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

36

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

Chapter 6: Lessons from China: Patient-centred without a patient voice?

Effort is necessary

In most cases, explanations for national scorecard results are simple to find. The UK may only be part

of the way to patient-centred care, but it does well relative to others in large part because it has been at

it longer. The first NHS patient charter appeared in 1991, and patient-centricity has been a formal policy

goal since 1997.^57 Starting with a primary care-based health system going back decades also certainly

did not hurt.

Conversely, Japan’s relatively low scores reflects, in large part, its lack of interest in patient-centricity

until more recently. Its physician-dominated, hospital-focused care has supported great longevity but

this success made it resistant to change, with major reforms attempting to integrate care around the

patient only within this decade.^58 In fact, general practice became a recognised board discipline only

in 2017.^59

How effective Japan will be remains an open question. Indeed, a much-heralded report of young

health-sector leaders commissioned by the health ministry, The Japan Vision: Health Care 2035, said

much that was laudable about changing toward a more value-based system with greater patient

autonomy and shared decision-making. Equally noteworthy, though, is that none of the experts

selected for the panel were patient representatives.^60 Nevertheless, Ms Nishimura is hopeful: “the

practice of everyone participating in treatment is spreading, even in Japan,” especially among younger

clinicians.

But not all effort succeeds

The most instructive national results, however, are from China.

The country is a consistently weak performer, gaining full marks on none of the 11 indicators and on just

four of the 26 sub-indicators. Often in benchmarking studies containing countries at different stages

of development, those with emerging markets do worse than richer ones because of fewer available

resources. In this case, however, the explanation is far more complex.

To begin with, money for change is not necessarily an issue. China has been engaged in widespread

health system reform since 2009, backed by extensive state investment. Total annual government

and compulsory scheme healthcare spending more than tripled between that year and 2015, reaching

US$338bn.^61 This growth was roughly 1.5 times that of GDP during the same period. Among the leading

57 Ruth Thorlby and Jo Maybin, A high-

performing NHS? A review of progress 1997-

2010 , 2010.

58 Kenji Shibuya et al eds, Japan Health System

Review, 2018; Economist Intelligence Unit,

The shifting landscape of healthcare in

Asia-Pacific, 2015; OECD, OECD Reviews of

Health Care Quality: Japan, 2014.

59 Makoto Kaneko, “Current trends in

Japanese health care: establishing a system

for board-certificated Gps,” British Journal

of General Practice, 2017.

60 Report available at: https://www.y-

shiozaki.or.jp/contribution/pdf/

20151221132002_77dW.pdf

61 WHO Global Health Expenditure Database,

accessed October 27th 2018.