Health Systems Leapfrogging in Emerging Economies (2013-2015)
For more information, see the project paper (“Health Systems Leapfrogging in Emerging Economies”).
I. Why do health systems of emerging economies need leapfrogging?
- Emerging economies face a major and growing challenge to their ambitions to put their health systems on a path to sustainability. As they try to catch up with more advanced health systems, they often replicate the path of developed economies. In following those examples, however, emerging economies risk manoeuvring themselves into financially untenable situations that could be even worse than those developed economies face today.
- Policy-makers must choose one of two paths: the familiar, but long, expensive and unsustainable path of developed economies, or a shortcut that leads to a sustainable future. Emerging economies are well suited to the second path. They have fewer impediments to change than developed economies: fewer sunk costs of existing infrastructure and equipment, lower fixed costs from building overcapacity, weaker vested interests (e.g. health professional associations) and a less divided public (e.g. privacy laws in developed economies that make data sharing and use difficult). They also have disruptive technological innovations, alternative operating and financing models, etc. at their disposal that were not previously evident or even possible for developed economies.
- Putting a health system on a path to sustainable development requires an understanding of the intended destination – the vision of an ideal health system. Health is generally a local matter. No universal model exists that will work for every country. It is appropriate for policy-makers to approach the challenge of developing their own vision with due humility.
- Whatever its particular design or implementation, however, an ideal health system should pursue three fundamental objectives:
o Better outcomes: Achieve better physical and mental health outcomes across all demographic and socio-economic groups through timely and effective interventions
o Individual satisfaction: Improve individuals’ satisfaction with the health system by respecting their dignity
o Financial sustainability: Keep the provision of healthcare affordable for both individuals and the economy as a whole
II. What is health systems leapfrogging?
- “Leapfrogging” means using a new technology, operating model or pattern of behaviour to accelerate the development of a system (be it an organization, industry or an entire economy) by helping it skip over development stages that had previously been unavoidable. In developed economies, techniques and structures that had been created to meet previous developmental challenges have tended to remain embedded in health systems, even after circumstances have changed or superior methods have become available. Outmoded organizational, behavioural and financial models can be expensive and difficult to replace.
- Leapfrogging helps to avoid such traps. A now-classic example is the introduction of mobile phones to remote areas of Africa. Those areas received the social and economic benefits of telephone networks without the sunk costs of massive landline infrastructure. They thus leapfrogged an entire stage of development, going directly from little or no telephone service to the same, efficient technology used in developed countries.
- Leapfrogging can occur at two levels. At a macro level, leapfrogging means the transformation of an entire system, for instance via comprehensive infectious disease programmes. This kind of large-scale change is very challenging and rare. At a micro level, leapfrogging means discrete but significant changes within specific components of the health system, such as task shifting within the workforce, revamping vaccine supply chains or leveraging innovation in medical diagnostics. The two concepts of leapfrogging can be mutually reinforcing.
- Successful leapfrogging opportunities meet three criteria: scalable, cost effective and easily accelerated, and they must be achieved without sacrificing the dignity of the individual.
Dessislava Dimitrova, Associate Director, Health Systems Transformation, Global Health and Healthcare - firstname.lastname@example.org
Scenarios for Sustainable Health Systems (2011-2013)
Health systems have been a great success of the past century, fostering longer, healthier lives and thereby contributing to prosperity and growth. These gains have come at a price: OECD countries have seen healthcare costs consistently outgrow the economy for decades. While this trend has been perceived as a long-term challenge, the fiscal crisis and demographic shifts have intensified the issues, making it necessary to explore how sustainable health systems can be achieved.
Worldwide, healthcare is now a US$ 7 trillion industry, creating valuable jobs and supporting economic growth. For 50 years, the rise of healthcare spending has consistently outpaced economic growth by an average of 2% in OECD countries: an ever-increasing share of national wealth has been dedicated to health.
This sustained growth of expenditure is due to interacting drivers of supply and demand. The demand for healthcare is expected to continue growing, owing to structural drivers such as population ageing, lifestyle and wealth, over which health systems have little influence. More accessible to address may be the incentives underlying supply-side inefficiencies, which are inducing demand, limiting value-conscious behaviour and discouraging “frugal innovation”. These drivers are presented in detail in the project report.
Navigating these difficult economic times is challenging for policy-makers faced with the need to rein in healthcare costs. The magnitude and proximity of health financing challenges suggest that incremental solutions may not be enough.
In 2012, the Forum’s Strategic Foresight team and health community built scenarios to explore the question “What might sustainably financed health systems look like in 2040?”, to envision fundamental transformations of health systems and identify promising potential solutions. Based on scenario insights, the project developed a set of actionable interventions to help policy-makers navigate towards desired outcomes.
- Derek Aberle, Executive Vice-President and President, Qualcomm Technology Licensing, Qualcomm, USA
- Cristian Baeza, Director, Health, Nutrition and Population, World Bank, Washington DC
- Andrew Cassels, Director, Strategy, Office of the Director-General, World Health Organization (WHO), Geneva
- Douglas Cole, President, Takeda Pharmaceuticals North America, USA
- Lord Ara Darzi, Professor of Surgery, Imperial College London, and Chair, Institute of Global Health Innovation, St Mary’s Hospital, United Kingdom
- Victor J. Dzau, President and Chief Executive Officer, Duke University Medical Center and Health System, Duke University, USA
- George C. Halvorson, Chairman and Chief Executive Officer, Kaiser Permanente, USA
- Nicolaus Henke, Director, Leader of the Global Healthcare Practice, McKinsey & Company, United Kingdom
- Joseph Jimenez, Chief Executive Officer, Novartis, Switzerland
- Lise Kingo, Executive Vice-President, Corporate Relations, Novo Nordisk, Denmark
- Khawar Mann, Partner, Head of Healthcare, Apax Partners, United Kingdom
- Sandip Patel, Senior Vice President, International Business, Aetna, USA
- Andrzej Rys, Health Systems and Products Director, European Commission, Brussels
- Daljit Singh, President, Fortis Healthcare, India
- Simon Stevens, President, Global Health, UnitedHealth Group, USA
- Mary A. Tolan, Founder and Chief Executive Officer, Accretive Health, USA
- Angela Wilkinson, Director, Futures Programmes, Smith School of Enterprise and the Environment (SSEE), United Kingdom
A series of workshops and interviews, aligned with key Forum events, convened a diverse group of stakeholders to explore opportunities for the transformation of health systems.
- In the initial phase (2011), over 100 experts from healthcare and related sectors were engaged in a collective debate on the future of health systems, building a fact base to make the case for change. The outcome of this dialogue is captured in the interim report, presented at the Annual Meeting 2012.
- In the second phase (2012), the project leveraged the Forum’s unique multistakeholder scenario approach, and identified fundamentally novel paths for transformation.
- The scenario process built on the convening power of the Forum, engaging diverse stakeholders in a forward-looking strategic dialogue on developed and emerging health systems. The quality of the strategic conversation was enriched by diverse voices and fresh ideas from other sectors, as new partners from finance, IT and nutrition, among others, were invited to join the project community.
- The project engaged a number of ministries of health and finance in selected countries to craft a robust vision for their health system until 2040 as well as a set of recommendations on how the vision can be attained. These country-level insights were synthesized into a set of key insights and best practices that can be replicated in other countries and thereby provide further contributions to transformation of global health systems.