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3 predictions from international legislative experiments proposed or enacted since 2020

By Isis MonteiroPaul Trigonoplos

June 29, 2022

    For most of 2020-21, governments focused health care legislation on responding to Covid-19. But in recent months, policymakers around the world have begun to re-prioritize pre-Covid ambitions and have also begun to attack new problems that have emerged or worsened in that timeframe, such as backlogs, ambulance ramping, climate change, and digital health safety and privacy concerns. And they are acting quickly as economic strain and public sentiment are pressuring politicians to enact change.

    All this to say, there is a flurry of policy experiments that every health care leader can learn from, but that no leader can keep up with. Our team is tracking the laws and proposals that are arising around the world, and we will publish research on the most critical areas throughout 2022.

    Our early analysis shows two areas where we are already seeing global policy convergence and one area where there's been a surprising lack of movement. Here's what we think they mean for the next few years in health care:

    1. As jurisdictions continue to add access points that are closer to the patient, hospitals' monopoly over care delivery will incrementally erode

    Jurisdictions are expanding health care capacity by building out new access points in lower-cost settings—namely ambulatory and urgent care centers—to meet increased demand from growing and ageing patient populations and patients who deferred care during the pandemic.

    The demographic and economic pressures driving this trend will not slow down, as populations are slated to continue to grow through the middle of the century, and governments are in cost-control mode coming out of two years of pandemic spending.

    We're seeing governments around the world diversifying—or planning to diversify—their system's non-hospital access points. In Australia, the new Labor government announced funding for an ambulatory surgical center model in Western Australia, in a bid to offload low-complexity procedures from hospitals. A similar model has also been proposed in Canada by the Ontario Medical Association to deliver outpatient surgeries and specialty care, including orthopedic, gynecology, and urology services.

    Public hospitals across the U.K., Canada, and Australia are experiencing unprecedented ED capacity pressures due to staffing and bed shortages, leading to ambulance ramping crises in some jurisdictions. In response to the crisis across Australia, the new administration also proposed opening 50 new urgent care clinics in primary care offices and community health clinics across the country to divert patients with non-life-threatening conditions away from overwhelmed EDs.

    2. Climate change will increasingly influence health care policy, impacting many parts of a hospital's operations

    We expect that policymakers will continue to enact stricter regulations and reporting requirements around emissions (as recently observed in at least 45 countries). In response, health systems will increasingly adopt sustainability initiatives. Further, as providers become more attuned to the business implications of climate change—including operating costs, ability to attract and retain staff, and maintain patient loyalty—they will increasingly take a more active role in protecting the environment. 

    The U.K. is arguably the most progressive jurisdiction in the world as it pertains to addressing health systems' impact on the environment. The NHS aims to become the first net-zero health system in the world by 2040. To that end, provider networks each recently released three-year "green plans," which lay out their strategies to reduce emissions and adopt climate emergency preparedness plans.

    We expect that more governments will introduce climate change-related policies that will directly impact health systems. We will continue to monitor upcoming elections, but we believe that the recent Australian federal election is a strong indicator of the direction that many governments will go as lawmakers oblige to the expectations of an electorate that is increasingly concerned with climate change.

    3. If governments don't act quickly to make payment parity and other incentives for telehealth permanent before they expire, patients' access to virtual services will regress to pre-pandemic levels

    During Covid, governments around the world introduced numerous policies to incentivize telehealth adoption. These policies aimed at removing barriers to access by expanding acceptable use cases, authorizing health care professionals other than doctors to provide virtual services, and/or increasing reimbursement for virtual services. As a result, telehealth utilization rates skyrocketed—and still remain at higher levels than they were pre-pandemic.

    However, the policies introduced during Covid may not stick for much longer, as only a few jurisdictions made the changes to the regulatory framework introduced during the pandemic permanent. In most jurisdictions, including the United States, regulation and payment for virtual services is still subject to revert to pre-pandemic status. In both cases, how and how much providers are paid for virtual services will change as governments determine how to leverage telehealth in the most cost-effective and efficient way. 

    Keep an eye out for upcoming policy deliverables

    Across the rest of the year, we will be publishing deliverables that topline emerging legislative solutions to evergreen problems in health care, such as rising costs, increasing demand for hospital-based and behavioral health services, workforce shortages, fragmentation, and inequity.

    We will also be conducting a meta-analysis of the policies that have been introduced across 10+ jurisdictions from January 2020-June 2022. Later in the year, we'll publish our insights on the common levers that governments pull to address challenges in health care, and other findings from the research.

    As we continue this research, we'd like to hear from you

    imagePlease email Isis Monteiro ( to discuss upcoming policies being introduced in your market.

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