Home health care could help sustain health care systems, study finds

Home health care technology may provide one important solution to global concerns about how to sustain health care systems threatened by rising costs and manpower shortages, but such a change faces multiple obstacles to adoption, according to a new RAND Corporation study.

The study finds that a wide array of health care stakeholders agree that expanding home-based health tools could give patients a greater ability to self-manage their conditions in partnership with their medical providers, and help improve their health and overall well-being.

However, moving care to patients' homes would be a major shift in the structure of health care and can be accomplished only if consensus is reached between patients, health care providers, insurance companies and policymakers, according to the report.

"The aging of the world's population and fact that more diseases are treatable will create serious financial and manpower challenges for the world's health care systems," said Dr. Soeren Mattke, the study's lead author and a senior natural scientist at RAND, a nonprofit research organization. "Moving more health care into the home setting where patients or family members can manage care could be one important solution to these challenges."

The findings are from a global study of the needs, expectations and priorities regarding home health care among key stakeholders in six countries -- China, France, Germany, Singapore, the United Kingdom and the United States. Researchers conducted interviews with government officials, regulators, providers, insurers, manufacturers, distributors and patient organizations, as well as reviewing existing research about home health care.

An increase in the world's elderly population, coupled with better treatment for many diseases, is expected to increase the number of people living with chronic conditions and disability in the decades ahead, putting pressure on the finances and the workforce of health care systems. In the United States, for example, people age 64 and older account for 12 percent of the population, yet incur 34 percent of the nation's total health care spending.

While this trend started in the developed world, it is increasingly affecting developing and transitional nations. For example, Singapore has become the world's most rapidly aging country and already 80 percent of all deaths in China are caused by chronic disease.

Home health care is an attractive solution because it empowers patients to self-manage their conditions to a greater extent and helps to shift care from high-cost institutional and professional settings to patients' homes and the community. Such a change could both save money and ease pressure on health systems suffering from worker shortages and capacity constraints, researchers say.

Home health care technology spans a broad spectrum from basic diagnostic tools, such as glucose meters, to advanced telemedicine solutions. Those advances have pushed the frontier of care management further into the home setting. The advances have the potential to not only support current care delivery, but to fundamentally change the model to a more efficient and more patient-centered one, according to the report. Home care also makes it easier for patients to age in place, if they prefer, and avoid institutionalization.

Despite the promise of expanding home health care, these technologies face a number of barriers to adoption. Restrictive insurance coverage and existing incentives for in-person home care creates obstacles, as does limited patient readiness because of insufficient health literacy, according to the study. Concerns about audience-appropriate product design and support, and limited information about whether the technology is effective and efficient also poses barriers to adoption.

While there are signs that home health care increasingly is on the radar of policymakers in many countries, researchers say that both the policy environment and the products themselves must be redesigned to realize the potential benefits.

Policymakers will have to develop a vision for the appropriate role of home health care and drive the agenda to implement that vision, the study says. Key components of that agenda will be the alignment of payment systems and incentives with policy goals, clarification of the regulatory framework for home health care technology, and efforts to promote patient receptiveness for new models of care delivery.

Manufacturers will need to develop affordable products with intuitive designs that meet patient needs, provide ongoing support for patients and their families, and integrate services and data with those of other professional care providers.

Companies also must provide evidence for the clinical and cost-effectiveness of home care products, while health care providers will need to embrace a new role as partners of their patients in the care process, rather than paternalistic caregivers, according to researchers.