Countries around the globe, no matter at what stage of economic development, are nearly unanimous in the view that significant strides in healthcare integration can be achievable over the next five years, with national governments leading the effort, a KPMG International study had found.
The survey entitled, The Future of Global Healthcare Delivery and Management polled 103 healthcare administrators and government officials at national and regional levels to understand how they envisioned integration evolving in their home countries over the next five years, and what the likely impact will be.
Spiraling costs and shifting demographics – mainly an aging global population - are the primary catalysts driving integration, although the influence of these vary among developed and developing countries. Integration[1], which is currently inconsistent in most countries, is seen by many supporters as a cost-effective means to sustain an emerging healthcare environment where a “continuum of care” would be the norm.
“Properly managed, healthcare integration could yield a healthier population and save money,” said Dr. Mark Britnell, KPMG Global Head of Healthcare and a partner in the UK firm. “It has been seen to minimize hospitalizations and prevent service disruptions.”
Fifty-two percent of respondents from developing countries rank rising healthcare costs as the main driver of integration in contrast to developing countries, where cost is not the only critical factor - close to one third of respondents view chronic disease as another key driver. Yet, while most respondents said that government regulations pose restrictions to integration today, close to 70 percent said that national government will take the lead in driving healthcare integration.
“Strong national-level leadership can help reconcile competing goals and priorities of the individuals and organizations involved in healthcare provision,” Dr. Britnell said.
Close to half of the respondents in the survey – 44 percent - expect that the chief role national government will play in integration will be in conducting pilot projects to test new ideas. Thirty-four percent see the public sector setting quality standards and nearly 30 percent expect government-owned and operated integrated networks.
Over 60 percent want to see formal networks in place to reduce fragmented care and create incentives for providers to work together. Agreement on cost and quality goals is incumbent for a formal network to succeed. So, too, are mutually agreed remuneration models such as bundled payment[2] and gain sharing[3].
Over half the respondents said that an overall government plan is needed to provide policies that provide the incentive for providers to coordinate care.
Regarding patient care, close to 75 percent of respondents expect to see primary care physicians leading the coordination with hospitals playing a role in forming alliances. However, some respondents said that such a model cannot work without a better remuneration policy that compensates physicians for the additional services.
“It is a challenging time for the local healthcare system and as the government needs to address the challenge of high debt and budget deficits, as well as the aggregating chronic problems of the past. The need to prepare for future spending commitments to manage demographic changes, better quality and efficiency, and required healthcare infrastructure investments make meeting these fiscal challenges all the more difficult — and critical. A key facet of good performance in healthcare seems to relate to the individual and organizational capacity to partner—be it with private investors, patients, clinicians, social care organizations, or insurance companies. In the successful cases assisted by KPMG, the ability to look holistically at an individual’s needs and provide funding and care support from ‘pooled’ budgets has reduced unnecessary bureaucracy and streamlined the care process, thereby making it more personal to the user, and more effective as a result. Similarly, public-private partnerships have demonstrated impressive results in sharing capitation risks and integrating care. Dramatic improvements in efficiency seem to occur where a single organization and dedicated team of clinical staff take responsibility for the entire value chain and use articulated information technology to stratify patient need and focus attention and effort for those at risk.” said Daniela Nemoianu, Executive Partner, Head of Public Sector & Infrastructure at KPMG in Romania.
[1] Integration is defined as coordinating services among healthcare providers through formal or informal means.
[2] A payment model designed to reduce costs and encourage coordination of care in which hospitals and doctors share a single fee.
[3] A model for aligning providers’ goals by distributing savings generated by integrating care among them.