Our goal is sustainable healthcare and integrated care is the means to realise it. With words to that extent, Jonathan Coleman opened the fourth world congress on integrated care. Coleman is both a doctor and the New Zealand Minister of Public Health. The congress took place in Wellington from the 23rd until the 25th of November. Six hundred people participated in it.
According to Coleman, sustainable growth in healthcare should eliminate the need for drastic measures every few years as a result of quick growth. The acceptable growth percentage can be determined in two ways. Firstly, as the outcome of the estimate of the cost development based on the demand for healthcare and the available macro-economic space. Coleman chooses growth that has been linked to the growth of the gross national income. Secondly, sustainable growth can be approached as an estimate of the number of necessary healthcare providers, based on the demand for care and the number of providers that becomes available through educational institutes. Based on numerous scenarios, the New Zealand government published a policy paper at the end of 2015 about sustainable healthcare with a restricted growth percentage for the long term. Ever since, policy makers have been spreading the message of this policy paper, throughout the country and at this world congress. New Zealand congress participants told me how their views receive nation-wide support. For the sake of clarity, sustainable healthcare in this context conjures up associations with efficient and purposeful healthcare and not necessarily with environmentally friendly healthcare.
For its healthcare policy, the New Zealand government has a Triple Aim: 1. Better health of the population thanks to prevention; 2. Better quality of care for the individual and 3. Lower costs of care per inhabitant. To realise this aim, Minister Coleman opts for integrated care, both within primary care and between primary care and hospitals. He also focuses on integration within youth healthcare and mental healthcare. During the congress, the general director of the Ministry for Public Health later added that stimulating prevention is also part of this vision.
Specific programmes for target groups
The New Zealand government manages healthcare programmatically: with specific programmes for target groups such as psychiatric patients, people with chronic conditions and young people with learning and developmental problems. During the closing session of the congress, the New Zealand minister of Finances indicated he planned to stimulate sustainability by introducing other forms of payment besides the currently used fee for service. In numerous parallel sessions, New Zealand researchers and local leaders gave talks on their progress with e-health.
Do Europe and North America also choose sustainable care?
This concludes my limited report of the well-organised, lively congress. Would Europe and North America also be able to choose sustainable care? The necessary data are usually available per country. In the Netherlands, for instance, prognoses are available: based on demand, healthcare should grow with 3.4 percent per year until 2022. That is too fast and therefore unsustainable. If it does, there will be no extra money available for the army, education and benefits. Another commission issued an advice about the employment opportunities in healthcare until 2030, with different scenarios about e-health and self-management support. The Dutch nonetheless did not link these two reports to arrive at a conclusion about sustainable growth percentages. Perhaps, this has something to do with the general elections on March 15th 2017: issuing this sustainability message now does not yield government parties more seats in the House of Representatives. Perhaps, sustainable growth related to the growth of the national income is a beckoning perspective for healthcare policy in North American and European countries.
Explicit focus on sustainability
The way New Zealand directly links integrated care to sustainability is new. In literature (see my own book for example) the former is only sporadically linked to limited growth and the Triple Aim. Usually, integrated care occurs on a limited scale and in local initiatives. This is the case worldwide. For the first time, there is a government that explicitly focuses on sustainability. In a few years, we will know whether or not this type of policy will bear fruit. It could be the topic of a new world congress in New Zealand.