THE ROLE OF PATIENT VALUE AND PATIENT-CENTRED
CARE IN HEALTH SYSTEMSThe project’s key findings include:
Progress toward patient-centred care to date is far from complete. The scorecard considers how
well countries are doing across various areas essential to the existence of patient-centred care. These
are sorted into four broad domains: the existence of policy; the provision of care in general; the delivery
of that care in a patient-centred way; and the role of patients and their representative groups in the
health system. These in turn drew on the results of a total of 11 indicators and 26 sub-indicators that
measured particular issues of relevance to each domain. By design, none of the indicator criteria are
very demanding. Good results across every one of them would indicate a solid foundation on which
to build patient-centric care rather than its full achievement. Nevertheless, every area has at least one
area of low alignment with patient-centred care, and overall low and moderate alignment is the most
common outcome. Even the UK, which had the most consistently good results, has developed only
islands of progress rather than system wide transformation.
Countries have committed to patient-centred care, but progress on detailed policy remains
mixed. Every country in the scorecard has adopted an overarching strategy to become more patient-
centred. Most also have a formal statement of patient rights of some kind. However, in other areas
crucial to embedding patient-centricity over which policymakers have significant influence, progress is
less common: less than half of countries have policies on shared decision-making, with accompanying
decision aids even more rare; extensive use of value-based, rather than fee-for-service, payments also
occurs in just four of nine; and although healthcare curricula in eight study countries contain some
element of training in patient-centricity, expert interviews indicate that such efforts are widespread
in none. Another sign of slow progress toward patient-centricity overall is that the results on these
indicators, however mixed, are far more positive on average than those in other parts of the scorecard.
Little progress toward patient-centricity beyond policy. The scorecard and research indicate that
the health systems being measured are doing their existing tasks in a more patient-friendly manner.
For example, booking appointments for primary care physicians or one’s usual doctor—as distinct
from specialists—is now in many scorecard countries a relatively easy task. Patient access to their own
records is enshrined in law in seven of nine study countries. The broader shift toward patient-centred
care, however, has been much slower, with scores for personalisation and integration of treatment
still low on average. For example, only France and the US have medical appointments that average 15
minutes in length, and just the UK has guidelines for integrated multi-disciplinary team care for all of
five diseases the study used as proxies in the scorecard. Even access to health records is more limited
than the law indicates, with technological barriers or lack of roll-out restricting it in practice in most
study countries.
Truly patient-centred care will need to look beyond clinical interventions. One implication of
this slow change is that it will take even longer for health systems to consider tackling, where possible
and appropriate, social determinants of health. Some progress is taking place in the US, where many
insurance providers are looking at how to address these issues for their members. The efforts of