健康的未来7：未来的医疗体系

Future of health 7 The healthcare system of the future This year'sFuture of healthstudy, the seventh in our series, takes a slightlydifferent direction from previous editions. Rather than focusing on a single topicof relevance for the healthcare sector and talking in depth to experts working inthe industry, we surveyed the users of healthcare systems – more than 5,000 ofthem, across 25 different countries. Our questions revolved around what it is thatthese ordinary citizens really want from their healthcare systems and, crucially, towhat extent existing systems meet those needs and expectations. Our findings show that across countries there is a high level of agreementabout certain principles: equity, strong coordination of care, effective useof digitalization, investment in public health and prevention, efficient use ofresources and clear governance. But beneath that consensus we find significantdifferences in how these principles should be realized in practice – withcentralized or decentralized governance, for example, or faster or more cautiousadoption of innovations. These differences show that, to be successful, eachsystem must reform in a way that fits its own social and cultural context. The main message of this report is clear: Healthcare reform must implementthe factors that have proven successful in high-performing systems. These aregenuine equity of access, continuous and person-centered coordination, data-driven digitalization, prevention-oriented public health, efficient use of resources,agile, transparent governance and transformative innovation. At the same time,building future systems means balancing shared values with local realities,grounding innovation in empathy and ensuring that reforms are in line withcitizens' expectations. Policymakers, providers and industry players who takethese expectations seriously will be better positioned to design resilient, trustedand high-performing healthcare systems for the decades ahead. Contents The case fora new perspective Rethinking systems for a changinghealth landscape The core assumptions underpinning today'shealthcare systems are increasingly at odds withthe demographic, economic and technological realities ofthe 21st century. Healthcare systems globally are showingsigns of strain, not just due to transient shocks such aspandemics but because of deeper structural mismatchesbetween their historical design and the emerging patternsof disease, aging and innovation. The gap between oldstructures and new realities means that we need a newperspective on how systems are designed, financed andgoverned.A safeguarding safety and quality, and systems will have toremain responsive to the needs and preferences of theirpopulations as those needs evolve. The world is undergoing an unprecedenteddemographic shift. By 2030, one in six people will be over60, and by 2050 the total number will double to 2.1 billion.1This change is accompanied by a parallel rise in non-communicable diseases, caused by a mix of environmental,lifestyle and genetic factors, which now account for nearlythree-quarters of all deaths worldwide.2Conditions such ascardiovascular disease, diabetes and dementia are growingnot only in prevalence but also in complexity and cost,particularly as populations age. These uneven patterns arecreating asymmetries in both care demand and workforcesupply, with the World Health Organization projecting aglobal shortfall of 11 million health workers by 2030.3 As we look at the health systems of the future, it isclear that demographic and epidemiological pressures willchange the disease burden of populations, technologicaladvancements will push spending growth, regulatoryenvironments will need to promote innovation while Healthcare spending is rising faster than economicgrowth in many regions. In the United States, healthcareexpenditure grew at a CAGR of 4.7 percent between2010 and 2022 compared with inflation at 2.5 percentover the same period.4The main cost drivers are agingpopulations, chronic disease and medical progress, whichoffer both opportunities and financial pressures. There isinherent tension between rising expectations and the fiscalconstraints facing healthcare systems. To meet these challenges and harness new thinking,health officials are calling for fundamental reform. As oneEuropean government highlighted, "We need a radicalshift from a siloed system that reacts to crisis, to joined-upservices that anticipate and prevent."7WHO leadership hasechoed this, describing the need for "radical reorientation"toward primary care and prevention.8 Our large-scale global survey makes it clear that reformis urgently needed. The survey covered 5,207 respondentsacross 25 countries,9evenly distributed by age, education,employment, income levels and gender, and including bothlarge and small, developed and emerging economies onevery inhabited continent.10 Too little per capita spending undermines quality,access and the resilience of the system; exc