The 2017 annual conference on Mobilising Business – Acting on Future Health emphasised that accessible, effective and affordable healthcare to all is one of the most urgent societal challenges. But, as conference co-chair Professor James Barlow pointed out, this problem cannot be solved alone. It needs to be tackled collaboratively with businesses and stakeholders from multiple industries. Currently, Professor Barlow argues, the three most challenging issues facing the world’s health systems are:
- Ageing and associated problems for developed and developing countries, with a predicted extra billion people aged 60+ over in the next 35 years globally;
- Obesity, with 2.1 billion people already affected globally;
- Anti-microbial resistance, which could lead to 10 million deaths a year and cost the world’s health systems $100 trillion by 2050 if no action is taken.
The conference focused on the major role businesses play in healthcare. More than 25% of the annual spending related to healthcare is on main inputs – pharma and medical biotechnology, medical devices, healthcare IT and the built environment. The conference highlighted that stakeholders need to rethink what innovation means, how it is nurtured and implemented, and the importance of a long-term view when capturing its impact.
Dr Mark Britnell from KPMG gave an introductory keynote presentation which sparked discussions throughout the day. Supported by his recent award-winning book, In Search of the Perfect Health System, Britnell presented a study he conducted with the World Economic Forum, Professor David Bloom and the Global Healthcare KPMG Team. The research addressed the premise that we can do more good for the world in terms of accessible, affordable healthcare if we change our business models and adopt new therapeutic advances.
Britnell’s hypothesis stated that “misalignments among stakeholders significantly contribute to the underperformance – of and waste within – the health sector”. He pledged that we do not place enough resources and effort in academia and businesses on reducing those misalignments in order to get more value from the system. There are excellent institutions addressing most diverse and prevailing healthcare issues. However, no institution exists or dominates this quest for better business processes and healthcare models, even though the mechanisms of health systems are fundamentally the same across the globe.
The study was conducted in 16 countries over 18 months and involved interviews with 60 players in the private and public sector, along with NGOs and charities targeting the three most prevailing health conditions: cancer, diabetes and mental illness.
The World Economic Forum highlighted that a shared vision of new models for health systems among “payers, providers, patients, professionals, policy-makers, politicians, the public and the press” is missing (Britnell, 2015). The study has shown that there is a clear misalignment among stakeholders in relation to their interests and objectives, leading to major waste in health systems, in both developed and developing countries.
To understand what a perfect health system strives to be, we may consider a model developed by the Institute of Medicine. Using this model, high-quality systems are composed of four key factors: vision, focus on the design of the clinical care process from the patient’s perspective, integration of care organisations into care systems, and the wider environment.
This model was discussed during the breakout discussion. Yet we found implementation to be a much greater challenge, as motivation and the drive to change are required to reinforce it. In our discussion it was stressed that a bottom-up approach may initiate change more effectively at a local level, and gradually evolve into a system-wide impact.
On a more macro level, Britnell summarised misalignment in three essential causes: divergent objectives, power asymmetries and cooperation failures. When wanting to design the perfect health system, Britnell stresses that we can only learn from a few nations. As outlined in his book, the perfect health system would combine:
- Values and universal healthcare of the UK
- Primary care of Israel
- Community services of Brazil
- Mental health and well-being of Australia
- Health promotion of the Nordic countries
- Patient and community empowerment in parts of Africa
- Research and development of the US
- Innovation, flair and speed of India
- Information, communications and technology of Singapore
- Choice of France
- Funding of Switzerland
- Aged care of Japan
The two main conclusions from Britnell’s research were, that if the world eliminated all health system inefficiencies:
- Global life expectancy could be increased by more than four years at current health expenditure levels, if each country matched the health outcomes of the best country in its spending class;
- Current global life expectancy could be sustained at one third of current healthcare expenditure” (World Economic Forum, 2016).
Tackling the global healthcare challenge requires a constant quest for innovation from one of the largest industries in the world. As Professor Barlow argued, innovation in healthcare is difficult. As Mark Britnell argued, the lack of alignment across health systems and institutions is further hindering innovation. Is the elimination of misalignment the first step towards a perfect global health system?
Britnell, M. (2015). In Search of the Perfect Health System. 1st ed. London: Palgrave
World Economic Forum, (2016). ‘Misaligned Stakeholders and Health System Underperformance‘