New governance - ensuring productivity rises significantly to avoid unaffordable healthcare

Every health system in the developed world is facing the challenge of inexorably spiralling costs. This is fuelled by longer life expectancy and the need for more care in our last few years of life; a rising prevalence of long term conditions such as diabetes because of the lifestyles we lead; and advancing technology that discovers new ways of treating people. 

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Coupled with this is the increased pressure from rising patient expectations. The World Health Organisation (WHO) observed recently that there are four key themes apparent in the way in which health systems have responded to these pressures: 

• Moving towards universal access – ensuring that health systems contribute to health equity, social justice and the end of exclusion

• Re-organising health services around people’s needs and expectations –  making them more socially relevant and more responsive to the changing world

• Securing healthier communities – by integrating public health actions with primary care, by pursuing healthy public policies across sectors

• More inclusive, participatory, negotiation-based leadership –  indicated by the complexity of contemporary health systems

In our view the four WHO themes are guiding systems towards a centre ground –  Structured Pluralism – where increasingly the overarching policy and strategy is set by the state, with separate bodies for regulation, finance and purchasing and a mixed economy of private and public provision.  No one model is right but systems are striving to balance the public or social model to ensure coverage, equity and integration with the benefits of market competition and patient choice to drive up quality and keep down costs.

However, there is patchy and conflicting evidence around the world about the impact some of these reform trends are having on productivity and affordability overall. In addition, key measures of the determinants of ill health, such as the rise in adult and childhood obesity in the developed and developing worlds are not improving as fast as needed to prevent spiralling costs.

Without significant improvements in productivity, and efforts to tackle key determinants of ill health, even higher levels of funding will be needed over the next two decades to deliver the high-quality services that citizens expect. 

This is a fundamental challenge that has been facing all health systems for some time. The current economic crisis just means that we will have to deal with this challenge rather more swiftly and decisively. 

So how can health system planners, payers and providers ensure that productivity begins to rise significantly to avoid the current course towards unaffordable health services?

We believe that focusing on four key areas will make a real difference in improving productivity: 

Ensuring that clinicians and frontline staff are at the forefront of the drive for enhancing quality and productivity – too many health organisations are dominated by siloed, top down cultures and professional rivalries. A new level of trust needs to be developed between leaders and front line staff, between managers and clinicians, and between different professional groups

• Harnessing the natural power of peer pressure by improving the design, and sharing of productivity metrics to help focus on the real priorities – we know many ways to improve health system efficiency, but we implement few of them. One reason is the lack of detailed understanding about relative performance. There are no perfect metrics for productivity, but there are many useful metrics that, together, can help monitor relative performance and improvement.

• Engaging the public in the debate about health care reform will be critical to success – the next few years will require us to look very hard at the way in which we deliver health services. This will mean some tough decisions to change or even close some services 

• Improving the design, visualisation and dissemination of productivity and performance information to enhance the impact – a well defined and visualised set of relevant metrics would be a major contribution to improving the process. Highlighting the extent of variation in productivity and identifying the best and worst performers can be a major spur to improvement efforts

To discuss how new and emerging governance models can positively affect productivity in the new healthcare landscape please contact us.