Citizen engagement: a model to lower costs and improve outcomes.

Author:Rooney, Ronan
Position:Technology speaks


Few will disagree that the $7.7 trillion spent on health and social programs globally is unsustainable. But is it possible to reduce program costs while improving citizen outcomes? The theory behind a new service delivery model based on "citizen engagement" is that you can. But before we can go about solving the problem, we need to first understand the cause.

In addressing cost issues, Willie Sutton, the legendary U.S. bank robber had it right--when asked why he robbed banks he famously replied, "Because that's where all the money is!" So, where's all the money going with health and social programs?



* There is a minority population of high-need/high-cost citizens who disproportionally drive healthcare costs. Today's programs were designed for the "average" citizen in order to address individual needs or barriers (e.g., shelter, income support, etc.). When faced with complex social contexts (the high-need/high-cost citizens and families) these programs don't simply deteriorate--they "disintegrate," resulting in huge costs for the taxpayer and poorer outcomes for the citizen.

* The social determinants of health play a significant role in determining the cost of providing health care. And it's not just about health care costs or the cost of programs like TANF and SNAP; the social determinants directly affect other major social issues such as child welfare, juvenile justice, public safety, elderly care, developmental disabilities and homelessness, all of which are hugely expensive and socially disruptive.

* The lack of meaningful collaboration among stakeholders is a significant barrier to making real progress--and has been for decades past. Lack of stakeholder coordination has commonly presented communities with major problems--"duplicating," "overlapping" and "fragmentary" are recurring descriptions of health and social programs.

* The fee-for-service payment model encourages a focus on outputs--since that's what generates income.


Much of this information is not new so, given our track record, why should we expect real change to occur now?

Today, the task of lowering healthcare costs, while improving citizen outcomes ranks among the top challenges facing mayors, governors, and national leaders around the world and there are many voices calling on administrations to focus their efforts on people, not programs.

This requires us to change the way we address citizens' basic...

To continue reading