In Search of the Perfect Health System is the first book to comprehensively examine healthcare systems across the globe in order to answer the all-important question: what does the ‘perfect’ health system look like?
Having traveled the globe hunting for innovation, KPMG’s Dr Mark Britnell identifies 12 characteristics to support optimal healthcare.
The global healthcare system is at a tipping point. Rising costs, disease patterns, politics and longer life expectancies mixed with advancing technologies and therapies are forcing a rebuilding of healthcare models. Patients are calling for increased transparency and empowerment; new businesses are emerging and greater efficiency has become a rallying cry. To support better healthcare, the entire ecosystem will need to adopt sustainable change and embrace the idea of universal healthcare, accountable care, value-based outcome payments and empowered patients.
Each nation is struggling to optimize its own healthcare system—but is anyone doing it well? Who are the role models and heroes in healthcare? And if we could take the best of the best and model the pieces into a perfect structure, what would that look like? Dr Mark Britnell, chairman of the Global Health Practice at KPMG International and senior partner, KPMG in the UK, presents such a sketch in his new book: In Search of the Perfect Health System. Analyzing the healthcare systems of 26 countries, he offers readers insight into how politics, culture and resources (in addition to science and education) play into delivery of services.
Working with public and private entities, Dr Britnell has spent more than two decades traveling to more than 60 countries. And the question he is most asked as he laps the globe is the following: Which country has the best health system and best care? “Obviously, there’s no such thing as a perfect healthcare system, but if you look at what’s good, it’s possible to build up a picture of what that might look like” Dr Britnell says.
Dr Britnell spotlights 12 characteristics that he would use to shape a healthcare system to meet current needs and bend to accommodate future innovations.
At best, 40% of the globe’s 192 countries have some form of universal healthcare. As global wealth becomes more polarized, political leaders will need to think long term and global, instead of short term and national. Britain’s universal healthcare system promises services to all, regardless of a person’s ability to pay. Established in 1948, the National Health Service is the one of the modern world’s first universal healthcare systems, one that evokes a strong sense of equality and pride among its citizens. Pride in its healthcare system even ranks higher than pride in the royal family. “We have seen that political will, managerial skill, time and money are needed to secure universal healthcare, but it is a wise investment in our collective future,” Dr Britnell says.
Four major health maintenance organizations (HMOs) provide care to the bulk of the country’s population. These HMOs, which act as purchaser and provider of services, can focus on preventative and primary care with evening and urgent care centers and home-visit services. And because there are four HMOs, the competition among them offers Israelis more choice than they would get in a single-payer system. “It’s the only system in the world where talk of a primary-care-centric system is reality, not rhetoric,” Dr Britnell writes.
Brazil takes a proactive, rather than reactive, role to health with its unprecedented national model for health- related community outreach. A team consisting of a doctor, nurse, nurse auxiliary and six community health workers look after a population of approximately 4,000 and visit every household every month. These teams, replicated throughout Brazil, help residents manage chronic disease and promote health screenings while supporting chronic conditions such as diabetes and hypertension. “They don’t wait for patients to walk through the doors of the community centers,” says Dr Britnell. “The community team is on the streets, in people’s houses, making sure they’re supporting people to live healthier lifestyles.” The result: dramatic drops in infant mortality and hospitalizations due to chronic disease or mental health illnesses.
Community outreach comprised of early intervention, crisis management and home treatment has been the hallmark of Australia’s mental health reforms. Successive governments since 1992 have funded and supported the country’s National Mental Health Strategy that promotes a more progressive approach over traditional hospitalization. “Not only has Australia de-institutionalized mental health, it’s been doing it in a sustained fashion,” says Dr Britnell.
Denmark, Finland, Iceland, Norway and Sweden have some of the most far-reaching public health and illness prevention policies in the world. This network of health programs is connected not only locally and nationally, but also between the public and private sectors, allowing for continuity of messages. “Equitable health and well-being” is a tenet to Nordic healthcare, where the state articulates a welfare policy, and the public sector provides services to residents who pay high taxes in return for social cohesion and well-being.
With a tiny number of health workers to fight the HIV epidemic, countries like South Africa, Uganda and Nigeria trained people with HIV themselves to distribute the drugs and support each other on how to stay healthy. “Expert client”-led programs are now being pursued for maternal, child and mental health.
American healthcare is often characterized as chaotic and expensive, producing lower than expected life expectancy. While that may be true, the world would not have the quality of drugs and medical devices it does today if not for the country’s investment in research and development. The US is the world’s biggest R&D hub; the National Institutes of Health alone is the globe’s largest benefactor of biomedical research. “All countries in the world—whether they’re developed or developing—actually benefit from it,” says Dr Britnell.
The rising number of Western tourists who travel to India for medical procedures is well documented—a testament to the affordability and quality of private healthcare providers on the subcontinent. Private medical entrepreneurs are combining quintessential capitalistic principles such as American assembly line methods and Japanese lean management to transform segments of India’s healthcare business. The idea: decreasing the overall cost of procedures by increasing the number of them, therefore allowing wealthier patients who can pay for service to absorb the cost of procedures performed on lower-income patients.
In 2011, Singapore launched the National Electronic Health Record program, now used by some 280 institutions. The idea is to link general practitioners, community workers and hospital staff to better inform the providers and patients. Some 40% of patients in Singapore can access their own medical information. The country’s goal is to organize healthcare interventions around the home rather than traditional institutions. The Lion City is increasingly using telehealth and telemedicine such as virtual eye exams by ophthalmologists and at-home support for rehabilitation following a stroke.
Patient choice is a cornerstone of France’s healthcare system, where citizens are free to see any physician or go to any hospital of their choice. No referrals are needed for specialists. Patients make payments for their services, and are later reimbursed via a medical record credit card.
Swiss healthcare is the least distressed health system that Dr Britnell has encountered in his travels. Healthcare spending there accounts for 11.5% of the country’s total GDP, making it the second most expensive system in the world. Switzerland’s investment in its people, and a good environment for innovations, allows for a strong economy combined with some of the happiest, healthiest and most educated people on the planet. “Health can be self indulgent, rather myopic, will always demand more money,” says Dr Britnell. “But it sometimes fails to make the link with a high-preforming economy. At the end of the day you have to have sufficient wealth to generate more health. Switzerland seems to do that better than anybody else.”
In 2000, Japan mandated long-term care insurance to provide for those age 65 and over—one-quarter of its population. People age 40 and above pay into a program that offers home help, community-based services and nursing care to any senior age 65 and over in need, regardless of ability to pay. The country’s political fortitude and courage to address care for its elders even as its economy remains sluggish is admirable.
“It’s a truism that we’ve all got something to teach, something to learn,” says Dr Britnell. “But when you compare health to other industries such as telecommunications, defense or energy, you can see there is tremendous scope for progress if we collaborate more effectively across the globe.”