Data from countries within the Organisation for Economic Co-operation and Development (OECD) shows a roughly inverse correlation between spending on health (as a share of GDP) and mortality, and a roughly inverse correlation between growth in spending on health and improvements in mortality (the correlations hold even if the US is excluded).
These glaring facts are likely to force ever more attention on health productivity, health innovation and the adoption of models from elsewhere that can demonstrably achieve more for less.
But what kinds of innovation will achieve the most impact? Huge sums are invested globally in medical research and development (R&D), and with good reason.
Yet less than 0.5 per cent addresses the behavioural and social factors that explain well over 50 per cent of mortality (and most of that 0.5 per cent focuses on compliance – getting patients to take their drugs).
Declining productivity of R&D in fields like pharmaceuticals means that attention is bound to turn elsewhere. Here are six places to look for innovations that can have a big impact on productivity.
First, more effective use of existing institutions. The methods used by Narayana Hrudayalaya in India show just how much impact approaches taken in other industries can have on health – with more intensive measurement, specialisation and peer review.
Major gains are also possible in primary care – a theme of NESTA’s work with GPs and others on ‘People powered health’.
Second, we should expect more use of ubiquitous cheap technologies rather than costly and often over-engineered telecare and telemedicine – whether to monitor blood pressures or other vital signs, to provide e-tutorials on self-care or to provide real time advice.
Third, to drive productivity improvements some of the patterns already seen in business services are likely to be used more widely.
Breaking down ‘service journeys’ into modular elements and then recombining them using web and other technologies; managing pricing and loading dynamically in response to demand; mobilising resources globally, such as call centres, and using intensive ‘customer relationship management’ tools to personalise what services are offered; and concentrating specialist advice, such as a team of doctors and nurses in a clinic and call centre, focused on just one condition, like diabetes or multiple sclerosis.
Fourth, we should expect more innovations that make the most of society’s capacity. Sweden’s patient hotels are situated next to hospitals and provide a pleasant environment for the patient and an extra bed for a spouse or parent.
Although they involve greater capital cost they achieve better clinical outcomes, mobilising a social capacity – the love and care of the family – to support healing.
Another example is Canada’s Tyze which organises an online network of support for isolated older people, allowing friends, family members and professionals to coordinate their care: who will visit to cook a meal, remind about prescriptions or do the shopping.
Fifth, we should expect to see more innovation around finance: Social Impact Bonds (UK), Social Benefit Bonds (Australia) and Pay for Success Bonds (US) are all pointers.
Already health insurers can incentivise their customers to change their diet or join gyms (for example, cutting their premiums if they can show improvements in their body mass index) and municipalities can reward social housing providers who do better in supporting older people at home and reduce the pressure on hospitals or residential care homes.
Sixth, the end of life is likely to be an important focus for innovation. Most people die in hospitals, tied up with tubes and with their bodies pumped full of drugs. Yet most would rather die at home and with more control over the timing and manner of their death. Across the world many models are being tested – such as home hospices.
The bulk of money and power remains tied up in institutions dedicated to the fields of innovation that delivered so much in the second half of the 20th century: pharmaceuticals, medical instruments and clinical procedures.;
But in a time of fiscal austerity, governments and publics won’t for long accept that it’s inevitable that more money doesn’t translate into better outcomes.
Geoff Mulgan is Chief Executive of NESTA. Please note that the views expressed in guest blogs on the Nuffield Trust website are the authors’ own.
This article is also available to read on The Guardian Healthcare Network website.
Mulgan G (2012) ‘New patterns of innovation in health and care’. Nuffield Trust comment, 29 February 2012. https://www.nuffieldtrust.org.uk/news-item/new-patterns-of-innovation-in-health-and-care