Towards equity in healthcare outcomes
Inequities pervade the modern world, despite our technological advances and a growing awareness of the importance of human rights.
For example, while countries like Australia and New Zealand offer their citizens some of the best quality of life anywhere in the world, with health systems ranking among the highest on performance indices in the Organisation for Economic Co-Operation and Development (OECD), a deeper look shows the likelihood of a positive outcome for a citizen presenting at a hospital on a given day, in a given place, is far from equitable.
Variation across health systems in Australia and New Zealand drives this disparity in outcomes. Not all hospitals are the same; they differ in the services they offer and have different processes and procedures. Likewise, not all doctors or nurses are the same — they have varying degrees of experience, specialties and ability to stay up-to-date on current medical advances.
Furthermore, hospital experience differs from day to day; present at a hospital on a Monday and your experience will differ quite considerably from another day of the week, depending on how busy the hospital is at that time or the backlog the staff is dealing with. Finally, consider the impact of hospital location on these disparities, as everyone does not have the same level of access to care.
The above variation imposes incremental risk to an individual in addition to whatever health risks they present with. In other words, these are not risks an individual acquires outside the healthcare system but risks the system imposes on the individual.
Health equity (ie, equitable quality of health and access to health care) and equity of outcomes (ie, reduced variability, or equal chance of a positive outcome) have become issues at the centre of some of the world’s pre-eminent health systems. These organisations believe equity is a core quality measure and part of their social contract with the citizens they serve.
The western world is better equipped than ever before to address health equity and equity of outcomes. Our health systems have made significant progress toward digitisation, and even without full digitisation, patients and their caregivers have left a wealth of digital footprints across the healthcare ecosystem. Modern technology can identify these digital footprints and analyse them for variation and inequity.
Emerging technologies such as artificial intelligence (AI), data science and data analytics can identify variance within and between health systems, creating opportunities for improvement and greater predictability in forecasting and planning. The key is integrating these technologies into the clinical workflow of the hospital.
UnityPoint Health, the 13th largest non-profit health system and fourth largest nondenominational health system in America, was able to ‘give back’ more than 1000 nights in their homes by reducing the average length of stay. By reducing clinical variation in treatment and building a strong analytics system around its efforts to support improvements, the group was also able to increase its sepsis screening rate by 36%.
External variation, meaning variation in the communities that people live in and their location relative to health facilities, is a significant contributor to healthcare variation. In London, when travelling east from Westminster, every second tube stop represents more than one year of life expectancy lost according to the findings of the London Health Observatory.
In Australia, a report from the Australian Institute of Health and Welfare (AIHW) showed potentially avoidable deaths in regional areas were far higher than metropolitan. Additionally, a New Zealand Medical Journal study showed Māori people had a much higher risk of COVID-19 fatality compared with New Zealanders from European backgrounds, with unmet health needs a key factor.
If our region is to maintain and build on its strong healthcare reputation and standards, it needs to bring greater focus to solving the healthcare inequity problem.
In addition to improving health outcomes for all members of their communities, health systems can enjoy another high-value benefit — reduced cost. Quality is a significant driver of cost savings, and equity is a core component of quality. UnityHealth was also able to lower its variable costs by more than AU$1.75 million, savings which could be passed onto patients along with the benefits from enhanced treatment.
Australia and New Zealand combined spend over AU$200 billion a year on health care. While there’s no more worthy area to dedicate resources to than health, there is huge unrealised potential to maximise the value of that investment and provide best-practice health care to everyone in Australia and New Zealand.
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