Healthcare systems cannot fund what they cannot measure

Every day, healthcare funders make decisions based on data. They know how many patients were admitted to the hospital. They know how many procedures were performed. They know how many days a hospital bed was occupied. These activities are measured, reported, reimbursed and built into healthcare budgets.

What they often cannot see is the hospital admission that never happened because a patient received effective palliative care at home.

They cannot easily measure the emergency visit that was avoided because symptoms were managed earlier. They cannot readily quantify the support provided to a family before a crisis developed. They rarely see the value created when a patient receives coordinated care that improves quality of life while reducing pressure on an already strained healthcare system.

This is one of the biggest blind spots in healthcare financing.

Healthcare systems tend to fund what they can see, count and measure. When palliative care outcomes are not captured, the value of that care remains largely invisible.

And what remains invisible is rarely funded adequately.

The funding challenge behind palliative care

Across Africa, the demand for palliative care is growing rapidly. More people are living with cancer, non-communicable diseases, chronic HIV-related conditions and age-related illnesses. Many require ongoing symptom management, psychosocial support, family assistance and coordinated care over extended periods.

At the same time, healthcare systems are under increasing pressure. Hospitals are overcrowded. Costs continue to rise. Populations are ageing. Healthcare funders and policymakers are being asked to deliver better outcomes with finite resources.

In this environment, every healthcare service must be able to demonstrate its value. Yet palliative care is often assessed through systems designed to measure activity rather than outcomes.

Current reimbursement models tend to reward hospital admissions, procedures, intensive care, theatre time and bed occupancy. These activities are visible, measurable and easy to reimburse.

Palliative care creates value differently. It helps manage symptoms earlier. It supports patients and families throughout serious illness. It enables care closer to home. It helps reduce avoidable admissions and unnecessary utilisation of acute healthcare services.

These are outcomes, not activities. The problem is that outcomes are often harder to measure than procedures. As a result, healthcare systems frequently see the cost of palliative care but fail to see the costs it helps avoid elsewhere in the system.

Why data matters more than ever

This is why the future of palliative care funding is increasingly a data conversation.

As healthcare systems increasingly explore value-based care, digital health investment and healthcare financing reform, the ability to demonstrate outcomes is becoming more important than ever.

If we want healthcare systems to move towards value-based care, bundled payments and outcome-driven reimbursement models, we need reliable evidence demonstrating value.

You cannot fund outcomes if you cannot measure them.

For too long, many of the outcomes associated with palliative care have remained largely invisible within healthcare data systems.

• How do we consistently measure improvements in symptom control?
• How do we quantify the impact of supporting patients in their preferred place of care?
• How do we demonstrate reduced hospital utilisation resulting from earlier intervention?
• How do we capture improvements in quality of life?

These questions matter because they influence policy, reimbursement and benefit design.

Without robust evidence, even highly effective interventions struggle to secure sustainable funding.

Why digital health changes the equation

This is where digital health becomes critically important.

When healthcare innovation is discussed, attention often focuses on artificial intelligence, robotics, electronic health records and advanced diagnostics. These technologies are important and will continue to shape the future of healthcare.

However, one of the most significant opportunities may lie beyond the hospital walls. Connected-care technologies have the potential to make previously invisible outcomes visible.

For the first time, technologies such as remote monitoring, wearable devices, telehealth platforms and integrated health records can generate objective evidence about outcomes that have historically been difficult to measure.

Remote monitoring platforms can identify deterioration before it becomes a medical emergency. Telehealth services can support patients and families without requiring unnecessary travel. Wearable technologies can provide real-time insights into patient well-being. Integrated digital records can help care teams monitor symptoms, interventions and outcomes across the continuum of care.

Importantly, these technologies do more than improve care delivery. They generate evidence. They create the data needed to demonstrate the impact of interventions that have historically been difficult to quantify.

A patient whose condition is identified early through remote monitoring may avoid an emergency admission. A family receiving timely support may avoid a healthcare crisis. A patient whose symptoms are proactively managed may require fewer acute interventions.

These outcomes matter clinically. They also matter financially. And for the first time, digital health technologies are creating new opportunities to measure them at scale.

Data must serve people

The purpose of better data is not to reduce healthcare to dashboards and metrics. In palliative care, data must always serve people. The goal is not simply to collect more information. The goal is to better understand whether patients are comfortable, whether symptoms are controlled, whether families are supported and whether care is being delivered in the most appropriate setting.

These are deeply human outcomes. But unless they are visible within healthcare systems, they will continue to be overlooked in healthcare planning and financing decisions.

Technology companies, healthcare providers, academic institutions, funders and policymakers all have a role to play in addressing this challenge.

Together, they can help build data systems that reflect the full patient journey rather than only the most expensive intervention points.

Making palliative care visible

Palliative care is not an optional addition to healthcare systems. It is increasingly recognised as an essential component of comprehensive healthcare.

In 2014, the World Health Assembly adopted Resolution WHA67.19, calling on member states to strengthen and integrate palliative care into national health systems at all levels. The resolution recognised that palliative care should be available alongside prevention, treatment and rehabilitation as part of a comprehensive response to serious illness.

This principle is also reflected in the World Health Organisation’s definition of Universal Health Coverage. According to the WHO, Universal Health Coverage means that all people should have access to quality health services across the continuum of care, including health promotion, disease prevention, treatment, rehabilitation and palliative care, without suffering financial hardship.

The policy direction is therefore clear. The challenge is implementation.

If palliative care is to be fully integrated into healthcare systems and benefit design, it must be visible within the financing structures that shape healthcare delivery. It cannot continue to rely on fragmented funding models or charitable support alone.

But integration requires evidence. Evidence requires measurement. And measurement increasingly depends on data.

This is why conversations about digital health, healthcare financing and palliative care can no longer happen in isolation.

The challenge is that many healthcare systems still reward activity rather than outcomes, despite growing evidence that outcomes-based models deliver better value for patients, providers and funders alike.

The future we should build

Africa’s healthcare future will not be defined solely by more sophisticated technologies or more advanced hospitals. It will be defined by whether we can use technology to make meaningful outcomes visible, measurable and fundable.

Because if healthcare systems are to reward outcomes rather than activity, they must first be able to see those outcomes. And healthcare systems cannot fund what they cannot measure.

//By Motlalentoa Motsoane, Chief Executive Officer, Association of Palliative Care Centres (APCC)