Returning to the daily routine after a long, and hot, summer break is always characterised by mixed feelings. Part wishes the languorous morning routines to carry on whilst other forces bring a refreshed mind optimistic about the challenges ahead. This morning’s bright and early start in Brussels was illuminated by two articles in the Financial Times (Tuesday August 18th) concerning themselves with the contrasting views of healthcare reform from opposite sides of the Atlantic. Whilst one, by Philip Stevens, focussed on the economic realities the second, by Stefan Stern, steered the reader in the direction of management challenges. Both focussed heavily on the politically sensitive issue of rationing and stated that which ever way a healthcare system is run, all systems end up rationing care by one means or another. They also commented on the fact that no politicians ever admit to this reality as both voters and themselves conspire in a delusion that costs can be controlled and everyone can receive unlimited care.
Healthcare is, to an extent, what some people would call a ‘high class’ problem in the modern age. The reality is that life expectancy and quality of life for the relatively well off (and that is most of us in what the OECD classifies as the rich countries – ‘Health Data 2009’) have improved massively over the last 100 years and that is due to huge advances in both the quality of care – largely technologically enabled – and a better understanding of the lifestyles that cause early mortality and morbidity. So we have achieved an enormous real return on investment which could be quantified by the price that is put on extra years of life (or more realistically the price of extra high quality years of life).
Stern’s comments about management and patient focus hit at the key targets for modern health systems. Patient centred management of resources can result in lower cost and better outcomes, much the way that quality systems have transformed both cost and quality of the industry that I know so well. To do this, technology and innovation have to be embraced and valued rather than seen as sources of short-term cash savings at the expense of the larger goals of higher productivity and quality of outcomes.
Whatever the future brings for healthcare, as the debate rages in Washington, it is not best served by becoming a political pawn in partisan battles for power. The facts, figures and options need to drive policy and that has not characterised previous attempts to reform any healthcare system in the world. The facts often point in different directions from the political rhetoric.
– John Wilkinson, Chief Executive Eucomed