Research Article: Evidence-based restructuring of health and social care

Date Published: November 14, 2017

Publisher: Public Library of Science

Author(s): Aziz Sheikh

Abstract: In this Perspective, Aziz Sheikh discusses research to evaluate health policy changes in the provision of care, commenting on a study by James Lopez Bernal and colleagues that examined specialist-dominated hospital care versus community-based care in the United Kingdom.

Partial Text: There is now across the world increasing policy interest in the need to restructure health and social care such that it is better suited to the needs of people living with long-term conditions. Although the emergence of the specialist hospital sector was an appropriate response to cater to the large numbers of people affected by life-threatening infectious disease epidemics, the burden of disease now predominantly arises from noncommunicable disorders. The use of hospitals as the mainstay of care for people living with long-term conditions is inconvenient for patients and an inefficient use of public resources.

Bradley and Taylor’s investigations in The American Health Care Paradox threw into sharp relief the need to consider expenditure on both health and social care in order to understand the relationship between expenditure and health outcomes [4]. This analysis, which has been widely debated in health policy circles, has underscored the need to integrate health and social care budgets in order to maximise the potential for health gains; for example, modest investments in home adaptations and mobility aids may be the difference between an individual’s ability to manage independently and a prolonged hospital admission.

Health is largely won or lost on the basis of major health policy decisions, but these are seldom evaluated [5]. The reasons are complex, including the time and costs of undertaking such evaluations and the distinct possibility that they may reveal inconvenient truths. Politicians, especially those operating in liberal democracies such as the United Kingdom, are vulnerable to the effects of adverse publicity associated with what are often perceived as ‘failed’ government initiatives. These political challenges are real and not easily overcome until such time as there is a cross-party, longer-term approach to restructuring care.



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