At the end of the first decade of the 21st century, we realized we had run out of money. The financial, economic and social crisis forced us to accept that the growth in healthcare expenditure that had been going steady for years was no longer sustainable.
The USA spent 18% of their GDP in healthcare, whereas most European countries spent between 8% and 12%. Such a non-stop growth had already been predicted by the economist William Baumol in the 1960s decade, after analyzing the healthcare sector behaviour and its relationship to the remaining productive sector. His diagnosis was known as “cost disease”.
Besides, we learned that healthcare expenditure levels per citizen do not correlate well with health outcomes obtained in every country. This is because healthcare involves an increase in costs that is unrelated to productivity (given the increase in the cost of the resources required for assistance). Therefore, citizens are compelled to allocating more and more of their incomes to pay for healthcare services.
Even so, interestingly enough healthcare systems in all countries in the Western world share five major problems (Muir Gray):
- Undesired differences in quality and healthcare outcomes
- Damages to patients as a consequence of the increase in activity
- Resource waste without value maximization
- Inequalities and unfairness
- Lack of disease prevention
All countries, especially those in the European Union, have thrown themselves into supporting innovation as a solution for the system’s crisis. In this context, in 2009 the Instituto de Salud Carlos III (ISCIII, “National Institute of Health Carlos III”) launched a call for the creation of an innovation unit network in large hospitals. In this call, funds were allocated to our institution to create an Innovation Support Unit in the framework of the Instituto de Investigación Sanitaria San Carlos (IdISSC, “Health Research Institute San Carlos”).
Our Innovation Support and Smart Health Unit (our business unit, www.shealth.eu) undertakes activities belonging to three different areas: model innovation, technological innovation and social innovation. Our ultimate goal is to transform the healthcare model and all agents involved by means of a “technological lever”. In short, we focus on projects intended to maximize value for patients. That is to say, projects aimed at achieving the greatest health benefits, with as little damage as possible, and improving perceived quality on their own health condition at the best possible cost.
This involves model transformations, from the current one made up of a cluster of assistance levels to an integrated one where teams are formed for the 30 major health issues (cardiac diseases, respiratory diseases, musculoskeletal disorders, metabolic disorders…) These teams should be focused on bringing value to patients and fostering positive changes in the payment for services and professional attention, such as leaving pay-for-service and pay-for-performance models and embracing the pay-for-value model.
All the aforementioned leads to suggesting changes in healthcare information systems, to promote data usage to build variability maps on healthcare results and, finally, perform reverse engineering in the system using the best healthcare results to achieve their redesign as a highly reliable organization.