Why We Should be Promoting 'Right Care'

Even as we applaud increased and better access to healthcare in Asia Pacific, The Lancet’s January issue introduces the concept of “Right Care” as the next frontier in creating health systems that are universal, safe and effective. In a series of four papers (free to read with registration), the authors focus on two types of seemingly contradictory problems in the healthcare industry worldwide: significant overuse of ineffective care, and underuse of effective care.

In China, overuse of ineffective care manifests as about half of antibiotics being unnecessarily prescribed to patients. In India, a second opinion centre said it advised against cardiac interventions in 55 per cent of patients for whom surgery was initially recommended. The WHO estimates that 6.2 million excess C-sections are performed each year – with Brazil and China accounting for nearly 50 per cent of these procedures.

Yet, the simple use of steroids to prevent premature births is much lower than it should be after nearly 40 years of evidence to support it. Recent news reports about rates of cervical cancer deaths being higher than originally thought in the United States are shocking. Cervical cancer is after all, one of the most preventable cancers and eminently curable when caught at an early stage. The fact that women are still dying of this disease points to underuse of effective preventive care like vaccines along with HPV DNA testing to identify women at high risk of the disease and help them manage it.

Overuse and underuse co-exist in the industry due to a host of complex reasons. However, the authors argue that shared decision-making between physician and patient could be a powerful lever to shift the balance closer to Right Care. They provide an inspiring vision of care that weighs up benefits and harms, takes individual circumstances, values and wishes into account, is evidence-based and cost-effective.

As healthcare communicators, we work with brands every day that are operating within what this article would define as the “grey zone” – where the benefit vs. harm ratio for a given patient is uncertain. Most of our clients acknowledge the importance of involving patients in decision-making to achieve a balance between potential benefits and acceptable harms of any given treatment.

That is in theory. But in reality, patients in both developed and developing markets in Asia-Pacific do not always have the necessary information or confidence needed to realize this vision of shared decision-making. Providers are too time-starved to explain complex information in an easily understandable format and patients are frequently too scared to ask questions.

This is where health communicators and brands can work together to go beyond the transactional nature of the launch of a new drug/device/test/procedure and provide resources that can truly empower both patients and providers. This means developing clear, simple messages about diagnosis, treatment options and benefits vs risks of treatment decisions. It also means equipping healthcare professionals to explain complex treatment and management pathways in a simple and relatable manner.

The authors argue that elimination of clearly ineffective care would free up funding to address unmet health needs. This would create demand for a new way of accessing and delivering the care that is right for the individual and health systems. While there will be winners and losers on the way to ‘Right Care’, in the end, the need for all to have access to quality, essential health-care services is a vital opportunity that we as communicators can help achieve.