Funding the top issue Asian hospitals face in patient care

While Asia’s health industry must address a host of vital issues, analysts agree hospital coffers need the most attention.

If it seems that today’s hospitals are shaping up to be better venues for healing, one need only follow the money to see why. Hospitals seem to be moving quickly to implement  management reforms to meet demand for better patient care, and a large part of this has been centred on better financial management of medical institutions.

While chiefly concerned with the  business of health management, hospitals also have to deal with the financial aspect of their operations— “how financial resources are generated, allocated and used in health systems,” as the World Health Organisation (WHO) puts it.

“There will be greater concern over how we spend our resources and the returns we get out of them. Hospital managers will have to simultaneously balance both commercial and societal concerns in order to thrive in the changing environment,” says Mark Cheong of the University of Malaya Specialist Centre.

Money: a valuable resource

According to a 2012 survey by the American College of Healthcare Executives (ACHE), “financial challenges” remained the top issue confronting hospitals, as it has been in the past few years, followed only by “patient safety and quality” and “healthcare reform implementation.” “As CEOs (chief executive officers) are positioning their organizations to succeed in an uncertain environment, it is not surprising that financial challenges, patient safety and quality, and healthcare reform continue to be on their minds,” says Thomas C. Dolan, ACHE president and CEO.

How well a hospital is run is usually a reliable indicator of the quality of patient care it is able to provide, according to a joint report by the Organisation for Economic Cooperation and Development (OECD) and WHO.

“Quality is a significant concern even in health systems that are well developed and resourced, with expected patient outcomes not always achieved and wide variations in standards both within and between health systems,” according to Health at a Glance: Asia/Pacific 2014: Measuring Progress toward Universal Health Coverage by OECD and WHO.

“Hospitals with high quality services would attract not only patients who can afford, but also preferred health care professionals,” says Krit Pongpirul, quality and research advisor at Thailand’s Bumrungrad International Hospital,
adding, “When the majority of hospitals become more efficient, safety and quality of care would be the key differentiation.”

Cheong adds, “with greater financial resources, we will naturally be able to better enhance our capabilities and add value to our services. Seeking better returns on investments seems easier said than  done, however, as there is still much room for improvement in this area.
According to Bruce Campbell, a neurologist and research fellow at Australia’s Royal Melbourne Hospital, “the efficiency of health care
delivery, regardless of local funding constraints,” remains a common problem among Asian hospitals.

This challenge should be taken positively by hospitals and healthcare professionals to make do and improvise with current resources. “In the face of financial constraints, we may have to discover more efficient processes and cultivate a greater sense of cost-sensitivity
throughout the hospital instead. The quality of our healthcare services and the outcomes received by our patients are sacred to us and should not be adversely affected by financial constraints,” Cheong says.

Meanwhile, some Asian countries seem to be faring better than others as far as patient care is concerned. Singapore, for instance, boasts a superior healthcare system, further bolstered by well-managed hospitals. “We want Singaporeans to be confident that they can always
afford the care they need. Part of this involves managing costs in our system,” says Gan Kim Yong, Singapore’s Minister for Health.

Financing, however, is only one aspect of patient care. “The exact configuration of services varies from country to country, but in all cases requires a robust financing mechanism; a well-trained and adequately paid workforce; reliable information on which to base decisions and policies; well maintained facilities and logistics to deliver quality medicines and technologies,” WHO says.

In order to guarantee the implementation of top patient care initiatives, countries are urged to adopt clear policies or standards that help define and operationalize the best patient care practices. “Where health systems, particularly in developing countries, need to optimise the use of resources and expand population coverage, the improvement process needs to be based on sound local strategies for quality so that the best possible results are achieved from new investment,” according to the OECD.

Some countries, for instance, have defined policies such as Malaysia’s Strategic Plan for Quality in Health, Nepal’s National Quality Assurance
Policy, and Cambodia’s National Policy for Quality in Health, Evaluating Quality Strategies in Asia/Pacific Countries, another joint WHO and OECD survey in 2013-2014.

“A legislative and regulatory framework for quality of care generally addresses three types of health system inputs: health professionals, health services, and the safety of pharmaceuticals and medical devices. Most of these countries responding to the survey have laws related to quality,” according to the OECD.

The manpower factor

In order to ensure quality, hospitals need to be staffed with competent health professionals capable of providing outstanding patient care.
OECD calls them “the foundation of a health care system.”

“Access to sufficient and well-trained physicians, nurses, technicians and hospital staff will continue to be a major concern for the foreseeable future,” says Michael Wong, CEO of Malaysia’s Pantai Hospital Ayer Keroh. The OECD, however, recognizes that doctors’ knowledge and skills need to be regularly updated in order to be properly utilized.

“Licensing, continuous professional education and development and professional certification and re-certification can help assure professional performance,” the OECD advises.

The burden of patient care is the heaviest on the general health workforce for a variety of reasons, according to WHO. “Workers in health systems around the world are experiencing increasing stress and insecurity as they react to a complex array of forces. Ageing population, new diseases, as well as increasing burden of current diseases, escalating conflicts, and violence, are all challenges to which the workforce must be prepared to respond,” the group says.

“The unmistakable imperative is to strengthen the workforce so that health systems can tackle crippling diseases and achieve national and global health goals,” WHO adds. 

Data accumulation and analysis 

Lastly, data gathering and interpretation also play a critical role in providing better patient care, both on a macro and micro level, as more comprehensive patient histories allow doctors and hospitals to monitor patients more closely and accurately, and tap a repository of baseline
information for the classification and recognition of national health trends.

“Health information is a national asset used by policy-makers, planners, health care providers, development partners and the general public to track health-system performance and to support better health policies and make effective health-related decisions,” WHO says.

The value of vital health data in quality patient care cannot be overstated. “Nationally consistent data can help identify system failings and inform policy making, and assist in decision making about the allocation of health resources. Ideally, data infrastructure should enable a patient to be monitored over time, to follow their journey through the health system, and examine their outcomes,” says the OECD says.

According toWHO and the OECD, 22 of the 23 countries it polled reported having nationally available hospital inpatient data. Room for improvement, however, may be found in the areas of cancer registries, prescription medicines, long-term care, psychiatric care, and patient experience.