Fixing healthcare is an Economist Intelligence Unit report commissioned by Philips, the first in a series of four to be published in 2009. The Economist Intelligence Unit bears sole responsibility for the content of this report. The findings and views expressed within do not necessarily reflect the views of Philips.
Everybody wonders what the future of healthcare will look like. Across the world, the issue is rarely out of the news. In the US, the new president, Barack Obama, has unveiled plans to implement universal healthcare coverage. In the UK, the long-established (and widely copied) National Health Service is responding to pressure to change. In developing countries, governments are exploring ways to provide better care and satisfy the needs of growing middle classes.
The focus on healthcare has come about because healthcare systems worldwide are being stretched—by the high costs of training, services and treatments, by increased patient demands, and by big demographic and lifestyle shifts. The current global economic downturn has put even more pressure on healthcare, and leaves less room for error. Healthcare systems everywhere need to be upgraded, and in some cases completely reimagined. The question is not whether this needs to happen, but how it should be done.
But what do those at the frontline of healthcare think should be done, to fix healthcare systems and keep citizens well? Between December 2008 and January 2009, the Economist Intelligence Unit conducted a global survey of healthcare professionals in four key economies—the US, UK, Germany and India—about the issues they see as most urgent for their healthcare systems, and ascertain what they see as the best way forward for those systems. Our findings, supported by interviews with leading healthcare experts, are set out in the following paper, the first in a series designed to explore ways in which healthcare systems are making tentative steps towards a more sustainable future. This report lists the frontline challenges, reviews the healthcare reforms that are seen as most likely to work, and looks at some of the directions healthcare may take in the future. Key findings from the research are highlighted below.
Healthcare professionals in developed economies are feeling the pinch. While generally satisfied with their jobs, healthcare professionals in the UK, US and Germany admit to being less satisfied than they were two years ago, and less confident that their systems can cope with increased demands. More than one-third of US and UK health professionals, and 60% of their counterparts in Germany, say their country's healthcare system has declined in efficiency over the last two years. In addition, although the quality and availability of healthcare has increased dramatically in the last century, healthcare professionals in the developed world indicate that progress has slowed—around 80% of respondents in the US, UK and Germany say citizens' overall wellness is no better now than it was two years ago, and a significant number say it has declined.
In India, the future looks brighter. While frontline healthcare staff in the US, UK and Germany point to stagnating health systems, their colleagues in India see a different story. Respondents there point to improvements across the board in the Indian healthcare system—more than 50% say the system is more efficient and effective, with better training, easier access to the latest treatments and technology, generally healthier citizens and happier patients. However, it is important to read these responses in context—the Indian healthcare system is basic in many respects, and faces huge challenges of its own.
Some recent healthcare policies are having counterproductive effects. Over the years, governments have implemented a range of remedies to lessen the pain of paying for increasingly expensive healthcare systems, including taxes, insurance, and co-payment schemes. But, on average, only 15% of healthcare professionals who took part in our survey—and in Germany, only 3%—believe that their government's healthcare policy has improved in recent years. Most healthcare professionals in developed countries blame their malaise not on a shortage of the latest technology, or insufficient training, or poor work environments, but on factors such as understaffing (42%), stress levels (39%), paperwork (32%), high levels of administrative work (32%), and poor management (31%). While the primary role of a doctor or a nurse is to provide care, nowadays they also find that they have the added role of managing targets. This does not seem to have led to improved efficiency or effectiveness. One respondent comments: "The increase in funding has been poorly channelled, and target-driven processes have not necessarily resulted in the best application of resources for the patient." According to another respondent, although costs of medical care have risen, there has been "no measurable improvement in either the number of patients treated or the effectiveness of that treatment." One UK professional states: "The NHS is less effective than it was, as the managerial objective setting has created a system of medical bureaucrats instead of a focus on care."
Proactive patients are stretching the system. All other factors aside, medical professionals in all the regions surveyed are in no doubt that patients are less passive today than in the past—and their proactivity is contributing to strains on healthcare systems. Today, they say, patients expect higher standards of care (52%), more information about their treatment (57%), more involvement in relevant decisions about their care (49%), and access to the latest treatments (49%). Less than one-third of respondents, however, believe that their healthcare system has the capacity to cope with rapidly growing demand.
Prevention is better than cure. Modern healthcare has largely been concentrated on cure, but many in the industry believe that focus needs to change. Most chronic diseases—including cancer, heart disease and diabetes—are largely preventable, and can in theory be avoided if people take more responsibility for their own lifestyles, it is argued. Treatment is expensive—the more cost-effective route for healthcare systems to take is to encourage prevention. It's a simple equation, but our survey finds that a re-emphasis of healthcare systems from cure to prevention may be difficult to effect. While 40% of healthcare professionals we surveyed would prefer their governments to do more to encourage preventive medicine, a large number (50%) also want scarce resources to be invested in frontline, primary care settings such as hospitals. Nor do healthcare professionals express much confidence in their government's ability to implement policies that focus on preventive care. Ceri Phillips, Professor of Health Economics and Head of the Institute for Health Research at Swansea University, points out that a politician might be unwilling to support the funding of a preventive medicine programme that could take five years to bear fruit, and prefer instead a very visible investment in a hospital.
Patients must be empowered to manage their own health more effectively. One of the most pervasive themes in discussing healthcare systems today is patient-centred care. For the purposes of our survey, we used a widely accepted definition of patient-centred care, meaning a system in which patients have more involvement in self-management of their health, in deciding on and administering their own treatments, and in which patient information and care are more integrated. Based on that definition, the findings of our survey were clear: more than 80% of respondents say patient-centred care will be important, or even critical, in both containing the cost of healthcare spending and improving standards of medical care. Again, achieving this in practice will not be easy—40% of respondents say resistance from government policymakers will be the biggest obstacle to establishing patient-centred care in their country, among other barriers such as coordination costs including the time and resources required (39%), lack of political will to change (36%) and resistance from the medical community itself (28%).
