Welcome to ISQua Login | Register | Contact Us

ISQua Education

  ISQua and IHI Debate


The issue of a global ageing population and its increasing demand on healthcare services is an important topic worldwide.  ISQua and IHI jointly participated in an asynchronous debate on the following topic:

"By 2030, residential care for the aged will be unaffordable and the absence of alternatives will lead to a crisis in quality care for the aged".  The ISQua team (Blue) supported the motion and IHI team (Orange) opposed it. 

Our voting for this debate was open from 24 May - 14 June 2014.  As you can see, by a small margin of 6% the Blue Team won.  To all who participated in this debate by voting and commenting, we thank you most sincerely for your contribution.  A special word of thanks goes out to the IHI speakers:  Don Goldmann and Jos De Blok and the ISQua speakers:  Riitta Aejmelaeus and Yuichi Imanaka and to Tracey Cooper and Paul Bartels who opened and closed this debate. 

Even though the voting is closed, we still invite you to post your comments on the arguments presented. Your ideas and contributions to this debate will enable us create an invaluable resource on this topic.

For the ISQua Fellowship participants using this Debate to add credit points to their Fellowship Programme, please note that 2 credit points are available for your participation and  you must comment on the debate in the comment box in order to receive these credits.


Proposing the Motion

Opposing the Motion

Riitta Aejmelaeus
Riitta Aejmelaeus
Senior Medical Officer,Valvira, National Supervisory Authority for Welfare and Health, Finland

Yuichi Imanaka
Professor Yuichi Imanaka
Professor of Healthcare Economics and Quality, Kyoto University Graduate School of Medicine, Executive Board Member for Japan Council for Quality Health Care

Don Goldmann
Chief Medical and Scientific Officer, IHI

Jos de Blok
CEO of Buurtzorg, Netherlands



Introduction to the Debate and Speakers

Proposing the Motion

First Speaker:  Riitta Aejmelaeus

Finland is the fastest ageing country in Europe. By 2026, 62% of the population will not be of working age.So the proposition for this debate is a stark reality in Finland.  The current aged care model will be unable to address this problem, so Finland is looking for alternatives. The single most effective alternative is home care. Older persons will be increasingly active and well educated and they will want to receive a high standard of service in their own homes.  My arguments in this debate will illustrate how this can be achieved.

Opposing the Motion

First Speaker:  Don Goldmann

People deserve to live and die with dignity, with the best possible health and functional status, and in the setting in which they prefer to live, which most often will be in their home. If we keep focused on this goal and are not distracted by extraneous concerns and nay-sayers, the cost of caring for the elderly will decrease and the quality of their care and their quality of life will improve. Better care and lower cost at the same time - no tradeoffs necessary. I will argue that there are three key elements to this effort - scientific quality improvement, innovations in health and health care systems, and technology (mHealth, telehealth/telemedicine) - and will review examples of how progress is being made in all of these areas.

Proposing the Motion

Second Speaker:  Professor Yuichi Imanaka

Health care financing is really in crisis, with the increasing debt of the government and the social security system. In Japan, the increasing speed of the aged to the working population is dramatic: from 11:1 in 1960 (The universal coverage of health care and pensions started in 1961), 4:1 in 2000, to 2:1 in 2025.  We have to cover the increasing demand in health care with the shrinking finance.  We must find solutions so that health care systems can be drastically and peacefully reformed to reach higher levels of efficiency, while retaining and improving quality and equity.  Otherwise, the social system could be fatally damaged, particularly due to inequitable distribution of scarce health resources.

Opposing the Motion

Second Speaker:  Jos De Blok

Civilized societies have to take care of their elderly and vulnerable people. This can be done in different ways. If we use the knowledge of the best practices and share this knowledge, if we use all the resources we have in the communities and co-create with patients, informal caregivers and professional caregivers and if we organize in a way most of the money is spent on solutions instead of bureaucracy: we can create a higher quality level against lower cost with a much higher satisfaction for the professional workforce