In January, Deloitte published its 2017 Global healthcare sector outlook, which confirms that the challenges of providing and funding health care around the globe have remained fairly persistent over the past few years, and they are unlikely to change in 2017. These, all too familiar challenges, comprise: rising demand and associated costs, growing prevalence of chronic diseases and comorbidities, development of costly clinical innovations; and increasing patient expectations and continued economic turbulence. While these challenges may appear somewhat intractable, green shoots of recovery are now being seen in some areas. This blog highlights the key findings from the global healthcare sector report.
The persistent challenges facing health systems across the world
As we found in our own report Vital Signs: how to deliver better healthcare across Europe, health systems share many similar care and cost challenges, however, how they choose to respond is largely influenced by the history, culture, economic and political environment in which the system operates. Moreover, each region, country and community deals with issues based on a unique set of local and national circumstances. For this reason, comparing health system performance is challenging, as they often have multiple complex goals and vary in terms of how much they are prepared to pay for healthcare and what they will trade-off or prioritise.
The global outlook report notes that many countries are moving from centralised to more localised health management systems and attempting to institute forms of universal coverage in a bid to tackle persistent variations in access and care quality. However, shortages of clinical resources and infrastructure issues are making it increasingly difficult for health systems to sustain current levels of service and affordability. Indeed, the scale of the challenges are likely to escalate globally unless solutions are identified and adopted at scale. For example:
global healthcare expenditure is expected to increase from $7 trillion in 2015 to $8.7 trillion by 2020, (with the extent of the increase varying from 2.4 per cent in Latin America, 4.3 per cent in the US and 7.5 per cent in the transition economies)
the elderly population (over 65 years of age) is anticipated to increase by 8 per cent from 559 million in 2015 to 604 million in 2020
the prevalence of dementia is projected to increase in every region of the world with the total number expected to double every 20 years (from 46.8 million in 2015 to 74.7 million by 2030)
chronic diseases such as cardiovascular disease, cancer and respiratory diseases are expected to cost an estimated $4 trillion (50 per cent) of global health care expenditure in 2020
the number of people suffering from diabetes is expected to increase from 415 million in 2015 to 642 million in 2040 with China and India having the largest number of diabetes sufferers (some 110 million and 69 million respectively).
Progress towards implementing potential solutions
Due to the complex and interrelated nature of these challenges, care delivery models that use multi-pronged, collaborative, and technology-enabled approaches are more likely to yield positive results. The global outlook report highlights a number of potential solutions, including the use of public-private partnerships to remedy the lack of health care infrastructure; mitigation of access issues through dual systems of public and private health care funding; effective patient engagement to improve patient experience; and the use of technology-enabled, virtual care.
Collaborative care models that address behavioral and physical health issues and programmes that tackle the social determinants of health inequality are also expected to help improve patient outcomes and lower costs.
Specific initiatives include:
Improving access - the global shortage of general and specialist staff is increasing patient waiting times and affecting their access to diagnosis and treatment. Workforce issues can be seen in both developed and emerging economies, with solutions focussed on identifying and securing the right mix of specialist, primary care, mid-level practitioners and the development of new staffing models. One such example is in Japan where the Government plans to train an additional 250,000 care workers by early 2020 to satisfy demand for elder care. Other examples involve the use of technology to improve access (such as telehealth, mHealth, wearable and implantable patient monitoring devices), especially in remote areas.
Containing costs - actions to reduce clinical and administrative waste and improve operational efficiency include consolidation, vertical integration, shifting care to lower-cost and non-traditional care settings, strategic procurement models; clinical pathway redesign, standardised clinical processes, shared service centres and technology-enabled care. In addition, reimagining and reconfiguring economic incentives to incentivise health care organisations to do the right thing, in the right place and at the right time, are critical to the push towards risk-sharing and emerging payment programmes such as outcome and value-based payment models. In addition, advanced health systems are shifting from a “break-fix” model of health care to one focused on prevention and the health of the population rather than episodic and transaction-based treatments.
Adding social determinants to the care equation - there is growing recognition among governments, payers, and providers that to manage population health and curb rising costs, social determinants of health and wellness need to be included in the care equation. Social determinants include income, education, living and working conditions, transportation availability, childhood trauma and a range of other environmental factors. In general, people with lower socioeconomic status have greater exposure to health-compromising conditions. However, funding silos exist and communication and collaboration among health and social care providers is often limited, disjointed, or absent even though evidence suggests that collaborative care models which address social determinants can improve patient outcomes and lower costs.
Adoption of innovation - technological innovation is increasingly seen as key to improving clinical care and reducing cost. Already, robotic surgery, 3D printing, implantable devices and precision medicine are showing potential in improving outcomes and reducing costs. In addition, big data and analytics are creating opportunities for innovation. While adoption of digital- and technology-enabled care is increasing, many health systems are still on the first digital rung; with funding and employee training issues remaining a barrier to widespread adoption and use. Telemedicine is starting to gain traction across the globe, providing easier access to clinical experts especially in geographic regions with widely dispersed, rural populations, such as Africa and Southeast Asia. The emergence of non-traditional health services and technology providers are disrupting the healthcare marketplace and have the potential to transform the prevention, diagnosis, monitoring and treatment of disease.
The trends and solutions described in the 2017 Global health outlook report highlight the complex nature of the world’s healthcare systems and the difficulties in alleviating identified challenges. While there are no universal solutions to the problems countries are facing, there are examples of good performance in most countries that can provide valuable learnings for all healthcare stakeholders.
Indeed, as the drivers and evidence for change continue to grow, it is incumbent on all stakeholders to consider whether success in one clinical area, payment model, or geographic region could be replicated in another? Can new technologies solve old problems? Otherwise, we risk an unequal, unaffordable and unsustainable healthcare future.