With less care, more health: how we can make this happen

The title of your inaugural lecture is ‘With less care, more health’. How do you envision this?

“My field is population health management. Its core is keeping people healthy and preventing disease by using data. One organisation is responsible for the health of a defined group of people. If we can better identify who is likely to face problems and when, and where people develop more risk factors than necessary, we can prevent many things that we currently let happen.”

Can you give an example of something we currently let happen?

“Take someone who is discharged after a hospital stay for COPD. We can use data to predict the chance that this person will be readmitted within thirty days. We send people home with the advice to take their medication, stop smoking, stay active and live healthy. That advice focuses on the individual: you must take care of your own health. But we know that following this advice is difficult for some people. Based on prediction models, maybe we should take a different approach for them to prevent readmission. For example, by involving their social network. These are the people who want to keep their loved one healthy and who have a big influence.”

“Within healthcare, we could also organise ourselves better with a more integrated approach. The medical specialist can inform the GP about specific points of attention for a patient. Or involve other primary care professionals. Maybe paramedics can help. Or there is a buddy programme. That requires organising care differently. Right now, organisations are too isolated and not encouraged to work together. We should bring this together much more. Everyone agrees on that. Yet it still doesn’t happen. Isn’t that odd?”

Why do you think it remains this way?

“I think the system is comfortable as it is. The pressure to change is not yet big enough. We simply organised healthcare this way at some point. At the same time, professionals often can no longer do what they would like or are capable of doing. A medical specialist and a community nurse are both incredibly busy and must keep going. If we organise things more smartly, they can consult each other when someone returns home after a hospital admission for COPD.”

“Of course, adjusting the healthcare system requires effort, but if you can use data to predict where problems arise and organise care differently, you can ultimately achieve more health with less care. Naturally, you must handle data carefully and not use it for other purposes. If someone does not want their data used, we do not use it. Still, many people are willing if it benefits their health. One of the most important values people have is their own health and the health of their loved ones.”

When talking about prevention, are you looking at a district-based approach?

“That depends entirely on the research question. Municipalities need guidance and this is a straightforward way to define groups. Sometimes it works. In some neighbourhoods and villages, there is a strong traditional identity. Other people need a different approach. It is important to look at what connects people: what is their group identity and who influences them? Maybe you need to look at sociocultural lines that run across cities and villages. Population health management explicitly considers the social factors that shape health behaviour and which interventions are likely to succeed.”

Besides being a professor, you are also director of the master’s programme Population Health Management. Why is this master’s needed?

“We train students who can help drive this shift. For example, some alumni now work at the Regional Integral Health Agreement in the Westland area of South Holland. There, they look at new ways of organising healthcare, including funding models and data infrastructure. Many other alumni work every day to address problems through population health management. These are just small steps for now, but eventually there will be many, and they will be part of the transformation.”

If we may dream: where would you like the field to be in a few years’ time?

“I hope that with modern technology and rapid developments, we can shape a healthcare system that truly fits people’s needs and preferences, and that reduces health inequalities in society. I think we can achieve this in fifteen to twenty years. This does not require major technological breakthroughs, but rather a different way of positioning ourselves in relation to people’s health.”

The inaugural lecture by Marc Bruijnzeels, ‘With less care, more health’, will take place on 13 February and can be followed live via the livestream on the Leiden University website.