12 steps to the perfect health system
And though organizations have made strides to transition to value-based care and better manage population health, overall the United States spends more on healthcare but ranks last in quality compared to 10 other industrialized Western nations.
It's hard to imagine or dream that a perfect health system could exist--one that would meet all patients' needs at reasonable costs.
So it was with interest that I recently started to read Mark Britnell's new book, "In Search of the Perfect Health System." Britnell, the former chief executive candidate for the National Health Service (NHS) in England, now serves as the chairman and partner of the Global Health Practice at auditing firm KPMG. He's spent the last five years working in 60 countries to help governments and public and private sector organizations with operations, strategy and policy.
His travels have allowed him to witness first-hand examples of great health and healthcare. Although he hasn't found a perfect health system, he writes that if he found one it would feature 12 components that take from the best practices from around the world. And it would look something like this:
1. Universal healthcare: The best, he says, is offered by the NHS in the United Kingdom. The NHS was the first in the world to create a universal healthcare system, one that is available to all citizens, regardless of whether they have the ability to pay for it.
2. Primary care: Britnell turns to Israel for the example of excellent primary care. Indeed, Israel has one of the highest life expectancy rates in the world (average age of 82) and one of the lowest shares of gross domestic product (GDP) spent on health. Primary care is supported by four health maintenance organizations that act as both purchaser and provider for preventive, primary and community services. Out-of-hours care is provided around the clock, he writes, and integrated with evening care centers, urgent care centers and home visit services.
3. Community services; For inspiration, he suggests we look to Brazil where community teams made up of doctors, nurses, nurse auxiliary and community health workers visit households every month, whether or not they demand or need it. These teams offer immunizations, chronic disease management and screenings.
4. Mental health and well-being: Australia has made the most progress in this area, according to Britnell's research, offering public funding to invest in crisis and home treatment, early intervention and assertive outreach.
5. Health promotion: The Nordic countries best address the social determinants of health, encouraging individual responsibility and fostering collective action, according to Britnell. The five countries have public health and illness prevention strategies that contribute to low smoking, alcohol consumption and obesity rates, he says.
6. Patient and community empowerment: Britnell says the world can learn about patient empowerment from Africa, which blends community activism, patient education, social marketing and behavior change to promote better health. One example is the maternity care program in Kenya, which encourages mothers and women to share experiences to help cut maternal and infant death.
7. Research and development: This is where the U.S. shines, he says, noting the number of high-impact drugs and medical devices we've developed. But he also called out the innovation of new business and care models, including Kaiser Permanente's health information and technology systems, Geisinger Heath Systems' population health management and Virginia Mason's lean manufacturing principals.
8. Innovation, flair and speed: Britnell has found inspiration for the adoption and adaption of new innovations in India, where several organizations have been able to create a hub-and-spoke model that focuses on cost effectiveness rather than cost-cutting. Examples included standardized care pathways, making it easier to shift tasks and do more with fewer staff; referral networks that channel patients to the correct settings and even hospitals manufacturing their own devices or implants when suppliers refused to reduce prices.
9. Information, communications and technology: Singapore offers great examples of the sharing of patient data via a national electronic health record that allows access to all hospitals, community facilities, practitioners and long-term care homes, he writes. This provides the country with the ability to fully analyze clinical, financial and operational data to better assess healthcare costs and outcomes.
10. Choice: There are no out-of-network providers in France. Patients can go to any doctor or hospital they wish, he says. Patient satisfaction is particular high, he notes, as are the country's quality and outcomes.
11. Funding: No country does it better than Switzerland, which spends11.5 percent of GDP on health, according to Britnell. The country also boasts high patient satisfaction, good clinical outcomes and life expectancy of 82.7 years. But Britnell notes that the country can afford to spend so much because its economy is globally competitive and dynamic.
12. Aged care: Japan offers its citizens compulsory long-term care insurance, which offers social care to all those older than 65 based solely on need. The ability to pay is not part of the assessment process. Care offered under the plan includes home help, community-based services, and residential and nursing care. The country has also created dementia homes where groups of people live together in a supportive, home-like environment, he writes.
Wouldn't it be wonderful to live in a country that offered this type of healthcare system? Given the continued fight in the country to just provide affordable care to all, it does seem impossible. But I guess we can dream.-- Ilene (@FierceHealth)
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