THE ROLE OF PATIENT VALUE AND PATIENT-CENTRED
CARE IN HEALTH SYSTEMSChapter 3: Patient-centricity: The gap between grand strategy and detailed policy
Declarations aplenty but fewer detailed plans
“There is a policy level push toward the idea that what the patient wants matters,” says Mr Graham.
This comes through clearly in our scorecard, with countries doing very well in creating the most basic
elements of policy frameworks to promote patient-centricity.
For all but three countries in this study, such documents cover much or all of the health system. The
outliers—Italy, Spain and the US—have still all seen significant progress in this direction, especially,
for the first two, in primary care. Rather than lack of interest, their lower scores reflect their greater
difficulties in creating comprehensive national policies because responsibility for care provision is
divided between either numerous regions or, in the US, an even larger number of distinct organisations.
Similarly, every country except China and Japan have some statement or bill of patient rights. In Brazil,
this is enshrined in the constitution. Mr Graham adds that this kind of commitment is an essential first
step to change, but “the question is ‘how much is this policy push being picked up by health providers?’”
The answer is mixed. Three other scorecard indicators cover areas over which policymakers and health
officials have substantial control. One is the existence of national or widespread policies or guidelines
to promote shared decision-making (see Table 3). These exist in only five of the nine study countries:
Brazil, France, Germany, the UK and the US. In Brazil, though, scorecard research found that the spread
of shared decision-making is still lagging in practice. Meanwhile, in countries without a policy, progress
toward shared decision-making can be slight.
Yukiko Nishimura, president and founder of the Advocacy Service for Rare and Intractable Diseases’
multi-Stakeholders in Japan, explains that, in her country currently, “the doctor thinks that treatment
is being carried out after conveying the treatment policy to the patient. As there is information
asymmetry between the two sides, the assumption is that the patient will follow the doctor’s
instructions.”
Table 3: Shared decision-making
Indicator Sub-indicator Brazil China France Germany Italy Japan Spain UK US
Patient involvement
in shared decison-
makingNational policies
for shared decision-
making1 0 1 1 0 0 0 1 10 = No/Not reported; 1 = National policies for shared decision-making exist.