Presentation (CTI)

OBJECTIVES: Health systems are under increasing pressure due to ageing populations, rising prevalence of non-communicable diseases, escalating healthcare costs and competition for government funds. These challenges have been further intensified by the COVID pandemic, health workforce shortages and geopolitical instability. This research identifies key barriers and enablers for health system redesign across OECD countries, to better inform policies that effectively facilitate change, prevent the deepening of health inequalities, and put patients at the centre of healthcare and decision making.
METHODS: A mixed-methods approach, combining a scoping literature review with semi-structured interviews informed this research. Interviewees included experts from OECD and other selected countries. We identified examples of health system redesign, plus barriers and enablers across three key areas: service delivery decentralisation and patient-centred care; screening and early treatment; and workforce transformation.
RESULTS: Over 100 examples of health system redesign were identified from ten interviews and analysis of 200 peer-reviewed articles and reports. Most redesigns occur at the local level, driven by bottom-up processes responding to specific community needs rather than national strategies. Initiatives were typically reactive, triggered by local pressures such as service gaps or access challenges. Over 30 barriers were identified across a range of categories including political, governance and policy; cultural and perceptual; digital and technological. Over 30 distinct enablers were identified including, for example: effective mechanisms for meaningful engagement of communities to develop integrated responses and build trust; shared decision-making, personalised care planning, and behavioural nudges to support self-management; patient navigators to help patients access effective treatment and care; and culturally relevant health literacy campaigns.
CONCLUSIONS: Healthcare redesign is the result of reactive responses to specific challenges. Though barriers and enablers to redesign vary by context, many are universal. Health policies must ensure these are considered while proactively addressing the specific challenges in order to effectively facilitate redesign.