Many public healthcare systems are based around a ‘sick care’ model where people seek and receive treatment when they fall ill. With many countries grappling a growing and ageing population (1), there is an increasing overall burden on healthcare systems per capita. One way of managing the growing demands on healthcare systems is a refocusing of resources and treatment towards a ‘preventative care’ model. In such a model, people are treated earlier, before they become ill, and they are assisted in maintaining healthy, active lifestyles. This would mean that the overall burden of diseases and health complications were minimized or avoided entirely.
For the purposes of this brief exploration, I will use public health care systems as the system of focus, given that they are widely argued to be the most equitable and cost-effective systems of population-wide healthcare provision within national boundaries (2). Questions of health equity between countries and regions will not be addressed, though these points are critical to issues of international equity in health and beyond.
To implement any fundamental restructuring in public services, there of course needs to be ample supporting evidence and socio-political support. The cost-benefits analysis of restructuring towards a ‘preventative’ model are difficult to quantify, as evidence in the form of randomized controlled trials (RCTs) is not feasible for methodological reasons (3). It is for this reason that there is hesitancy in adopting such a transition. However, a recent review of over 200 public health interventions (4) concluded that the ‘vast majority’ of public health interventions are highly cost-effective. For example, In the NHS Five Year Forward View (5), it’s strongly put that “if the nation fails to get serious about prevention, then recent progress in healthy life expectancies will stall, health inequalities will widen, and our ability to fund beneficial new treatments will be crowded-out by the need to spend billions of pounds on wholly avoidable illness”.
The provision of healthcare towards preventative measures is a viable, and indeed urgent, means for decreasing costs to taxpayers, and improving health outcomes. Further, this approach would be mutually beneficial to all stakeholders. For instance, private-public partnerships may provide a sustainable avenue for the improvement of healthcare services and social welfare outcomes — a win-win scenario of sorts, whereby both the private sector and the public benefit from the effective mobilization of resources. Of course, private-public partnerships are not without their complications (6) but from the perspective of public policymaking, so long as there is no conflict between private interests and the health provision activity, there is an opportunity for success (7).
In summary, we need to urgently pivot towards a ‘preventative’ care model, whereby people receive treatment earlier, and are kept in a healthier default state. This transition will be economically sensible — to ensure that the services delivered at cost to the taxpayer are of a high standard, as well as being ethically just, more effective and earlier health intervention will ensure that the disease progression is kept at minimum, thereby improving aggregate quality of life through treatment. Perhaps most importantly, if we are to invest in such a change now, the results may not be borne out for 30 years, but they will be instrumental in maintaining our healthcare provision as the burden on such systems increases.
1 — Lutz, W., Sanderson, W. and Scherbov, S., 2008. The coming acceleration of global population ageing. Nature, 451(7179), pp.716-719.
2 — Marriott, A., 2009. Blind Optimism: Challenging the myths about private health care in poor countries. Oxfam.
3 — Schwappach, D.L., Boluarte, T.A. and Suhrcke, M., 2007. The economics of primary prevention of cardiovascular disease–a systematic review of economic evaluations. Cost effectiveness and resource allocation, 5(1), pp.1-12.
4 — Owen, L., Pennington, B., Fischer, A. and Jeong, K., 2018. The cost-effectiveness of public health interventions examined by NICE from 2011 to 2016. Journal of Public Health, 40(3), pp.557-566.
5 — NHS England, Public Health England, Health Education England, Monitor, Care Quality Commission, NHS Trust Development Authority Five Year Forward View, http://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf [Accessed 08 July 2021]
6 — Barlow, J., Roehrich, J. and Wright, S., 2013. Europe sees mixed results from public-private partnerships for building and managing health care facilities and services. Health Affairs, 32(1), pp.146-154.
7 — Parker, L.A., Zaragoza, G.A. and Hernández-Aguado, I., 2019. Promoting population health with public-private partnerships: Where’s the evidence?. BMC public health, 19(1), pp.1-8.