Mulley, A; Coulter, A; Wolpert, M; Richards, T; Abbasi, K; (2017) New approaches to measurement and management for high integrity health systems. [Editorial comment]. The BMJ , 356 , Article j1401. 10.1136/bmj.j1401.

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Abstract

Healthcare economies across the globe are in crisis. High income countries—whether their healthcare economies are market driven like the US or tax funded like the UK—are struggling with relentless demand for more services that are increasingly costly to deliver. Low and middle income countries are struggling to provide better and more equitable access to potentially lifesaving interventions while wisely allocating scarce resources across all sectors that affect human and social development. In rich and poor countries alike, policy makers, citizens, and health professionals are drawn to technology but are not learning how to use it most effectively or from mistakes made when its limits go unrecognised or unheeded.1 Variation in regional rates of therapeutic and diagnostic interventions and hospital based care exists globally with no measurable benefit in populations receiving more services.2345 At the same time effective primary healthcare and social services that can have a greater effect on health and wellbeing are being underused.467 The failure to deliver the right care at the right time in the right place contributes to the waste of as much as 40% of healthcare expenditures.48 Recognition of this waste, which is often associated with harm to patients, has spurred health policy reforms across the globe. One common objective is people centred care, which focuses on the needs and wants of individuals and engages them in management of their own care, including behaviours that promote and sustain health and wellbeing. A policy forum held earlier this year, which included health ministers and other representatives from members of the Organisation for Economic Cooperation and Development and seven other countries, advocated a shift from “a system centred on providers to one centred on people’s individual needs and preferences.” The same shift has been advocated in China and for other countries investing heavily in developing healthcare economies.91011 Reform has been successful in some settings, but nowhere has the scale of reform been sufficient to allay concerns about personalised care or about system sustainability. A high integrity health system is one dedicated to providing services that people need and want—no less but no more—and that puts the interests of patients and the public above those of all other stakeholders.12 In this analysis, we discuss how next generation reforms towards a high integrity health system will need to move from the “what” to the “how” of change, to reflect a greater understanding of the sources of resistance, and to take new approaches to measurement and management to guide system performance and innovation.

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