Five stars doctors:
Defining universal challenges in health reform is itself a challenge, let alone proposing
appropriate responses to such challenges. We hope to avoid the risks inherent in such
generalization by focusing on some major changes that would lead to the adequate provision
of health care to all. Although the spectrum of causes of death, disease and disability that
hinder an enjoyable and productive life varies considerably with environment, socioeconomic
context and demography, we will try to identify determinants valid in any health care delivery
system.
In much of the world, both health care beneficiaries and those who plan, finance and
provide health care are increasingly aware of the need to reform health care systems but have
very different priorities and expectations. For example, consumers primarily want high-quality
health services in adequate quantity; health professionals want to expand their knowledge base
and exercise independent judgment in providing the best possible care; and health care
policy-makers want care for all citizens that is cost-effective.
For a health care system to make the necessary changes and run efficiently, however,
the main stakeholders must decide to work together and must agree on a set of fundamental
values. Relevance, quality, cost-effectiveness and equity are values implicit in the goal of
health for all, endorsed by all nations and governments, which offers such a basis.
Relevance: Relevance in health care can be defined as the degree to which the most
Quality: High-quality health care uses evidence-based data and appropriate technology to
deliver comprehensive health care to individuals and populations, taking into account their
social, cultural and consumer expectations. important problems are tackled first.
Cost-effectiveness: The rise in health care costs is due to universally observed phenomena:
specialization in health care, which implies the use of costly procedures; increased access to
health services due to sociodemographic changes; increased demand from individual
consumers as expectations for a better quality of life result from wider access to information.
Equity: Equity, which is central to a socially accountable health care system, means
striving towards making high-quality health care available to all. The central goal of the WHO
Global Strategy for Health for All is that all people receive “at least such a level of health that
they are capable of working productively and of participating actively in the social life of the
community in which they live.
The concept of the “five-star doctor” is proposed as an ideal profile of a doctor
possessing a mix of aptitudes to carry out the range of services that health settings must deliver
to meet the requirements of relevance, quality, cost-effectiveness and equity in health. The five
sets of attributes of the “five-star doctor” are summarized.
The five-star doctor
* Care provider
* Decision-maker
* Communicator
* Community leader
* Manager
Details of these attributes are given below
• Care-provider. Besides giving individual treatment “five-star doctors “must take
into account the total (physical, mental and social) needs of the patient. They must
ensure that a full range of treatment - curative, preventive or rehabilitative - will be
dispensed in ways that are complementary, integrated and continuous. And they must
ensure that the treatment is of the highest quality.
• Decision-maker. In a climate of transparency “five-star doctors” will have to take
decisions that can be justified in terms of efficacy and cost. From all the possible ways
of treating a given health condition, the one that seems most appropriate in the given
situation must be chosen. As regards expenditure, the limited resources available for
health must be shared out fairly to the benefit of every individual in the community.
• Communicator. Lifestyle aspects such as a balanced diet, safety measures at work,
type of leisure pursuits, respect for the environment and so on all have a determining
influence on health. The involvement of the individual in protecting and restoring his
or her own health is therefore vital, since exposure to a health risk is largely determined
by one’s behavior. The doctors of tomorrow must be excellent communicators in
order to persuade individuals, families and the communities in their charge to adopt
healthy lifestyles and become partners in the health effort.
• Community leader. The needs and problems of the whole community - in a suburb or
a district - must not be forgotten. By understanding the determinants of health inherent
in the physical and social environment and by appreciating the breadth of each problem
or health risk “five-star doctors” will not simply be treating individuals who seek help
but will also take a positive interest in community health activities which will benefit
large numbers of people.
• Manager. To carry out all these functions, it will be essential for “five-star doctors” to
acquire managerial skills. This will enable them to initiate exchanges of information in
order to make better decisions, and to work within a multidisciplinary team in close
association with other partners for health and social development. Both old and new
methods of dispensing care will have to be integrated with the totality of health and
social services, whether destined for the individual or for the community.