NextBillion - An Initiative of the William Davidson Institute at the University of Michigan

Wednesday, March 2, 2016

One of the greatest conundrums in global health is why so many countries don’t get what they pay for. A relationship between health expenditure and health exists, but is far looser than you might think. Many nations spend a quarter or even a half of what others do for the same or better outcomes.

Lifestyle and cultural factors undoubtedly play a role in this, but after working in more than 60 countries, I have seen how patterns in the way that healthcare is managed, delivered and funded is also crucial. Here are five factors that are often at play:

1. Integrated care

One of the best systems I have seen to balance the two seemingly opposed forces of competition and collaboration is in Israel. Healthcare there is divided into four health maintenance organisations (HMOs), which both pay for care and operate their own pharmacies, primary care clinics and hospitals. That creates a strong incentive to keep patients well and out of hospitals by getting providers across the pathway to work together.

At the same time, the HMOs are constantly improving their services to attract more members. This is the foundation for a truly tech-savvy, primary care-led service that is always innovating, and which enjoys an average life expectancy of over 82 years for just 7.2% of GDP.