Today, I was teaching the last class of Hospital Management. I was trying to bring home the concept of value based health care to them, using Michael Porter's work on the topic, and telling them that they will be the future healthcare managers and providers; so they need to understand the concept. In between a discussion on Porter's concept of value, bundled pricing and IT enabled Integrated Practise Units(IPUs), one student commented that value based health care seemed like a utopian concept to her, much like an idealistic world, that we will never be able to attain. She had her own long list of arguments to support her precept. I was not able to answer her question adequately in class.
Long after the class was over, I kept thinking that if ever we are given a power to build up the most ideal healthcare system, what would it be like?
An ideal healthcare system, first of all would be equitable and non-discriminatory. It will not discriminate between rich and poor, powerful and vulnerable, or caste, creed, race or religion. This would mean that anyone who fell ill would be provided the same service by the provider. To create this kind of system, state will take the initiate and health care would be entirely in public domain. The state and the society would be so evolved that people will consider healthcare as a human right and would be willing to make all efforts to let every individual exercise his right to access health. The rich would be willing to pay for the poor. Society and the state will take the responsibility of taking care of an individual's health at different stages of his life.
The first step towards achieving such a healthcare would be to get lessons pertaining to healthy lifestyle getting included in the course books, healthcare being offered as a compulsory course during all the school years. From childhood to adulthood, children would get to learn important lessons on human body, healthy life and lifestyle through books and experiential learning. Sports, Yoga, Meditation and Healthy diet would be an essential part of school curriculum. No child would be able to pass high school, until he has attended the necessary 'health', part of his courses and practical's.
Of course to make this a reality, education will have to be equitable too. Everyone will go to a similar school and study the same curriculum.
Everyone will be covered under a state insurance for a lifetime, immediately after the birth. The premiums for this insurance would be paid by all citizens, every year, in the form of tax. All the hospitals, healthcare units and wellness centres would be financed by the National Trust, created out of healthcare tax collection. Health would be entirely in the public sector, no private practise would be prevalent in the country. The payer will have to just pay his taxes to get an access to healthcare.
Every child will get a unique health identity number(HIN), as soon as he is born. All the health records, right from the time of his birth will be recorded and saved digitally. All the hospitals in the country will be on the same network, will be connected by IT infrastructure and will be sending and receiving information at a fast pace. There will be huge national databases which will store all the health information of all the citizens of the country. There will be a real-time updation of database.
All the hospitals and health and wellness units will be connected in the country. Vaccination and Screening programs will be conducted for the entire population and the data thus generated will be available to physicians, healthcare providers, researchers and people. Rigorous research on diseases and socio-economic-environmental aspects of health will be done in national laboratories.
All the transactions, for each individual at the hospital would be cashless. When a patient entered in a hospital he will be registered with his HIN, and all his past records will be made available to the doctor at the click of a mouse. Any new diagnostic tests, or imaging done for him will be updated in the database by his HIN. He need not pay anything at different levels of care. His bill will be raised as per the cost at each level, will be accumulated at the time of his discharge and will be sent to the insurer. Healthcare will be provided on a no-profit basis. Bundling of costs will be done and bills will be raised accordingly. There will be no such thing as healthcare pricing. Healthcare costing, and costs will be determined based on the actual cost of the service provided at each level. Healthcare provider will have no incentive in increasing the cost of care. He will be naturally creating value by reducing the unnecessary cost, as it will only increase his or his colleague's work.
It would be considered honourable to work for the healthcare system. Healthcare providers would be highly respected in the society. The exact demand for the healthcare workforce, be it doctors, nurses or paramedics would be projected accurately, based on Health Data Analytics. The workforce would be educated and trained accordingly. High level of personal ethic would be considered as a pre-requisite for an admission in educational institutions providing health education. There would be a standard remuneration structure for the health providers and workers, based on specialisations. The workforce would be self-motivated, dedicated and efficient.
This model of healthcare would be naturally value based. Value created at different levels of healthcare system will determine the final health outcome. Value generation, rather than volume generation would be the practise, simply because bigger volumes will not be incentivised or rewarded. This way, the healthcare service will naturally move towards wellness rather than cure, towards preventive care rather than curative care. The resources in the economy will be optimally utilized. Infrastructural needs will be taken care of by the government. Health Infrastructure will be created by the government, technological development in healthcare will not be allowed to bag a market price, and most of the technological development will come through government funding. Disruptive innovation will be rewarded on an individual basis, but market forces will not be allowed to fix the price for innovative technology.
It will be a Utopian world, so it will be a clean environment, be tobacco free and everyone will be adequately nourished. People will lead stress free lives because they would be evolved, and they would have the intelligence to make a sustainable and justifiable use of natural resources.
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Utopia - has a merit. Human being's imagination of Utopia, makes it possible to evaluate the deviations from the Utopia, in the real world.
If the real world, remains real, we can still rate ourselves and our systems, on the scale of deviations from the Ideal System. The lesser the deviations, the better the system is.
I hope, this answers your question - My dear Students.
