HealthCast and Health Reform

HealthCast and Health Reform

Many of the world’s largest economies are tackling major regulatory reforms that will alter how medical delivery organizational structures and funding mechanisms can drive personal behaviors that impact health costs. Because governments spend so much of their budgets on healthcare, regulatory reform is a constant process. Health leaders in Europe surveyed by PwC were evenly split on whether the industry needed more or less regulation. In the U.S., where a major debate on health reform enveloped the Congress in 2009 and 2010, only 30% of health leaders said regulation needs to increase some or a lot; 36% said it needs to decrease some or a lot. The remainder was neutral.

Regulatory reform is addressing behavioral, genetic and medical system influencers.

Behavioral: As obesity rates grow across the globe, governments are issuing and enforcing new rules about food labeling, product placement and food preparation. However, governments increasingly understand that behavioral change depends on partnerships with private industry.

Genetic: Unfortunately, regulatory reforms suffer from the same silos as the industry itself. Hospital regulators regulate hospitals, drug regulators regulate drugs. Few look at the system as a whole. In a converged, customizable world, regulators must look at how different aspects of the system can work together to improve patient health.

Funding: The move to coordinated care pathways is the beginning of a shift of funding from treating sick patients to keeping them healthy. However, to succeed in these models, stakeholders must be familiar with how they can work seamlessly together. For example, when the National Health Service (NHS) in the U.K. asked for bids for its integrated care pilots, stakeholders had to show that they already "had a proven track record of working together, therefore a better chance of succeeding," said Gary Belfield, the acting director general of commissioning and system management for NHS’ Department of Health. "We didn’t want the first year of the pilot spent building relationships, only to figure out they didn’t work."

Health Reform in the United States

Debate on whether governments or markets do a better job on health improvement continues with both arguing that their methods benefit the individual. In practice, a blend of the two is most effective, and many are pursuing public-private partnerships to accelerate improvements.

In the U.S., for example, a major health reform bill passed, which is expected to expand access to 32 million Americans. The U.S. is the only industrialized country in which a substantial percentage of the population -- 15% -- is uninsured. However, under the new health reform law, 95% of Americans are expected to have either public or private health insurance by 2014. For more on how US health organizations can prosper in a health reform world: Health Reform