The answers are sitting there, in plain view
Health care services is a bugger’s muddle. Siloed, corrupt, the pace of change makes the fog-bound English law courts described by Charles Dickens in his novel Bleak House look dynamic.
And yet the answers are sitting there in plain view for all to see. That much is evident from the latest World Economic Forum report, which suggests that the average citizen of the world would live four years longer if systems were properly aligned. The report is worth a read because it will be discussed at Davos and will then become the basis for future reform moves. It is also (mercifully) only 22 pages long. Based on interviews conducted by KPMG and some top down analytics from Jessica Sullivan and Daniel Cadarette at Harvard, the report looks at problems in three areas, cancer, diabetes and mental health.
It identifies three big problem areas:
Divergent objectives cover conflicts of interest between stakeholders, myopic targets or payment mechanisms (such as fee-for-service) and inadequate data and tools for decision-making. It covers problems such as payments so pitiful that doctors won’t do the work or the over prescription of antibiotics.
Power asymmetries covers the way big tobacco can still bully countries or the way that NGOs insist that money is spent on solo conditions. (In 2009 1% of the aid budget went to non-communicable diseases, which account for 45% of the disease burden in developing countries).
Cooperation failures means things like electronic healthcare records, which don’t work.
What follows is some juicy case studies (inevitably successes rather than failures such as the £10bn the NHS in England wasted on healthcare records).
So how to correct these things?
The key answer is that alignment is a result of leadership and a commitment to improve quality, affordability, equity and efficiency of care. Conversely, poor health care services are a failure of leadership.
So are things getting better? Mark Britnell, global partner for healthcare services at KPMG, an author of the report, reckons the short answer is no. He says value healthcare, defined as payment by outcome, rather than by activity, is not being introduced substantially in many countries.
Can private sector operators play a role? Healthcare Nova thinks yes but you have to recognise that most operators in Emerging Markets act for the rich and are incentivised to do stuff by payment systems. This is a shame because what is called for is an efficient, neutral intermediary with a wide enough platform to carry out a very wide range of activities and cover the patient treatment pathways right through from primary/prevention to acute care. And it is important that the intermediary is not owned by big pharma or big medtech. And then you need a payment system, which rewards activity, not outcome.
We’ve seen only a few examples of this. Most prominent is the way German rehab group Median has extended its mental health back to acute and forwards to outpatient on city centres. This leads to better outcomes, which is mighty pleasing for the German pension funds who face massive payments if a 40-year-old never returns to work. That looks like alignment to us.
We would welcome your thoughts on this story. Email your views to David Farbrother or call 0207 183 3779.
