State-of-the-art excellence in a healthcare system is an essential component of an ideal healthcare system. This post describes the components of a state-of-the-art healthcare system. It also discusses why these components are important and how they can be measured.
Does the Healthcare System Use State-of-the-Art technology, knowledge, Research, and Clinical Best Practices in Managing Individual and Population Health?
There are four variables that characterize state-of-the-art healthcare: technology, knowledge, research and clinical best practices. These variables represent a combination of physical and human capital. Together they provide the tools required to have a significant positive impact on individual and population health. Each of these variables can be measured for each major healthcare institution in a country and then aggregated over these institutions to get a value for this attribute for each country.
The technologies used in healthcare can usually be measured to a reasonable degree of accuracy by estimating capital expenditures in each institution per year and aggregating over those institutions in the country. Accounting methods exist to estimate the value of old equipment that is still being used. This is measured in PPP US Dollars.
This can be measured by number of years of education and training, CME credits, MOC activities for the faculty and staff of each institution. This is a plain number.
We will restore science to its rightful place and wield technology's wonders
to raise health care's quality and lower its costs.
The obvious variable to measure is first of all the number of publications by faculty and staff weighted by journal rankings (such as those published by SCImago). In addition, research grants awarded to each faculty and staff can be computed. This is a combination of Dollars and a plain number.
This can be measured by the number of evidence-based best practices established in each institution. This is a plain number.
Since there are four variables which are evaluated by expenditure Dollars and plain numbers, it is best to rank countries in each of these variables and then take the equal weighted aggregated rank for the attribute of state-of-the-art excellent healthcare.
This method of aggregation is one possibility and there can be alternative ways to estimate this attribute. The OECD data on healthcare 2013 suggests using MRI machines per 1000,000 population and MRI exams per 1,000 population as proxies for medical technology. One could also use the percentage of primary care physicians using EMR as another proxy.
The important observation is that there are four components that characterize what it means to be state-of-the-art. Proxies can be assigned as adequate measures for each of these components. These proxies can then be summed to yield a measure of state-of-the-art variable.