Is Universal Care the foundation of best health outcomes for a nation?

I have for some time being exploring and trying to find the ideal and most effective International health care systems. To me such a system would meet the R.A.C.E. criteria namely:-

  • Rational
  • Appropriate
  • Cost effective

While these words mean different things to different people I am looking at a system of care that has the highest Health outcomes for the lowest cost and meets all the requirements of Coordination of care.

I have been blessed to travel extensively internationally and had the advantage of seeing many different health systems over the world covering Africa, Asia, Europe, North and South America.

From healthcare data published it would seem that North America (USA) spends the most for some of the worst overall health outcomes for a country as a whole. They also have the highest % of citizens with no healthcare cover. While Europe has the most universal care systems in the world the costs are escalating at a rate that the member countries can’t afford going forward.

A while back I read a very interesting provocative article by Robert Kaplan and Michael Porter called The Big Idea: How to Solve the Cost Crisis in Health Care. It was referenced by two Harvard press books namely;-

  • Redefining Health Care: Creating Value-Based Competition on Results.
  • Time Driven Activity based costing.

What they are trying to communicate is that much of the rapid escalation in health care costs can be attributed to the fact that providers have an almost complete lack of understanding of how much it costs to deliver Patient care. In other words they lack the knowledge necessary to improve resource utilisation, reduce delays, and eliminate activities that don’t improve outcomes.

While there are many international studies that prove and or support that Universal care does improve a Countries overall health outcomes it is not the only solution or change that is required to solve the health care crises.

We need dramatic improvements in the value of health care to obtain better health outcomes for more people at affordable costs. These improvements will come from innovation in the structure and organisation of care delivery, including medical and non-medical approaches.

Countries like South Africa, the United States and many others must achieve universal health coverage, not because it is the right thing to do or that it is just for reasons of fairness and compassion, but because it will help Countries ensure efficient, high-value care.

As Elizabeth Teisberg a Visiting Professor at the Geisel School of Medicine at Dartmouth College and co-author of Redefining Health Care: Creating Value-Based Competition on Results reminds us that “As long as insurance coverage is unavailable for pre-existing conditions, is re-priced when someone gets sick, and is unaffordable for low-income working people, the dysfunctions of the system will continue to compound, and spending will rise without improving value. Skyrocketing health care costs will be reallocated to providers, employers, and consumers who have the means to pay. Everyone — businesses and individuals — will end up paying more in health care costs for poorer overall health outcomes.”

The outcome of the Supreme court ruling around The Affordable Care Act is not a full move to Universal cover in the USA it is an important step toward enabling health insurance for many of US citizens who are now uninsured.
Why is Business in South Africa and many developed countries reluctant to embracing the need for health care reform? Do they see it as Socialism.not Capitalism? But is Health care not a social good more than a commodity for profit?

Throughout Europe different countries achieve universal coverage with a variety of approaches for example, single payer, multi-payer, and individual payers with subsidies; with and without direct involvement of employers; with varying percentages of physicians paid by the government. In addition there are varying models of individual and/or national/state funding/budgeting models with different waiting periods based on certain criteria.

As our Minister of Health has said many times and it is true and a reality in South Africa the absence of primary and preventive care leads to compounding problems, worse outcomes, and much higher expense. Universal access to care is imperative for improving health and productivity as well as the effectiveness and efficiency of health care in South Africa.

The lack of universal coverage in South Africa has led to cost-shifting and huge administrative costs in the private sector.

As Elizabeth Teisberg in her book states: ”Yet public reforms alone won’t solve the crisis. Only by shifting the focus from ‘more health care’ or ‘cheaper health care’ to ‘better health and better care’ can employers bend the spending curve and achieve greater value for each dollar spent.”

At a previous BHF annual conference in Sun City I challenged Employers to create a Social Compact with Government. Sadly only a few forward-thinking employers are taking bold, strategic action to improve future health as a way to reduce future health care spending. Many already understand that the productivity losses from poor employee health (absenteeism, presenteeism, disability, and early retirement) cost their businesses more than health benefits. Leaders in the private sector can make significant differences by supporting innovations that dramatically reduce the burden of chronic disease and increase value in health care delivery. Rather than fight Health care reform or move to a cost to company pay structure as a way reduce financial exposure for employee’s health benefits, business and health care executives should focus on initiatives that improve health in their immediate communities. These initiatives could include a range of employee health initiatives like wellness drives, to new approaches and facilities for secondary prevention in chronic conditions such as diabetes and heart disease, to new types of delivery teams based on coordination of care, new paradigms and better ways of measuring outcomes and there with greater success.

In my own mind and view of the future we need to enter into a Social compact between the Private and Public/State sectors, we need to redesign the way we cost health care based on a Time driven Activity based costing on what is required and not want is done resulting in improved Health outcomes. We need a new way of thinking and paradigm around health care and the models and systems we use. System thinking like BioMatrix approaches can help us finding lasting solutions that result in Rational appropriate and Cost Effective health care delivery.

Working Together we can make a difference for all.


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