Time for a checkup. How do patients perceive access to healthcare?

What are the big healthcare challenges in individual countries? (8 min read)

Experts from Germany, Japan and the United Kingdom offer unique ideas to tackle issues such as aging populations, budgetary pressures and increasing demand for services.

Jul 04, 2017

Listen to audio version (8:49)

It is a sad fact that medicines do not always reach the people that need them. Every day someone struggles to get the medical help they need, even in upper-middle- to high-income nations with advanced healthcare systems. Globally, about every second adult (55%) perceives access to healthcare as low in their country, according to the 12-nation Sandoz Healthcare Issues Perception Study (SHIPS) 2016. Medical professionals have even stronger views. In the same survey, some two-thirds of healthcare experts (67%) say that access to healthcare could be better. They are also worried that caring for ever-increasing numbers of elderly citizens in these countries will strain medical services.

Seeking medical care Percentage of patients who can get a same-day appointment

What must healthcare systems do to bring new and existing medicines to people, and to overcome shortages in medical care? Medical professionals, and patients themselves, are helping to identify problems and are suggesting ways to improve the situation. Here, experts in Germany, the United Kingdom and Japan give their opinions on the challenges facing their country’s healthcare systems, and offer unique ideas to tackle these issues.

Germany - A balancing act for healthcare providers

Dr. Michael Fiek, cardiologist, Munich, Germany

One of the great healthcare success stories of the past century is that people are living longer than ever. In Germany, for example, life expectancy has doubled in this period.¹ Yet as people age, they are more likely to suffer from chronic conditions and issues related to lifestyle.

Nationally, more than 356,000 people died of cardiovascular diseases in 2015, ² often after years of living a sedentary lifestyle combined with too much stress – a damaging combination, says Dr. Michael Fiek, a cardiologist and senior physician in Munich, Germany. “People are getting older and older, which means they are also sicker and live longer with their illnesses,” says Fiek. It also means that they place greater demands on healthcare systems.

At the same time and to address those budgetary challenges, Germany’s healthcare sector is shifting toward greater efficiency and reducing costs.³ While this is a necessary step, Fiek believes that the growing emphasis placed on profitability from medical care needs to be managed carefully so that it doesn’t put physicians under pressure. “Our daily balancing act is providing good medical care despite an aging population.”

Patients should be given adequate medical and specialist treatment without having to wait months for an appointment.

Dr. Michael Fiek, cardiologist and senior physician, Germany

One example of a shift in how patients access hospital care can be seen in the increase in for-profit hospitals, and in the expansion of hospital chains. Germany has a mix of public hospitals, private non-profit hospitals and for-profit hospitals. Between 1990 and 2014, the percentage of private, for-profit hospital beds has risen by nearly 230%, despite an overall decrease in hospital beds by almost one-fourth.⁴

Although trends such as hospital privatization could help reduce costs to the healthcare system overall, Fiek and others want to ensure that any reforms result in more individualized treatment. “Many doctors today hope that the drive to profit in medical care will focus on providing patient-centered care,” says Fiek. He goes on to suggest that one way this could be achieved is if for-profit hospitals have to direct some of their returns back in to hiring more staff and improving medical facilities. He believes that this way, it might be possible to ensure that patients receive adequate medical and specialist treatment without having to wait months for an appointment. Both are important for improving access to medical services for patients in Germany, including the growing numbers of elderly.

Japan - Western conditions in the Far East

Goro Ikushima, Head of Pharmacy Department, Matsudo City Hospital, Japan

In Japan, medical professionals are seeing an increase in what they consider “Western” health conditions such as an unhealthy diet, high blood pressure and physical inactivity.⁵ These are among the top ten health risk factors in the Japanese population. Whereas two decades ago, 15% of the overall government expenditure was on healthcare, this share has risen to more than 20 % today.⁶ Goro Ikushima, head of the pharmacy department at Matsudo City Hospital, Japan, is concerned.

“An increase in lifestyle-related diseases such as diabetes among adults is already a problem in Japan; it is not an issue to be addressed five or ten years in the future,” says Ikushima. One of the unintended consequence of globalization leads is, for example, a spread of fast food, snacks and sugary soft drinks.⁷ Japan therefore now has new public health and educational campaigns under way, to encourage people to eat less fast food, or not to smoke,. “I’d say this is an issue that will also become relevant to African countries, where the diet is becoming increasingly westernized, and in China, too” says Ikushima.

For certain care routines, a pharmacist can provide equivalent level of medical service as a doctor.

Goro Ikushima, Head of Pharmacy Department, Matsudo City Hospital, Japan

Another factor behind the increase in chronic illness and healthcare expenditure is age. As the ranks of senior citizens in Asia grow, the incidence of age-related health conditions is also increasing. Ikushima believes that the aging population is actually the greatest challenge to his country’s healthcare system. He has been thinking a lot about how to meet new demands in the coming years, yet he sees the challenges as an opportunity to introduce change.

Based on his own experience, he advocates a reassessment of medical roles in the country: “In Japan, students who want to become pharmacists study for at least six years, and gain extensive knowledge of medical conditions. So it could be an option that for certain types of services – such as using a stethoscope or taking a blood sample - pharmacists are equipped to perform those services as well.”

Particularly for elderly patients who have limited mobility, removing the need to visit physicians for routine check-up procedures could increase their access to medical services.

In Japan, the aging population is challenging the country’s healthcare system. However, some medical professionals see it as an opportunity to introduce change.

The UK - Technology to the rescue

Monica Fletcher, Chair of UK Inhaler Group, United Kingdom

Longer lives, accompanied by growing numbers of chronic or lifestyle illnesses, are also key trends presenting challenges to the healthcare system in the United Kingdom. The country’s National Health Service (NHS) offers comprehensive care, but relative to several other high-income nations, the NHS has fewer doctors to go around (2.8 doctors per 1,000 patients)⁸.

“In the UK in particular, we are seeing an increase in demand of our healthcare services. Physicians are struggling to keep up,” says Monica Fletcher from the UK Inhaler Group, a coalition for people with respiratory diseases. She believes that technology can make better access to healthcare possible. Her suggestion is to give patients more control over monitoring their own health.

Seeing the doctor Countries with the most physicians per 1,000 population

“I really hope that we are soon able to harness the use of technology to improve access to services in a way that has already been achieved in other sectors, such as banking,” says Fletcher. “In those sectors, we use contactless cards, wireless technology and online banking 24-hours a day, almost seven days a week. We should be able to do the same when it comes to monitoring our health.”

I hope that we are soon able to harness the use of technology within health services. The possibilities are endless.

Monica Fletcher, Chair of UK Inhaler Group, United Kingdom

Finding a digital way to reduce “paperwork” could also help relieve the high workloads that healthcare staff must handle, Fletcher adds. “If, for example, patients had access to their own medical records, this would result in less administrative, time-wasting interventions.”

Monica Fletcher is optimistic that technology can help bridge the gap in medical services in her country, and in healthcare systems elsewhere. Many examples of this already exist, including telemedicine, and mobile health applications, all of which put medical services and medical information directly in patients’ hands. There is a high need for such services, and both medical professionals and patients alike are coming up with suggestions for ways to improve access to medicines, medical information, and treatment in their societies. “The possibilities are endless, really,“ Fletcher adds.