Intended for healthcare professionals


Delivering health with integrity of purpose

BMJ 2015; 351 doi: (Published 17 August 2015) Cite this as: BMJ 2015;351:h4448
  1. Albert Mulley, director1,
  2. Tessa Richards, senior editor/patient partnership2,
  3. Kamran Abbasi, international editor2
  1. 1Dartmouth Center for Healthcare Delivery Science, Hanover, New Hampshire, USA
  2. 2The BMJ
  1. Correspondence to: K Abbasi kabbasi{at}

Health systems must learn how to co-produce and deliver services that patients and the public value

Unsustainable costs of care and rising demand from ageing populations are forcing health systems to reform. Fundamental shortcomings in current models of healthcare contribute to wide variations in quality, access, harm to patients, and waste that now consumes 20-40% of health resources. Over one billion people worldwide do not get the care they need.1

We are at a crossroads. We can continue with business as usual, repeating the mistakes of market driven and tax funded healthcare economies, investing more and expanding health services based on traditional models of delivery. But this means more countries will face soaring public deficits. These will force urgent stop-gap measures that compromise the quality of care and divert resources from investment in the social determinants of health, which contribute more to longevity and wellbeing than healthcare itself.2

Or we can do things differently, beginning with questioning three assumptions that still dominate thinking about healthcare.

The first is that increasing provision will improve population health. Medical interventions that consume more than 90% of healthcare spending in high income countries avert as little as 10% of the preventable mortality in these countries. …

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