The most efficient health systems
Vantage Technologies, a leading developer of database management software for the UK's NHS, have analysed data from the Organisation for Economic Co-operation and Development (OECD), WHO, United Nations Development Programme (UNDP) and the WorldBank to reveal the countries that get the best health care and quality of life, for the most efficient spend.
The USA has the highest expenditure globally
A per-person spend of $11,072 places the USA far ahead of every other country in health care expenditure. However, a life expectancy of just 78.5 years, health care coverage of only 84 per cent and a HDI rank of 15th in the world doesn’t match up to this expenditure. In comparison, the Czech Republic, which spends a comparatively low $3,426 per person on health care, has a higher life expectancy of 79 years.
There are several reasons for this problem within the American health care system. A key issue is the full privatisation of health care, without a baseline right to treatment. Outside of the USA, a lot of countries have this baseline free health care, which means that private health care can’t exceed its value, or else more people will use public services. Because private health care systems don’t have this alternative to keep prices in check, they can charge excessively for their services.
The complicated structure of health care also has a significant impact on these expenditures. Administration fees alone cost US insurers and providers $812 billion in 2017, or 34.2 per cent of national health expenditures that year.
How do other countries compare in expenditure?
Switzerland comes in at second most expensive, spending $7,732 per person. However, with the second-highest life expectancy, at 83.6 years, and the second-highest HDI rank in the world, this capital is effectively allocated.
Despite regular criticism, the National Health Service (NHS) is effective when comparing the government spend versus the outcomes of human development and lifespan. While critics point to Switzerland achieving the lowest death rates in Europe, or Germany having a consistently quality health care system, they don’t compare these to the level of expenditure.
In fact, the UK has a higher life expectancy than Germany, with lower health care funding than in other large economies. The Swiss spend $3,079 more on health care per person than the UK, while Germany spends $1,993 more per person than the UK. Critics can’t ignore these massive differences in expenditure when debating the outcomes that the NHS provides. If the UK matched Swiss expenditure per person, an additional $206 billion would be spent on health care annually.
Overall, Singapore takes the top spot. Placed 6th in the WHO’s ranking of health systems in 2000, and ranked by Bloomberg as the most efficient in the world in 2014, their health care system is highly regarded. There are many reasons why Singapore has a highly regarded model.
To avoid the excessive use that entirely free services receive, individuals pay part of the cost, with the rest subsidised. This disincentivises individuals from consistently and unnecessarily using health care services they don’t require.
There is also a nationwide health insurance system – Medisave, whereby Singapore’s individuals contribute compulsory monthly payments that finance health care. This is government-controlled, to avoid the USA model of unrestricted medical insurance, whereby there is a monetary incentive to provide more expensive and unnecessary treatments.
Private decision-making on drugs used by the public sector also encourages all pharmaceutical companies to drop their prices to be in with a chance of drug subsidisation, rather than lobbying to place their drug in hospitals at a higher price. The UK’S NHS, for example, are much more transparent about the drugs they plan to subsidise, which can result in suppliers changing their pricing.
Administration is also incredibly efficient, with data shared across all departments to identify any inefficiencies and improve upon them. In 1997, half of ambulance calls were for non-emergencies. In response to this, Singapore introduced a few measures to discourage non-emergency calls. The government introduced a fee of $185 for those who called for non-emergencies. Alongside this, they delivered public education and messaging to highlight the situations that constituted an emergency and non-emergency.
This approach to reducing unnecessary health care costs wouldn’t have been possible without an integrated data system communicating between departments.
“The electronic health records are all connected, and data are shared between them,” said Dr. Marcus Ong, Singapore’s Emergency Medical Services director. “When patients are attended to for an emergency, records can be quickly accessed, and many nonemergencies can be then cleared with accurate information.
“By 2010, there were more than 120,000 calls for emergency services, and very few were for nonemergencies.”
How can health care systems become more efficient?
Vantage Technologies have listed three of the key areas that health care providers can optimise to reduce expenditure and improve outcomes.
Overtreatment is defined as a suboptimal ‘treatment that is excessive or too frequent.’ An example of overtreatment is the overprescribing of antibiotics that result in antibiotic-resistant bacterias. Overtreatment is as much a danger to a patient as undertreatment – both can result in adverse health effects.
However, the unnecessary allocation of resources also increases health care costs. In a health care system where per patient spend is exceptionally high but lifespan remains low, overtreatment could be the causation. Personalising patient treatment, and avoiding enforcement of across the board treatments, aids optimising of treatment, as well as allocation of appropriate resources.
Disincentivising excessive use
While overtreatment is due to provider practises, excessive use is a result of patient behaviour yet is influenced by overall health and education policy. A key takeaway from Singapore’s success is the coordination of departments to reduce health care resource wastage. Utilising data on admissions and public behaviours that harm health care efficiency is an easy way to identify cases of excessive use.
These can then be reduced with further education on the situations that constitute a trip to A&E or an ambulance call-out, targeted awareness of preventable emergencies, or fines for excess use. These practises influence public behaviour to decrease the burden on health care, increasing efficiency.
One of the highest costs in any health care system is administration, without any link between higher admin expenditure and better quality care. Certain systems, such as the US health care system, involve multiple private insurers which can drastically increase costs. A decentralised network of mostly private hospital owners also results in increased costs when moving and communicating between different services. A lack of overall data also reduces the ability to optimise and reform health care, as overseers can’t easily analyse issues within processes.
Martyn Goodhand, Managing Director at Vantage Technologies, comments on the findings of this research: “Data and administrative systems are the key to optimisation. Many health care systems that we analyse have a variety of software collecting data for different departments. These systems aren’t compatible and can’t communicate. So admin costs are then increased when the process could be automated by using the same system.
“Putting all of your data on the same system, in one place, can have many benefits. When you have an overall view of data and results, you can pinpoint areas of inefficiency and see the reasons why that might be the case. This can inform macro health care policy to increase efficiency.
“An immediate effect is a huge reduction in costs" he added. "In the USA, the standardisation of administrative processes could save up to $29,000 per physician annually.
“Even if you have a multi-system, multi-company health care structure, this can be integrated using a single software, for cross-boundary information gathering and sharing, with far less administration. We recommend that health care providers study their software systems and find a modular system that can provide the entire service on one platform.”
COVID-19 "causing mass trauma among world’s nurses"
Healthcare providers are facing ongoing nursing shortages, and hospitals are reporting high rates of staff turnover and burnout as a result of the COVID-19 pandemic. In June a report found that levels of burnout among staff in England had reached "emergency" levels.
Registered nurses Molly Rindt and Erika Haywood are nurse mentors on US recruitment platform Incredible Health. In this joint Q&A they tell Healthcare Global about their own experiences of burnout and what can be done to tackle it.
What does it mean to be suffering from burnout?
Some of the most common reasons for nurse burnout include long work hours, sleep deprivation, a high-stress work environment, lack of support, and emotional strain from patient care.
While every profession has its stressors, the nursing industry has some of the highest burnout rates. The massive influence on patients’ lives, the long hours, and many other factors put nurses at risk of severe burnout. And with the rise of COVID-19, many healthcare professionals feel the strain more than ever.
Burnout in nurses affects everyone — individual nurses suffer, patients are impacted, and employers struggle with enormous turnover. This is why it’s crucial for healthcare systems and management to watch for signs of nurse burnout and take steps to provide a healthier workplace. Employers should be careful to watch for burnout symptoms in their healthcare staff — and not ignore them.
Symptoms include constant tiredness, constant anxiety related to work, emotional detachment and unexplained sickness.
How widespread is this problem?
Unfortunately, burnout affects approximately 38% of nurses per year and even the WHO recently labelled burnout as an official medical diagnosis. To put this statistic into perspective, nearly 4 out of 10 nurses will drive to work dreading their shift. Burnout is a reason nurses leave their positions.
Other top reasons for leaving included a stressful work environment, lack of good management or leadership, inadequate staffing, and finding better pay or benefits elsewhere.
Even before the pandemic, demanding workloads and aspects of the work environment such as poor staffing ratios, lack of communication between physicians and nurses, and lack of organisational leadership were known to be associated with burnout in nurses.
Have either of you experienced burnout?
Rindt: I have experienced burnout as an RN. I was constantly fatigued, never felt like I was off work, and would frequently dream I was still at work taking care of patients. In my particular situation, I needed to take a step back and restructure my work schedule to allow for more time off. After doing this, I was able to reduce burnout by deciding to work two shifts back-to-back and then have 2-3 days off.
Haywood: I definitely experienced constant anxiety related to work - so much so it would impact the days I wasn’t at work. At one point, I was even on medication to help combat the anxiety and stress I was facing on the job.
I had heart palpitations, chest pain, and wouldn’t be able to sleep before working the next day, which slowly started to impact other aspects of my life. I knew I couldn’t continue to live this way, it wasn’t sustainable. Because of this, I began to focus on my needs and prioritising self-care, especially during the beginning of the pandemic. Putting my needs first and not feeling guilty were necessary for me to overcome burnout.
What impact is COVID-19 having on nurses' wellbeing?
Some nurses have suffered devastating health consequences. Many nurses have dealt with excessive on-the-job stress, fears of becoming infected, and grief over seeing patients succumb to COVID-19 while isolated from their families.
New evidence gathered by the International Council of Nurses (ICN) suggests COVID-19 is causing mass trauma among the world’s nurses. The number of confirmed nurse deaths now exceeds 2,200, and with high levels of infections in the nursing workforce continuing, overstretched staff are experiencing increasing psychological distress in the face of ever-increasing workloads, continued abuse and protests by anti-vaccinators.
However, other small silver linings that came from the pandemic include increased professional autonomy, leadership opportunities and career growth potential.
How much of the cause of burnout is due to the hospitals or healthcare providers, and what can they do to address it?
Nurse fatigue poses serious problems for healthcare organisations, and a recent survey from Kronos found 63% of nurses say their job has caused burnout. The survey also found that more than 4 out of 5 nurses think hospitals today are losing good staff because other employers offer a better work/life balance.
Nurse burnout not only contributes to staff turnover, but it can impact the facility’s quality of care, patient satisfaction, and even medical outcomes.
Strategies to address burnout include training improving nurse-to-patient ratios, include nurses in policy discussions, and prioritise fostering a healthy work culture in hospitals.
What does your role mentoring nurses on the Incredible Health platform involve?
Rindt: My role can vary based on the needs of the nurses. The nurses love knowing they have someone in their corner who can give interview preparation advice or provide suggestions on how to improve their resume. Knowing that there is someone who is well-versed in the job process and can help set expectations on what to anticipate, really helps to remove a layer of uncertainty.
Haywood: When screening nurses, it is customised to what their individual RN or nurse practitioner needs, and at a time that is most convenient for them. Nurses are busy and often aren’t thought of first. Being able to provide support from the very beginning of their career advancement journey helps tremendously. We also provide resources such as resume templates and tips that can help nurses be successful and feel supported.