A Vision for Integrated, Patient Centered Healthcare
By William A. Haseltine, President and CEO, and Taara Chandani, ACCESS Health International
The promise of universal access to quality healthcare can only be realized if we fundamentally shift our thinking on how we structure health systems. Today, in too many countries throughout the world, health systems are fragmented across multiple dimensions. This has significant implications on efficiency, equity, and population health outcomes.
Take India, for example. India spends roughly $100 billion U.S. on healthcare each year, with most of these costs borne by individuals and households. In India, government-sponsored supply and demand side programs operate in a fragmented design, the public and private sectors lack coordination or standardization, and service providers cater to distinct segments of the population, with the rich and poor accessing vastly different standards of healthcare and displaying inequitable burdens of disease.
The lack of integration between healthcare financing and delivery results in inefficient deployment of available resources and suboptimal health financing choices. In India, out-of-pocket expenses at point of service makes up most of the health financing mix, which drives catastrophic expenditure. This results in a significant economic burden on marginal sections of the population. That, in turn, creates barriers to appropriate health seeking behavior.
The best performing healthcare systems in the world have a unified policy framework under which financing and provisioning of care are designed to provide an integrated healthcare system for all. A system that assures continues improvement in health outcomes. A vision for India and other countries like it is to progress toward an integrated health system that is centered around the needs of the individual, where success is measured in the achievement of health outcomes. An integrated health system requires a strengthened regulator, a consolidated payer and purchaser, and a coordinated provider network. In effect, it would mean that everyone accesses affordable and high health services from comparable health providers, be they in the public or private sector, in an ecosystem that prioritizes prevention and wellness, early care seeking, and appropriate diagnosis and treatment.
Integrating care between primary, secondary, and tertiary levels is the foundational building block of any reform. This means that people access a comprehensive range of services — from preventive and promotive services, to the management of chronic illness, acute emergency services, and specialized or tertiary level medical care — delivered through a network of coordinated care providers. The system proactively engages, enrolls, and screens users through an integrated information system, ensuring that they access appropriate care at the right level.
How does this play out in the real world? In India, this would entail responding to changing patient and demographic needs, coordinating and standardizing service delivery between the public and private sectors, and introducing an integrated technology platform that ensures the collection and use of comparable data. Executing this vision would require:
- Actively engaging communities to improve equity in access and oversight of health services, empowering them to demand adequate healthcare and hold the health system accountable.
- Ensuring specialized and separate focus on payment, governance, and monitoring of healthcare with an ultimate goal of enhancing the capacity of government to strategically purchase services from public and private health care providers, under a robust governance and monitoring framework.
- Introducing outcome-based payments to providers that reinforce the importance of primary care.
- Introducing systems for continuous quality improvement and clinical excellence, using innovative management and information systems.
India is home to world class examples of transformational health innovations — 108 emergency services, 104 telehealth, Aaravind Eye Care systems, to name just a few. Applying innovations like these to a patient centered preventive healthcare model in India would unlock enormous potential and serve as a template for emerging economies around the world.
India is an example of the tangible steps that need to be taken to move toward the goal of universal access to high quality and affordable healthcare. Recent celebrations for Universal Health Coverage Day have shown us that there is no better time to act than now. We must each do what we can to humanize our health systems, put people first, and ensure that they meet the needs of all individuals at every stage of life.
