6
THE ROLE OF PATIENT VALUE AND PATIENT-CENTRED
CARE IN HEALTH SYSTEMS
Humana, a US-based insurance company, in partnership with other relevant organisations to reduce
food poverty and social isolation show what this might look like if it becomes more common.Relevant measurement is still too rare on the ground. In our survey, patient group respondents
cited a focus on outcomes that matter to patients as the most important element of patient-centred
care. Finding out whether such outcomes are being achieved means determining what those metrics
are and measuring them. This has yet to take place on any meaningful scale. Only one country, the
UK, has any widespread use of Patient-Reported Outcomes Measures (PROMs) and the number of
procedures for which PROMs are used there has declined. Efforts are taking place to create metrics
that look further beyond clinical results, such as Patient-Reported Experience Measures or Patient-
Centred Outcomes Measures, but their use is also unusual. The same is true of patient preference
surveys. It is not simply a matter of starting to measure; health systems will need to change training,
workflows and financial incentives to incorporate such essential data in a meaningful way. A similar
set of problems also faces the integration of patient-generated health data, such as information from
fitness trackers or home medical devices.A lack of patient engagement can undermine efforts at patient-centred care. Many of the
national scorecard results can be explained by the amount of official attention that patient-centricity
has received over the years. China, however, is an unusual case. It has some of the weakest scorecard
results, but patient-centred care has been a policy priority since 1997 and the government has invested
substantial funds into general healthcare reform over the past decade. One reason for its lack of
progress toward patient-centricity is that healthcare reform, while very much “for the patient”, is not
“by the patient”. A failure to engage with those receiving care helps explain ongoing low patient interest
in primary care and hostility of patients toward clinicians in China.Patient engagement needs to become expected for every kind of patient. Progress toward
patient-centricity varies by disease group. In some cases, such as HIV/AIDS, patient advocacy has
broken down earlier barriers to engagement between clinicians and patients. Unfortunately, for
certain other conditions in other places, such as epilepsy in Italy, many barriers remain strong. Part
of the solution will be a greater willingness of patients themselves to take an active role in their care.
Expecting each community of people living with a different disease to go through the same fight in
turn, however, is wrong. Health systems need to make clear to patients and their caregivers that they
are welcome to co-create their own care to the extent that they wish. This will also require taking the
initiative to make the tools and processes needed to support co-creation, such as decision aids and
shared decision-making, far more widespread.