Obama’s Healthcare Reform might bring hope (if not solutions) for millions of Americas, but global healthcare challenges are far bigger than a reform can solve. Challenges are increasing dynamically and no obvious solution is in blue print. Renowned healthcare and medical tourism consultant Dr Prem Jagyasi travels extensively to dig out real global healthcare challenges and its impact on society.
In the last three years, I have traveled to 20 countries within the US, Europe, Middle East and Asia to understand healthcare scenarios in each country. The result is obvious that unequal economy, unequal care, unequal health spending and unequal healthcare services bring nothing but unequal challenges for each country. On the whole, people are healthier, wealthier and live longer today than 30 years ago. There have been significant improvements in access to water, sanitation, communicable diseases and antenatal care. There have never been more resources available for health than now. However, there are other trends that must not be ignored. First, the substantial progress in health over recent decades has been deeply unequal, with convergence towards improved health in a large part of the world, but at the same time, a considerable number of countries are increasingly lagging behind or losing ground, as reported by the World Health Organization.
The healthcare system worldwide is observing significant issues arising from a shift in diseases, an increase of non-communicable and chronic disorders, Baby Boomers and an aging population, a fragmented healthcare system, commercialization of healthcare and increases in the cost of care while countries are facing a shrinking healthcare budget. Moreover, there is very little anticipation and slow response by authorities to tackle such challenges. Many government bodies are engaged in the management of diseases, and are not at all close to the prevention programs, which presents a major problem.
The growing reality is that many individuals present with complex symptoms and multiple illnesses, which challenges service delivery to develop more integrated and comprehensive case management.
As per the World Health Organizations recent report, there are five common shortcomings of healthcare delivery worldwide.
People with the most means – whose needs for health care are often less – consume the most care, whereas those with the least means and greatest health problems consume the least. For instance, 5% of the US Population spent almost half of the healthcare spending. Public spending on health services most often benefits the rich more than the poor in high- and low-income countries alike.
Wherever people lack social protection and payment for care is largely out-of-pocket at the point of service and they can be confronted with catastrophic expenses. Over 100 million people annually fall into poverty because they have to pay for health care that they cannot really afford in the first place.
Changing the perspective on access to one framed in terms of ensuring comprehensive, effective and efficient healthcare highlights the problems associated with the fragmentation of care delivery. The excessive specialization of healthcare providers and the narrow focus of many disease control programs discourage a holistic approach for the individuals and the families they deal with and do not appreciate the need for continuity in care. Health services for poor and marginalized groups are often highly fragmented and severely under-resourced while development aid often adds to the fragmentation.
Poor system design that is unable to ensure safety and hygiene standards leads to high rates of hospital-acquired infections, along with medication errors and other avoidable adverse effects that are an underestimated cause of death and illness.
Resource allocation clusters around curative services at great cost, neglecting the potential of primary prevention and health promotion to prevent up to 70% of the disease burden. At the same time, the health sector lacks the expertise to mitigate the adverse effects on health from other sectors and make the most of what these other sectors can contribute to health.
Let’s have a look on healthcare challenges in each country:
Although nearly two trillion USD a year is spent on medical care, many people are receiving more care than they need, many are receiving less than they need and many are receiving the wrong kind of care.
The United States spends the most money on medical care of all advanced industrialized countries, but it performs more poorly than most on many measures of health care quality. The US scores 33% worse than the best country on mortality from conditions amenable to health care, that is, deaths that could have been prevented with timely and effective care.
Government takes the burden of providing Healthcare Services through the world’s biggest healthcare workforce – NHS. Only 10% of the population has private insurance coverage. Lack of personalized services, funding shortage and staff severity are key challenges which leads to high waiting times for treatment.
Canada's healthcare system is funded by both the federal government, and by the provincial and territorial governments. Patient waiting times, overall healthcare funding, shortages in personnel and improvement of medical technology are key areas which need improvement in the country's healthcare system. Some argue that Canada’s health system should include home and long-term care. There is also criticism about the difference in healthcare coverage in difference provinces.
Japan has a system of universal health coverage, although individuals may receive coverage relatively differently. It can be divided into two broad categories: National Health Insurance and Employees’ Health Insurance. Membership in either program is compulsory. There is also a national health program for people over 70, which is funded by contributions from the two main plans. The Japanese social system as a whole is expected to struggle in the future, as its population of young working citizens will increasingly be outnumbered by elderly retirees. Preventive measure to control common health issues are under criticism. In Japan, hospital stays are two to three times longer than in the West. Access to healthcare system is also a concern in Japan.
South Africa's health system consists of a large public sector and a smaller but fast-growing private sector. Although the state contributes about 40% of all expenditures on health, the public health sector is under pressure to deliver services to about 80% of the population. The standard of healthcare delivered varies from province to province. With less resources and more poor people, cash-strapped provinces like the Eastern Cape face greater health challenges than wealthier provinces like Gauteng and the Western Cape. Government has controlled Malaria and other regional diseases, but controlling and managing AIDS is still a big challenge for the South African healthcare system.
Most Germans receive health care coverage through the public health insurance plans, which are funded from contributions of employers and employees. Currently, the rate is 15% of the net income which is compulsory deducted to the insurance system. Though quality and variety of healthcare services in Germany is one of the best in the world, the German healthcare system suffers from a lack of competition, insufficient or inappropriate care, shrinking revenue and an aging population.
WHO ranked France number one for Healthcare services, but high healthcare funding is a serious concern for the country. Concern is constantly rising about keeping healthcare expenditure under control by taking several measurements to control cost of insurance and fixing treatment costs.
Healthcare in GCC (UAE, Oman, Saudi Arabia, Bahrain, Qatar and Kuwait) has a higher demand than supply. Economic growth coupled with population growth is far higher than healthcare infrastructure growth. Currently GCC spent almost $12 billion USD on healthcare which will increase to $60 billion USD in just the next few years.
Healthcare conditions are getting worse as many healthcare diseases are increasing above 200%. Chronic and affluent disorders, along with genetic disorders are key challenges for the Arab world. Though GCC governments have initiated huge healthcare investments, lack of resources leads to lack of operational outcomes which cause several GCC nationals to opt for healthcare services abroad. Lack of healthcare trust within national the healthcare system presents a unique challenge in this part of the world.
The global healthcare struggle for affordability, accessibility, availability and quality of care is apparent. Fragmented healthcare systems, commercialization of healthcare, unequal economies, healthcare resource shortages, aging populations, chronic health disorders and a lack of prevention programs are key factors behind struggling global healthcare challenges.
There is no upfront blueprint solution for global healthcare crises. Certainly, primary healthcare with a focus on prevention programs can bring relief, but healthcare challenges are beyond reform or available solutions. Every country presents unique challenges which require unique solutions and no global reform would work to cure healthcare blues. Though collective experience with globally shared learning and understanding could be utilized more productively, and it would certainly bring better results, healthcare systems would still continue to struggle for many more years to come. Needless to say, prevention should be the prime focus of any healthcare system or reform.
Source: World Health Organization, National Coalition on Health Care, Exhealth Research and Wikipedia.
Dr. Prem Jagyasi is a Chartered Management, Healthcare Marketing and Medical Tourism Consultant. Providing high-profile consultancy services to Government Authorities and Private Healthcare organizations, he is noticeably leading medical tourism consultant. He also serves Medical Tourism Association, as an Honorary Chief Strategy Officer. He can be reached at Prem@Jagyasi.com | www.DrPrem.com