The role of patient value and patient-centred care in health systems
Patient-centred care, with its emphasis on patient value, is a widespread health system goal. To examine the progress of the evolution towards more patient-centred health care and draw lesson for the future, The Economist Intelligence Unit conducted a survey and interviews on patient representatives, a cohort in which IAPO was present.
The findings show that despite some progress, especially in Europe and the US, in practice such care often remains more aspiration than reality. Change has been largely in disconnected pockets rather than across entire systems. The scorecard produced as part of the research repeatedly shows weaknesses in many countries in indicators on which it simply should not be that hard to excel.
It is clear that change will take action that goes beyond formal declarations. Given the diversity in health systems, offering a simple checklist of reforms would make no sense. The study nevertheless does reveal several general areas where policymakers in many countries should take particular note and consider appropriate actions:
Health systems that have not done so need to make basic but fundamental policy changes.
Despite widespread backing for patient-centred care, it is difficult in practice to build a healthcare system in which all stakeholders work together for the benefit of the patient (as well as their families and carers). Support for shared decision-making, including the production of relevant decision aids, should become the norm rather than the exception. Financing should reflect considerations of value rather than volume. Education and training for healthcare professionals must include a greater element of preparing them for the practice of patient-centred care. These may seem disparate issues, but what they have in common is that they are fields over which policymakers have substantial leverage—influence that has been exercised in too few scorecard countries to date.
Health system reform efforts need to move from improving existing activities to reshaping fundamentally what they do.
Many health systems in the scorecard are becoming more userfriendly, such as allowing the use of online appointments through new technology. This should not be confused, though, with patient-centred, value-based care. Integration and personalisation remain a long way off, with workflows and payment systems all needing to adjust in order for existing goals to become reality. Even where progress has taken place, such as through opening up medical records to patients, health systems should not confuse formal legal rights to records with actual access to the information.
Measure the right things for patients.
The scorecard shows very little progress on measuring processes and outcomes that promote patient-centricity. In particular, the lack of PROMs is surprising, as is their all too frequent development without real patient input. PROMs, however, should only be the beginning, with other relevant metrics needed to map the patient experience and the nonclinical outcomes that may matter to patients. Even the creation of metrics will not be enough. Again, workflows, payment schemes, and training will need to change for their full integration. Until all of this happens, adequate measurement, and therefore patient-centred care as a whole, will remain in the starting blocks.
It cannot be done without making patient engagement the norm.
Efforts to improve patientcentred care without patients’ input are likely to fall short. China’s experience over the past two decades reflects what can happen when even well-funded, well-intentioned reform fails to understand what patients really think and want. To some degree, this problem is far from unique to China. Too often, some patients are more active in health systems than others, with patient-centricity the prize of successful advocacy movements, while health systems can become less interested in those with other diseases. Here, cultural change is essential. Patients need to step up, but for this to work well barriers to doing so should fall. It is not about taking power away from the clinician and provider in order to give it to patients. Partnership needs to become the default state of clinician-patient interaction if patient-centred care is to become a reality. For this to occur it requires more than just cultural change on the part of clinicians and patients; policymakers too need to listen and act in an appropriately supportive manner.