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

20

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

Lack of progress on this indicator has profound implications for change elsewhere. Mr Balch explains

that “when you start to design truly patient-centred care, the crucial thing is shared decision-making

and goal-concordant care planning that is co-created with the patient.” This goes far beyond informed

consent to true co-creation of care (see Box).

A second lever over which policymakers exercise substantial control is funding. Getting this right

is another fundamental requirement for success, explains Mark McClellan, Margolis professor of

business, medicine and health policy at Duke University: “Taking steps toward patient-centred care

means moving payment systems to focus on people and the best outcomes that they care about.”

Again, the scorecard shows only partial progress (see Table 4). Every study country engages in some

use of value-based payment systems, but in five of nine (Brazil, China, Germany, Japan and the US)

this remains small scale. Moreover, of the other four, the extent of value-based care in Spain varies

markedly by region.^21 Meanwhile, in the UK, another country scoring well for use of such funding, Dr

McClellan notes that the practice is yet to break down many provider silos.

A third potential area where policy or regulation could engender change over time is clinician

regulation and training. Here, eight countries score for at least some evidence of attention to patient-

centred care within one healthcare-related profession (see Table 5). Even in the outlier, Japan, interest

in the topic is not completely absent. Although scorecard research uncovered no sign of formal efforts

to integrate patient-centricity into medical education, Ms Nishimura reports that “in recent years,

attempts to understand patients, such as inviting patients as guest speakers, are expanding.”

Table 4: Value-based payments

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

Value-based payment

systems as provider

incentives for

implementation of patient-

centred care

n /a 1 1 2 1 2 1 2 2 1

0 = No/Not reported; 1 = Value-based payment systems are used as provider incentives for the implementation of patient-centred care in some parts of the health system;

2 = Value-based payment systems are used as provider incentives for the implementation of patient-centred care across the whole health system.

Table 5: Education and support for healthcare staff

Indicator Sub-indicator Brazil China France GermanyItaly Japan Spain UK US

Education and

support for

healthcare staff

Education and training around

the principles of patient-centred

care for health professionals as

part of the curriculum in medical

nursing schools

1 1 1 1 1 0 1 1 1

Support of health professionals

in service settings

0 0 1 0 0 0 1 1 0

Education and training: 0 = No/Not reported; 1 = Education and training about the principles of patient-centred care for health professionals as part of the curriculum in medical/

nursing schools.

Support of health professionals: 0 = No/Not reported; 1 = There is support for health professionals in service settings.

21. Economist Intelligence Unit, Value-based
    healthcare country snapshot: Spain, 2016.