Developing a Healthcare System
A regional approach to strategy development can enable health systems around the world to make significant improvements in health care delivery.
October 2015 | by David Delaney
Although they may differ in structure or philosophy, health systems around the world have a common goal: to improve the health of the population they serve by delivering high-quality, accessible, and financially sustainable health care. Given ballooning health care costs and increasingly demanding consumers, achieving this goal is becoming ever more challenging. Quality, access, and sustainability form an elusive triad for most health systems, which struggle with at least one of these dimensions. For example, the United Kingdom has focused heavily on access and has succeeded in reducing wait times significantly, but now, more than ever, it needs to address sustainability as the government begins to squeeze public spending in light of the global financial climate. The United States, too, faces a daunting challenge in sustainability; its health care spending already accounts for more than 15 percent of GDP—yet the country still lacks universal coverage. Australia is focusing on quality and sustainability at the federal level, but in some of its states—Victoria, for one—access remains an important concern.
Effecting the whole-system change necessary to respond to these challenges is a difficult undertaking, but not an impossible one: some health systems are achieving considerable success by focusing on regional approaches to health care delivery.
What is a ‘Regional’ Approach?
There are a number of ways health systems can take a regional view. One is simply to follow existing geopolitical boundaries. London, for instance, has 1 regional strategic health authority, under which sit 31 separate payors, each covering an average of 240,000 people. In Sweden, all decisions relating to health care provision are made by the country’s 21 regional health authorities. Canada’s health care system is run by its 13 provinces and territories.
Another way to take a regional view is to follow the natural patient flows resulting from referral patterns (for example, from primary care to secondary care). In many areas, health care delivery is relatively self-contained—perhaps consisting of a major hospital, a few smaller ones, and several primary care providers. It is possible to identify the services provided within this “ecosystem,” analyze the end-to-end patient pathways used to deliver these services, and then pinpoint the levers that could be used to alter patient flows and rationalize capacity.
Third, a health system can define its regional boundaries by determining the optimal population base over which to design services. For example, there is strong clinical evidence that a minimum population of 2 million to 3 million is required to ensure sufficient volume to provide high-quality care in trauma services. In acute cardiac services, the minimum population size appears to be about 500,000. These and similar findings in other service lines support a regional approach to developing a health system strategy, irrespective of whether there is a formally defined geopolitical region. In fact, geopolitical boundaries often do not align with the optimal population base for the provision of high-quality services.