What is needed is a new perspective on healthcare because healthcare in almost every country is organised with respect to only two dimensions.
The first is the traditional distinction of levels of care: primary, secondary and tertiary, also known as generalist, specialist and super-specialist care. It is important to emphasise that there are two other important levels of care– self-care and informal care – which are often omitted from discussion.
The second dimension is the bureaucratic dimension, either public bureaucracies – which may be geographically defined or linked to a specific task such as the management of a hospital – or private companies that, in competition, develop the technological innovations needed.
What is needed is a third dimension, focused on sub-groups of the population with a common need, as shown below.
This approach is of course common in industry, where what are called service lines dominate decision-making at the top level, whereas in the health service, decision-making usually focuses on the two dimensions illustrated in 2D Healthcare image. Supermarket chains obviously have to have finance departments, procurement teams and real estate of different sizes, but the principal focus is on customers and their needs for meat, fish, vegetables, etcetera: these are the service lines for which management are held accountable for a ‘return on investment’.
In the past, the ICD was used to segment populations, but increasing use is now being made of a new taxonomy called Bridges to Health. Its main advantage is that it allows people to be classified not only with respect to single conditions but also with respect to multimorbidity – an increasingly important issue as a result of population ageing. It has eight groups:
- Maternal and child health
- Acutely ill
- Chronic conditions, normal function
- Stable but serious disability
- Short period of time before dying
- Limited reserve and exacerbations
- Frailty, with or without dementia
The OVSP Learning Programme
This is the second of the five modules in our online learning opportunity to help you develop the understanding and skill to
- Improve healthcare systems by increasing value and reducing waste (Module 1)
- Shift the focus from bureaucracies to populations (Module 2)
- Design population based systems and deliver care through networks (Module 3)
- Create a culture of stewardship (Module 4)
- Optimise personal value (Module 5)
As a result of learning from this module, and from other people learning with you, you will be able:
- To describe the main healthcare revolutions of the last 100 years and discuss the distinctive features of the Third Healthcare Revolution
- To understand how and why the concept of ‘value’ has developed
- To explain the need for ‘population health management’
- To define the limitations of structural reform and identify the shift that needs to be made from bureaucracy-based healthcare to population-based healthcare