For everyone working in the healthcare sector, 2017 arrives with much to celebrate and a great deal to ponder. On the one hand, we can look back on decades of sustained progress, with universal coverage of healthcare rising and people enjoying generally healthier and longer lives than ever before. Funding is increasing and the OECD’s figures on the state of play show the number of doctors and nurses has grown significantly across most OECD countries since 2000.
Putting people at the centre: The future of health
When is healthcare successful? All too often, the answer is that we don’t really know. Although healthcare consumes almost a tenth of GDP in the OECD, our understanding of the value and outcomes that this large and often growing spending achieves remains limited.
Two issues are at the centre of the debate on how to make sure our health systems more sustainable: tackling unnecessary spending on health, and making sure that medical innovations deliver the right products at the right price. Both of these two key issues are epitomised by one of the biggest public health challenges we face today: that of antimicrobial resistance (AMR).
Is there such a thing as a right amount of health spending? In an ideal world, this would likely mean spending that achieves effective healthcare services, with good outcomes for patients, the right number of professionals with the right skills, and delivers good value for tax payers with little, if any, wastage. Finding that balance is a difficult challenge.
The healthcare sector is awash with data, whose range and volume are growing exponentially. But they will sit unused in data warehouses, often from fear of being misused, unless fundamental action is taken. The OECD Recommendation on Health Data Governance can help countries in managing the risks and harnessing the benefits from health data.
Pepe is a 74 year-old widower, who lives with one of his two sons in a small apartment in the Spanish city of Valencia. His son works at night and sleeps all morning. Pepe spends most of his day at home and feels lonely and depressed. He suffers from pulmonary fibrosis, heart failure, hypertension and dyslipidaemia. He takes corticosteroids, nebulisers and inhalers, as well as drugs against hypertension, statins and anti-coagulants. Pepe is often short of breath and also requires oxygen therapy. Sometimes he feels like he is dying and his son takes him to hospital. In the last 18 months, Pepe visited the hospital emergency room 39 times. He was admitted to the pulmonology department in eight of these visits.
We often say that in healthcare policy there is no one-size-fits-all solution. But despite the many differences in how countries define, organise and deliver health services and medical care, a number of common challenges can be tackled together. Most national health systems face unprecedented pressures to evolve, be it because of demographics, technological developments, changing epidemiology or patient engagement, and they often struggle to deliver tailored, patient-centred care, while keeping their spending in check.
Significant changes in demographics, epidemiology and lifestyles have created novel challenges for health systems. Recent OECD estimates suggest that the share of population aged over 65 will rise to nearly 30% by 2060. Given existing budgetary constraints, today’s health systems are struggling to meet the challenges posed by an ageing society and the increasing burden of chronic diseases and related comorbidities it brings.
The OECD Health Ministerial in Paris on 17 January has the ambition of paving the way to “The Next Generation of Health Reforms” with “people at the centre”. Representing the Trade Union Advisory Committee to the OECD (TUAC) on this occasion, and in close partnership with the Public Services International (representing public sector trade unions), I am bringing the voice of the labour movement to the table.
The word “patient” comes from Latin, and means “the one that suffers”. Healthcare has historically been about “taking care” and “protecting” the patient that suffers. Under this view the patient is more or less helpless. The healthcare professional on the other hand plays the dominant role, as an authority, to be heeded and obeyed. This attitude is all too prevalent today, in that the passive patient is not seen as having useful knowledge or capacities, and so must wait patiently for the doctors’ orders.
Countries around the world are struggling with rising healthcare bills. Every introduction of pricey new biologics, surgical procedures, and exotic “precision” treatments causes ever-increasing fiscal stress, leading to deficit spending, cutbacks in other government services, and insurance costs shouldered by firms and employees alike. Yet, freezing budgetary allocations is clearly not an option, as citizens in our ageing societies are likely to demand more and better access to new health innovations, and essential healthcare services. What can be done?
In the coming two decades, it is expected that the number of individuals aged 65 and over will nearly double, so that there will be over 1 billion older adults worldwide. With our healthcare systems struggling to cope, this prospect has been characterised by some as a “grey tsunami” that threatens to raise costs, create inefficiencies and ultimately bankrupt us. Describing our changing demographic as a tsunami is problematic.
Is the concept of “people-centred care” just new jargon for cost-cutting and to reduce access to routine healthcare? Or does it have the potential to improve both the health and well-being of people, while making the health system more efficient and less costly, and helping people to become healthier at the same time? This is the existential and fundamental question which policymakers and funders, together with the public and wider healthcare community, must answer.
Did you know that there is a correlation between diabetes and education levels? People with the lowest level of education are more than twice as likely to report having diabetes than those with the highest level across EU countries, a close look at Eurostat data shows (see chart).
Health systems strengthening efforts have focused on enhancing performance without significant attention to what value means to the ultimate users of the system–patients. Generating metrics that can better drive health systems in a manner that places patients at the core is an ethical, health and economic imperative. In fact, measures that comprehensively assess patient experiences, preferences and outcomes, can improve accuracy in priority-setting and promote the delivery of value-based care.
OECD Observer: On the OECD healthcare conference website you paraphrase Donald Berwick: “We are all guests in our patients’ lives”.* What exactly do you mean by this eloquent phrase?
Telehealth is not a substitute for seeing real doctors, but can play a valuable role in patient-centred healthcare and in closing the rural-urban divide as well. But it will require investment and determined policies.
At a time when universal health coverage struggles under the onslaught of rising costs and budgetary strains around the world, the OECD Ministerial Statement: The Next Generation of Health Reforms of 17 January 2017 offers much needed support to the ideal of equitable access to people-centred healthcare.
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