The Impact of Policy on Healthcare Sustainability

We are pleased to share our new study on how health policy can start counting carbon alongside cost and outcomes. Using depression care in France as a case study, we tested a pragmatic model showing that climate considerations can be built into routine healthcare decision-making without waiting for a completely new policy architecture. For us, the central message is a policy one: the carbon footprint of care is not just a feature of treatments, but of systems. It is shaped by how services are organised, where care is delivered, how far patients travel, and how carbon-intensive healthcare infrastructure remains. In our analysis, transport was a major source of emissions in psychotherapy-based pathways, while hospitalisation contributed substantially in combined care. That means decarbonisation is not only a clinical question — it is also a question of service design, access, infrastructure, and coordination. This is why we think the debate should move beyond whether carbon “changes the result” in a narrow economic sense. Even when carbon costs represent a relatively small share of total costs, measuring them helps reveal where policy action is most likely to matter: local access to care, teleconsultation or hybrid follow-up, transport policy, hospital energy performance, and broader decarbonisation strategies across the health system. Our study does not argue that treatment decisions should be made on carbon footprint alone. Clinical appropriateness, effectiveness, safety, equity, and patient preference remain paramount. But once clinically acceptable options are on the table, carbon data can strengthen policy deliberation and help align healthcare delivery with climate commitments and the public good. More broadly, we hope this work contributes to a simple but increasingly urgent idea: sustainable health policy is not only about greener buildings or procurement rules; it is also about making the environmental consequences of care visible in the decisions health systems already make every day. Full access here: https://lnkd.in/eS9pBK3Q #HealthPolicy #ClimateAndHealth #SustainableHealthcare #MentalHealth #PublicPolicy #HealthSystems Michael Padget Guilhem M. Odessa Dariel Kevin ZARCA Charlotte Halpern Laurie Marrauld Anneliese Depoux Laboratoire interdisciplinaire d’évaluation des politiques publiques (LIEPP) Etienne NOUGUEZ Thomas Rapp Zeynep Or Sandy Tubeuf Charlotte Desterbecq Zeynep Or Charles Flahault Lionel Collet Alexandra Hays-Alberstat Sebastien Taillemite

As policymakers advance Medicaid work requirements—which mandate at least 80 hours/month of work, volunteering, or job training for able-bodied adults to maintain eligibility—the fallout for health systems could be substantial. Per a recent analysis from The New York Times, the 2025 Reconciliation Bill wouldn’t just require millions of Americans to verify employment status; it would also require states to build complex new eligibility-tracking systems with little lead time. 🔍  Why this matters for health systems: 1. Gaps in enrollment will grow, and systems will bear the cost: Millions of patients who are eligible for Medicaid may still lose coverage due to the complexity of new verification requirements. Many won’t complete the paperwork or meet digital access needs in time. Health systems will need to proactively screen and enroll these patients, or risk absorbing the cost of care. 2. Chronic care disruptions = more acute events: Coverage gaps interrupt regular care—diabetes screenings, cancer prevention, behavioral health check-ins—which can quickly escalate to costly ED visits and hospitalizations. 3. Early rollouts have shown real harm: In Arkansas, over 18,000 people lost coverage within months of work requirements taking effect in 2018. In Georgia, a similar policy launched in 2023 covers just 2,300 people, despite 90,000 being eligible, drastically reducing access and reimbursement for providers. 4. Disproportionate impact on vulnerable populations: Caregivers, people with fluctuating work hours, those without reliable internet, and marginalized communities are most likely to fall through the cracks. This drives deeper health inequities and higher downstream costs. 💡  What health systems should do now: ▪️ Prepare for a surge in uncompensated care, especially in rural and safety-net settings. ▪️ Implement proactive digital communication strategies to stay connected with at-risk patients between visits. ▪️ Invest in financial navigation and digital screening tools to help patients check and maintain eligibility across Medicaid, ACA plans, charity care, and other programs. ▪️ Monitor real-world outcomes in other states to inform outreach, capacity planning, and policy response. If you are a provider leader concerned about the pending changes, please reach out - happy to share the work we have done to model anticipated impacts and necessary changes.

🚨 NEW PAPER 🚨 In a new analysis piece for BJGP we (me & Xaroula Kerasidou, with Angeliki Kerasidou, Sharifah Sekalala & Angela Daly) argue that, although the government keeps putting more and more pressure on AI to "save" the NHS, without a coherent strategy that compensates for critical gaps in UK policy, this techno-optimism risks more harm than good. In Beyond Techno-optimism: Four Critical Limitations in the United Kingdom’s AI Policy for Healthcare, we show how current policy consistently overpromises, underdelivers, and sidelines what really matters. Here are the four persistent limitations: 1️⃣ A disproportionate focus on growth Policy frames AI adoption as inherently beneficial in terms of *efficiency* for the healthcare service, and often prioritises the UK's economic competitiveness over evidence of actual patient benefit. But deploying AI is expensive, and even if savings exist, there’s no guarantee they’ll be reinvested into equitable care. In fact, efficiency-driven AI could worsen inequalities by over-treating those flagged as “high risk” while neglecting others. 2️⃣ Regulation, ethics and public trust The UK’s early leadership on data ethics has been replaced with a “pro-innovation” stance that casts regulation as an obstacle. Yet healthcare shows the opposite: proportionate governance builds trust and enables sustainable innovation. Ignoring this lesson risks repeating costly failures like care.data and Babylon Health — and eroding public confidence further. 3️⃣ Back to basics, again NHS technical infrastructure is not ready for widespread AI deployment. The variation in infrastructure across 'the NHS' is significant. Paper records persist, GP systems lag, datasets are siloed, and vendor lock-in hampers progress. Expecting AI to thrive here is like running HS2 on wooden tracks. Without major investment in digital foundations, AI risks amplifying existing problems rather than solving them. 4️⃣ Build for a sustainable future AI has a large carbon and resource footprint - but UK health policy barely acknowledges it. From compute power to water and minerals, these costs are real and unevenly distributed. Although the efficiency of AI systems is improving all the time, and AI may replace other more energy-draining teachnologies or tasks, a net-zero NHS cannot coexist with *unchecked* AI expansion. Policies must include environmental impact assessments and prioritise sustainable, simpler solutions where possible. 🔎 Together, these limitations reflect a flawed sociotechnical imaginary: a vision of AI as a technical fix for deep structural challenges. To change course, UK AI policy must rebalance priorities toward equity, ethics, readiness, and sustainability. The 10-year plan was a missed opportunity to reset, but there is still an opportunity to course correct in the implementations stage - let's not waste it. 👉 Full article here: https://lnkd.in/eB_hCSZ5 [OA preprint version coming soon, or just ask me]

💡 New in The Lancet Global Health: A WHO–World Bank policy paper outlines seven key actions to sustainably finance the prevention, control, and management of non-communicable diseases (NCDs) and mental health conditions — challenges that now account for a growing share of global disease and economic loss. Despite global commitments, most countries still allocate less than 10–30% of needed funds for NCD and mental health services. The paper calls for smarter, more equitable financing through domestic action and targeted international support. Key recommendations include: 1️⃣ Building national coalitions to raise visibility and advocacy. 2️⃣ Expanding health taxes and removing harmful subsidies. 3️⃣ Reducing the cost of essential medicines. 4️⃣ Using program funds to strengthen foundational systems. 5️⃣ Increasing overall public spending on health. 6️⃣ Investing in better governance and data systems. 7️⃣ Reforming financing models to support long-term chronic care. The message is clear: Financing NCDs and mental health is not just a health issue — it’s an economic and social investment that underpins sustainable development and equity.

From Siloed Projections to System-Wide Planning: How We Built Singapore’s Healthcare Capacity Framework 3 years ago, our healthcare demand projections were done in silos. Today, we have a coherent, system-wide framework that links demand to infrastructure, manpower, and budget planning. Honoured by the recognition on the work done by the team. Here’s the transformation journey. The Challenge We Faced Demand for each care setting is projected independently, using different assumptions and methodologies. 2023: Building the Foundation Introduced more granular inputs: added parameters e.g. functional impairment levels and family support in long-term care projections. Linked patient flows: Connected across settings (e.g. ED visits to acute inpatient to community hospital). 2024: Achieving System Coherence The coordination challenge: Working across 8+ divisions (IPP, HSD, PCC, APO, MP&S, HF) while handling new policy simulations & evolving capacity decisions. The solution: Set up Capacity Planning Committee (CPC) as single decision platform, replacing piecemeal EXCO discussions. The breakthrough: Obtained approval for our projections alignment framework: • Single baseline model across all projections • Common parameters where models intersect • Systematic accounting for care transformation impacts Real impact: Secured approval for new hospital beds through white space activation and new hospital sites. 2025: Advanced System Modelling Healthier SG simulation: Collaborated with Duke-NUS to quantify HSG’s long-term impact on healthcare demand and costs - answering our persistent questions. Disease-based projections: Piloted new method for mental health services, endorsed and used for service planning Tight deadline delivery: Completed baseline and care transformation projections across all settings that should have taken a few years to complete within one year. The Framework That Changed Everything Our Long-Term Capacity Planning Framework now seamlessly connects: • Demand drivers (population aging, functional impairment) • Care settings (from acute to community to home-based care) • Resource planning (manpower, infrastructure, budget) Policy interventions like HSG, right-siting efforts, and palliative care strategies are incorporated. Key Lessons Learned 1. Coordination is as important as methodology - The CPC structure solved more problems than technical improvements alone 2. Resilience matters - When our HSG model wasn’t endorsed initially, we went back to fundamentals and rebuilt stakeholder confidence 3. Granular parameters drive better insights - Moving from broad assumptions to specific factors like family support levels improved accuracy The result? A coherent planning system that helps Singapore prepare for demographic transitions while optimising resource allocation across the entire healthcare continuum. What challenges are you facing in system-wide planning and coordination across multiple stakeholders?

Medicare Advantage margins aren’t being compressed by one change — they’re being reshaped by many. While recent CMS updates point to a modest rate increase for 2027, most plans understand the reality: Rate growth alone will not offset rising medical costs, utilization, and regulatory pressure. The result? Sustainable growth in Medicare Advantage will depend less on pricing — and more on operational excellence. Here’s where plans are focusing: 📊 Risk Adjustment Scrutiny Is Increasing Regulatory oversight continues to intensify, placing pressure on: Coding accuracy and documentation Retrospective review strategies Vendor oversight and compliance The focus is shifting from maximization → defensibility. 🎁 Supplemental Benefits Need to Prove Value Supplemental benefits have become a key differentiator — but also a cost center. Plans are reassessing: Which benefits actually drive member engagement Impact on retention and Star Ratings Alignment with clinical outcomes The question is no longer “What can we offer?” but “What delivers measurable ROI?” 🤝 Broker Strategy Is Evolving Distribution remains critical, but economics are changing. Plans are evaluating: Broker compensation alignment with retention Acquisition cost vs. lifetime value Channel performance variability Growth at any cost is becoming less viable. 🔁 Retention Is the New Growth Strategy As margins tighten, member tenure matters more than ever. High-performing plans are investing in: Early member experience Proactive engagement and navigation Rapid issue resolution Retention is no longer just a KPI — it’s a financial strategy. The takeaway: Even with incremental rate increases, the Medicare Advantage landscape is entering a phase where margin expansion will be earned operationally — not given through pricing. Plans that align risk adjustment, benefit design, distribution, and retention strategies will be best positioned to compete. The next phase of MA growth will favor those who execute — not just those who scale. How is your organization adapting its strategy in response to evolving CMS policy and rate dynamics? 🎯 #MedicareAdvantage #HealthcareStrategy #ManagedCare #StarRatings #HealthPlanOperations #PMTAdvisors

Leadership takeaway from the recent federal funding disruption Last week’s short but consequential partial government shutdown was resolved with a funding package covering Labor, HHS, Education, and related agencies through September 30, with a short‑term extension for DHS. While operations normalize for now, another funding deadline looms later this month reminding healthcare leaders that policy uncertainty remains a structural reality, not an exception. Beyond the headlines, there are several important leadership implications: 1️⃣ Stability matters but resilience matters more The temporary shutdown resulted in 23,000+ HHS furloughs, even as essential functions continued. For health system leaders, this reinforces the need to design care models and operational plans that can absorb external shocks whether from funding lapses, regulatory delays, or workforce disruptions without compromising patient care. 2️⃣ Flexibility is now a core strategic capability The extension of telehealth flexibilities through 2027 and the hospital‑at‑home waiver through 2030 brings welcome stability. At the same time, the recent lapse caused some hospital‑at‑home programs to pause services to remain compliant. The lesson: leaders can’t just adopt innovative models; they must also hard‑wire governance, compliance, and contingency planning so those models can withstand policy turbulence. 3️⃣ Safety‑net funding buys time not certainty Eliminating scheduled Medicaid DSH cuts until FY 2028 and maintaining funding for community health centers and rural providers provides short‑term relief. From a leadership perspective, this is an opportunity not to exhale but to use the runway to strengthen margins, rethink service mix, and invest in sustainability before the next policy inflection point. 4️⃣ Workforce investments still require local leadership action Federal dollars directed toward rural health, workforce development, maternal health, and underserved communities are meaningful. But funding alone doesn’t solve workforce shortages. Executives still need to make intentional choices around care models, scope optimization, culture, and leadership development to translate dollars into durable access. 5️⃣ Transparency expectations are rising Expanded CMS oversight of pharmacy benefit managers signals a broader trend: increased scrutiny, data transparency, and accountability across the healthcare value chain. Leaders should expect this pattern to continue and proactively strengthen data, governance, and compliance capabilities rather than reacting once requirements are enforced. Moments like this underscore that healthcare leadership today isn’t just about running organizations, it’s about navigating uncertainty, making disciplined tradeoffs, and building systems that can bend without breaking. Policy stability helps, but strategic resilience is what ultimately protects access, quality, and mission.

Austerity ≠ Deleveraging. Cost-Cutting ≠ Cost Containment. Ray Dalio insightfully argued that austerity alone cannot solve a debt crisis—it shrinks income faster than it reduces debt, worsening the underlying problem. As a public health physician and health economist, I see a parallel in healthcare financing. Too often, cost containment is mistaken for cost cutting. Cutting staff, capping budgets, or limiting services may bring short-term relief—but like austerity, these measures often backfire. They erode system capacity, delay care, and lead to higher costs in the long run. What, then, is true cost containment? Here are six smarter, sustainable strategies: 1. Invest in prevention and early intervention Catching conditions early—especially chronic diseases—reduces costly downstream complications. 2. Redesign payment systems Transition from fee-for-service to value-based models that incentivize outcomes, not volume. 3. Strengthen primary care Empowering primary care reduces fragmentation, improves continuity, and lowers reliance on hospitals. 4. Leverage data and technology Use predictive analytics and AI to manage risk, personalize care, and streamline operations. 5. Right-site care Shift services to lower-cost settings (e.g., ambulatory, community, or home care) when clinically appropriate. 6. Engage patients as partners Informed patients make better choices, adhere to treatments, and often choose less intensive care when properly supported. Deleveraging requires growth, not just cuts. Sustainable healthcare requires value creation, not just budget reduction. The challenge is not merely to spend less—but to spend smarter. What strategies have you seen work in your systems or regions? #HealthcareEconomics #RayDalio #HealthPolicy #CostContainment #ValueBasedCare #PublicHealth #SystemsThinking #SustainableHealthcare

Across the GCC, billions have been poured into state of the art hospitals, glass towers filled with cutting edge technology, and high profile international partnerships. Bed ratios are climbing closer to OECD averages (GCC countries now average 2–3/1000).National health budgets are steadily expanding.KPIs look stronger year after year. Yet the most important indicator tells a different story: NCDs are rising, not falling. According to WHO, NCDs cause 75% of global deaths, and in the GCC the figure exceeds 80% of mortality. Obesity prevalence ranks among the world’s highest (40–50% in some GCC states). Diabetes affects 1 in 4 adults across the region. And Cardiovascular disease remains the single leading cause of premature death. This paradox exposes a painful truth: we don’t have a shortage of hospitals we have a shortage of outcomes. Hospitals and insurers continue to track metrics that look good in financial reports but say little about real health: • Bed occupancy rate • Average length of stay • Revenue per patient day • EBITDA margins etc. These keep providers and insurers happy, but without linking KPIs to patient outcomes, they remain an illusion of progress a system that measures activity, not impact. Healthcare only changes when money follows results. That’s the harsh truth. What if providers are only paid if: For diabetics: % of patients with HbA1c <7.0 -Hospital admissions for diabetic ketoacidosis- Amputation rates For cardiovascular disease % with LDL-C <70 mg/dL post-MI BP control <130/80 mmHg 30-day readmission after AMI or heart failure For cancer :% diagnosed at early stage Time from diagnosis to treatment Survival rates Without tying payments to metrics, they remain optional. With such linkage, they become non negotiable drivers of behavior. Healthcare financing must shift to a 4 tier system: 1. Base Payment covers essential service delivery (like DRGs/case rates), paid only if safety and reporting standards are met. 2. Outcome Bonus extra payment when specific results are achieved 3. Shared Savings / Penalties providers and insurers share savings when avoidable admissions fall, but reimbursements are reduced if outcomes worsen. 4. Patient Activation Incentive rewards linked to patient engagement How? Start Small: Focus on high burden NCDs like diabetes, cardiovascular disease, and cancer. Government Mandates: Only legislation can force providers and insurers to adopt outcome based KPIs and link them to contracts. National Outcome Registries: Build unified digital platforms to track results across public and private systems. Pilot, Then Scale: Test in select hospitals or regions, refine, then expand nationally. Public Reporting: Release quarterly dashboards showing survival, complications, readmissions, and patient reported wellbeing not just financials. The GCC should not wait for others to perfect value based care it has the capabilities to lead the way now, even if the first model is imperfect.

We built One Health policies. We forgot the business model that will sustain them. Over the last decade, Africa has made real progress in advancing One Health. We now have national strategies, coordination platforms, and action plans that recognize the interconnectedness of human, animal, and environmental health. That is no small achievement. Yet across many contexts, a familiar challenge remains: moving from well-designed policies to sustained action at the community level. One Health frameworks are often strong on coordination, surveillance, and technical capacity. Where they tend to struggle is on a quieter but equally important question: How is One Health implemented in ways that can sustain themselves over time? In practice, many frontline actors, doctors, nurses (human/animal), veterinary paraprofessionals, community health/animal health workers, agro-vet retailers, sanitation providers, and environmental service enterprises, play critical roles in delivering One Health outcomes. They vaccinate humans/animals, support disease reporting, improve food safety, and manage environmental risks. However, these actors are rarely positioned within policies as economic agents with viable business models. Entrepreneurship, when mentioned at all, is often framed as a partner to engage, rather than as a mechanism for delivery. This matters because sustainability is not only a technical challenge; it is an economic one. When service delivery depends largely on short-term projects or external funding, continuity becomes difficult once those resources taper off. Across Africa, there are already examples where One Health outcomes are being delivered through enterprise-led models, where prevention, surveillance, and environmental health are aligned with livelihoods and local markets. These experiences suggest that economic incentives can reinforce public health goals, rather than compete with them. Entrepreneurship is needed in One Health implementation, not as a replacement for government leadership and not as privatization, but as a complementary approach that strengthens the said implementation. Governments remain stewards and regulators, while entrepreneurial actors help translate policy into sustained, last-mile action. Looking forward to learning and exchanging ideas on this for those who are interested in One Health implementation. Shehu Shamsudeen Abubakar Abubakar Abdurrahman Hassan Jibril Nichar Gregory One Health in Action Initiative