THE ROLE OF PATIENT VALUE AND PATIENT-CENTRED
CARE IN HEALTH SYSTEMSof traditional clinical outcomes, however, is difficult because, as discussed next, a current weakness in
patient-centred care efforts is that appropriate metrics are lacking.
Charting uneven progress
Whatever the measurement issues, in rhetorical terms, the notions of patient value and patient-
centricity have won the day. As Mr Mühlbacher notes “there is hardly a health system that doesn’t claim
to be patient-oriented. The question is, ‘how are they incorporating that perspective?’”
The answer varies widely by geography and level of economic development. Kawaldip Sehmi, CEO
of the International Alliance of Patients’ Organisations, reports that in Asia, especially in developing
countries, “paternalism is still there. Little interest is paid to the patient perspective. It is a beggars-
can’t-be-choosers approach for patients.”
Things are better in Europe, but even there substantial disparity remains, notes Chris Graham, the CEO
of the Picker Institute, Europe, a charity dedicated to advancing patient-centred care. These systems,
he says, are at different places “on a learning curve: some are moving further toward active patient
involvement; others are less advanced, but soliciting patient feedback is becoming normal; others still
are further back, trying to grasp the issue.” He adds that progress generally follows economic growth.
The degree of progress toward a more patient-centred model varies widely, and not only by geography
and wealth. Change within different elements of this multi-faceted shift, even in single countries, is also
frequently uneven. Mr Balch notes that many providers have made advances in listening to patients,
but “healthcare systems have multiple facets that impact patient care such as clinical pathways,
electronic heath record systems, quality measurement and decision aids. In many of these other areas
there remains a lot of paternalism, for lack of a better word. Either through omission or commission,
they do not incorporate patient views into their design principles.”
Amid these difficulties, a large majority of respondents to our patient group survey agreed that
policymakers in their countries are committed to learning from patient-centred care practice
elsewhere. Given this aspiration, and the wide variations in progress in different countries, now is an
appropriate time to consider how well different countries are doing in pursuit of patient value and
patient-centricity. The rest of this report examines this in detail and, in so doing, aims also to reveal
some of the barriers to progress that need addressing.