Yes, we’ve been good at the treatment side of things; maybe in some instances too good, because the amount we now spend as a nation on delivering comprehensive healthcare to our population has almost reached 9% of gross domestic product (a four-fold increase in total spend over the last 20 years). Like many other western economies with stagnant growth prospects for the foreseeable future, the inexorable rise in healthcare delivery costs are starting to become too large a financial burden to bear.
Although we have spent a lot of time, energy and money creating better treatments we have singularly failed to look at the person at the centre of the process; the patient. The medical profession has blithely continued with their perceived remit of treating disease and largely ignored the root causes of people becoming unwell in the first place. We know that by far the biggest determinant of health status in developed nations is lifestyle, yet the majority of public health initiatives addressing these issues have been largely ineffectual and we need to ask ourselves why this is.
Undoubtedly the comparative lack of funding for public health over the years explains some of this phenomenon, but there appears to be more to the problem than just a lack of spending. Speaking as a physician I can tell you that the majority of doctors do not know how to go about helping their patients make lifestyle modifications for the benefit of their health. It’s not something that is covered during medical training and many of my colleagues in the profession are quite open about their lack of confidence in orchestrating behavioural interventions, preferring instead to focus upon the more tangible pathology that such behaviours invariably result in. Paradoxically the medical profession has been extremely protective of the doctor-patient relationship and reluctant to let anyone else get involved in any substantive way. The result is an epidemic of lifestyle-related health issues the magnitude of which threatens the sustainability of our current healthcare system.
All is not doom and gloom though. With many nations looking critically at how they deliver healthcare resources there is an increasing realisation that the traditional, transactional model of healthcare has to change. Healthcare reform in both the UK and USA focuses more on outcomes and population level cost containment, rather than episodes of care, and with this I believe comes opportunities for entrepreneurs.
With doctors increasingly being required to engage their patients in initiatives that have the potential to impact downstream costs and utilisation the “lock out” from the doctor-patient relationship that we have seen to date is likely to change. And this is where entrepreneurs need to play; how can we help the traditional deliverers of care better communicate and engage with their patients? How can we make it easier for them to address lifestyle related health risks? And ultimately how can we use new approaches to bring about health behaviour change in the population?
These are not easy questions to answer; if they were I am sure the health service would have worked out some solutions by now. Undoubtedly we will still be confronted along the way the perennial arrogance of the healthcare profession’s belief that they have all of the solutions, but let’s give it a go and dare to think differently about an interaction that has remained largely untouched for hundreds of years.
Peter is an established entrepreneur having grown and sold two businesses in the healthcare sector in the last 10 years; he was a founding member of global health management consultancy, vielife (acquired by CIGNA). He now runs Glasslyn Health Solutions, an independent health consulting company with a client base in Europe and the US, and is co-founder of nGage Health, a provider of technology driven patient engagement solutions to healthcare providers. He still practices medicine on a part-time basis at the Whittington Hospital in London.