The world economic crisis and the growing burden of financing healthcare mean there is a clear need to develop more sustainable systems. Hilary Thomas presents a six-point plan for fundamental reform
Creating sustainable healthcare systems was high on the agenda at the World Economic Forum in 2012.
One of the key points coming out of the World Economic Forum at the start of this year focused on the fact that that the financing of health systems has increasingly burdened developed economies.
Participants agreed that “the drivers of the growth in expenditure are unlikely to recede”. With this came the conclusion that there is a clear need to develop a more sustainable way of managing health systems.
Yet the magnitude of the challenge suggests incremental solutions may not be enough. No one is suggesting that a solution could have been uncovered in the 11 months since this debate was aired, but a shared vision of new models for health systems still does not exist.
‘Any sustainable system will need to get under the skin of what motivates individuals to engage in their healthcare’
Across the NHS unprecedented changes are taking place – from some hospitals effectively being placed in receivership to others putting all of their staff at risk. That’s not to mention the vast majority of NHS funds being placed into the hands of GPs, who for the first time in 60 years will be made fully accountable for the money they spend.
Simultaneously, the “dependency ratio” between the healthcare needs of the country’s retired population and the ability of its taxpaying workforce to fund healthcare is widening.
The only solution must be radical. KPMG has been considering this issue and our report, Acute or Chronic? The impact of economic crisis on healthcare and health, suggests that healthcare providers must adhere to a six-point plan to genuinely deliver quality care to patients. This includes:
Redesigning delivery models to reduce dependence on institutional care, whether in a hospital or a residential care bed. For it to succeed, it is imperative that a pathway approach is adopted – one built around the patient rather than an organisational focus.
Empowering patients to take more responsibility for their own wellbeing. This might mean understanding patient needs better through them taking an active role in self-care, whether that is recording regular vital signs, using technology or being better supported to stay at home through earlier intervention.
There is a growing number of pilots in the UK where the use of real time information is allowing more appropriate responsive care for those with long term conditions, mental health diagnoses or the frail elderly. In New York, Microsoft HealthVault has launched a project that uses technology to engage with three million people, including those who are homeless, have a mental illness or diabetes, so they can take ownership of their condition and benefit from greater awareness of it, rather than the traditional delegation of responsibility to a healthcare professional.
‘A less than radical response will put the population at risk in more ways than we might imagine’
Focusing on measuring and purchasing value for patients, not just on reducing costs. The aim should always be to return patients to their homes as quickly as possible – not out of delegation of care or dereliction of duty, but as a direct result of improvements in care that ensure patients are able to reclaim their independence quicker.
Making better use of technology to improve health management and reduce mistakes. Even something as simple as electronic prescribing may not only improve the efficiency of prescribing to enable patients to be return home more promptly, it also provides better data collection and reduces prescribing errors.
Tackling corruption and fraud, where it exists, around payment and procurement. This is a real threat to several systems beyond the UK, which if not addressed undermines value, progress and sustainability.
Focusing on prevention to reduce admissions. Building on the importance of self-care as a component in any future system has been significantly undervalued in the past, yet investment in smoking cessation, encouraging exercise and a healthier diet will lead to benefits in decades.
The underlying rationale of the six-point programme is that any sustainable system will need to get under the skin of what motivates individuals to engage in their healthcare. It might be “nudge style” by making this competitive in some way, or by finding a form of gratification that creates the incentive.
We will struggle to cope with the inexorable rise in demand at the front door of hospitals unless changes are made to the technology, drugs, facilities and processes used to treat patients.
Increasing waiting times, growing the self-pay market and relocating services to move less urgent cases elsewhere will have a short-term benefit but they are unlikely to bring about the much needed step change.
Austerity programmes aimed at reducing public expenditure on healthcare may ultimately diminish the population’s overall health. Some measures may have been designed to reduce costs without affecting the quality of care, but they pose a risk as vulnerable groups such as those on low incomes or with chronic health conditions may find it harder to access appropriate support to improve their health outcomes, exacerbating inequalities in health.
We must explore new and more sustainable approaches to health service delivery – a less than radical response to this challenge will put the population at risk in more ways than we might imagine.
Professor Hilary Thomas is a partner at KPMG Management Consulting