Taking the pulse of health care

Leading the Way is a column written by PricewaterhouseCoopers professional staff. It appears in the Business section of the Bangkok Post twice each month. The column provides specialised advice to corporate decision-makers in Thailand on global and local business trends.

This article appeared in the June 27, 2006 issue of the Bangkok Post.

In Thailand, a trip to the doctor is easy and relatively inexpensive. Could this change? There is growing evidence that the current health systems of nations around the world will be unsustainable if left unchanged over the next 15 years. Health-care organisations and governments are urgently seeking solutions to temper costs while balancing the need to provide access to safe, quality care. Yet, conventional approaches are failing, even in the most advanced nations of the world, throughout Europe, Asia, the Middle East, Australia, Canada and the United States.

Population growth and shifting demographics toward an ageing population are frequently mentioned as root causes for unsustainability. However, these issues alone aren't making health systems unsustainable. For example, Italy, Japan and Spain, three of the fastest-ageing countries, spend less per capita than the US. Despite beliefs to the contrary, ageing baby boomers in the US are contributing only to a small percent of the increase in health spending, and are not a major driver for increases that are far above the overall inflation rate.

There is, however, concern about the decreasing proportion of populations which will be paying into publicly funded health-care systems. Rather than blaming ageing as a problem, it should be celebrated as a success. A longer, high-quality and productive lifespan is the goal of most health-care systems.

Higher spending on health care isn't necessarily bad. As economies grow, spending on health care also grows and contributes to a more productive society. However, critics say that at some point, higher health spending may deliver only modest additional returns. In addition, recent evidence shows that higher spending may not be buying higher quality. Questions about value are troubling and universal.

Because they are often viewed as a local industry, health-care organisations haven't exchanged ideas globally as much as other industries such as manufacturing and services. While each country faces unique hurdles, regulatory, economic and cultural, the primary challenge of rising costs holds true across the board, and ultimately leads to this question: How to create sustainable health systems that are capable of managing costs, while providing equitable access to quality health care?

We think the following features are key to a sustainable health-care system:

• Quest for common ground: A vision and strategy is needed to balance public versus private interests in building an infrastructure and in providing basic health benefits within the context of societal priorities;
• A digital backbone: Better use of technology and interoperable electronic networks accelerate integration, standardisation, and knowledge transfer of administrative and clinical information;
• Incentive realignment: Incentive systems ensure and manage access to care while supporting accountability and responsibility for health-care decisions;
• Quality and safety standardisation: Defined and enforced clinical standards establish mechanisms for accountability and enhanced transparency, thereby building consumer trust;
• Strategic resource deployment: Resource allocation appropriately satisfies competing demands on systems to control costs while providing sufficient access to care for the most people;
• Climate of innovation: Innovation, technology and process changes are a means to continuously improve treatment, efficiency and outcomes; and
• Adaptable delivery roles and structures: Flexible care settings and expanded clinical roles provide avenues for care that are centred on the needs of the patient.