In Search of the Perfect Health System
Palgrave, London, UK, 2015
Reviewed by Chris Eagle, MD, MBA
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In 225 pages, Mark Britnell, global chair and senior partner for health at KPMG and previously a senior executive in the UK’s National Health Service (NHS), provides a terse travelogue of 25 health care systems, presenting the key features (good and bad) of each system based on personal experience and insightful reflection. Not only a travelogue, the author describes the common challenges found across all of the systems and the various solutions they offer.
Mr. Britnell has an evident passion for health care, which permeates his analysis and writing. Some of this enthusiasm is personal, arising from his own experiences as a patient with prostate cancer. Most of this passion is professional. Mr. Britnell has experienced health care at all levels, and that experience is evident both in his clear focus and friendly but challenging analyses. Although the book is, in part, a personal reflection, the author’s thoughts are well referenced, reasoned, and balanced.
He starts the journey with the perspective that “there is no such thing as a perfect healthcare system and it certainly doesn’t reside in any one country.” If this sounds nihilistic, it is quickly followed by key examples from health systems with components that are working extremely well. Some of these exemplars are not widely known. For example, Israel has excellent primary care. Mental health and well-being are key features of the Australian health care system. “Innovation, flair, and speed” describe health care delivery in India.
These initial rapid-fire examples provide the point of departure for the 25 health system reviews that follow. These reviews are short three- or four-page essays focused on the most salient features that distinguish each system. They are neither comprehensive nor academic in nature but are practical and incisive. The countries covered are diverse, reflecting most sections of the globe, from Australia and Brazil to Russia and the USA. The final section of the book is focused on global health care challenges and how systems can and have risen to meet them. The issues include universal problems, such as clinical quality, engagement of patients as partners, and population aging.
An important chapter deals with the “paradox of change.” The “lack of alignment between payers, providers, patients, professionals, policymakers and politicians, public and the press is a serious drag on innovation and progress.” The author identifies 10 themes that various countries are employing to tackle change. These are: health promotion; population segmentation; scaled-up primary care; clinical services that are both localized and distributed; clinical pathways; workforce development; tertiary centres that serve as anchors for local health systems; care for the aged provided from the home; community-based mental health services; and, above all, health systems that treat patients as active partners in their care.
Inevitably, brevity limits depth. A global perspective is not developed on some important issues, such as aboriginal health, early childhood development, or the link between health and social services. However, these issues are mentioned in specific country chapters.
There is much wisdom in this short book. The common themes in health care reform around the globe are identified and, from the 25 country examples, the key forces driving change emerge. Those interested in health care reform in Canada will find this book an exceptionally informed, readable, accessible, and incisive review of the responses to change in other health systems. It serves not only as a reference but also as a motivator for action.
I highly recommend this book. If we feel disturbed about the lack of progress in health reform in Canada, this book shows that clear remedies are within our grasp.
Chris Eagle, MD, MBA, FRCPC, is a professor in the departments of Community Health Sciences and Anesthesia, Cumming School of Medicine, University of Calgary; adjunct professor, School of Public Health, University of Alberta; and adjunct professor, Royal Roads University.
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