x Abu Dhabi, UAESunday 21 January 2018

Reasoned approach to welfare of health care

As obesity and chronic but preventable diseases continue to mount globally, so too do costs. Halting this alarming trend requires more than just stopgap solutions.

Dr Toby Cosgrove is the president and chief executive of Cleveland Clinic. Fatima Al Marzooqi / The National
Dr Toby Cosgrove is the president and chief executive of Cleveland Clinic. Fatima Al Marzooqi / The National

Worldwide health care is on an unsustainable path.

The global system is too inefficient. The cost is too high. The quality is too varied. To make matters worse, the world populace continues to grow unhealthier with each passing year, as expanding obesity rates lead to increased incidence of chronic disease and disability worldwide.

Getting health care back on the right course isn't a simple proposition. It will require doing things differently. It will require better patient outcomes at lower costs. Most formidably, though, it will require the participation of an entire population. Change within the healthcare system will be futile if we don't find a way to control chronic diseases, which starts with controlling obesity.

Looking at the United States, about 60 per cent of healthcare costs are linked to chronic diseases - heart disease, diabetes, stroke, lung disease and certain cancers - that are almost entirely preventable if we would eat healthier, exercise more, stop smoking and limit our alcohol intake. Yet chronic diseases are still the leading causes of death and disability in the US, pushing healthcare costs ever higher.

To get an idea of America's challenges, spending on health care topped US$2 trillion (Dh7.34tn) in 2011.

It's a major contributor to the national debt, accounting for 24 per cent of the federal budget. It accounted for 5.2 per cent of GDP in 1960 but is estimated to surpass 20 per cent by 2021, according to the Centers for Medicare and Medicaid Services. Simply put, what that means is that if we continue on our current path, $1 in every $5 spent in the US economy will go towards health care.

We, as members of the healthcare community, can do better.

At Cleveland Clinic, we've been recognised for delivering high quality at low costs. According to Medicare, our cost per hospitalised patient is below the US median, so our efforts are working.

What makes Cleveland Clinic different stretches back to our founding 92 years ago, when we were established as a physician-led group practice that runs a hospital - not a hospital that employs doctors. This distinction is important. Decisions from the chief executive on down are made by physicians based on what is best for the patient.

Our doctors are signed to annual salaried contracts, with yearly performance reviews that include each doctor's quality ratings, clinical outcomes and research. There's no financial incentive for doctors to order more tests or perform more procedures.

We have a wealth of data that can tell us what's working and what's not. For instance, we were able to comb through data of heart surgery patients to find that those who received blood transfusions during surgery had higher complication rates and lower long-term survival rates. This finding - mined from our own data - changed the way we do things; we now have strict guidelines in place to limit transfusions.

Another part of the cost solution is to educate doctors about what items cost. If doctors don't know the cost difference between a silk stitch, about $5, and staples, about $400, it's impossible for them to make informed decisions.

At Cleveland Clinic, we've been engaged in a continuing effort to trim costs from the behind-the-scenes activities that rarely affect patients but that add to their bills. Through a concerted focus on our supply chain, we use rigorous value-based purchasing protocols, market intelligence and business analytics to examine every purchase from the standpoint of value, utility and outcomes. Over the past two years, this has resulted in cost savings of $100 million.

Inevitably, though, cost savings will come through consolidation and mergers. Just as airlines, supermarkets and bookstores have done, hospitals will consolidate to drive efficiency. Change has to start at home to address factors influencing our health that we can control.

Knowing that non-communicable diseases, such as diabetes and cardiovascular disease, are leading health concerns in the UAE and across the Arabian Gulf, we are looking to tailor our best practices for the people of this region. That's why in 2005 we established a partnership with Abu Dhabi's Mubadala Healthcare to bring Cleveland Clinic's model of care to the region by establishing Cleveland Clinic Abu Dhabi.

The result is a world-class multi-speciality hospital in Abu Dhabi, specifically designed to address a range of complex and critical care requirements unique to the Abu Dhabi population. Modelled around Cleveland Clinic and designed to tackle conditions prevalent in the region, Cleveland Clinic Abu Dhabi will have five centres of excellence in heart and vascular medicine, neurological medicine, digestive diseases, eye, respiratory and critical care, and more than 30 other service lines.

There are more than 250 employees in place at Cleveland Clinic Abu Dhabi working to replicate and tailor our best practices. Abu Dhabi patients will receive our group-care model and experience our "patients first" philosophy just as they would if they were in the US.

To tackle the problems that plague the global healthcare system, change truly does have to start at home.

By establishing a new home in the UAE, we are proud to bring the heritage of Cleveland Clinic so we can address the global healthcare challenges with our partners in Abu Dhabi.

Dr Toby Cosgrove is the president and chief executive of Cleveland Clinic, which manages Sheikh Khalifa Medical City in Abu Dhabi