More health, less care: how can we make this happen?
Professor of Population Health Management Marc Bruijnzeels calls for a healthcare system in which prevention really works. Together with his team and master’s students, he is driving a shift in the system as we know it today.
The title of your inaugural lecture is ‘More health, less care’. How do you envision this?
‘My field is population health management. The core is using data to keep people healthy and prevent disease. One organisation is responsible for the health of a certain group of people. If we can get a better idea of who is likely to have problems and when, and where people develop more risk factors than necessary, we can prevent many of the things that we currently let happen.’
Can you give an example of something we currently let happen?
‘Take someone who is discharged after a hospital stay for COPD. We can use data to predict the chance that they will be readmitted within 30 days. We send people home with the advice to take their medication, stop smoking, stay active and live healthily. That advice focuses on the individual: you must take care of your own health. But we know that some people find it difficult to follow this advice. Perhaps we should take a different approach and use prediction models to help prevent readmission: for example, by involving their social network. These are the people who want to keep their loved one healthy and who have a big influence on them.
‘Within healthcare, we could also be better organised with a more integrated approach. A medical specialist could inform a GP about specific points for a patient or involve other primary care professionals. Maybe paramedics could help or a buddy programme. That requires organising care differently. Right now, organisations are too isolated and not encouraged to work together. We should bring them together more. Everyone agrees on that, but it still hasn’t happened, which is odd, isn’t it?’
Why do you think nothing changes?
‘I think the system is comfortable as it is. There’s not enough pressure to change. We just organised healthcare this way at some point. However, professionals are often no longer able to do what they would like or are capable of doing. A medical specialist and a community nurse are both incredibly busy and have to keep going. If we organise things more smartly, they can consult each other when someone returns home after a hospital admission for COPD.
‘Of course, adjusting the healthcare system takes effort, but if you can use data to predict where problems arise and organise care differently, you can achieve more health with less care. You obviously have to handle data carefully and mustn’t use it for other purposes. If someone doesn’t want their data used, we don’t use it, but many people are willing for it to be used if it benefits their health. One of the most important values people have is their own health and the health of their loved ones.’
With prevention, are you looking at a neighbourhood-based approach?
‘That depends on the research question. Municipalities need guidance, and this is an easy way to define groups. This works sometimes: some neighbourhoods and villages have always had a strong identity. But other people need a different approach. Then you need to look at what connects people: what is their group identity, and who influences them? Maybe you need to look at sociocultural lines running across cities and villages. Population health management explicitly considers the social factors that shape health behaviour and which interventions are likely to succeed.’
Besides being a professor, you are also director of the Master’s in Population Health Management. What makes this so important?
‘We train students who can help drive this shift. For example, some alumni now work for the Regional Integral Health Agreement in the Westland area of Zuid-Holland. They look at new ways of organising healthcare, including funding models and data infrastructure. Other alumni work every day to address problems through population health management. These are just small steps for now, but eventually there will be many, and they will be part of the transformation.’
Where would you like the field to be in a few years?
‘I hope that modern technology and rapid developments will enable us to shape a healthcare system that meets people’s needs and preferences and reduces health inequalities in society. I think we can achieve this in 15 to 20 years. That won’t require major technological breakthroughs, but a different way of positioning ourselves in relation to people’s health.’
Marc Bruijnzeels will give his inaugural lecture, ‘More health, less care’ on 13 February. This will be streamed live on the Leiden University website.