Rethink the model of healthcare for everyone

Vision concepts / statements: self-managing and smarter citizens make for better patients in collaboration with service-oriented professions

The health sector requires a rethink not as a system of sickness management but as a social asset in which the population stops generating physical and psychological pathologies. Today’s model of care is a reaction system designed to rescue people in different levels of physical and psychological distress.

That model has generated greater demand flow over decades and depending on the economic model deployed there is perverse incentive to expand the demand volume or expand the capacity to meet the demand.

The patient or client is a passive category in the design of the system, despite efforts to ‘consult’ with people as healthcare consumers the producers develop and promote the service based on their capacity to deliver. It is not a service concept it is an access permission process granting conditioned service to specified categories of demand actors.

A service needs free acting clients-patients not consumers

Without real freedom to choose and engage the client / patient experience is a conditioned and controlled one designed around idealist and programmatic thinking. The individual does not exist except as an agent of the design concept, as a passive consumer of healthcare.

This manifests either as a pay for the service you may receive or a statist system which is a capacity governed control over access which defines levels of access and by denying the existence of demand in unmet need and waiting lists.

The NHS system concept is managed according to the

• demand funded + waiting lists + plus unmet need + evolving pathology within the whole population.

It serves a level of critical need and that is tolerated through low levels of disease and some level of waiting.

The payment for access system, US is the classical example, does inject awareness but excludes significant demand and minimises effective healthcare support. US has a very poor return for the total expenditure outlay as a society for the total health outcome result.

Hybrid systems using both can achieve more or less outcomes per unit of cost.

Many advanced countries healthcare economics will suffer from Baumol’s cost disease, which can be used to make excuses but in fact reinforces the poor learning within the more advanced systems and the macro-economic settings that govern them. More complex and ‘civilised’ social organisations, such as advanced societies, attract inflated cost simply by being the advanced system. It is vital that each system has transparency and courage to maintain challenges to performance, including cost.

In general, this approach to healthcare is not a service concept, it is a bureaucracy / monopoly, giving access to formal processes which may or may not meet your needs. Large organisations, state actors such as NHS or corporations that dominate healthcare provision in pay for access systems, control the access according to financial and or procedural codes not health.

Throughout the first 3 or 4 decades of its existence the NHS model functioned well enough. However, in this period the unmet need and the waiting list were active components of the demand flow. This aspect is part of demand management although presented as exogenous and dysfunctional in the broader social setting. We hear a lot about the waiting list today but that feature of demand flow has decades of history, it is a function of the system of managing healthcare in NHS settings. It is certainly aggravated by short-term funding cycles; however it is the management system that creates the waiting list as a method of managing demand.

Autonomous clients and autonomous carers as a baseline concept offer a radical service alternative. Unlike consumer products where stock outs / shortages occur and can be accepted this is not a valid outcome for health. If I do not get my new TV or sofa or butter I can get by without any manifest pathology. If I do not get my health need met it evolves into a more complex need, and more cost to me or the system.

Zero exclusions and zero unmet need like ‘waste’ in the ‘lean’ world are the only acceptable targets to seek. It is almost treasonable to ask about performance in NHS because the whole system is politicised and sensitive to single points of critique. Everyone has a valid point but no one is resolving the fundamentals.

Health is a social issue and people are at the centre

Healthy people manage themselves; their ‘needs’ are altered as they create new patterns of behaviour and clinical history. This model of provision is inclusive. This approach to health organisation reflects shared endeavours to create a completely human health model in which all are responsible and our first action is self-managed care.

The core is that the individual is aware, accepts self-managing as a desirable way of being and acting, thus, is a more responsible and ‘smarter’ patient. They are smarter because they possess deeper awareness / data and are proactive in seeking support. They are smarter because they engage the manifest pathology as theirs and in which they wish to maintain autonomy.

The current model is tracking expanding needs and unmet needs with population growth, we witness failure but continue with the same model. The roles we have developed within this model pursue the design principles that illness and breakdown is what we are about. The system is not designed to promote health but focuses on illness avoidance and or mitigation. Efforts to address prevention are sponsored by the illness culture, resulting is tame efforts at the margin mainly about ‘educating’ the public which is little more than exhortation.

The dysfunctional roles / actors are the producers and consumers of consumer healthcare-

Big pharma as a business, highbrow science and passive consumers as a cultural context. We as citizens must accept that if the whole system is broken, we have played a part within that decay.

In the past two hundred years we have run out road. We create pathologies, pathways and pharmaceuticals to fix behavioural dysfunctions.

Demand is generated by the population

We don't think about health demand in this way but the population is a system, like an anthill. We are not ants, although we could learn from them. The ant acts for the whole community but does have downtime. It is estimated the ant is 'lost' or off track, for almost 50% of its daily routine. We humans think of ants as acting like a whole body of ants performing different roles to make 'ant life' work.

In the same way we humans create the health demand we do and as such we can learn to do that differently. My suggestion is that we can all contribute and it can be a life liberating experience.

We all need to get smarter to affect better health outcomes and to get control over the activity we call healthcare. Bureaucracy and monopoly as organisation concepts may have suited the industrial era but over the last 2-3 decades, they have generated major losses and dismay. The public space is dominated by lack of trust and corruption.

At present we are experiencing poor leadership and poor services. It is up to all of us to engage in a smarter and more proactive approach to healthcare. Individuals as clients / patients but also as citizens can affect these outcomes if they take ownership of their own health life cycle. Illness is episodic, but health is a whole life experience. From day one we should be engaged in learning about our own health and to exercise the maximum autonomy over it.

The self-managing client can act more quickly and regularly to smooth the life cycle of their health. They can act on the spot; they can be aware of basic data and they can adopt basic practices and therapies to maintain health.

We can all accept old age is not ‘illness’ but that it is simply wear and tear. We can all be physically and mentally more effective into longer chronological life years with higher average quality of life years.

Our clinical and pharmaceutical partners can adapt to our smarter behaviour and enable a more therapeutic intervention.

Urgent and trauma driven health crises must be treated as such. The incidence of urgent/ emergency care should be a tiny percentage of our overall episode population. True breakdown would be treated as always and hopefully without waiting lists etc.

The transformation of healthcare will be a progression requiring collaboration and emergent ideas.