1、Reflection PaperGlobal Future Council on Health and Healthcare 2018-2019A Vision for the Future:Transforming Health SystemsSeptember 2019 World Economic Forum91-93 route de la CapiteCH-1223 Cologny/GenevaSwitzerlandTel.:+41(0)22 869 1212Fax:+41(0)22 786 2744Email:contactweforum.orgwww.weforum.org 20
2、19 World Economic Forum.All rights reserved.No part of this publication may be reproduced or transmitted in any form or by any means,including photocopying and recording,or by any information storage and retrieval system.The views expressed in this paper are those of the authors and do not necessari
3、ly reflect those of the World Economic Forum or the Organisation for Economic Co-operation and Development(OECD)or its member countries.3A Vision for the Future:Transforming Health SystemsContentsForeword 5Executive summary 6Introduction 7Methodology 9The health journey scenarios 10Scenario 1:Wellne
4、ss journey in a low-income country or context 10Scenario 2:Woman and child journey in a low-income country or context 12Scenario 3:Diabetes patient journey in a middle-income country or context 14Scenario 4:Cancer patient journey in a high-income country or context 16Scenario 5:Healthy ageing journe
5、y in a high-income country or context 18Recommendations 20Conclusion 22Acknowledgements 23Endnotes 244Global Future Council on Health and Healthcare 2018-20195A Vision for the Future:Transforming Health SystemsForewordHealth systems are under major pressure globally.Population growth,ageing,the emer
6、gence of personalized medicine and the growing potential of new technologies,along with rapidly rising costs and the entry of disruptive and non-traditional competitors,will increase demand for services and affect the performance and sustainability of healthcare delivery systems.By 2050,one in six p
7、eople will be over 65 years old1 and more people will live with one or more chronic diseases.Despite reforms in funding and payment models in some countries,there is ample evidence of waste and inefficiencies in health systems.2 Global healthcare spending is projected to continue increasing.These tr
8、ends demand urgent attention from all stakeholders in the health system.Such systems must transform to deliver what people need better,while remaining financially viable in the long term.This paper argues that todays health systems need to be reformed,and that reform is possible.It identifies some k
9、ey conditions for reform and barriers that need to be addressed to encourage this transformation.Prepared by the World Economic Forum Global Future Council on Health and Healthcare 2018-2019,this paper lays out five scenarios developed by the Council of how individuals with different health needs na
10、vigate through or relate to the current health system,and the challenges they face in doing so.The Council then considered forward-looking scenarios outlining what these individual health journeys could look like with improvements in health system delivery.The Council considered quality,accessibilit
11、y,affordability and equity as key principles for future health systems.Through these future-oriented scenarios,the Council articulated how improved and more cost-effective journeys for individuals in health systems could be achieved across different regions.These scenarios are achievable;building bl
12、ocks for the more sustainable,people-centred health systems mentioned in them already exist.Nonetheless,realizing such scenarios by 2030 would require decisive action,such as:Reorienting health systems to increase the focus on preventing disease and promoting good health and earlier interventions Pr
13、ioritizing universal health coverage,including by strengthening high-quality primary and community healthcare Ensuring the smarter use of innovation and technology-based solutions to make health systems more efficient,effective and responsive to peoples needs Promoting well-designed partnerships Dev
14、eloping a fit-for-purpose institutional architecture and governance globally,nationally and locallyThus,a quality health system that meets the needs of individuals,families and whole populations is within reach.Achieving that will require eliminating unnecessary waste,encouraging good health outcome
15、s,breaking down systems that operate in isolation in care service provision,and using digital health data and technologies better.All stakeholders within the broad health system will need to work together to make a difference for individuals and populations.Helen E.Clark,Prime Minister of New Zealan
16、d(1999-2008)Francesca Colombo,Head,Health Division,Organisation for Economic Co-operation and Development(OECD),ParisVanessa Candeias,Head,Shaping the Future of Health and Healthcare,World Economic Forum6Global Future Council on Health and Healthcare 2018-2019Executive summary This paper,“A Vision f
17、or the Future:Transforming Health Systems”,addresses the need for health systems to be reoriented to meet populations needs in the context of the Fourth Industrial Revolution.It discusses present and future challenges faced by health systems,adopting a systems approach that places the experiences of
18、 individuals,families and communities at the centre of its analysis.The paper addresses two sets of issues:1.The requirements for future health systems to achieve good outcomes for individuals,families and communities in a sustainable and equitable manner2.The ways that health system architecture ca
19、n support this effort at all levels.Expected transformations:A qualitative scenario analysis of individuals experiences identified key areas where changes within health systems can occur and can be achieved.These include,among others,developing a fit-for-purpose health workforce,implementing cost-ef
20、fective technologies and operationalizing innovative service delivery arrangements.The scenarios describe a range of current journeys undertaken by individuals and how they might develop in the future.They address the potential and conditions for the transformation and improvements required to achie
21、ve the 2030 Agenda for Sustainable Developments objective of having a well-functioning,resilient and people-centred health system.Methodology:Several inputs shaped the scenario development focus group discussions with patients,prior in-depth interviews conducted with patients and engagement with pat
22、ient organizations,depending on the specific scenario.Key experts,who provided information on the health system context,helped to develop all scenarios.Analysis:Throughout this paper,the analysis focuses on barriers,opportunities,risks and missing competencies which,if present,would have an effect b
23、y transforming health systems and contributing to societal well-being.The paper concludes with reflections on the current global health architecture.The scenarios:Exploring the interaction between individuals and the health system,the journeys also include how a person,their family and/or their comm
24、unities currently interact with the system.Some scenarios address factors beyond health systems,such as the role of education,transportation and the environment.The scenarios focus on individuals experiences,including their interaction with other members of the community and healthcare providers.All
25、 the scenarios represent a future that is within reach.The elements mentioned in the scenarios are already present and could well become common by 2030,with key enablers such as cost-effective technology and adequate supply of appropriate professional skills,and with more focus on prevention.The sce
26、narios are:1.Wellness journey in a low-income country or context2.Woman and child journey in a low-income country or context 3.Diabetes patient journey in a middle-income country or context4.Cancer patient journey in a high-income country or context5.Healthy ageing journey in a high-income country o
27、r contextRecommendations:Todays health systems require a fundamental transformation to meet the health needs of populations in 2030.This paper identifies what needs to happen to achieve this transformation and who should be accountable for driving change.7A Vision for the Future:Transforming Health
28、SystemsIntroductionThe World Economic Forum Global Future Council on Health and Healthcare brings together a diverse group of experts,members of patient organizations,policy-makers and government leaders.The Council met in Dubai in November 2018,where participants discussed and agreed on the structu
29、re and main contents of this paper.A prior report,Health and Healthcare in the Fourth Industrial Revolution:Global Future Council on the Future of Health and Healthcare 2016-2018,produced by the previous Council,3 described how the Fourth Industrial Revolution will affect health systems in the comin
30、g decades,and explored the societal and governance implications of key emerging technologies related to health and healthcare.This paper,“A Vision for the Future:Transforming Health Systems”,acknowledges that this revolution will fundamentally reshape the way people live,work and interact with each
31、another.The paper addresses an additional challenge:the Fourth Industrial Revolution will profoundly affect the practice of medicine,such that health systems will need to be reoriented to meet populations needs.The paper outlines the present and future challenges health systems face,adopting a syste
32、ms approach and putting the experiences of individuals,families and communities at the centre of its analysis,which is rarely done in health systems research.It acknowledges that all the actors involved need to work in close partnership to design quality health systems.This paper considers the socia
33、l determinants of health and analyses scenarios in a range of settings,highlighting the importance of context.It supports people-centredness,quality,accessibility,affordability and equity as key principles for health systems,and highlights the need to focus on delivering what people need,good outcom
34、es,and experiences of care that individuals and populations value.Putting people at the centre of the health system and health policies involves enabling them to make choices that are positive for their health and involving them in decision-making processes.The paper addresses two sets of issues:1.T
35、he requirements for future health systems to achieve good outcomes for individuals,families and communities in a sustainable and equitable manner2.The ways that health system architecture can support this effort at all levels.The paper presents five qualitative scenarios of individuals experiences t
36、o identify key transformations required for high-performing future health systems.These transformations include,among others,developing a fit-for-purpose health workforce,implementing cost-effective technologies and providing innovative service delivery arrangements.The scenarios describe a range of
37、 current health journeys undertaken by individuals and how they might develop in the future.They address the potential and conditions for the transformation and improvements required to achieve the 2030 Agenda for Sustainable Developments objective of having a well-functioning,resilient and people-c
38、entred health system.These scenarios have a unifying theme of addressing the transformative effects that technology could have in each setting in the coming years.Each scenario is achievable but would require strong political will to address current bottlenecks,improve health system governance and r
39、emove silos.Many innovative technologies relevant to health and healthcare already exist.Health systems should not lag other sectors in using such technologies to transform service delivery.The scenarios explore interactions between the individual and the health system,including how a person,their f
40、amily and/or their communities interact with the system.Some scenarios address factors beyond health systems,such as the role of education,transportation and the environment.The scenarios focus on individuals experiences,including their interaction with other members of the community and healthcare
41、providers.8Global Future Council on Health and Healthcare 2018-2019The five scenarios are:Scenario 1:Wellness journey in a low-income country or contextEnemali,a 40-year-old farmer,lives in a rural village.As the only male child,he stopped attending school to look after his siblings and his sick mot
42、her.He also began working on their farm and rearing livestock.Enemali lacks access to many basic amenities essential to ensuring healthy living and a better quality of life.He eats an unbalanced diet composed mainly of carbohydrates that come from his farm but cannot afford foods rich in other essen
43、tial nutrients.Enemali has access to some health services from a nearby community health centre,but would have to travel a half day to reach a hospital in the main town.Scenario 2:Woman and child journey in a low-income country or context Anaya is an 18-year-old woman in rural India and is experienc
44、ing her first pregnancy.She has little access to healthcare,had not engaged in the past with the medical system and has not seen a provider since she became pregnant.With no clinic within easy walking distance,she receives guidance from her family on how to best care for herself.Moreover,she and her
45、 family have limited income and resources.She is small for her age and,though undernourished,does not present other known poor health indicators.Her family is determined to ensure she delivers in a clinic.Scenario 3:Diabetes patient journey in a middle-income country or contextLiyana,a 40-year-old w
46、oman in a South-Asian country,was diagnosed with early type 2 diabetes and hypertension.The hypertension diagnosis was made at a local private clinic she visited for advice on other non-related symptoms.She was prescribed medicines,but had difficulty buying them regularly from a pharmacy due to the
47、steady rise in their cost and the need to prioritize the health needs of her children and husband.Scenario 4:Cancer patient journey in a high-income country or contextCheryl,a 48-year-old woman,discovered a lump in her breast and sought testing,which led to a diagnosis of breast cancer with a small
48、1.5 cm tumour.The good news is that a further test showed the cancer had not spread.Given her family history of breast cancer,she undergoes surgery followed by radiation and combination chemotherapy.Following another test at the end of her treatment,her doctor considers her still at risk.As she coul
49、d be eligible for additional therapy through a clinical trial,her doctor recommends this to hopefully further reduce her chance of recurrence.Cheryl is overweight,has type 2 diabetes and is also advised to make lifestyle changes.Scenario 5:Healthy ageing journey in a high-income country or contextMr
50、s Tan,aged 50,is free of chronic diseases such as hypertension or diabetes.Considering herself rather healthy,she has recently experienced moments of panic when remembering small things,or when familiar routes have suddenly become impossible.She discusses this with her husband,who accompanies her to