Adding the 3rd dimension: Thinking in populations
For decades healthcare, both tax based and insurance based, has been two dimensional. One dimension is the traditional levels of care – primary, secondary, and tertiary or, to put it another way, generalist, specialist, and super specialist. At last both self care and informal care, the commonest types of care are now being added to these levels of care. The second dimension is the bureaucratic dimension with either population-based bureaucracies or institutions like hospitals all within a legal framework, hence the term jurisdictions.
The different levels of care change but little with respect to one another but the bureaucracies change frequently in part because it is tempting to reorganise bureaucratic structure, because it is relatively easy to do, although not so easy to cope with the consequences. It is now being appreciated and expressed through The White Paper titled Integration and Innovation that these two dimensions, though necessary are not sufficient and we are now moving to 3D healthcare with the third dimension being populations, or to be more precise systems focused on segments of the population defined by need; for example, people with respiratory disease, people with depression or people in the last year of life.
This third dimension facilitates the development of the new paradigm of value-based healthcare because it allows the development of budgets putting together all the resources focused on one particular subgroup of the population; programme budgeting or service line accounting as it is called commercially. However equally, or more, important is the fact that by bringing together all the people interested in a segment of the population, including of course the people who are affected, the people called patients and carers, it is much easier to develop the culture of stewardship. The White paper Integration and Innovation, highlights the need to think about populations with one of the four purposes for systems being Improving population health and healthcare.
This module focuses on population healthcare, namely healthcare organised not with respect to buildings, specialties, or equipment but with respect to the segments of the population defined by a common need which may be a symptom such as breathlessness, a condition such as arthritis or a common characteristic such as frailty in old age. The taxonomy which best suits the challenge is called Bridges to Health.
It is the first of five modules on the steps that need to be taken to create the new paradigm of value-based health and social care and is followed by modules on system design, the development of networks, ensuring personal value and culture change.
Module 3 Micromodules and Topics
- Micromodule 3.1 – Understanding the importance of population segmentation
- Micromodule 3.2 – Applying segmentation to population stewardship forums – Bridges to Health
- Micromodule 3.3 – Estimating population segment resources