As science progresses, health care management is faltering

Expatica,Germany

Mon,31 August 2009

We have the technology, and often the money and the will, but poor management of our medical systems is preventing us from delivering quality health care, says a new report

Over the past few decades, there have been astonishing innovations in the field of biotechnology. But these new capabilities have not necessarily translated into better health care worldwide, according to a new report.

Why not? The answer is simple: poor health care management. With lumbering administrative systems, long waiting lists and overworked, underpaid staffs, patients can rarely access these state-of-the art technologies, even if they are there.

“The incredible advances seen in medical technology have not been matched by innovation in health care management and processes,” said Robin Bew, editorial director of the Economist Intelligence Unit (EIU), the group that authored the report. “This is a failure that costs taxpayers and patients dearly.”

Elizabeth Teisberg, a professor at the University of Virginia and co-author of the recent book Redefining Health Care, agrees: “Twenty-first century medical technology is delivered with 19th century organisational structures,” she told EIU. “The most powerful innovation in the coming decade will be structural and organisational–new ways of working, new team approaches to delivering the full cycle of care.”

Room for improvement

The report, which is based on desk research, discussions with experts and the results of a survey of 775 health care professionals, sought to identify organisational and structural impediments that are hindering innovation in health care management and to provide recommendations based on their findings.
One top recommendation was for health care providers to strategically integrate their services, so as to better suit the needs of patients. EIU cited the West German Headache Centre at the Essen University Hospital as a good example of this model. The Headache Centre offers patients consultations with various types of specialists, all of whom work within the same facility and collaborate on diagnosis and treatment recommendations. The Centre’s inventive structure has earned concrete results: 80 percent of the patients that have been through its programme have not missed more than six days of work in six months, resulting in lower costs for the health care system.  
"Care delivery needs to be organised around the needs of the patient instead of around the clinical specialty of the doctor," said Eric Silfen, chief medical officer for Philips Health care, the company that commissioned the report.

Becoming your own advocate

The report also emphasised that the rise of medical information available on the Internet is something that should be supported, not worked against.

According to the Pew Research Centre, 83 percent of Americans with Internet access use the web to look for health information. These “e-patients” are also increasingly using social networking platforms to teach each other about conditions and treatments, EUI said.

“Many initially saw the spread of medical information on the Internet as a nuisance or even a risk,” according to the report. Instead, health care professionals should view the Internet as a valuable way for patients to take agency over their own health and as a venue to enrich doctor-patient conversations. Ultimately, these advancements in patient knowledge could “create the basis for a more market-driven system where customers are able to make informed choices about varying providers,” said EIU.

The importance of taking control over one’s own health care is also important due to the widely varying standards between health care providers, both locally and globally, said Dr Sneh Khemka, medical director at Bupa International, a leading expatriate health insurance company. Numerous factors, like sanitation standards, access to drugs and medical infrastructure, can greatly impact the quality of care patients receive.

Consequently, patients must become their own advocates, said Khemka: “Staying knowledgeable, seeking wide information about your own condition, keeping healthy and ultimately knowing who to go to when you do need to access health care” are the keys to receiving good health care.

This advice goes as much for people living in wealthy developed nations as it does for those in the developing world. In fact, according to Khemka, health care systems that receive a lot of money (most developed nations spend at least 10 percent of their gross domestic product on health care and the US infamously spends closer to 20 percent) are vulnerable to another danger: over intervention by doctors.

For example, the Dartmouth Atlas of Health Care, published by the Foundation for Informed Medical Decision Making, an organisation that researches and analyses the American health care system, recently found that certain surgical interventions were performed not dependent on actual need, but more on surgeon preference.  

“That means that patients were having procedures they didn’t need and didn’t want,” said Khemka. “As medical systems become more defined, they reach further and further into society, and the risk of medical over intervention grows. A health care system may assume intervention is necessary when it isn’t.”

So when it comes to keeping healthy, ditch the apple-a-day, pick up a pad and pen and get involved in your own medical treatment.

Jessica Dorrance/Expatica

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