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Global Healthcare Megatrends: Regulatory requirements

There are more than 7 billion people on the planet today. Our growing global population has triggered some of the biggest healthcare challenges we’ll ever face. Listening to clients in Australia, Canada, Singapore, United Kingdom and United States, I believe many of these issues are universal. This is the fourth post in a five-part series that explores the clinical, population health, financial, regulatory and technical challenges we share as a global healthcare community.

Governments play an important role in standardizing healthcare systems around the world. They regulate three primary areas:

1)      Reimbursement

Governments regulate healthcare because it is a significant portion of the global economy. Australia, Canada and the United Kingdom spend about 8-11% of their Gross Domestic Products (GDPs) on health care.

The United States outpaces all other countries by spending a whopping 17.9% of its GDP on health care. Unfortunately this spend does not result in better outcomes. Many countries are trying to incentivize better outcomes with new reimbursement models (insert link to Financial models post).

These swiftly evolving and significant markets require government oversight. Especially for developed countries with private insurance companies. To ensure quality and protect patients against things such as bogus insurance policies.

2)      Quality measures

Government agencies strive for better care through a series of quality measures. Some items are mandatory – such as Meaningful Use in the United States. Others are voluntary best practices – such as National Institute for Health and Care Excellence (NICE) in England.

The more quality measure entities there are, the more opportunity there is for overlapping regulation from one agency to another. All have developed their metrics with the best of intentions, but the complexity can be challenging.

Governments around the world are looking to harmonize these quality measures. Singapore, for example, is looking to standardize a national drug database. These are Herculean efforts to determine how to share and standardize information.

3)      Certification

Governments around the world are backing healthcare IT and Electronic Medical Record (EMR) initiatives. The United States and United Kingdom top the list with US$19 billion and US$12 billion respectively.

It stands to reason that governments want to certify solutions that are capable of managing the complex healthcare environment. Vendors have devoted a lot of research and development resources toward these certification goals, especially over the last couple of years.

Some would argue that spending this amount of effort on government certification has a negative impact on innovations in usability and new features. It is certainly a challenge to balance the many priorities competing for attention.

Regulatory environments vary in terms of their formality, structure and centralization. But they all have the best intentions to provide better patient care for better outcomes.

One of the great challenges being encountered by the healthcare industry is ensuring appropriate quality of care while not inhibiting innovation.  Too much regulation can divert financial and human resources away from other innovative and vital development and adoption efforts.

How are regulatory requirements affecting your organization?

Editor’s Note: In Dr. Samo’s next blog post, he’ll describe the global technical landscape of Healthcare IT. Previous posts covered clinical challengespopulation health and financial models.

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About the author

As Allscripts Chief Medical Officer, International, Toby helps establish long-term clinical strategy and short-term priorities for Allscripts solutions. Additionally, he is responsible for executive-level and physician sales support. He is also the single point of accountability for customer experience, business performance and solutions roadmap and the forward looking strategy of the clinical solutions for International Markets. He is also the Patient Safety Officer for Allscripts. Previously, Toby was Medical Director of Information Technology at The Methodist Hospital (Houston, TX), a long-time Allscripts client, and Vice President of Medical Informatics at Physia Corporation. Prior to these positions, Toby has had a long career in private practice as an Infectious Disease physician.

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