Our healthcare system needs a new start

Shahrokh Shariat | © feelimage / F. Matern
Shahrokh Shariat | © feelimage / F. Matern

The pressure on medical service providers to bring about a fundamental change in the healthcare system has been growing for decades. However, on the way to a meaningful change it is necessary to overcome hurdles. It is about time to rethink the fragmentation of the healthcare system.

Exploding costs, an aging population, advances in medicine, and growing patient and administrative expectations have made the status quo untenable. Changes in healthcare are inevitable. Waiting does not make the situation better. I have already commented on this in numerous blog entries and articles(1-8)

In my opinion, there is a sensible solution: increasing the patient-centered value in healthcare using the value-based healthcare approach according to Michael Porter. It’s time to turn hurdles into solutions.

Fragmentation in healthcare is a major challenge

The organisational structure in most health care facilities is basically sector-centred. Hospital physicians treat a wide range of diseases relevant to their specialty. A urologist, for example, sees patients with urinary tract infections, offers prostate treatments and treats diseases of the bladder. Doctors are rooted in their specialties and it is assumed that patients will find their way to the appropriate specialty themselves. In this structure, we doctors usually work hard to help patients every time we meet them – and we expect to do our job well in this way. Our efforts are mainly focused on increasing the volume, the quantity of services we provide, in order to ultimately gain expertise, which in turn is measured in patient numbers – and this per specialty.

This approach may have made sense in the past, when it was possible for the few specialists to know everything there was to know medically. Today, however, progress has made many previously incurable diseases treatable, and medicine is rushing ahead with new findings that we need to take into account in treatment. It is therefore essential that doctors from different disciplines work together to provide the best possible state-of-the-art care. For example, a patient with advanced renal cell carcinoma requires care from urology, oncology, radiology, internal medicine and sometimes vascular surgery and intensive care.

Poor coordination, lack of cooperation

But the current isolated and fragmented organisation of care in our country makes multidisciplinary and integrative health care extremely difficult. As a result, duplication of work and unnecessary delays are unfortunately embedded in the structure of the system. In many cases, even patients are forced to coordinate their care and ensure that the various treating doctors communicate with each other.

It also creates the false impression that excellent care is inherently more expensive, which hampers efforts to get patients to the right high-quality medical service providers. After all, more costly is not necessarily better.

For the private practice sector, it is estimated that a patient goes to five to seven different doctors per year on average, to three to four different medical practices. There is little or no integration of medical findings and therapies among each other. The integration of health care between the private practice sector and the clinicians is important and would have a major role in contributing to an increase in value (note: “value” according to VBHC) for the patients. If all physicians involved in health care were integrated as in a large company, teamwork could also become part of the “job description” and self-image. However, the trust that is crucial for well-functioning teams takes time and is a process, also in terms of providing optimal care for patients.

Strategic change instead of selective increases

Fragmentation also means for me that many doctors unfortunately do not see or have the possibility to bring further experts on the specific case of illness directly into the treatment team. (such as nutritionists, physiotherapists, psychotherapists or other professional groups).

There is overwhelming evidence that a high volume of patients with a particular disease is important for success rates. However, politicians often mistakenly equate the increase in the local area with better care. Having more doctors of a particular care service in a region does not necessarily lead to better health for the population. On the other hand, centres with higher patient volumes can often offer more.

Current structures only guarantee patients low or unequal value in treatment and are extremely resistant to change.

The above-mentioned hurdles make it clear that the transition from the old system to a patient-centered value-based system is a real strategic challenge and does not just require a series of individual steps.

Let’s work together on a “reset” for our healthcare system. A real solution is within reach. (See Part 2: Value Based Health Care Management)

This commentary is the first of two parts on the topic “Changes in structure are inevitable”.


  1. Shariat, Shahrokh. 2016: Runter vom „hohen Ross“ im Gesundheitswesen. Blog „Gedanken zur Medizin“, derStandard.at, 21.10.2016
  2. Shariat, Shahrokh. 2016: Wert und Nutzen statt blindes Leistungsdenken. Blog „Gedanken zur Medizin“, derStandard, 11.03.2016
  3. Shariat, Shahrokh. 2015: Qualitätsmessung im Gesundheitswesen hilft Patienten – und senkt Kosten. Blog „Gedanken zur Medizin“, derStandard, 04.05.2015
  4. Shariat, Shahrokh. 2016: Warum sich das Gesundheitswesen auf Behandlungsergebnisse ausrichten muss. Blog „Gedanken zur Medizin“, derStandard, 22.07.2016
  5. Shariat, Shahrokh. 2018: Wettbewerb im Gesundheitswesen – Risiken in Lösungen umwandeln. Klinik 1/2018
  6. Shariat, Shahrokh. 2016: Warum Führungskräfte auf das Krankenhauspersonal hören sollten. Blog „Gedanken zur Medizin“, derStandard, 24.06.2016
  7. Shariat, Shahrokh. 2015: Teamarbeit ist die Zukunft der Medizin. Blog „Gedanken zur Medizin“, derStandard, 31.07.2015
  8. Shariat, Shahrokh. 2014: Warum nicht jedes Spital alles anbieten muss. Blog „Gedanken zur Medizin“, derStandard, 20.11.2014
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