Challenges and Solutions

Challenges and Solutions 2018-06-08T10:55:37+00:00

The Challenge

Tremendous progress has been made over the last forty years however there are still three outstanding problems which are found in every health service no matter how they are structured and funded:

One of these problems is unwarranted variation in access, quality, cost and outcome, and this reveals the other two

  • Underuse of high value interventions which results in
    • failure to prevent the diseases and disability that healthcare can prevent and which may also aggravate
    • inequity
  • Overuse which always results in
    • waste, that is anything that does not add value to the outcome for patients or uses resources that could give greater value if used for another group of patients and may also result in
    • patient harm, even when the quality of care is high

In addition the services will have to cope with rising need and demand without resources increasing at the same rate. For the sustainability of healthcare we therefore need to get more value from the resources. The meaning of the term value is different in the USA where it is defined by the relationship between outcomes for the patients treated and costs, whereas in every country committed to universal health coverage this would be termed efficiency, with value a broader concept, called in NHS England ‘Triple Value’:

  • Personal value, determined by the outcomes that matter to an individual for a given amount of resources used by the health system and the individual and their family and, from the population’s perspective, two different types of value
  • Allocative value, determined by how well the assets are distributed to different sub groups in the population
  • Technical value, determined by how well the resources are allocated for investment, for a particular subgroup of the population. For example, people with a symptom such as back pain, or a condition such as breast cancer, or a common characteristic such as having multiple conditions, are used for all the people in need in the population

The Solution

To achieve this we need to continue with the processes that have increased effectiveness and value in previous decades, namely:

  • Preventing disease, disability, dementia and frailty to reduce need

  • Improving outcome by providing cost effective, evidence based interventions

  • Improving outcome by increasing quality and safety of process

  • Increasing productivity by reducing cost

But more of the same, even better, quality, safer care is not sustainable and new activities are required for sustainable healthcare. This process will require: a change in culture, training in new skills and concepts, and the development of a new type of organisation – population-based systems.