Why we're heading for a global healthcare crunch – and how to avoid it

The cost of providing healthcare is spiralling, but considering the value of services could help save money. Photograph: Alamy

Humankind has managed to get people to the moon, created devices which connect us with others anywhere in the world, and made 640 tonnes of metal fly through the air, so why can't we find a sustainable model for healthcare?

Healthcare spending is growing at an unsustainable rate, faster than economies and faster than wages. In the US, it is predicted that in just seven years health will cost 20% of GDP. The UK will catch up some time within the next 50 years, depending on inflation. NHS England recently revised upwards its expectations for efficiency savings, claiming that on top of the £20bn savings it had already predicted, an additional £30bn will need to be found between 2014 and 2020.

Commentators often argue that the answer to the problem is to refocus the healthcare system from delivering activity to delivering value; simply spending more money does not translate to better outcomes.

So what is value in healthcare? It may be patient outcomes or results achieved per pound spent; this is hard to visualise so it may be better to say that value equals solving health problems for patients to leave them in a better position than when they approached the service, and at a cost which is more efficient than paying for the long-term consequences of the presenting problem.

Spend a few minutes digesting these sentences, for they explain the root of the problem and the barriers to better value-based services in healthcare. The particular pressures that health services face are the difference between solving a problem and responding to an illness, and the difference between taking the long term or short term view.

To understand this fully let's look at the mobile phone industry. Telecommunications solves problems for people and adds value by making us more productive. It does this because technology adapts to how people want to use it.

Most people reading this article will have smartphones, but I can guarantee that we all use these technologies in different ways. We'll have different apps arranged to solve individual problems, creating individual opportunities and overcome unique barriers.

Smartphones, like some other products and industries, have created adaptive systems which allow us to boost our own productivity. In adopting a new device we will each make a judgement about the upfront cost versus the medium term cost of not buying something, and we might also make an investment in making our lives easier in future, at an immediate cost.

Those of us who work in healthcare will know that, in general, the system is focused on the short term to fix acute illness, rather than building physical resilience to avoid the longer term consequences of poor health. We also recognise that healthcare does not adapt to help people to solve their own problems. Instead, and quite unintentionally, it can make patients adapt around its own systems.

When it comes to value, many healthcare services work in the opposite direction: they take a short-term view and respond to things which have already gone wrong. But there are some exceptions.

Public health as a model is inherently value based, or at least it can be. Let's take vaccinations as an example. Depending upon who we are, and whether we are travelling to certain countries, we each receive different vaccinations. So the process of vaccination adapts around us and the lifestyle we choose.

Public health is also a longer term investment; we have vaccinations now to reduce the risk of contracting debilitating disease in the future. It is productivity-boosting by its very nature.

So where does this leave us? Now that we have a twopoint framework for value in healthcare, it would be interesting to use it as a thinking tool.

How could your service or services become more value based? Set some time aside to think it through, because if the theory is right (or at least nearly right) then this is what will determine the sustainability of what you do. And ultimately, the sustainability of the NHS.

Put differently, if we don't begin to do something about the barriers then perhaps we really are headed for a global healthcare crunch.

Anoop Maini is senior policy advisor to the health services regulator Monitor.

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