Easing the disease burden in ageing Asia: implementing integrated healthcare and promoting self-care is an Economist Impact report, sponsored by Johnson & Johnson Pte. Ltd. This report aims to examine integrated care in five countries across Asia and explore the integral role of self-care in promoting integrated care within these health systems.
Faced with rapidly ageing populations, and a rise in non-communicable diseases (NCDs) and chronic conditions, countries in Asia have been pursuing an integrated care approach to keep health services effective and sustainable. For some, that has involved a greater emphasis on preventive, community-focused care; stronger linkages between health and non-health services; and enhanced patient empowerment. Despite many improvements, however, progress has been uneven, both within and across countries. Research by Economist Impact assessed progress on the integrated care agenda across five countries: China, India, Japan, Singapore and South Korea. We found vast differences between the leaders and stragglers, as well as gaps and inconsistencies across all five.
One area of particular focus was self-care. It offers health systems a way to make up for their own shortfalls and fill gaps at relatively low cost without placing major additional burdens on healthcare providers. Practised by individuals, families and communities for thousands of years to maintain health, treat illness and manage disability, nowadays self-care is bolstered by a wealth of tools, technology and information available to people.
Our research uncovered the following key factors as integral to the improvement of integrated care:
- Patient empowerment and self-care
Patient empowerment is lacking in many Asian countries. Weaknesses include a lack of overall efforts to improve health literacy (especially among poorer people), as well as limited awareness among patients of the options available to them when navigating health services. In addition, self-care is an under-used tool in the countries we studied, despite its clear utility and relatively low cost. - Political will
Political backing for integrated care is a mixed bag. Some countries (Singapore being a prime example) dedicated funding and policymaking space 10-15 years ago, putting them on a stronger footing. Elsewhere progress has been made in recent years, with rapid catch-up in some cases. In India, commitments have been extremely limited, and the lack of progress is clear. - Implementation
Implementation of integrated care and self care is dependent on two specific areas: a move towards community-based services and improved data infrastructure. In terms of the former, the countries studied have made great strides in establishing extensive networks of community-care facilities. In terms of data infrastructure, the picture is less rosy, with fully integrated, live-updated Electronic Health Records (EHRs) a rarity. Some countries lack any EHR infrastructure, while others operate numerous systems, split between regions, different public or private providers, and individual facilities. These same fault lines also complicate the flow of financing, hindering the integration of services for individual patients.
In this report, we detail four key actions that will help countries in Asia to eliminate disparities and fill gaps in terms of integrating care, therefore, preparing their health systems for the increased burden arising from population ageing, rising NCDs and chronic conditions, and, in all likelihood, further infectious disease outbreaks following the COVID-19 pandemic:
- Carve out a central space for self-care
- Educate people about the care continuum and optimal treatment options
- Welcome patient organisations as stakeholders in policymaking
- Develop robust data infrastructure—namely interoperable, real-time EHRs
