Dr. Stephen Brookes QPM, Programme Director, MSc International Healthcare Leadership discusses the trends and challenges facing today's healthcare leaders in this interview with Dr. Kathy Shi, Founder and CEO of SinoUnited Health in Shanghai. Stephen has over 35 years' experience of public service and academic expertise, and Kathy has over sixteen years' experience of treating and managing cardiovascular diseases.
Healthcare equality, how are we getting there?
Kathy: "In China, government health insurance has extended from covering 400 million urban dwellers in 2009 to 1.4 billion today, including rural populations. Also, government insurance is covering a growing percentage of patients’ costs, but there are still variances between big and small cities."
Stephen: "In the UK, it’s the 70th birthday for the NHS, which has been providing free healthcare at the point of delivery, but still there are huge inequalities in accessing healthcare. In recent years, it has been calculated that inequality in healthcare costs the NHS 20 billion GBP per annum."
What are the key trends and reforms in healthcare?
Kathy: "Technology is a key trend and has enabled the launch of online booking systems, so patients can book online and even via Wechat at some clinics and hospitals. Government policy reforms are supporting private sector provision and encouraging training in healthcare."
Stephen: "Reform in different parts of the world has seen a shift in the provision of healthcare to the private sector. Investment in private healthcare is increasing in places such as the GCC in the Middle East and Singapore, for example. In the UK, reform has been ongoing over the 70 years of the NHS. The current main reform is the creation of Clinical Commissioning Groups (CCGs). The Ministry of Health gives around 160 billion GBP of funding per annum directly to the CCGs, which are General Practice (GP) led and commission secondary and tertiary care services. A patient would go see their family physician/GP, who then refers them to see specialist doctors if there are particular needs.
"One main challenge of government reform is to reduce waiting times. Another key element of reform in the UK is TCS – Transforming Community Services – which transfers care to people in the community rather than main hospitals."
Kathy: "In China, the GP system or family physicians are not generally in place. But here, we can usually get access to hospitals more quickly. People tend to go to tertiary hospitals once they get sick. The government is trying to encourage people to go to the community hospitals first – this would allow better allocation of resources."
What impact is technology having?
Kathy: "The online aspect of technology increases the convenience of access."
Stephen: "The real test of technology is not the real technology itself, but the capability and capacity behind that technology. For example, booking an appointment with a GP while there is little availability would, in fact, defeat that system. Other aspects of technology, such as monitoring patients over long distances would revolutionise how healthcare is provided and have a huge impact in rural areas. Also, technology can help with the provision of integrated healthcare."
Kathy: "I think that it also has big implications in telemedicine, for example quarantine disease management for rural areas. But this needs a combination of online and onsite visits because safety is always the top priority."
Stephen: "Another benefit is the preventative agenda through monitoring with electronic devices."
Kathy: "Not too much technology is good because it can cause unnecessary anxiety, for example when patients see fast heart rates on their Fitbits and overreact."
What are the main global challenges facing healthcare?
Stephen: "Over the years, I have seen common challenges for numerous healthcare systems. Three common challenges for healthcare are prevention (having equitable access to healthcare in a timely and efficient way); better-integrated care (including primary, secondary, tertiary and also public and private healthcare); and ensuring patients get treatment in the right way at the right time by the right people."
Kathy: "I believe prevention is even more important than treatment, which can be achieved through good patient education."
Is there a doctor-patient conflict?
Kathy: "It is sad to hear about this. There is an old saying in China: 'doctors have a heart like your parents'. Doctors become doctors because we want to help people. Healthcare providers can do better and patients can understand better. Communication is very important for sure. Healthcare providers can try to provide better quality care – they need to make sure they spend enough time with patients, explaining and evaluating. They also need to respect patients and have a good bedside manner. In the meantime, patients need to understand better."
Stephen: "This is also very important in the UK and a top priority for the Department of Health. Patients are much better informed today and can be much better engaged in the relationship with the physician. We hear sad news that some physicians get killed, which is absolutely tragic and should not be allowed to happen. The relationship is multi-faceted."
Kathy: "As healthcare providers, if we want to provide high-quality care, we must engage with the patient. The patient must trust you, otherwise they cannot be engaged. In our organisation, we do it this way and we spend more time with the patient. We need to have this passion."
Stephen: "Passion is absolutely key and the other word is trust. In a national survey of trust level for occupations, physicians and doctors were on the top of the list, and we don’t want to lose that.
"On a global scale, the healthcare system is going through reforms. In China, attention is being given to widening provision, fair use of different tiers of healthcare resource and the introduction of family clinic/GP systems, as well as supporting private care. In some cases, lessons can be learned from the UK and elsewhere globally. In both China and the UK, the use of technology is influencing the current and future of healthcare. Healthcare leaders, such as managers of clinics and hospitals, senior physicians and nurses, managers and technicians from the clinical, medical and technology sectors, and healthcare services investors can be better prepared for the challenges and opportunities facing this industry."