44
THE ROLE OF PATIENT VALUE AND PATIENT-CENTRED
CARE IN HEALTH SYSTEMS
Conclusion: Vital considerations for patient-centred care
Patient-centred care, with its emphasis on patient value, is a widespread health system goal. It is
not only more consistent with modern expectations than intervention-focused, provider-centric
care, it holds out the potential of better outcomes—both traditional clinical ones and those deemed
important by patients—at reduced cost. These hopes are evident in relevant policy declarations and
strategies across all nine countries assessed in this report.However, 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 repeatedly shows weaknesses in many countries in indicators on which
it simply should not be that hard to excel.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 our scorecard are becoming more user-
friendly, 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,