibarluzea, Director of Health Research, Innovation, and Evaluation at the Basque Government’s Ministry of Health. Dr. Gutiérrez-Ibarluzea oversees strategic planning, R&D policy, and coordinates the Basque Health Research Institute, BIOef. He is also an active member of Health Technology Assessment International (HTAi) and participates in WHO initiatives. In addition, he currently serves as President of the EuroScan International Network, a consortium of more than 20 organizations worldwide dedicated to horizon scanning — the early identification and evaluation of emerging technologies likely to impact healthcare systems. With members across Europe and the Asia-Pacific region, EuroScan plays a key role in informing health authorities and supporting proactive decision-making.

Objectives and Structure of the Discussion

The conversation aimed to shed light on how health authorities define and prioritize innovation, the main health challenges they face, and the strategic directions they are taking to address them. The discussion is structured into three main parts:

1. Health and Quality Challenges: identifying current priorities and the structural issues facing public health authorities.
2. Artificial Intelligence (AI) and Innovation: exploring how AI can address healthcare challenges and the opportunities and limitations it presents.
3. Case Studies: reviewing concrete examples to make the discussion pragmatic and actionable, focusing on real-world applications and collaboration models.

Participants are invited to actively contribute questions throughout the session, ensuring an interactive and informative exchange.

Dr. Iñaki Gutiérrez-Ibarluzea:

I think this is a very relevant question in many respects. One of the main issues we’ve been discussing for years, and which remains a pressing concern is the sustainability of healthcare systems. Budget constraints are tightening everywhere, and this is now a central challenge, even for high-income countries. If we continue along the same path in terms of spending and investment, we will eventually reach a point where our systems become financially unsustainable. On one side, we face the technological pressure, the constant emergence of new and costly innovations. On the other, there’s a profound demographic shift affecting most countries. We’re dealing with the consequences of our modern lifestyles, such as rising obesity and declining physical activity. These, combined with an aging population, represent both a success story and a growing challenge for healthcare systems.

Another important aspect is that we can no longer think locally. For a long time, we assumed our populations were relatively stable and genetically homogenous. That’s no longer the case. The pandemic reminded us that we are now part of a global health ecosystem, with increasingly diverse populations and needs, even within high-income countries.

And then, of course, there’s climate change, which adds a completely new layer of complexity. We are already seeing its effects: the appearance of tropical diseases in regions where they were previously unknown, and extreme weather events, unprecedented floods, heatwaves, or freezing periods, all of which have direct impacts on mortality and morbidity.

So, if we look at all these factors together, technological pressure, demographic shifts, lifestyle-related diseases, globalization, and climate change, we can see that healthcare systems are entering a period of deep structural transformation. The challenge now is not just to adapt, but to ensure that these systems remain sustainable and resilient in the face of such rapid change.

Géraldine Andrieux:

The heatwaves we’ve been experiencing during recent summers are really striking. So, when you look at all these factors, would you say we’re facing more challenges than before, or is it more that different challenges are now combining and amplifying each other compared to the past?

Dr. Iñaki Gutiérrez-Ibarluzea:

No, I think one of the things we are missing is new approaches that could help us to address these challenges. Right now, we are still relying on old formulas, and they are no longer effective. They simply won’t succeed because they are not aligned with the realities we face today.

We need to explore all types of solutions and adopt different ways of approaching the problems confronting our health systems right now. 

Géraldine Andrieux:

That’s why it’s good that we’re having this discussion and that we can launch an innovation program focused on this topic, which is something that is very much needed. This discussion will serve as a starting point for identifying and developing new solutions.

Dr. Iñaki Gutiérrez-Ibarluzea:

Indeed any crisis is an opportunity. I think this is a particularly good moment for several reasons. One of them is that the maturity of technology today is much higher than it was a decade ago. We were discussing this with service providers in the Basque Country, and it’s clear: we now have tools and capabilities that simply didn’t exist before. The challenge is that we need to be sufficiently clever in terms of using them for the sake of the systems.

Géraldine Andrieux:

Indeed, implementation, making sure these innovations are applied in practical, impactful ways is also a challenge.

When we prepared today’s discussion, and reflecting on our previous conversation, you highlighted this study from Imperial College London published in June this year. I think it would be very interesting if you could share a bit more about this analysis and explain the key points, especially this statement from Lord Darzi, the Director of the Institute of Global Health Innovation at the Imperial College in London: “By 2035, prevention and digital health could prevent millions of chronic diseases and save billions in treatment costs. However, only a fraction of investments currently targets community-based, data-driven models: hospital spending still accounts for over 60% of health budgets. “

Dr. Iñaki Gutiérrez-Ibarluzea:

Yes, I think it was a very honest analysis of the UK healthcare system, highlighting some of the key aspects related to investment over the years. One of the main issues is the lack of anticipation. Once again, old formulas were used without proactively preparing for what was coming.

On one hand, healthcare systems, especially in high-income countries, have been quite successful in keeping people alive. On the other hand, this focus has often neglected quality of life. People who might have died earlier are now living longer, which is a success, but it also creates new challenges for the system.

One of the main points raised in the analysis was about the type of investment. Most funding has been concentrated on healthcare delivery, rather than on health. Promotion and prevention have not been central priorities; systems have focused on treating disease rather than maintaining health. That focus, while successful in many ways, has also created limitations.

Lord Darzi and his team highlighted that only a small fraction of investment currently targets community-based, data-driven models. Hospital spending still accounts for over 60% of the health budget. But if you include drugs and other costs, the focus is even more heavily skewed toward reactive care. We’ve concentrated on solving immediate problems but not on addressing underlying ones.

Other factors driving costs include personnel expenses, rising demand for health professionals, and societal expectations. Citizens now expect care to be faster and closer to home, which increases demand exponentially. You can’t simply expand supply; the system needs different approaches.

The Darzi report proposed several solutions, including technological innovation. But technology alone isn’t enough. The key is first to understand the problems. Their approach emphasized moving from analog to digital, from hospital to community, and from pathology to prevention. However, this isn’t sufficient. More effort is needed in health promotion and early diagnosis, not just disease treatment.

Finally, one of the challenges is that health professionals are trained to identify and treat diseases, not to promote health. Medical and nursing schools focus on pathology, rehabilitation, and treatment, but not on maintaining well-being. We need to work with health professionals to strengthen health promotion, prevention, and the identification of healthy habits, building evidence for what works in practice.

Géraldine Andrieux

So, as you said, these are not health systems focused on keeping people healthy, but rather healthcare systems focused on treating illness and hospital care.

Dr. Iñaki Gutiérrez-Ibarluzea:

Yes, I think in many countries around the world, ministries changed their names from “Ministry of Health Care” to “Ministry of Health”, and that was the case for us about a decade ago. However, it seems we still haven’t fully embraced the concept of focusing on health rather than just healthcare.

This creates another challenge: we continue to repeat some of the same mistakes we made in the past. I believe this is part of the reason why we are where we are today, and why the near future may not look particularly optimistic unless we shift our approach.

Géraldine Andrieux

As you said, let’s turn these challenges into opportunities. Could you summarize, what are the most urgent needs today that we should focus on addressing, especially given the budgetary constraints and the investment required to shift the paradigm from healthcare to health? Technology could help, digital solutions might help, but what are the top priorities right now for you?

Dr. Iñaki Gutiérrez-Ibarluzea:

Probably, if we look directly at the issue, budget constraints are the main challenge, without a doubt. As I mentioned earlier, recent studies have pointed out that technological solutions are actually putting pressure on healthcare systems, because costs are increasing by around 6% a year. When we compare that to GDP growth in many countries, the numbers simply don’t align.

For example, in a high-income European country like Germany, GDP growth today is close to zero or just one percent a year, while in other well-performing economies it might be around 2.5%. So if technology adds cost instead of delivering savings or efficiencies, it clearly becomes a major pressure on the health budget.

Other factors relate to demographic success. Life expectancy is increasing globally though, as noted in the US, there are exceptions. Longer lifespans bring additional needs, particularly for older populations, and if we don’t address them, this creates further challenges.

Another critical issue is disparities. Even in high-income countries, there are inequalities in access to healthcare and socio-economic differences that strongly influence both quality of life and life expectancy. This remains a central concern: how to provide a healthcare system that is fair in terms of access and provision, while also addressing all the needs of the population.

Géraldine Andrieux:

How do you do that? What direction are you taking to address those challenges?

Dr. Iñaki Gutiérrez-Ibarluzea:

I was joking earlier when I said you have to choose between fear or death.  And right now, I prefer fear. I’d rather be honest about the challenges we face. Fortunately, we are in a good position to act: technology is more mature, we have more data than ever, skilled professionals, and a society that is ready for solutions.

Some of these challenges can be addressed by the proposals outlined by NHS England for the next ten years, following Lord Darzi’s report. For example, moving from analog to digital and making decisions based on evidence rather than uncertainty. To do this, we need to ask the right questions and clearly define the current challenges.

We also need a paradigm shift. Most healthcare systems today are evaluated on surrogate outcomes, waiting lists, first visit access, or length of stay, rather than real patient outcomes. There is a growing movement toward value-based healthcare, which I strongly support. We need to focus on value and ensure that this perspective is communicated to society. Citizens should not only see metrics like waiting lists or hospital stays, but understand improvements in life expectancy, quality of life, and patient-centered outcomes. Healthcare performance should be measured based on these outcomes, not just structural or process metrics. Hospitals will always be needed for acute and complex care, but we must also invest in community care. This means understanding why patients transition from health to disease and designing solutions at the community level using data, preventive strategies, and targeted interventions. We need more than just more primary care physicians or community nurses; we need a deeper understanding of disease dynamics and effective tools to intervene early.

Prevention is essential, but I would go further: we need health promotion, anticipating problems before they occur. Just as with climate-related challenges, like fires in Spain, the goal is not only to respond but to understand why problems happen and how to minimize them. In healthcare, this means preventing patients from deteriorating and reducing costs before they arise.

Finally, a substantial portion of healthcare spending is wasted.  Roughly 25 to 30% according to the New England Journal of Medicine and OECD reports. This includes inappropriate use of interventions, misaligned procurement, and inefficient practices. In the past, some of this was unavoidable due to lack of data, but now we have the information to analyze and make informed decisions. Addressing these inefficiencies is critical to creating a sustainable, high-performing healthcare system.

Géraldine Andrieux:

We’ll come back to the topic of data and AI shortly, but first we want to focus on a few questions about innovation priorities. Specifically, how is the Basque Health Ministry currently shaping its innovation agenda, and how does it collaborate with innovative companies and corporates to implement it?

Dr. Iñaki Gutiérrez-Ibarluzea:

What we are trying to create is an innovation ecosystem that fosters collaboration among all key actors.  This was announced yesterday at BioSpain, the largest healthcare-focused event in Spain.

We need the participation of all stakeholders:

• Healthcare providers and the Ministry of Health, who control funding and set priorities;
• Clusters of companies, which bring knowledge and alternative perspectives on the healthcare system;
• Academia, which contributes research and evidence; and
• Innovators and the productive sector, which drive new solutions.

The goal is to combine public and private efforts. Most impactful solutions emerge from the interaction between healthcare systems and the innovation ecosystem, bringing together government, society, academia, and industry.

Dr. Iñaki Gutiérrez-Ibarluzea:

In the past, collaboration was a need; today, it is a must. There is knowledge missing on both sides, within the healthcare system and among innovators. To effectively address the challenges we face, we need to work together to provide solutions. The first step is simply creating that collaboration.

Dr. Iñaki Gutiérrez-Ibarluzea:

As I was saying, this needs to be addressed on a global scale. Otherwise, we might try to impose local solutions on a system that is far too vast. We are not just dealing with local problems — these are global challenges that affect us in many ways.

Géraldine Andrieux:

What you’re saying is music to my ears. This ecosystem approach is exactly what we are working on. It’s part of the rules and DNA of Blumorpho. You’re calling for a paradigm shift, and this is truly the best way to achieve it. Very interesting.  I’m excited to continue this discussion.

Dr. Iñaki Gutiérrez-Ibarluzea:

We also need to challenge innovators. Until now, they’ve been primarily focused on market-driven needs, often emphasizing prevention and early identification, which is important. But we need them to also focus on health promotion, helping to shift the system from being reactive to disease toward actively supporting overall health.

Géraldine Andrieux:

And this is something we need to do together.

Géraldine Andrieux:

What is needed to operate your vision? Do you already have a list of solutions you are looking for?

We’ve received a question about point-of-care diagnostics. Is this the type of solution you need to support the paradigm shift and advance the evolution of the health system?

Dr. Iñaki Gutiérrez-Ibarluzea:

Ultimately, what we need are tools that help us understand the dynamics of health and disease. When I talk about the dynamics of health and disease, I mean that many systems are still relying on static analyses. In epidemiology, for example, we used cross-sectional studies, a snapshot of the situation, and planned based on that.

But today, with the solutions available in healthcare systems, we have the tools to take a more sophisticated, dynamic approach. Understanding these dynamics allows us to plan more effectively and transform the way we organize care.

This includes early identification, biomarkers, and combining different types of data, not just from healthcare systems, but also environmental exposures, lifestyles, and socio-economic conditions. By analyzing how these factors interact, we can anticipate changes and intervene earlier, rather than just reacting. Otherwise, we end up putting bandages on problems.

Géraldine Andrieux:

A One Health approach and breaking down silos, as you mentioned, is essential to truly address the challenges.

From this perspective, is it possible for you to collaborate with innovative companies? And would you also need to work with large private companies?

I think you already started answering, because you mentioned the need for an ecosystem approach.

Dr. Iñaki Gutiérrez-Ibarluzea:

In the past, collaboration with innovative companies was a need, because the health system couldn’t solve all problems on its own. There were challenges we couldn’t address internally, so we looked to innovators for solutions. Today, collaboration is no longer optional, it is a must.

From the start, pre-commercial procurement initiatives, including those launched by the European Commission, were limited in impact, partly because systems weren’t yet mature enough to clearly communicate their needs to innovators. The traditional approach,  “come to us with your offer and we’ll see if it fits” is no longer sufficient. Instead, we need to define our challenges clearly and work together with innovators to find solutions. Prioritizing these challenges allows for focused, practical collaboration.

Communication is crucial. Innovators and healthcare systems represent two different worlds that must connect. Big companies also play a vital role: they can scale innovations globally. Local testing and solution development is essential, but scaling requires the infrastructure and capacity that only larger companies can provide.

At the same time, we need a healthy ecosystem of innovators, often small companies or startups, that work alongside large companies and healthcare systems. The system’s role is to identify realistic needs, not just accept solutions pushed externally. Together, this creates a dynamic where the pull from the health system drives innovation, supported by a mix of small innovators and global companies, ensuring solutions are both practical and scalable.

Géraldine Andrieux:

You mentioned the need to shift the paradigm: moving from healthcare to health, from treatment to prevention. This requires budget and financing. Have you already started thinking about specific business models to support this approach, or do you see the process of challenging innovators and co-creating solutions as the way to define the right business model?

Dr. Iñaki Gutiérrez-Ibarluzea:

One of the key challenges is who pays for these changes. Who funds the shift from treatment to prevention and the running costs of such programs? If we look at traditional healthcare systems, they are not structured to cover these costs, so we need other actors to contribute. This was evident during the pandemic: we realized that without health, there is no wealth. If lockdowns had continued unchecked, economies would have collapsed.

Currently, the paradigm mostly compares different solutions in terms of investment versus immediate results, but that is no longer sufficient. New metrics are emerging, such as productivity-adjusted life years, but this raises the question: who pays for productivity? Health systems fund healthcare, quality of life, and life expectancy, but productivity benefits the economy, so companies and other government sectors, for instance, Ministries of Economy, also have a role.

This suggests the need to rethink how health systems are financed, beyond traditional healthcare budgets. It’s about creating new funding models that support a shift from healthcare to health, linking investment in prevention to societal and economic benefits. Society needs to understand and embrace this paradigm shift.  It’s a key element for sustainable, impactful health systems.

Géraldine Andrieux:

Yes, financing is definitely a key issue. To enable the shift in business models from healthcare to health, we need approaches that provide both health impact and economic return.

Dr. Iñaki Gutiérrez-Ibarluzea:

Yes indeed. Financing is critical, but we should also consider that investors in health may not necessarily be traditional healthcare funders. Other actors could play a role. Importantly, financing becomes less of a constraint if we develop new solutions that generate a return on investment. In other words, effective innovations can create a self-sustaining cycle, where health improvements and economic benefits reinforce each other.

Géraldine Andrieux:

This ties into what we discussed earlier: public-private partnerships, blended finance, and similar approaches could all be very interesting. As health authorities, would these be options you are considering to enable the shift toward a health-focused system?

Dr. Iñaki Gutiérrez-Ibarluzea

We need to find funding wherever possible. Combining public and private funds is key. There’s an important distinction here: it’s not about privatizing healthcare provision, but about public-private partnerships for investing in solutions. In this context, data generated by public service providers should be shared with private companies to develop solutions. This approach reduces the cost of creating and validating solutions and improves the potential return on investment.

Géraldine Andrieux:

That’s very clear, and it opens the discussion for the weeks and months ahead regarding the actions we are implementing.

Géraldine Andrieux:

I also wanted to briefly touch on AI. You mentioned several times the need to be more proactive, to anticipate better, and to shift from siloed approaches to a more ecosystem-based approach. Could AI be the breakthrough innovation for these challenges? Is it something you are currently assessing?

Dr. Iñaki Gutiérrez-Ibarluzea

Yes, we are testing AI solutions, I would say in a sandbox environment, so it’s a safe space for experimentation. This is very interesting.

I was recently at the International Health Data Forum in Cardiff, and even major companies providing AI solutions highlighted that while AI is promising, the key is having good data. Systems need to provide well-curated, high-quality data. Without that, even the best AI solutions won’t succeed. For example, Microsoft’s Dr. Watson project struggled, and one of the main reasons for its limited success was precisely the lack of sufficiently curated data.

The main limitation for AI so far has been the lack of sufficient, accurate data, which is why collaboration is essential. Where we currently have good access to reliable data, for example, in diagnostics with objective biomarkers and imaging data. We see great potential. This reduces fear in the system because rather than replacing humans, AI is being used for intelligence augmentation. It allows us to process information faster than humans can, and in some cases, AI itself can help generate high-quality data. There is definitely space for AI, but we need to align expectations and focus on areas where it can operate safely and effectively. European healthcare systems tend to be conservative because we require guarantees and want to avoid errors. Some AI solutions introduced in the past actually increased mistakes rather than solving problems, highlighting the importance of careful implementation.

So, the challenge is twofold: we need to provide AI with high-quality data, and we need to ask the right questions. Only then can AI truly support healthcare systems. Interestingly, the Health Data Forum concluded with the principle: first data, then artificial intelligence. I would add: first questions, then data. We need to define the questions that require data, ensure we have high-quality data, and then test and enhance our capabilities to analyze that data and develop solutions using the tools available, artificial intelligence being one of the key ones.

Géraldine Andrieux:

One of the main challenges remains access to data and how to use it effectively, as data ownership is often a significant barrier. We’ve already been discussing some potential solutions together, but is data management a key concern for you? Would you be open to engaging in data-sharing or data-exploitation initiatives to address it?

Dr. Iñaki Gutiérrez-Ibarluzea

Well, it’s part of my nightmares, though I would say they are good nightmares. It’s true that managing data is a major challenge right now. In our country and region, we are closely monitoring the new European regulations on the secondary use of health data. By 2029, all public health data should be available for use, but we believe we can act much earlier with the technology we already have.

To do this, we need human intelligence to guide the process. There’s a paradigm shift: previously, European regulation treated data as owned by citizens, requiring informed consent for any use. Now, with the new rules, data can be used unless citizens opt out, but we still need to define concrete use cases.

We are working on this actively, proposing examples rather than pilots, because calling something a pilot implies a lack of trust in what we are doing. We call them use cases. We select specific use cases and explore them in depth, with the goal of scaling them in various contexts.

Géraldine Andrieux:

Let’s explore these use cases, because it’s useful to explore specific challenges and illustrate what we just discussed. At the start of our session, you highlighted the impact of the pandemic. Given its major effects, is the pandemic still considered a risk, and how are you factoring it into your planning? Are you also considering AI-based solutions to address this? Let’s cover this briefly so we can understand the current situation and the main threats related to it.

Dr. Iñaki Gutiérrez-Ibarluzea

Definitely, some people may say COVID is no longer an issue, and perhaps they are right. With the evolution of coronaviruses, future outbreaks may not even reach epidemic levels. But pandemics will continue to be a major risk. As I mentioned earlier, we can no longer think locally. We are global. Diseases that were once confined to tropical countries, like malaria or dengue, are now appearing elsewhere. For example, tiger mosquitoes (Aedes albopictus) are present in central Europe. We are also seeing new strains of flu, some originating from animals, which could become problematic. H1N1 in birds is one such example nearby. There will come a time when these viruses cross species barriers, so we need to be prepared.

This is why anticipation is key. We cannot wait until a pandemic strike to produce PPE or other emergency responses. If we plan ahead, such measures may not even be needed. Technology is certainly part of the solution, but only if we use it wisely. We can no longer claim ignorance. To anticipate effectively, we need access to real and relevant data, collaboration with other players, and a global perspective. Governments and healthcare systems cannot address these challenges alone. We need global investment, human expertise, and AI-driven solutions to support public health. Anticipation will be the critical factor in managing future risks.

Géraldine Andrieux:

Very good. Thank you very much for all the insights and sharing today. I think you’ve covered the topics we are focusing on at Financing Health Innovation very well.

To give a bit more context, these sessions are dedicated to the co-construction of solutions that truly fit the needs of health players. We start from the identified needs and work on fostering strategic collaboration among all key stakeholders, structuring a value chain with measurable impacts and coordinated actions. By doing so, we can potentially shift the paradigm, from simply checking boxes to truly measuring outcomes and impact. These models are also designed to be economically sustainable, engaging financial players with the right funding mechanisms.

Meanwhile, I also want to highlight that when we talk about the Basque Country and its Ministry of Health, many people agree that you are truly paving the way for innovation. So thank you again Iñaki for your time and contribution today. You’ve highlighted that while we face many challenges, there are also tremendous opportunities. This is exactly why we are very pleased to start working on this program together.