Introduction
The well-being of all people around the world depends largely on their health status. Functional health systems and structures should attain their functions without the threat of collapse or reduced efficiency. This implies that it must be sustainable, dynamic and all rounded to cater for the needs of patients and sustain its workforce. However, the most important characteristic of good healthcare systems and structures is that they should be accessible and sustainable (Thompson, Foubister and Mossialos, 2009, p. 11). Why should this be the case?
A sophisticated health care system that is only available to a clique of some people in the whole society is not effective. Good healthcare services should serve even the poor who cannot afford insurance covers for their health expenses. Nevertheless, health services are fronting major challenges in the next two decades, which threaten them with collapse if not addressed. These challenges transcend boundaries and share common characteristics from country to country, as the world braces itself for more changes eminent in the 21st century. This takes us into looking at the challenges. What are they? Are they insurmountable or does the lack of good policies makes them so grave?
Major challenges
The major challenges facing health care systems and structures over the next two decades include skyrocketing costs of healthcare, policymaking and implementation, change in demography coupled with an ageing population (Thompson, Foubister and Mossialos, 2009, p. 9). Technological developments together with complex health care systems and high patient expectations with mounting pressure on accountability and ethics fall also under this category.
Surging costs of healthcare services bite the most across borders. This is so because the cost of health care providers does not rely on one sector entirely, instead it affects different sectors from different perspectives. It affects both the patients and providers, raising diverse issues like sustainability, accountability, infrastructure, privacy safeguards among others. However, the most biting challenge here is maintaining sustainability without compromising the accountability of the providers.
According to Thompson, Foubister and Mossialos (2009), sustainability is a problem of accounting where healthcare system income fails to satisfy health system requirements and obligations (p. 14). This leads directly to soaring costs because the system needs more money to meet the demands of patients. Costs rise when social cost on health expenditure surpasses the value raised from that spending. Financing healthcare services goes hand in hand with sustainability.
The challenge facing healthcare services for the next two decades fall into two categories of sustainability: fiscal sustainability and economic sustainability. Fiscal sustainability refers to public expenditure towards healthcare while economic sustainability accounts for growth in health disbursement as a ratio of GDP. What is the challenge here?
In the wake of the global recession, many countries are likely to face lower gross domestic product, which translates to unsustainable health care services. The effects of a global meltdown may persist for the next two decades. Thompson, Foubister and Mossialos (2009), notes that countries will have to increase health care costs to counter the effects of low gross domestic product (p. 16). This may come indirectly with governments increasing public revenue to match health system obligations; a situation likely to face public opposition and the resulting stalemate may lead to a collapse of these important institutions in society. Health insurance policies throw more controversy on the issue of cost as an eminent challenge to healthcare services and this exposes health care services financing loopholes. Insurance policies remain high and many people cannot afford them.
Currently, health care financing maybe through public financing or insurance firms. Public financing appears to be the easy way out, however, Thompson, Foubister and Mossialos (2009) note that this comes with its problems (p. 22). The money to finance the practice comes from citizens implying that governments have to increase taxes to cater for the same. Private insurance providers may prove expensive which aggravates the problem. The way out of this impasse is to come up with good policies. Unfortunately, policymaking and implementation is the second challenge fronting healthcare services across borders.
Health policies should entail strategies that address population health wholly, tackling every portion of health determinants. Health determinants in this context encompass socio-economic conditions like poverty, physical environment together with the different personalities in society. Currently, there is a body dubbed ‘health in all policies (HiAP) that falls under the European Union. HiAP is a horizontal, gratis policy-associated scheme with a great potency for fostering population health (Stahl, Wismar, Ollila, Lahtinen & Leppo, 2006, p. 33). Policies determine and contribute largely to healthcare services provision. It is important to note that, policies made in other sectors, affect healthcare provisions directly or indirectly. Given the scope of population health, it is crucial to examine how some of the determinants pose a challenge to healthcare services.
A perfect example of a wider scope of the role of policies on population health comes out clearly in the ecological view of health. This emphasizes studying the environment surrounding people and their response to it. Stahl et al (2006) note that, public policies play a pivotal role in this case (p. 35).
The challenge comes in stipulating public policies that will enable people to have control over their health. This goes hand in hand with creating supportive environments and developing personal skills in a bid to reorient health provision. Unfortunately, the more the number of parties involved in policymaking, the more it becomes difficult to stipulate policies. This is because different parties bring in different opinions and this may scuttle the whole process. Unfortunately, Stahl et al (2006) posit that policymaking should be more involved as policymakers try to formulate and implement inclusive policies (p. 38).
These challenges if unchecked may lead to a collapse of the healthcare sector in the next two decades (Stahl et al, 2006, p.29). For instance, there are pertinent health issues related to climatic change. Global warming is escalating by the day, and this may lead to far reaching consequences in health circles. More illnesses are likely to arise in the wake of increased global warming and this may overwhelm the existing health services, hence bringing them down.
This boils down to the issue of policymaking. If the concerned authorities make and implement the right policies, this challenge would be surmountable. Housing policies also determine health care requirements because poor housing and sanitation are predisposing factors to some sicknesses. Fundamentally, policymaking in all other sectors has to consider the issue of health; regrettably, this is not the case currently.
Other challenges include changing human ecologies coupled with ageing populations. In the next two decades, the current population will be aged; a factor that throws healthcare systems in crisis for two reasons. Firstly, as people age, they become prone to sicknesses calling for improved healthcare attention. Secondly, these people become dependants. Human population statistics indicate that life expectancy is on the rise. These are good news; however, increasing life expectancy translates into a rising dependency ratio. This fact coupled with the surging health costs may bring healthcare systems to a downfall.
Technological developments also pose challenges to healthcare systems if not well utilized. Sophisticated information technology is slowly finding its way into the health care systems. Stahl et al (2006) point out that Information technology poses the challenge of accountability and privacy of patients’ information. Most probably in the next two decades, this technology will be highly sophisticated to improve quality but the issue of privacy remains pertinent here. The final challenge is high patient expectations, accountability, and ethics pressures. People expect a lot from doctors without knowing that some of the illnesses are preventable. This exposes misinformation or a total lack of the same regarding health issues. Increasing research backed up by new technology exposes the question of ethics like in making test-tube babies among other issues. Extrapolating these challenges without any change into the next two decades is a sure way of saying that health systems will crash.
Possible remedies
To counter the effects of these challenges there is a dire need to tackle these problems out rightly. Reforms to streamline healthcare costs should commence immediately. This will ensure that people access adequate healthcare services that are sustainable both economically and fiscally. Stahl et al (2006) recommend a review of the existent health financing programmes to come up with strong strategies that would tame the soaring costs (p. 23).
Policymakers need to be aware of existing problems and should involve the wider public in explaining to them the rationale behind policies made before their implementation. This will foster improved success rates in their implementation. There is also a need to strategize and formulate policies at international, national, and local levels to involve as many parties as possible (Thompson, Foubister & Mossialos, 2009, p. 40).
Conclusion
Healthcare systems and structures face numerous challenges ranging from soaring costs, poor policymaking, effects of information technology, accountability of health care providers, ethical concerns and increasing expectations of patients from doctors. Nevertheless, these challenges are surmountable and with proper planning coupled with strategizing, in the next two decades these challenges will be manageable (Stahl et al, 2006, p. 58).
List of References
Stahl, T. Wismar, M, Ollila, E. Lahtinen, E & Leppo, K. 2006. Health in All Policies. Finland: Ministry of Social Affairs and Health.
Thompson, S. Foubister, T. & Mossialos, E 2009. Financing Health Care in the European Union: Challenges and Policy responses. European Observatory on Health Systems and Policies.