Health Policy January 29, 2019
How to Develop a 21st Century Health System

By Dr Mark Britnell - World Healthcare Journal

What does the perfect health system look like? Asks Dr Mark Britnell, Global Chairman & Senior Partner, Healthcare, Government & Infrastructure, KPMG International.

As Global Chairman for Health for KPMG, I’ve had the privilege of working in 78 countries on more than 350 occasions over the past decade. This has provided me with a unique opportunity to look closely at the strengths and weaknesses of health systems around the world.

In this series of articles we explore a number of these aspects in further detail, bringing you our practical knowledge and experience of health systems and services from our leaders across our international healthcare practice network: 

  • Building universal health coverage and payor mechanisms
  • Delivering a healthcare workforce fit for the future
  • Health infrastructure and public private partnerships
  • Regulation and governance across healthcare
  • Strengthening primary and integrated care
  • Health worker training and education
  • The role of prevention and digital health
  • Health data and data governance 

Globally, governments and businesses are enabling more patients to access universal healthcare (UHC), which has led to marked improvements in life expectancy.

By improving public healthcare, governments and businesses are increasingly recognising the economic and social benefits of a healthy, long-living population.

These latter points are important, as politicians realise that investment in “healthcare for all” is a value and not just a cost.

It has been estimated that a one-year increase in life expectancy can increase GDP per capita by 4 per cent, and the recent Lancet Commission noted that reductions in mortality in low and middle income countries accounted for approximately 11 per cent of recent economic growth. Given the ways in which healthcare has a direct gain on a country’s GDP, new global health funding streams have increased dramatically and remains an almost uniquely favoured area of interest for international donors.

KPMG’s new Center for UHC exists to help countries overcome these issues. We have developed an unmatched suite of tools, intelligence, insights and experience to make UHC reforms a success.

Despite this, our recent study with the World Economic Forum has emphasised the importance of ensuring that health system incentives, structures, and policies are aligned in order to achieve this. Our report demonstrated that if all countries performed at the level of the best in their spending group, average global life expectancy would cumulatively increase by four years. While some health systems are better aligned than others, many examples of alignment coexist with significant misalignments, conflicts and inefficiencies. The question is how we can learn from others to ensure we get this right.


The world doesn’t have a perfect health system, but if it did, it might look like this:

  • The values and universal healthcare of the UK
  • Primary care in Israel
  • Community services in Brazil
  • Mental Health and well-being in Australia
  • Health promotion of the Nordic countries
  • Patient and community empowerment in parts of Africa
  • Research & Development in the US
  • Innovation, flair and speed in India
  • Information, communication and technology in Singapore
  • Healthcare choice in France
  • Health funding in Switzerland
  • Aged care in Japan 

As health systems around the world grow, strengthen and mature in the coming years, what does the future vision look like? It will be increasingly important to understanding what citizens want, with reforms frequently failing to deliver their promise of building the system around the patients that use them. A ‘Paradigm Shift’ is needed; the current care model is heavily focussed on the hospital, and around the world we are seeing a pivot towards strengthening primary care led models, underpinned by patient and clinician activation and engagement to enable the behaviour changes needed.

Delivering this successful shift will entail a move from the traditional approach of building and organising around providers to focusing on organising around demand (the patient) and a focus on expanding primary care coverage with more highly skilled professionals to manage a broader set of chronic conditions. This will be supported through a smart and technology-enabled front line healthcare delivery mechanism to maximise the provision of care within existing human resource.

The complexity of reinventing health across a nation, whilst also reinforcing the critical role it plays in developing a sustainable, accessible and cost-effective healthcare system, is a huge task requiring the greatest minds and world-class experience. I am proud that KPMG Healthcare brings both to clients around the world, and pleased to share some of our learning with you in the sections that follow.


Same solutions, Different countries

  1. Prevention and promotion across public and private sectors
  2. Population and patient segmentation and stratification
  3. Scaled-up primary care
  4. Centralised and localised clinical services as necessary
  5. Clinical pathways supported by improvement science
  6. Workforce development and motivation
  7. Hospitals as health systems
  8. Medical home as a hub for aged care
  9. Community-based mental health services
  10. Patients as partners. Communities as carers. A dignified death.

Mark Britnell is KPMG’s Global Chairman & Senior Partner, Healthcare, Government & Infrastructure, and one of the foremost global experts on healthcare systems. He has a pioneering and inspiring global vision for health in both the developed and developing world, having led healthcare organisations at local, regional, national and global levels – provider and payer, public and private.

E: Mark.Britnell@KPMG.co.uk | T: +44 7771 772194, +44 207 6942014


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