The Economist (Intelligence Unit) – Creating Healthy Partnerships (2019)

28

THE ROLE OF PATIENT VALUE AND PATIENT-CENTRED
CARE IN HEALTH SYSTEMS

This may seem a small point, but the implications are large. Ms Sofia notes that, in her experience,

one common issue for all patient groups whatever the disease community they represent is “the very

little time and little listening that they get from doctors and researchers. This is a major concern. I’m

not blaming doctors, because it is often a structural problem inside the health system.” In the five to

ten minutes available in many countries, it is simply too difficult to address many complex situations. It

also makes it harder to pick up signs of unusual conditions. Ms Nishimura notes that the average time

it takes even to diagnose a rare disease is around five to seven years.

As for integrated pathways, only the UK had guidelines recommending co-ordinated multi-disciplinary

team care for all of HIV/AIDS, epilepsy, psoriasis, osteoporosis and mental illness (see Table 8). Similarly,

despite progress in specific areas, we found that navigation across various treatment providers for

complex conditions remains a challenge across all the scorecard countries.

In short, integration around the person being treated—a necessary condition for truly patient-centred

care—is still at a very early stage. Dr McClellan explains, “we are going through a lot of growing pains.

A lot of organisations have been trying but we are not getting it right the first time. Most don’t have

the competencies and capabilities to succeed with these new models. They need to figure out how to

make orderly change. We are on a journey with some clear bright spots but still a really long way to go.

It is a global problem.”

The general difficulties in co-ordinating and integrating care are similar to the inherent barriers of

change in healthcare discussed earlier. Moreover, the particular challenges can vary by country: in Japan,

for example, the government is hoping that increasing the role of GPs will help provide more coherent

individual treatment;^36 while in the UK, where GPs have long been system gatekeepers, the issue is more

likely to be low spending on system innovation.^37 As Mr Graham puts it, “systems need to do this in [their]

own context. What might work in the English NHS might not work in Germany, for example.”

Table 7: Holistic approaches to patient care taking account of co-morbidities

Indicator Sub-indicator Brazil China France Germany Italy Japan Spain UK US

Personalised care according

to patients’ values and

preferences

Holistic approaches

to patient care

taking account of

co-morbidities

0 0 2 0 0 0 1 0 2

0 = Not reported/Duration of regular visit less than 10 minutes; 1 = Duration of regular visit 10-14 minutes; 2 = Duration of regular visit ≥ 15 minutes.

Table 8: Existence of national clinical practice guidelines recommending co-ordinated and integrated patient care

with multidisiplinary teams (selected conditions)

Indicator Sub-indicator Brazil China France Germany Italy Japan Spain UK US

Continuity of care Existence of national clinical

practice guidelines recommending

co-ordinated and integrated

patient care with multidisiplinary

teams (selected conditions)

0 0 0 0 0 0 0 1 0

0 = No national clinical practice guidelines recommending co-ordinated and integrated care with multidisciplinary teams for ≥3 of 5 selected conditions;

1 = Existence of national clinical practice guidelines recommending co-ordinated and integrated care with multidisciplinary teams for at least 3 out of 5 selected conditions.

36. Kiyoyuki Tomita, “Japanese Healthcare
    at a Crossroads (1): Toward Integrated
    Community Care,” Tokyo Foundation for
    Policy Research web page, 2017.


37. Ben Collins, “Adoption and spread of
    innovation in the NHS,” King’s Fund Paper,
    2018.