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Whole-System Thinking Is Key in the Quality Versus Cost Debate

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Global leaders gathering in Davos this week once again find the world's response to growing healthcare pressures high on their agenda.

Good health - both mental and physical - remains one of the most pressing social and economic issues of our time, consuming the largest share of the world's GDP and growing.

Part of the reason for this is that our concept of healthcare has become far too narrow in recent years.

We have come to view the role of health systems as fixing people when they become sick, rather than giving them the tools to stay healthy. We delegate problems to hospitals and the clinicians working in them, rather than creatively engaging our communities, public and private organizations to actively promote better health.

The simple truth facing the delegates in Switzerland this week is that we need to move away from this mindset and focus our energies instead on how we keep costs down by helping everyone to stay healthy.

This key observation is at the heart of KPMG's latest international health report Necessity: The mother of innovation' which is being unveiled at the Davos summit.

Based on studies of a number of younger health economies around the world, the Report has identified a tendency for many of them to try and replicate traditional western models - often to their long-term financial detriment.

This pressure to try and emulate well-established, secondary care-based models is completely understandable, driven as it is by the changing needs and expectations of newly emerging, influential and financially empowered middle classes.

However, our experience shows that these systems often have significant underlying weaknesses compared to those health economies that have stepped back and taken the time to develop new, flexible, community-based solutions.

'Necessity: The mother of innovation' reflects the thinking from over 70 KPMG clients and healthcare leaders, emphasizing that emerging markets which take a whole system approach, using care models and payment regimes that focus on population health improvement, are the ones most likely to be delivering affordable, sustainable, high quality care.

These systems are the ones that have spent time looking at care pathways in detail and redesigning them to make the best use of scarce skills and resources. In many cases the most successful ones have experimented with every aspect of system design, including people, pathways, procurement, environments, technology and management.

It is becoming clear that this holistic approach to healthcare planning is the sensible direction of travel for those healthcare systems coming to terms with rapidly growing and maturing economies.

But what really sets apart those countries and regions delivering consistently high quality care at manageable cost, is a willingness to explore the alignment of funding models and health outcomes.

Increasingly, around the world, we are seeing the best value delivered in systems that contain 'activist payers' - purchasers of services, both private and public, who are prepared to use financial and contract mechanisms to shape the behavior of the people providing and using healthcare services.

As we all look to reduce the financial burden of caring for our sick without compromising on the quality of care they receive, I believe there are valuable lessons for all of us in the work of these new pioneers.

I am forever hopeful that global leaders getting together this week in the shadow of the Alps to discuss the international response to tomorrow's healthcare challenges will agree.