Building healthy and equitable societies and driving industry transformation are two themes that have been interwoven throughout the agenda at the World Economic Forum (WEF) Annual Meeting this week in Davos, Switzerland. Throughout this crisis, healthcare has been found to be a key influencing factor in achieving both of these elements.
The pandemic has clearly illustrated the important role health systems play in supporting economically active societies, shining a light on longstanding structural drivers of health inequities related to the social determinants of health, precarious working conditions, and pre-pandemic health status. Thus, increasing not only health inequity but also leading to growing economic disparities. Apart from that the pandemic has strained relationships between governments and citizens around the world,1 resulting in protests about public health measures limiting individual freedoms and livelihoods.
During and following the crisis, the state of healthcare systems around the world has become top of mind with the general public thanks to news headlines on supply chain shortages, procedure backlogs and healthcare worker shortages. To the casual observer, it may seem that the pandemic is to blame for much of the trouble the healthcare sector is experiencing but this is only part of the story.
Long-before COVID-19 appeared, healthcare systems around the world were struggling to keep up with demand for services and contain costs amid aging and growing populations and rises in non-communicable diseases like cancer, cardiovascular disease and diabetes. Workforce issues have been a long-standing concern. For instance, in 2016 the World Health Organization projected a shortfall of 18 million health workers by 2030, in mostly low- and lower-middle income countries.2
The pandemic has been a stress test measuring healthcare systems’ ability to respond to the crisis and in due course has woken the world up to the importance of having well-functioning healthcare systems. Having heard the comment, “if we can only get past the pandemic, things will get better”, 30 years of working in the sector tells me this is a naïve viewpoint. Due to long-standing industry issues, people need to realize that COVID-19 is just one example of the strain healthcare systems may be under in the future whether it be due to new public health emergencies, natural disasters or the effects of climate change. To build back better post-pandemic, healthcare systems fundamentally will likely need to be designed, funded and operated differently.
According to a 2021 KPMG study, a majority of healthcare leaders in provider organizations around the world believe their industry is in need of “disruption and change”. But, notwithstanding the clear awareness of the need for change, there was also a consistent contradictory theme throughout this study, with most healthcare CEOs holding well-intentioned transformation ambitions but having yet to initiate or implement many of them. There seems however, to be no conscious intent by these leaders to dismiss transformation. On the contrary the sooner they can embark on the journey the better. In practice, however, the size and complexity of the transformation needed is simply too heavy to be carried only on the shoulders of provider organizations.
Working collaboratively to solve healthcare system challenges
To create truly sustainable and resilient healthcare systems in jurisdictions around the world, system-wide transformation is needed. Transformation of such magnitude will require collaboration at the ecosystem level between all stakeholders including governments, public and private providers, healthcare payors and industry groups. These groups need to come together to take collective responsibility and align themselves around transformational priorities and investments, whether they be:
- System funders making a paradigm shift away from a curation approach to prevention and population health management to address preventable risk factors (e.g., tobacco use, poor nutrition, lack of physical activity, and alcohol use) that contribute to chronic disease rate increases
- Payor and providers realigning their strategies and reimbursement systems to support moving towards integrated community-based care models, helping to ensure care is delivered at the right time in lower cost settings to enable access, and improve patient outcomes
- System funders revising long-term capital investment plans to help ensure healthcare systems have the necessary digital infrastructure in place for interoperability to support integrated and digital care delivery
- Private players like life sciences and technology companies using their capacity and capabilities to innovate, scale and supply new drugs, technologies and digital delivery tools that can save lives or just help make healthcare provision more accessible and affordable
- Research and educational institutions better anticipating the impact of innovation and technology on delivery models and the capabilities needed in the future for health and care workforces, to equip staff with the skills to thrive in the future
There is also a role for other groups within jurisdictional health ecosystems to play in supporting transformation. With evidence growing that health outcomes are impacted by a wide spectrum of social determinants3 — not the least being housing, education, poverty and nutrition — the need for healthcare organizations to partner with groups and industries that contribute to people’s lives and not solely to patients’ clinical outcomes is becoming more and more important. This calls for increased collaborations and private public partnerships that help improve health and wellness. To realize fundamental transformation the key competencies and capabilities of a wide spectrum of partners will likely be needed to keep health and healthcare systems sustainable and resilient.
Seeing this need academic, non-governmental, life sciences, healthcare and business organizations are taking action, and have come together since 2020 to form the Partnership for Health System Sustainability and Resilience (PHSSR). First established by the London School of Economics, the World Economic Forum, and AstraZeneca, this globally collaborative group were later joined by Royal Philips, KPMG, Apollo Hospitals and the Center for Asia-Pacific Resilience and Innovation. Through its work the PHSSR seeks to build knowledge through independent evidence-based research reports that study health system areas that include financing, governance, workforce, medicines and technology, service delivery, population health, and environmental sustainability, in order to identify strengths, potential weaknesses, opportunities and risks.
While in Davos, I moderated the “Collaborating to Build Resilient and Sustainable Health Systems” WEF Affiliate Session sponsored by the PHSSR. At this event panelists discussed how public-private partnerships (PPPs) have a role in ensuring health systems are equipped to deal with future stresses and shocks. Given that healthcare systems tend to be fragmented, panelists cited the need for strong collaboration, not only between the public and the private sector, but between all stakeholders involved to enable success. As such PPPs will need to become PPPPs to delineate the collaboration between public, private, providers and professionals.
Sustainable and resilient healthcare systems are the cornerstones needed to build healthy and equitable societies. To build towards this goal, all stakeholders within countries’ health ecosystems must take collective responsibility and work together to support and deliver on transformational strategies. While healthcare is in essence nationally organized, there is also a need to work together at the global level to learn and share insights to strengthen our systems.
Footnotes:
1 Carothers, T. (2020). The Global Rise of Anti-Lockdown Protests—and What to Do About It. World Politics Review.
https://www.worldpoliticsreview.com/articles/29137/amid-the-covid-19-pandemic-protest-movements-challenge-lockdowns-worldwide
2 World Health Organization. (2022). Healthcare workforce. www.who.int/health-topics/health-workforce
3 Investing in social services as a core strategy for healthcare organizations: Developing the business case, KPMG LLP (US)
and the Commonwealth Fund, March 2018. https://www.commonwealthfund.org/publications/otherpublication/
2018/mar/investing-social-services-core-strategy-healthcare
