Let me start with a disclaimer: I am overweight. My kids and my wife keep telling me that I need to be mindful of what and how much I eat and be more disciplined with my exercise regime. Why do people like me have to listen and heed this advice?
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When healthcare professionals take the Hippocratic Oath, they promise to prescribe patients regimens based on their “ability and judgment” and to “never do harm to anyone”.
Although extraordinary progress in medical knowledge during the last 50 years, coupled with the development of new technologies, drugs and procedures, has improved health conditions and quality of life, it has also created an ever-growing quandary regarding which drugs, medical procedures, tests and treatments work best.
And for policy makers, administrators and health economists, the unrestrained acquisition and use of new medical technologies and procedures (e.g., open heart surgery to replace clogged arteries, ultrasound technology scanners to aid in the detection of heart disease, and life-saving antiretroviral drugs for HIV/AIDS) is increasing health expenditures in an era of fiscal deficits.
In many countries, I’ve see how ensuring value for money in a limited-resources environment is not only difficult but requires careful selection and funding of procedures and drugs. It also comes with serious political, economic and ethical implications—and with new drugs and technologies appearing every day, this challenge isn’t going away. What should countries do?
Принимая клятву Гиппократа, профессионалы из области здравоохранения обязуются лечить пациентов, основываясь на своих «способностях и суждениях», а так же «никогда и никому не навредить».
Впечатляющий прорыв в области врачебных знаний за последние 50 лет, сопровождаемый развитием новых высоких технологий, лекарств и методик лечения, значительно улучшил средний уровень здоровья и качества жизни в целом. Однако при этом зачастую это приводит к ситуации, когда все труднее и труднее становится определять, какие же лекарственные средства, методики, тесты и процедуры окажутся самыми эффективными.
Для тех, кто принимает решения и управляет экономикой здравоохранения, бесконечное приобретение и внедрение новых медицинских технологий и процедур (например, операции на открытом сердце, ультразвуковая сканеры для выявления болезней сердца, а так же антиретровирусная терапия против ВИЧ/СПИД) ведет к существенному росту расходов на здравоохранение, особенно заметного в эпоху бюджетных дефицитов.
Health systems are under pressure in Asia. Epidemiological and demographic transitions are taking place much faster than in Europe and America, in the span of a single generation. With the transition comes the non-communicable disease (NCD) epidemic that requires more sophisticated and expensive interventions provided by hospitals, inpatient or outpatient. Rapid economic development in Asia has lifted millions out of poverty and raised peoples’ expectations for services. Between China, India, Thailand, Philippines, Indonesia and Vietnam, expansion of health insurance coverage during the last decade has reached an additional one billion people, making services more affordable and thus increasing demand. Advancing medical technology eagerly awaited by specialist doctors sitting on top of health professional hierarchies further expands possibilities for treatment. The middle class votes with their feet and takes their health problems to medical tourism meccas like those in Bangkok and Singapore, voiding their own countries of additional income to health care providers. Policymakers are scrambling to expand hospital capacity, boost the pay of health professionals, and encourage investment to meet the demand.
But governments do not wait. They are exploring hospital autonomy, decentralization, user fees and private sector participation. These policies often pose risks that need to be mitigated by policies and institutional arrangements. For example, health care providers sometimes order unnecessary procedures to earn additional revenue, thanks to the powerful incentive of the fee-for-service payment mechanism and information asymmetry between the patient and health care provider. This can mean financial ruin for both the patient and new, relatively weak health insurance agencies.
Despite these challenges, hospitals aren’t high on the international health development agenda, save a few initiatives to improve quality and provider payment reform.