The aim of healthcare is to help people live long, healthy lives. And these days a lot of people are. Many factors have converged to help achieve this, from the significant advances in medicine and technology, to the notable shift from the traditional ethos of ‘doctor-knows-best’ to the modern, educated patient mindset, in which patients are empowered to become part of their treatment decisions. In many countries, healthcare today is centred around the patient and patient choice.
Success in healthcare provision and education is evident in the ageing population, the move towards personalised medicine and the increase in more informed and demanding patients. Yet, when we consider the pressures of our modern society, coupled with mounting health costs and worsening economic conditions, the very concept of ‘patient-centred care’ appears threatened.
Measures to restrict costs on medical technologies are springing up across the globe. Controlling ‘supply-side’ costs can be relatively simple to implement, with price-cuts and reference pricing leading the way. National bodies across Europe and increasingly in the reimbursed Asia-Pacific Region, such as Taiwan and Korea, are taking the long-term view of cost-containment, with the adoption of some form of health technology assessment (HTA), restricting access based on ‘cost-effectiveness’.
Controlling costs from the ‘demand-side’ is more challenging. In countries with state-run systems, such as the UK’s NHS, with the founding principle of ‘free care at the point of delivery’, we are seeing the controversial introduction of patient co-payments – a step that immediately contributes to health inequalities and restricts choice for those less-able to pay. In an attempt to manage local priorities and demands, many countries are devolving reimbursement and formulary responsibility to the local level. A smart idea in theory, but in practice this move conjures up some tricky ethical questions: is it fair for two patients with the same disease state, who live a short distance apart but under the care of different healthcare providing authorities, to have access to different treatments, based on cost-controlling treatment decisions? This ‘post-code lottery’ has caused huge upset with some patients benefiting from the latest advances in medicine, whilst their neighbours are denied access to the same treatment.
Difficult decisions are being made with the end goal of providing the best health gain for the population. And within today’s cost-cutting environment it appears that cost-decisions are restricting patient choice. So when the money is running out, and resources are limited, it’s time for societies to address how to get the most for their money. Creating measures to determine value for money is a necessary process in today’s environment, and restricting patient choice is, unfortunately, a necessary outcome.
Or is it? Surely we can find a way to ensure patients have choice and access to the latest advances in medicine? By working closely with governments and healthcare providers, the industry can initiate new business models and innovative solutions to facilitate access to the latest medical advances by streamlining care and providing value for money. It’s a matter of working together to achieve the best health-gain for society.