Beyond Market Access: Why healthcare-system understanding is becoming a leadership capability

Europe’s changing healthcare environment calls for more than stronger access execution. It requires leaders who understand how healthcare systems work, anticipate how they are changing, and recognise what must become true for innovation to create sustainable value. This is not simply a broader role for Market Access. It is an emerging leadership capability for the healthcare business.

The evolution is bigger than Market Access

Market Access is often described as a specialist discipline around pricing, reimbursement, HTA, and payer engagement. These capabilities remain essential. But the more important development may now be taking place beyond the functional boundaries.

As innovation, policy, financing, healthcare delivery, and societal expectations become more interconnected, understanding and navigating healthcare systems is becoming fundamental to strategic leadership. Leaders may understand the science, product, and commercial opportunity, yet, still have only a partial understanding of the business if they do not understand the system in which an innovation must be adopted.

My central reflection is therefore not that Market Access needs a bigger organisational role. It is that access thinking, healthcare-system literacy, and the ability to contribute to system shaping must become part of how healthcare leaders make decisions. Market Access provides important expertise, but this capability cannot remain confined to one function.

Europe’s innovation challenge is a leadership challenge

Europe’s challenge is not a simple trade-off between innovation and affordability. It is the harder task of sustaining both while protecting equity, system resilience, and long-term competitiveness. Ageing populations, chronic disease, workforce shortages, and constrained budgets are changing what systems can absorb, while expectations for faster and more equitable access continue to rise.

Global pricing dynamics, international price referencing, launch sequencing, European policy reform, and greater scrutiny of outcomes now connect decisions once treated separately. A choice made for one market can influence availability elsewhere. Short-term cost containment can affect investment, launch attractiveness, and patient access, while industry must recognise the legitimate uncertainty and financial pressure faced by public systems.

These interdependencies mean leaders can no longer treat access as a downstream technical question delegated to specialists. Innovation strategy needs an integrated view of evidence, health investment, policy, system capacity, and patient outcomes. Leaders need to see these connections while portfolio choices, evidence priorities, launch ambition, and resource allocation can still be shaped.

This is particularly visible across Central and Eastern Europe. Differences in funding capacity, HTA maturity, policy development, and patient pathways challenge general European assumptions. This diversity is not a regional weakness. It shows why market archetypes matter, why different starting points require different strategies and why a European innovation model that does not work across diverse systems is not yet a complete European model.

From specialist expertise to organisational capability, from responding to the system to helping shape it

Healthcare-system understanding cannot sit exclusively within Market Access, Policy, Government Affairs, or Healthcare Affairs. When evidence strategies, investment levels, launch sequences, and portfolio choices are shaped, leaders themselves need to deeply understand the system assumptions behind those decisions.

In this broader sense, access is not only the route from regulatory approval to reimbursement. It is the set of conditions that allows innovation to be recognised, financed, adopted, delivered, and translated into patient benefit. Understanding access therefore requires insight into stakeholder incentives, policy, economics, care pathways, system capacity, evidence expectations, and patient realities.

That starts with a clear patient value hypothesis: which patients are most likely to benefit, under which conditions, and what must a healthcare system recognise or change to enable that value? This creates discipline around patient populations, evidence gaps, pathway barriers, and the choices required to expand impact over time. Scenario planning adds further discipline by making explicit what is likely, what could improve, and what would trigger a different course.

The traditional access question is often: “How do we secure access for this product?” The more strategic question is: “What needs to become true in the healthcare system for this innovation to deliver its potential, and how can we contribute?” Scientific innovation does not automatically create patient benefit. Systems must be able to identify the right patients, finance adoption, provide diagnostic and delivery capacity, implement pathways, and learn from outcomes.

System shaping does not mean redesigning healthcare around an individual product. Credible engagement starts with shared needs such as prevention, earlier diagnosis, pathway quality, capacity, relevant evidence, or sustainable outcomes. The mindset moves from responding to the system, to understanding it, to helping shape the conditions in which innovation and better care can succeed.

One strategic ecosystem, shared leadership responsibility: Healthcare-system literacy as an executive capability

No single function can create these conditions. Government Affairs interprets political priorities. Policy Shaping supports frameworks that value innovation. Healthcare Affairs connects unmet need with pathways. Patient Engagement brings lived experience. Market Access translates value and system realities into sustainable routes to treatment.

Real-world evidence, including registries and patient-reported outcomes, help systems revisit uncertainty and assess value over time. The opportunity is not simply to produce more data, but to build an evidence ecosystem around questions that matter to patients, clinicians, payers, and policymakers.

These disciplines should remain distinct, but operate through one strategic logic. Access is created across an ecosystem. No single function can own it, and no leadership team can treat it as a downstream task.

This does not mean every executive must become a Market Access expert. It means leaders need enough healthcare-system literacy to recognise interdependencies, challenge assumptions, and make decisions grounded in how healthcare systems actually operate.

The capability combines knowledge and mindset: understanding system incentives, constraints & realities; anticipating policy and stakeholder change; connecting innovation with care delivery; using scenarios not single-point assumptions; making decisions under uncertainty.

A personal perspective

I am convinced healthcare-system understanding will become a defining capability for healthcare leadership. Leaders will still need strong scientific, commercial, and operational judgement. But they will also need to understand the systems in which innovation must be financed, adopted, and translated into patient benefit.

Market Access remains an essential discipline within this broader capability. Its expertise becomes most powerful when connected with other perspectives through a shared understanding of patient value, system realities, and the conditions required for sustainable innovation.

The question is therefore not whether Market Access deserves a bigger seat at the leadership table. The table itself is changing. The healthcare leaders who succeed will understand not only the innovation they bring, but the systems in which it must create value, and their responsibility to help shape those systems responsibly.

About the author

Benedikt Giessrigl is a Market Access and Healthcare Affairs leader for Central and Eastern Europe. He has broad cross-functional experience across medical, marketing, market access, healthcare affairs, and patient engagement, with a particular interest in how better healthcare-system understanding can support sustainable innovation and patient impact.