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12 components of a ‘perfect health system’

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Mark Britnell’s new book is In Search of the Perfect Health System. He’s the chairman and partner of the Global Health Practice at auditing firm KPMG and spent the last five years working in 60 countries to help public- and private-sector organizations with operations, strategy and policy.

  of FierceHealthcare took a look at his ideas.

“Although he hasn’t found a perfect health system, he writes that if he found one it would feature 12 components that take from the best practices from around the world. And it would look something like this:”

1. Universal healthcare

2. Excellent primary care

He takes a close look at Israel, where primary care is supported  by  four health maintenance organizations that act as both purchaser and provider for preventive, primary and community services. Out-of-hours care is provided around the clock… and integrated with evening care centers, urgent-care centers and home visits.

3. Community services

He suggests  that we look to Brazil,  where  community teams  of doctors, nurses, nurse auxiliary and community health workers visit households monthly.

4. Mental health and well-being

Australia publicly funds  a lot of crisis and home treatment, early intervention and assertive outreach.

5. Health promotion

Nordic countries best address the social determinants of health, encouraging individual responsibility and fostering collective action and public health and illness-prevention strategies that contribute to low smoking, alcohol consumption and obesity.

6. Patient and community empowerment

Mr. Britnell touts patient empowerment in Africa  that blends community activism, patient education, social marketing and behavior change.

7. Research and development

“This is where the U.S. shines, he says, noting the number of high-impact drugs and medical devices we’ve developed. But he also called out the innovation of new business and care models, including Kaiser Permanente’s health information and technology systems, Geisinger Heath Systems‘ population health management and Virginia Mason‘s lean manufacturing principles.”

8. Innovation, flair and speed

Mr. Britnell praises the adoption and adaption of new innovations in India, where several organizations have created a hub-and-spoke model  focused on cost-effectiveness rather than on cost-cutting.

9. Information, communications and technology

Mr. Britnell cites Singapore’s  sharing patient data via a national electronic health records allowing access to all hospitals, community facilities, practitioners and long-term care homes — letting the country fully analyze clinical, financial and operational data to better assess healthcare costs and outcomes.

10. Choice

There are no out-of-network providers in France: Patients can go to any provider they wish. he says. Patient satisfaction is  high as are quality and outcomes.

11. Funding

Mr. Britnell says that no  country does it better than Switzerland, which spends 11.5 percent of GDP on health,  high patient satisfaction, good clinical outcomes and life expectancy of 82.7 years.

12. Aged care

Japan has  compulsory long-term-care insurance, which offers social care to all those older than 65 based solely on need. This includes home help, community-based services and residential and nursing care,  as well as homes where groups of people with dementia live together in  home-like environments.


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