7 steps toward a better and more affordable health system

Health care systems in advanced economies are plagued by rising costs. But improving service is not some utopian vision, explains IESE's Núria Mas.

Increasing life expectancy, an aging population, more chronic diseases and constant clinical and technological advances add up to skyrocketing health care costs. At the same time, resources are limited and budgets are stretched.

An urgent rethinking of the health care systems in advanced economies is required. In this rethinking, a key question emerges: Are the available resources being used in the best possible way?

That is the question addressed by Núria Mas, IESE professor and holder of the Jaime Grego Chair of Healthcare Management, and Wendy Wisbaum, consultant on health policy and public health, in "The 'Triple Aim' for the Future of Healthcare."

Better health, better care and lower cost

According to Mas and Wisbaum, the solution to the challenges facing health systems boils down to achieving what is known as the "triple aim": better health, better care and lower cost.

Is the "triple aim" possible? The authors believe the answer is yes. And they defend their belief with evidence from Europe and the United States that there is room for improvement at current spending levels. For example, recent research from the U.S. finds that approximately 30 percent of health care spending does not improve patients' health. If that 30 percent could be redirected to make patients healthier, real progress could be made.

The remedy, in seven steps

Living up to the "triple aim" is tough, but not impossible. The authors propose seven steps toward this three-pronged goal:

1. Measure, measure and measure. What gets measured can be improved. We should promote transparency and the exchange of information in order to establish metrics to compare different clinical procedures, hospitals and geographic areas.

2. Compare. As a starting point, look to the experiences of other countries, regions and hospitals in order to detect possible flaws and locate opportunities for improved clinical procedures and resource management.

3. Understand what works and why. Identifying success stories is the first step. But in order for the results to be replicated, it is essential to understand the mechanisms underlying each success. They are not always obvious, and they may be conditioned by the peculiarities of different health systems.

4. Promote a value-based approach. When making decisions, we must look beyond the costs. It is not just about spending less, but spending better. Resources must be allocated according to the value they bring in terms of improved health, while taking into account the costs and benefits of alternative treatments.

5. Utilize technology. Technology's growing impact on the delivery of health services is a proven and accepted fact. Yet we are still far from tapping its full potential. The application of information technologies promises to reap rewards both in terms of better health and cost savings. Technology can help us customize treatments, promote the self-management of chronic illnesses and enable real-time access to important information.

6. Redesign payment systems. The "triple aim" requires a more integrated vision of health care, with greater emphasis placed on prevention and disease management. And this new focus requires rethinking payment systems and incentives so that they are aligned with longer term and broader societal goals.

7. Change the culture of health. We must continue efforts to educate and raise awareness in our society to promote healthier habits (prevention, control and adherence to prescribed treatments) and innovations to improve health systems.

What do the experts say?

The article by Núria Mas and Wendy Wisbaum is the opening chapter in the book also called The Triple Aim for the Future of Healthcare, published by FUNCAS in January 2015. Coordinated by Mas and Wisbaum, this book also includes chapters by economists and health experts reflecting on best-practices for implementing the "triple aim" and rethinking health systems.

The experts tackle the topic from various angles, including the importance of leadership in health systems, the search for efficiency, the critical role of integrated care, planning and incentives, the increasing relevance of patient-centered systems, collaboration among health professionals and trends in the health care workforce.

The final section includes an article about wages and job stability in the long-term care (LTC) sector in which the authors -- including IESE professors Marta Elvira and Carlos Rodríguez-Lluesma -- warn of the potential danger of workforce shortages for providing long-term care in Europe.