The future of global healthcare delivery and management
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31 Martie 2011 |
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KPMG ROMÂNIA S.R.L. |
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Healthcare systems and governments worldwide are trying to curb rising costs while improving patient care and outcomes. This has led to a growing interest in healthcare integration—i.e., coordinating services among providers through formal or informal means. Supporters of integration say that, properly managed, it can yield a healthier population and save money. It can also help minimize hospitalizations, reduce the need for costly rehospitalizations, and prevent service duplication.
An impressive 95 percent of respondents to a global survey conducted by the Economist Intelligence Unit in May 2010 support greater integration within the healthcare delivery system in the next five years. Despite this near-unanimity among respondents, progress toward healthcare integration is patchy.
Successful integration will depend on various elements: the nature and structure of existing healthcare systems; jurisdictions' perceptions of the urgency of cost and quality issues; and resources allocated to implement it.
The survey, sponsored by KPMG International, investigates how government officials in health-related agencies—often the initiators of the process—and hospital administrators expect integration to evolve in their home countries in the next five years.
Doctors, insurance providers, and life sciences companies were not surveyed, although they also play important roles in integration. The research examines the barriers to integration and the changes necessary to overcome them. It then explores the role of government, the models that are likely to emerge, and the potential impact of integration on healthcare providers.
Healthcare integration defined
Integration is defined broadly in this research. It ranges from informal coordination among healthcare providers (e.g., among hospitals or between hospitals and primary care physicians) to a structured linkage among several parts of the system, such as through an umbrella organization that encompasses hospitals and other providers.
Seeing Double
Two main factors drive the current effort to integrate healthcare delivery worldwide: rising expenses and changing patterns in the demand for healthcare. "I would say it is a double movement," says Eric de Roodenbeke, Chief Executive Officer of the Ferney Voltaire, France-based International Hospital Federation, which has members in more than 100 countries. "It's difficult to say which one is driving the other one."
The aging of the population has changed the nature of the services required and increased the incidence of expensive-to-treat chronic diseases. The World Health Organization (WHO) projects that the global population of those 60 years and older will rise from 600 million in 2000 to 2 billion in 2050, while mortality, morbidity, and disability rates attributed to the major chronic diseases that now account for nearly 60 percent of all deaths and 43 percent of the global disease burden will rise to 73 percent of all deaths and 60 percent of the global disease burden by 2020. (Terms defined in Glossary.)
These shifts in the nature of healthcare services will also change the kind of care required, from acute care to a ‘continuum of care,’ under which a full range of healthcare services are needed. Continuum of care service can be improved through close coordination among providers.
Another significant driver of healthcare spending is the increased use and cost of medications and medical devices. Global pharmaceutical sales are expected to increase at a 4–7 percent compound annual growth rate, rising from US$825 billion in 2010 to US$975 billion by 2013. The global medical equipment industry, valued at US$280 billion in 2009, is forecast to grow by more than 8 percent annually to exceed US$490 billion by 2016.
While cost and changing demographics are almost universal drivers of integration, their importance differs among developed and developing countries. For example, 52 percent of survey respondents from developing countries rank rising healthcare costs as a top driver of integration, compared with 43 percent of respondents from developed countries. Chronic disease, in contrast, is more likely to be important in developed countries: it was chosen by 27 percent of those respondents compared with just 6 percent of those from developing countries. The challenges facing emerging markets such as China and Brazil, where large portions of the population are moving into the formal economy for the first time, are different from those of poorer countries that struggle to meet the most basic healthcare needs.
Glossary
ACOs: Accountable care organizations are defined by the US Medicare Payment Advisory Commission as 'a set of providers held responsible for the quality and cost of healthcare for a population of Medicare beneficiaries. An ACO could consist of primary care physicians, specialists, and at least one hospital.'
Bundled payments: A payment model designed to reduce costs and encourage coordination of care in which hospitals and doctors share a single fee. There is no single model for distributing payment among the providers.
Care pathways: Plans of care over a defined time period for patients with a specific condition. They are structured and multidisciplinary, and include details of progress and outcomes. Their goal is to improve continuity and coordination of care across disciplines and sectors.
Continuum of care: Delivery of a full range of healthcare services over a period of time. For patients with a disease, this includes all phases from diagnosis to end-of-life.
Gainsharing: A model for aligning providers' goals by distributing savings generated by integrating care among them.
Health information technology interoperability: The ability of two or more systems or components to accurately, securely, and verifiably exchange and use information electronically. Interoperability assures the clear and reliable communication of meaning by providing the correct context and exact meaning of the shared information.
Morbidity rate: The ratio of sick to well people in a community in a given period of time.
Mortality rate: The ratio of deaths in a given population to that population in a given period of time. This rate is usuallyexpressed in deaths per 1,000 individuals per year.
Global disease burden: The mortality and loss of health due to diseases, injuries, and risk factors for all regions of the world.
Population health model: A model of care in which an entity is responsible for managing healthcare for a defined patientpopulation.
Standardized order set: A preprinted or electronic order form that covers all anticipated orders, such as tests, drugs, and precautions, for a particular condition.
Statutory health insurers: Competing health insurers in Germany, also called 'sickness funds,' that are federally regulated but self-administering not-for-profit corporations. They cover about 90 percent of the German population.
