医疗保健的价值：加快卫生系统转型的步伐（英文版）.pdf

Insight Report Value in Healthcare Accelerating the Pace of Health System Transformation December 2018 Prepared by the World Economic Forum, in collaboration with Boston Consulting Group (BCG) 51357_Value_in_Healthcare_report_2018_final.indd 1 07.12.18 15:17World Economic Forum 91-93 route de la Capite CH-1223 Cologny/Geneva Switzerland Tel.: +41 (0)22 869 1212 Fax: +41 (0)22 786 2744 Email: contactweforum weforum 2018 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. 51357_Value_in_Healthcare_report_2018_final.indd 2 07.12.18 15:173 Value in Healthcare: Accelerating the Pace of Health System Transformation Foreword Preface Value in Healthcare Today and Tomorrow Barriers to progress Accelerating the pace of change A Users Guide to Health System Transformation Examples of health system transformation Creating a context for multistakeholder collaboration Developing targeted solutions A Roadmap for Global Health- Informatics Standardization An urgent challenge A five-part agenda Preliminary timeline The Global Coalition for Value in Healthcare A new public-private collaboration Four strategic priorities Appendix: The Value in Healthcare Informatics Working Group Contributors Endnotes 4 6 7 7 8 10 10 13 15 20 20 21 23 25 25 26 28 30 32 Contents 51357_Value_in_Healthcare_report_2018_final.indd 3 07.12.18 15:174 Value in Healthcare: Accelerating the Pace of Health System Transformation Foreword The World Economic Forums system initiative “Shaping the Future of Health and Healthcare” aims to provide answers to the question: How can the world deliver affordable and quality healthcare for nearly 9.7 billion people by 2050? In a world characterized by an ageing population, more and more people suffering from long-term chronic disease, and ever-increasing healthcare costs, improving healthcare value by delivering better health outcomes to patients at lower costs is a critical imperative. We have a long journey ahead in building sustainable heath systems globally that put people at the centre, and we believe we have a collective responsibility to do so. For the past three years, a critical source of new thinking and research on how to improve healthcare value has been the World Economic Forums Value in Healthcare project. Since its launch in July 2016, the project has laid the foundation for health system transformation by defining the critical components of a value-based health system and by emphasizing the centrality of multi-stakeholder collaboration to achieving value-based system transformation. In this report, the third and final installment in the Value in Healthcare report series, we introduce three concrete steps for accelerating the pace of value-based transformation in health systems around the world: 1. A user guide for policymakers and private sectors stakeholders that synthesizes key learnings from efforts around the world to transform health systems towards value; 2. A practical roadmap to guide health informatics standardization, improving our ability to leverage the powerful force of healthcare data towards medical research and real-world evidence, clinical decision-making, patient empowerment and ultimately, improvement in care outcomes; 3. A global coalition that can foster collaboration and continue to drive the agenda for value-based health systems. We are at a critical turning point for value in healthcare globally. Stakeholders in the sector need to codify and disseminate best practices, develop the global enablers for value-based healthcare, and create new platforms for deeper collaboration. The World Economic Forum and its partners remain committed to the value-based transformation of the worlds health systems, even as the Value in Healthcare project comes to a close in its current format. At the January 2019 annual meeting in Davos, we will be launching the Global Coalition for Value in Healthcare, a collaboration between the World Economic Forum and leading healthcare stakeholders to continue promoting and driving global health-system transformation. You can read about the coalition in the concluding section of this report. The commitment of the Value in Healthcare projects Executive Board, Steering Committee and our Knowledge Partner, Boston Consulting Group, has been critical to the success of our work. We thank them and all the other stakeholders that have joined us on this important journey. We are excited about what we can continue to achieve together. Jeremy Jurgens, Member of the Managing Board Vanessa Candeias, Head, Global Health and Healthcare System Initiative, World Economic Forum 51357_Value_in_Healthcare_report_2018_final.indd 4 07.12.18 15:175 Value in Healthcare: Accelerating the Pace of Health System Transformation 51357_Value_in_Healthcare_report_2018_final.indd 5 07.12.18 15:176 Value in Healthcare: Accelerating the Pace of Health System Transformation Preface by The Executive Board, Value in Healthcare project In July 2016, the World Economic Forum, in collaboration with Boston Consulting Group (BCG), launched the Value in Healthcare project. The goals of the project were: To develop a comprehensive understanding of the key components of value-based health systems To draw general lessons about the effective implementation of value-based healthcare by codifying best practices at leading healthcare institutions around the world To identify the potential obstacles preventing health systems from delivering better outcomes that matter to patients, and at lower cost To define priorities for industry stakeholders to accelerate the adoption of value-based models for delivering care In the nearly two-and-a-half years since its launch, the Value in Healthcare project has: documented the experience of leading value-based innovators; developed a comprehensive framework describing the necessary components of a value-based health system; launched local initiatives in value-based transformation at regional health systems in the metropolitan area of Atlanta, Georgia, in the US, and in Ontario, Canada; and explored models for the development of key enablers of value-based healthcare in particular, health informatics. These initiatives have been described in detail in two previous reports: “Value in Healthcare: Laying the Foundation for Health System Transformation” (April 2017) and “Value in Healthcare: Mobilizing Cooperation for Health System Transformation” (January 2018). In this, our third and final report, we focus on three initiatives for accelerating the value-based transformation of global health systems. A “users guide” to health system transformation, based on our review of leading transformation efforts around the world and our experience in launching the Atlanta and Ontario initiatives A “roadmap” for global health-informatics standardization, which sets out a comprehensive agenda for accelerating the development of global health-informatics standards, including a proposed “digital health bill of rights” that puts patient empowerment at the centre of informatics standardization efforts A new public-private coalition for value in healthcare, known as the Global Coalition for Value in Healthcare and initially hosted by the World Economic Forum, which will serve as a global platform to share learnings, develop effective best practices, and guide the development of value-based health systems worldwide The value-based transformation of health systems is a critical imperative both for addressing patient needs and for ensuring the long-term sustainability of the global healthcare industry. The Value in Healthcare project has moved the ball forward and the members of the Executive Board are committed to sustaining that progress through the Global Coalition for Value in Healthcare. In conclusion, we would like to acknowledge the dedication and contribution of the many healthcare leaders in our Steering Committee as well as the vision and ambition of the Value in Healthcare project team. (For a list of participants, see the Acknowledgements at the end of this document.) As an industry, we have embarked on an exciting transformation journey. As industry leaders representing both the public and private sectors, we look forward to playing an active leadership role in that journey in the years ahead. 51357_Value_in_Healthcare_report_2018_final.indd 6 07.12.18 15:177 Value in Healthcare: Accelerating the Pace of Health System Transformation Value in Healthcare Today and Tomorrow There is growing consensus among stakeholders in the $8 trillion global healthcare sector that the industry faces a serious value problem. Despite decades of efforts to control spending, costs continue to rise at roughly double the rate of GDP growth in most developed countries. 1In addition, there are wide variations in health outcomes across hospitals, regions and countries, with no clear causal relationship between money invested and health delivered. 2The national health systems that spend the most money do not necessarily provide the best care. 3And there is considerable evidence that a substantial portion of healthcare spending is, quite simply, wasted on avoidable medical complications, medically unnecessary treatments or administrative inefficiencies. 4In 2016, the World Economic Forum launched the Value in Healthcare project to explore innovative ways to address healthcares value problem through an approach known as value-based healthcare. According to this approach, value is defined as the health outcomes achieved for defined population segments (for example, all individuals suffering from a particular disease or belonging to a specific risk group) for a given cost. And the goal of a value-based health system is to continuously improve the ratio of outcomes to costs through the provision of increasingly targeted, segment-specific clinical interventions. 5Since then, the project has documented the experience of leading value-based innovators; developed a comprehensive framework that describes the necessary components of a value-based health system (see Figure 1); launched initiatives in value-based transformation at regional health systems in the metropolitan area of Atlanta, Georgia, in the US, and in Ontario, Canada; and explored models for the development of key enablers of value-based healthcare in particular, health informatics. 6 Barriers to progress The Value in Healthcare project has articulated a vision for the value-based transformation of health systems globally. Realizing that vision, however, is a complex challenge. Despite the considerable progress by leading stakeholders around the world, there remain significant barriers to value- based healthcare that are embedded in existing health systems. Take, for example, the systematic tracking of health outcomes for all patients who suffer from a given disease or who belong to a specific risk group, which is a cornerstone of any value-based health system. National disease registries and international organizations such as the International Consortium for Health Outcomes Measurement (ICHOM) have made enormous progress in defining which outcomes to track. 7But the lack of global standards for health informatics and the challenges Figure 1: The Value in Healthcare Framework for a Value-Based Health System Source: BCG analysis Policy Payments Delivery organization Benchmarking research enable expansion across geographies and population segments; coordinate global initiatives; drive policy change Test this vision in the real world Pilot new models for cooperation to build trust among stakeholders, and identify barriers to change Realize full potential of system improvement Support continuous learning and improvement through evidence- based approaches Accelerate the pace of change Share best practices; develop global enablers; create platforms for collaboration Year 1 of the Value in Healthcare Project (2016) Year 2o f the Value in Healthcare Project (2017) Year 3o f the Value in Healthcare Project (2018) Source: BCG analysis 51357_Value_in_Healthcare_report_2018_final.indd 8 07.12.18 15:17