“Although the impact of these factors differs between developed and developing countries, this is only a question of degree as they have emerged as common to both,” says Sandile Hlophe, Head of the Healthcare Sector at KPMG.
Integrated healthcare delivery could include informal coordination among providers (eg between hospitals or between hospitals and doctors) to the establishment of structured links between various parts of the system. Of the 103 health executives surveyed worldwide, 68% were drawn from the developed world with 32% representing the developing world. Greater integration in healthcare provision within the next five years was supported by 95% of those surveyed.
“While the percentage of those surveyed who support integration is impressively high, there has been uneven progress towards realising it,” says Hlophe. “In the South African context, we have to face the challenge of uneven distribution of scarce health resources and the urgency with which we need to address cost and quality issues.”
The survey found that governments play a leading role in funding healthcare provision, determining regulatory issues and providing the hardest push for integration. However, respondents felt that government policies often were found to be the biggest obstacles to the implementation of integration as well. At the same time, they felt that national (68%), provincial (25%) and local (7%) spheres of government will lead the way towards integration over the next five years, with the drive being strongest in developing countries. While representatives from medical aid schemes were not sampled, 11% of respondents felt that medical aid schemes also had a role to play in integration.
In terms of the top five enablers required to achieve integration, a government plan was ranked number one, with government payment policies that incentivise integration ranked number two. Cooperation amongst service providers and the rapid deployment of IT systems came in at number three and four respectively. The elimination of regulatory barriers completed the top five integration enablers.
Respondents also felt that governments had a significant role to play in encouraging the use of electronic health records (EHRs) to achieving integration. “Although developing countries face greater challenges than developed countries in terms of IT, they also need to ensure that EHRs can be accessed across different platforms. Some developed countries have wasted millions of dollars because of a lack of interoperability between IT systems,” says Hlophe. “This would also require the development of IT standards in the healthcare sector at national, provincial and local levels.”
Although the study found some differences between the developed and developing countries, there are a number of issues that are common.
“So, what does an integrated healthcare system look like? The most significant impact will be on the number of patients that would be treated at traditional facilities. More than two-thirds of those surveyed believed that the volume of patients at primary healthcare facilities would substantially increase, which is a significant shift from the current situation.” This was followed by 67% saying that home healthcare will assume greater importance and 65% identifying nursing homes and hospices as playing major roles. Only 23% saw hospital inpatient facilities playing an increasing role in an integrated healthcare system environment.
“These findings are not surprising. They reflect an attempt to effectively treat chronically ill patients while preventing hospitalisation. The net effect is that the healthcare landscape will experience fundamental change,” says Hlophe.
Based on the survey findings, the recommendations developed include:
- The introduction of incentives to encourage integration in the healthcare sector
- The introduction of healthcare IT systems that are interoperable based on common standards
- More intensive training for healthcare providers and patient caregivers with a focus on integration of these service providers
- The introduction of pilot projects, at a low-cost, to test country-specific models
- The allocation of sufficient resources to drive healthcare integration.
“Given the proposed changes to healthcare policies currently being discussed, South Africa has the opportunity to leap-frog some of the challenges facing the sector and move rapidly towards an integrated cost efficient and quality health sector model. A key enabler will be strong political will and leadership to get us there,” concludes Hlophe.
About the survey
KPMG International commissioned The Economist Intelligence Unit to survey 103 healthcare administrators and government officials on the current state and changes expected in healthcare integration and to learn more about certain healthcare organisations that are showing the value of integration in achieving a notable balance between cost and quality.
- 68% represented developed countries, and 32% were from developing countries across North America, Western Europe, Asia-Pacific and Latin America.
- 73 respondents were hospital administrators. Of these, 55% were from hospitals with 500 beds or more and 58% had a minimum of 2 000 employees. The minimum number of beds was 250 and the minimum number of employees was 500.
- 30 respondents were from government agencies or departments related to healthcare drawn from national, provincial and local levels.
- Many respondents were responsible for more than one function: 53% were involved in healthcare policy, 50% in providing healthcare services, 30% in regulation, and another 7% in other activities.