Moving into 2018, scheme’s reserves are under threat, memberships are stagnant and the system continues, for the most part, to tolerate overutilisation of hospital services while failing to invest in strengthening community-level care. Alternative fee models remain tentative and marginal, neither inspiring nor supporting any structural changes in the fragmented way healthcare services are delivered. In light of this, I predict the following for the coming year:
One space in which reform is beginning to happen is amongst groups of practising clinicians, who recognise the fault lines in the current set-up and are seeking better forms of payment; ones that support teamwork and reward outcomes (rather than the number of services performed). This involves forming independent multidisciplinary practices that, with deep knowledge of their community’s health profile, can deliver holistic clinical and social care at the community level. Consulting together and being paid collectively, they can reduce costly hospitalisation by treating their patients in the community and using alternative facilities. As we are seeing in other countries, once these teams and systems mature and grow, they will increasingly demonstrate their value in terms of both reduced cost and better patient health outcomes – giving schemes, businesses and future NHI purchasing committees successful alternatives to the status quo.