Modeling the future of health system

Taking healthcare where it needs (TH-WIN)

James Fleck, MD, PhD: Anticancerweb 29 (01), 2023

Primary Health Care (PHC) has a resolution rate of 85%, but when care is restricted to general practitioners, it becomes less cost-effective and, consequently, does not arouse the interest of the private market. As health is everyone's need and right, PHC becomes a tripartite responsibility, including the government, private and social sectors. The lack of administrative creativity overloads and discourages PHC, a sector of undeniable relevance in public health. General practitioners and other health professionals who work exclusively in PHC feel undervalued due to overwork and low financial return, combined with interventions classified as low complexity. However, in a well-designed interactive health system, only 15% of PHC consultations will require highly complex procedures, often associated with higher costs. Currently, High Complexity Health Centers (HCHC) are oversized, as they also offer PHC. HCHC are widely available in large urban areas and their costs are provided by public and private resources, combined with the patient's co-payment, generating an undesirable global out-of-pocket crisis imposed on the patient and family. Logistical barriers generate inadequacy and delay in referral and counter-referral, underestimating the PHC and overestimating the HCHC. TH-WIN will break this paradigm by bringing high complexity decision-making to PHC, using new generation technical inputs to fill in the gaps.

TH-WIN identifies precise and confident patient’s clinical data records as the cornerstone for a well-succeeded integration of PHC and HCHC. The record should be standardized, hopefully using a global semantics. New ontologies are in advanced stage of implementation, which would provide a healthcare paradigm shift in electronic-personal health records (, which would make them globally available. A joint effort of physicians and IT professionals would result in proper program and device implementations. The generated large amount of clinical data (Big Data) could be processed by artificial intelligence (AI), that would provide a new scientific methodology for AI-oriented algorithms, both for clinical and administrative purposes. State-of-the art medical knowledge could be universally available and a collective intelligence effort could orient point-of-care decision making, filling out the imprecise gap, currently observed in a PHC-HCHC variable intersection area (VIA) of any healthcare system. VIA work-up can be customized for different communities, states and countries fulfilling patient’s needs and rights. Referral and counter-referral would be based on telemedicine and telemetry.

TH-WIN would fight inequities, following the principle that healthcare should be universal. Recent COVID-19 pandemic showed how fragile we are. There is no geographic barriers anymore. The planet works like a small community. Everyone's safety is supported by a universal and well-balanced health care system. All communities, states and countries could be reached. The extent of interventions can be designed individually, based on local ICER/QALY criteria. Local, national and international committees would evaluate specific needs and proposed interventions. Taking healthcare to where it needs to be is a rational way of dealing with the current imbalanced distribution of the healthcare system by identifying opportunities for VIA-improvement.

 * Photo by Tomasz Frankowski on Unsplash