Healthcare Development

Healthcare and healthcare systems: inspiring progress and future prospects

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Abstract
Background
Healthcare systems globally have experienced intensive changes, reforms, developments, and improvement over the past 30 years. Multiple actors (governmental and non-governmental) and countries have played their part in the reformation of the global healthcare system. New opportunities are presenting themselves while multiple challenges still remain especially in developing countries. Better way to proceed would be to learn from historical patterns while we plan for the future in a technology-driven society with dynamic demographic, epidemiological and economic uncertainties.

Methods
A structured review of both peer-reviewed and gray literature on the topic was carried out.

Results
On the whole, people are healthier, doing better financially and live longer today than 30 years ago. The number of under-5 mortality worldwide has declined from 12.7 million in 1990 to 6.3 million in 2013. Infant and maternal mortality rates have also been reduced. However, both rates are still considered high in Africa and some Asian countries. The world’s population nearly doubled in these 30 years, from 4.8 billion in 1985 to 7.2 billion in 2015. The majority of the increasing population was coming from the least developed countries, i.e., 3.66 to 5.33 billion. The world will be short of 12.9 million health-care workers by 2035; today, that figure stands at 7.2 million. Health care expenditures among countries also show sharp differences. In high income countries, per person health expenditure is over USD 3,000 on average, while in poor countries, it is as low as USD 12, WHO estimate of minimum spending per person per year needed to provide basic, life-saving services is USD 44. The challenges faced by the global health system over the past 30 years have been increased in population and urbanization, behavioral changes, rise in chronic diseases, traumatic injuries, infectious diseases, specific regional conflicts and healthcare delivery security. Over the next 30 years, most of the world population growth will occur in the urban areas of poor countries. The rapid, unplanned and unsustainable style of urban development will make developing countries cities the key focal points for emerging environmental and health hazards. Changes will be seen in design, culture and practices of hospitals to better meet the needs of patients, families and providers. Top driving factors of global healthcare system for next 30 years will be leading causes of mortalities, non-health factors (impact of nutrition, sanitation and women’s empowerment), investment in health workforce and growth of medical tourism in future healthcare scenario.

Conclusions
Evaluating the patterns of previous 30 years and predicting the progress and challenges of future health system are no rocket science. Medical care will be more self-directed in a more tech-savvy population as information will be more accessible and user friendly with higher quality. Health driving factors such as clean water, sanitation and food will take the center stage in humanities struggle and even increase population size.

Keywords: Health systems, indicators, progress, achievements, challenges, future of healthcare, technology in healthcare
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Introduction
Health care and health systems all over the world are undergoing intensive reforms. Internationally, the existing institutions for multilateral cooperation are facing unprecedented challenges. Many institutions are finding it increasingly difficult to fulfill their mandates. There are inefficient overlapping efforts among various multilateral organizations, but paradoxically, there are responsibility voids in executing some key functions. At the same time, other players, such as non-governmental organizations and transnational corporations, are gaining prominence.

In today’s more complex world, it is difficult to define health systems, what it consists of, where it starts and where it ends. The World Health Organization in its report on Health systems in 2000 defined health systems as “all activities whose main responsibility is to promote, restore and maintain health” (1).

Multiple forces are transforming the pattern of disease and health as well as creating a need for new institutional arrangements. Just as governments are reinventing their respective national health systems, international health must be rethought so that it can respond effectively to the emerging challenges.

The current paper discuses opportunities and challenges around global health care systems in next 25–30 years. The paper will analyze the future needs of healthcare in next 30 years and review key achievements and challenges faced globally both in developing and developed countries. Geo-political and environmental forces will drive the transformation of health care delivery and finance over the next decade, leading to changes in hospital and health system.

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Methods
A structured review of both peer-reviewed and gray literature on the subject was conducted. The search was conducted using the keywords “health systems progress”, “achievements”, “challenges, health indicators, future of healthcare” and “technology use in health”. The relevant information was collected.

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Results
The result section was divided into two parts, including health systems progress over the last 30 years and health systems of future. These results were further grouped into categories and themes for better understanding.

Health system progress [1985-2015]
To move towards the future, it is extremely important that one must build on its past success and adapt to changing economic, demographic and epidemiological realities. On the whole, people are healthier, wealthier and live longer today than 30 years ago. If children mortality was still the same as that in 1978, there would have been 16.2 million deaths globally in 2006. Based on the latest UNICEF estimates, published in September 2014, the number of under-5 mortality worldwide has declined from 12.7 million in 1990 to 6.3 million in 2013, an overall decline of 50.3%. About half of these under-5 deaths occurred in only five countries: India, Nigeria, Pakistan, the Democratic Republic of Congo (DRC) and China (2). The 50% reductions of under-5 deaths can be attributed to the decrease in pneumonia, diarrhea, and measles. According to the statistics, these three illnesses were responsible for most of the deaths. However, if the trend continues even with this reducing rate, about 4.4 million children younger than 5 years will still die in 2030 (3). A number of initiatives gearing towards the improvement in the overall health status were commenced during these years, including Millennium Development Goals in 2000, Global Strategy for Women’s and Children’s Health in 2010 by the United Nations Secretary-General.

Population
The world’s population doubled between 1965 and 2010, reaching to 7 billion a millstone in 2011. Another historical milestone was achieved in 2007 when 50% of the global population lives in cities and towns, making urban centers the dominant habitat for humankind (4). Fertility decline and increased longevity contributed to increasing numbers and proportion of people aged 60 and over. Currently, there are 810 million people aged 60 and over worldwide, with a projection of 2 billion by 2050 and more people will be over the age of 60 than those aged 14 and under (5). In the future, population growth will occur mainly in developing countries. With relatively high birth rates and a high proportion of young people, populations of the least developed countries are projected to double from 803 million in 2010 to 1.7 billion by 2050. Table 1 gives comparison of global population between more developed regions and less developed regions in 1985 and 2015.

source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5344175/

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