Across the developed world, policies were introduced to tackle the pandemic that prioritised limiting the transmission of disease with the intention of reducing pressure on health services. Preventive care appointments were delayed, elective surgeries were cancelled, and patients were encouraged to stay at home. Many with the lowest sociodemographic status, however, were not able to work from home, could not afford to distance and were in key, front-line jobs. And those with existing health issues and were most vulnerable, were required to shield for months at a time, with care homes locked down altogether—policies developed to support society through the pandemic defined ‘health’ as simply “the absence of the virus.” All this activity was intended to protect health services that were already struggling under the pressures of increasingly expensive healthcare and growing ageing populations. The pandemic has demonstrated time and again that current health services are not fit for purpose, and that they are least equipped to support those in greatest need.
This has shone a light on the limits of modern healthcare, the beginnings of which were established some 175 years ago in many countries. The transformation of hospitals from "Houses of Death" in the late 1800s, the increased focus on hygiene by the end of the 19th century, the discovery of vaccines and antibiotics in the 1920s, and increasingly effective therapies since the 1950s, have all greatly contributed to the healthy societies that most developed countries experience today. Life expectancy has increased, instances of infectious disease have fallen (current pandemic notwithstanding) and the significant focus is to support patients with chronic conditions. Approximately one in three adults globally are being treated for complex chronic conditions, many of which have been identified as lifestyle conditions, and thus highly avoidable with preventive care, early enough intervention and long-term decision-making. These developments have also contributed to a transformation of healthcare financing in these developed countries—from out-of-pocket payment to reimbursement.
Watch Hans Kluge, MD, the regional director for Europe with the World Health Organization, talk with HIMSS TV about universal health coverage, equitable vaccination rollout, and the power of connectivity to enable preventative care.
Across most developed countries healthcare delivery has a publicly funded element, with varying degrees of privatisation and health insurance. Health systems largely rely on a primary service of general practice often within a community setting, and a secondary specialist service, often delivered in a hospital. Specific funding mechanisms vary between countries, but the philosophy of evidence-based medicine, organised around different specialisms, where a patient presents with symptoms, a medical history is amassed, alongside biochemical tests, to determine a diagnosis and prognosis, and appropriate treatment and management results. In acute or emergency medicine, a similar process of assessment and treatment is used, albeit a little quicker.
Only 0.96% of healthcare funding in the U.K. is spent on preventive care, compared with 0.5% in Denmark and 0.8% in the Netherlands. This is largely focused on screening programmes to allow early diagnosis, rather than on behavioural processes that might avoid individuals becoming patients in the first place. Perhaps the pandemic has finally demonstrated that it is time to shift this focus, and build a health system that genuinely focuses on enabling every single person to reach their health potential; to shift the focus from disease management to enabling health. To consider how to promote health more broadly, to intervene earlier, to support individuals in other areas of their lives that have such a significant impact on health, including the social determinants, and ensure that our key workers, who make such a clear and important contribution to all our lives, are not disadvantaged for their efforts.
As we work toward this goal, there are three concepts that aim to both address the need for increased attention to prevention in health systems everywhere and provide guidelines for the health systems of the future:
We envision a future in which countries reallocate and boost health resources such that one-half of total health expenditure goes to prevention, while the other half goes to treatment. This model aims to not only boost early diagnoses, but also address needs for behavioural change as well as engage individuals in healthy activity. In this way, the scope of what could fall under preventive care could be very broad, from support for sports clubs to digital platforms, or community care centres.
We believe that future health systems should strive to keep 80% of the population as healthy as possible through prevention and initiatives to support health and wellbeing, while also providing the best possible care to the 20% of the population that need it most. This approach is not about limiting care, but maximising quality of life and wellbeing throughout the lifespan for all.
Across the globe, we see efforts to develop solutions that will benefit the wealthiest 10% of the population while neglecting the remaining 90%. We need to create sustainable healthcare solutions for the 90% that are broadly applicable outside the top 10%, keeping in mind that only about half of the global population has access to real health care. With this as a guiding principle, we hope that better health can become a reality for all, in spite of adverse social and economic conditions.
While they are not guaranteed or universal solutions, these concepts may serve as fundamental building blocks for the future that can be tailored to suit local needs and experience. With a foundation in place, the new health systems of the future can be realised.
By Bogi Eliasen, Director of Health, Copenhagen Institute for Future Studies, a HIMSS Future50 Leader; Harriet Teare, DPhil, Consultant, Copenhagen Institute for Future Studies, Research Leader, RAND Europe; Terry Vrihenhoek, PhD, Consultant, Copenhagen Institute for Future Studies, Staff/Faculty Advisor, University Medical Center Utrecht; HIMSS Members
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