By Graham Dover, PhD
I was fortunate in my training. I was introduced to the costs of care in a unique and powerful way when I joined the National Health Service in the UK, the largest single-payer health care system in the world, at a time of profound change.
Our task was to implement a revolution in primary care – to devolve health care budgets to GPs so that they could directly manage their prescribing and elective care. As part of the program, these doctors received key information such as prescribing patterns in their group and referral rates. Variances sparked lively debates between physicians that led to significant changes in patient care. In my practice, the doctors used their new knowledge to increase their use of generics and negotiated contracts with providers to secure higher quality care for more patients. Up until that point, the costs of care were either considered on an individual patient level, or not considered at all (someone somewhere would pick up the tab). I had the privilege to work alongside these doctors and watch them extend their advocacy role from patient to system transformation.
Many years on, the need for physicians to continue to play such a role is more critical than ever. The complexity and scale of health care systems can disconnect values from action and make change extremely difficult, to the point that it’s often easier to maintain systems than deal with the costs of dismantling them. Nowhere is this more evident than in the way medicines are discovered, developed and distributed. The majority of people accept that this system is broken but few can imagine any alternative. Many have come to accept the rising price of medicine as inevitable.
The consequences are dire. The World Health Organization estimates that 10 million die each year because of lack of access to medicine that exists but is financially out of reach, while more than 100 million are forced below the poverty line because of medical expenses. There is a myth that this is just a developing world problem: One in 10 Canadians struggle to pay for their drug treatments, even if they have insurance, and fifty million Americans are skipping their medication because of cost.
On World Health Day, April 7th 2014, an Initiative was launched – www.accessourmedicine.com, . It has a simple statement: Everyone should have access to affordable medicine. In a matter of weeks, and with minimal fanfare, more than 30,000 people from over 140 countries have signed this declaration. Many of the signatories are physicians who think that there needs to be a shift in mindset from the belief that breakthrough innovations must be expensive and thereby exclusive to the conviction that health care innovations can only be considered truly innovative if they are affordable to all.
The Access Our Medicine Initiative is taking its collective voice to world leaders setting global priorities for the next 10-15 years in order to ensure that access to affordable medicine is part of the 2015 United Nations Sustainable Development Goals. If successful, this will establish a clear baseline from which to measure performance and also help to galvanize and connect the efforts of those developing solutions around the world.
In practice, much will depend on the participation of front-line professionals – especially physicians – able to articulate the “lived experience” of their patients and to participate in proposing and supporting system change. It won’t be easy. So much is invested in keeping things as they are and yet transforming access to medicine requires disrupting complex sets of institutions. This is possible. Our experience with HIV/AIDS shows the power of creative collaborations, in which physicians play a pivotal role, to develop affordable medicine. The challenge now is to secure affordable medicine for all diseases for all people.
Please consider adding your voice by signing the declaration at: http://bit.ly/1fVj7Qo
Graham Dover, PhD, Executive Director of Mindset Social Innovation Foundation. The Foundation is one of the supporters of the Access Our Medicine Initiative.