Confident View Ahead: Citizen-Led Healthcare Systems – A Strategic Imperative for Outcomes and Sustainability.

January 2026

Healthcare systems are entering an era of structural imbalance: rising demand, constrained clinical capacity, and intensifying fiscal pressure—regardless of whether the primary payer is government or private insurance. Global health spending reached US$9.8 trillion in 2021 (10.3% of global GDP), and the macroeconomic environment is making it harder to sustain pandemic-era funding levels.1

In high-income systems, the pressure is visible in hard numbers. OECD data show that health expenditure averaged ~8.8% of GDP pre‑pandemic (2019), rose to 9.7% (2021), and then fell to 9.2% (2022)—not because needs disappeared, but because the acute COVID-19 response eased and inflation reduced the real value of spending.2 In the United States—an insurance-heavy market—national health expenditures grew 7.5% to $4.9 trillion in 2023, with hospital spending rising 10.4% and prescription drug spending up 11.4%.3 Projections anticipate health spending continuing to outpace GDP growth in the coming decade.3

Across low- and middle-income contexts, the sustainability challenge shows up as financial hardship and uneven access. WHO reports (2024) that out-of-pocket spending remains the main source of health financing in 30 low- and lower-middle-income countries, and in 20 of those, patients pay more than half of total health spending out of pocket. That is not only a health issue—it is an economic and social stability issue.

Simultaneously, the World Health Organization (WHO) projects a shortfall of 11 million health workers by 2030, with the largest gaps in low- and lower-middle-income countries, but workforce strain is evident across all markets.4

These pressures are not a temporary “post-pandemic” phenomenon; they are structural. The unavoidable implication for decision-makers is this: no health system can remain sustainable if it relies exclusively on clinician-led, facility-based care as the default response for every health need.

That is why citizen-led healthcare systems—often discussed under the umbrella of “self-care”—must be treated as a core component of modern health systems, not a peripheral wellness concept.

Citizen-led healthcare: care designed around people, backed by the system when needed 

We use the term “citizen-led healthcare systems” deliberately here. These systems are designed community-first, to meet people where they are—at home, at work, and in local settings—while ensuring citizens can reliably determine what they can manage themselves and when to seek professional advice.

WHO defines self-care as the ability of individuals, families, and communities to promote health, prevent disease, maintain health, and cope with illness and disability, with or without the support of a health worker.5 This is a critical point: citizen-led care is not “do-it-yourself medicine” or a replacement for clinicians. It is a structured, evidence-based capability that helps people navigate everyday health needs safely and escalates to professional care when red flags appear, symptoms persist, or risk is high.

Importantly for policymakers, WHO recommends self-care interventions for every country and economic setting as “critical components” on the path to universal health coverage (UHC).6 That recommendation reflects a pragmatic recognition: health systems must extend reach and resilience beyond bricks-and-mortar delivery.

Why this matters in every financing model—government payer or insurance payer

Whether the payer is the government or insurers, the economic logic is the same. Costs ultimately show up as some combination of:

  • taxation and public budgets,
  • employer premiums and wage trade-offs, and/or
  • household out-of-pocket spending and financial hardship.

Recent WHO analysis underscores why this is so urgent in lower-resource contexts: out-of-pocket spending remains a major driver of health financing challenges in many countries, and in some settings it represents the dominant source of health spending—undermining equity and access.7 Even in mature systems, growing utilization, chronic disease burden, and workforce bottlenecks create a persistent mismatch between what citizens need and what the system can deliver at the point of care.

Citizen-led healthcare directly addresses that mismatch by shifting the system from an over-reliance on “appointments as the gateway” toward a more modern model:

  • prevention and early action before conditions worsen,
  • appropriate self-management of minor, self-limiting conditions,
  • supported self-monitoring for long-term conditions, and
  • smarter triage and escalation when professional care is required.

In other words, citizen-led healthcare improves outcomes and experience and protects system capacity—without changing the fundamental promise of access to professional care when it is clinically needed.

The economic case: freeing capacity and improving productivity 

A frequent misconception is that citizen-led care is “soft” policy. The opposite is true: credible analyses increasingly quantify the upside.

A 2024 multi-stakeholder white paper involving Bayer, the Global Self-Care Federation, and the Business Council for International Understanding estimates that scaling self-care could deliver approximately US$119 billion in global financial savings per year, free up 1.8 billion physician hours, and preserve 40.8 billion productive days—equating to substantial societal welfare gains.8 Complementary Global Self-Care Federation research has similarly emphasized material savings and capacity release from appropriately implemented self-care.9

Executives and senior officials do not need to accept any single estimate to see the strategic direction: even modest reductions in avoidable utilization and frictional demand translate into significant savings when scaled across populations—particularly in primary care, emergency departments, and chronic disease pathways.

The enabling condition that cannot by skipped: health literacy and self-care literacy

Citizen-led healthcare only works when citizens are supported with capability, not just access.

WHO defines health literacy as the ability to access, understand, appraise, and use health information and services to promote and maintain health and well-being—and emphasizes that health literacy is not solely an individual responsibility; organizations and governments must make information trustworthy, understandable, and actionable.10 Survey evidence shows the magnitude of the challenge: the European Health Literacy Survey found that nearly half of respondents had limited health literacy, with wide variation by country and clear social gradients.11

Therefore, raising health literacy is the first priority for any serious citizen-led healthcare agenda.

Building on health literacy, the Global Self-Care Federation has further advanced the concept of self-care literacy as a practical sub-domain—focused on the knowledge, motivation, and competencies to make appropriate self-care decisions, including avoiding incorrect self-diagnosis and recognizing when escalation is needed.12 This emphasis aligns directly with what health systems need most: safe self-management plus timely clinical escalation.

The executive takeaway: Build market-access resilience that works everywhere

What leaders should do now: five system-level commitments:

  1. Make citizen-led healthcare an explicit pillar of national and enterprise health strategy.
    Treat it as infrastructure: a defined component of primary care, UHC roadmaps, and insurance benefit strategy—not an optional add-on.
  2. Invest in health literacy and self-care literacy at population scale.
    Fund plain-language, culturally appropriate education; embed capability building in schools, workplaces, and community settings; and raise the standard for the “information environment” (including digital).
  3. Build clear “manage vs escalate” pathways that clinicians trust.
    Citizens need consistent guidance on what can be self-managed (with tools and guardrails) and what requires professional assessment. This should be backed by clinical leadership, supported by pharmacists and primary care teams, and integrated into digital front doors.
  4. Enable access to safe tools—and regulate for quality and equity.
    Citizen-led systems rely on safe, effective self-care interventions: appropriate OTC medicines, diagnostics, devices, and digital supports. Regulation should protect citizens (quality, labeling, claims, pharmacovigilance) while enabling responsible access and reducing inequity.
  5. Align incentives and measure what matters.
    Payers and providers should be rewarded for improved outcomes and appropriate utilization—not just activity. Measurement should include system capacity indicators (avoidable visits, adherence, and escalation timeliness) and equity outcomes (who benefits and who is left behind).

Why Confident Strategy Group is at the forefront of the policy shift

The global policy environment is already moving. The Global Self-Care Federation is actively advocating for the codified recognition of self-care within the WHO system, including the push toward a WHO Resolution on Self-Care as part of advancing UHC.13 That momentum reflects what senior leaders increasingly recognize: citizen-led healthcare is not a “nice to have.” It is a modernization agenda.

CSG has been operating at the intersection of health system realities, evidence translation, and coalition-driven policy change—helping partners move from intent to implementation in citizen-led models.14 CSG’s CEO, Dr. Jeanette Fielding (PhD), brings deep expertise in advocacy, alliance building, and policy engagement—having managed complex negotiations, collaborated on new policy, and worked globally with stakeholders across sectors.15 This combination—systems understanding plus practical policy execution—is essential to making citizen-led healthcare real at scale.

Bottom line for decision-makers

Citizen-led healthcare systems are no longer optional. They are a prerequisite for:

  • better outcomes (through early action and sustained self-management),
  • better experience (through autonomy and access), and
  • better sustainability (through capacity relief and smarter utilization).

The choice facing leaders is not whether citizens will self-manage—they already do. The question is whether health systems will support it safely, equitably, and intentionally, so that citizen-led healthcare becomes a disciplined asset for national resilience and long-term prosperity.

References:

  1. World Health Organization. Global spending on health: coping with the pandemic. Published January 31, 2024. (World Health Organization)
  2. Organisation for Economic Co-operation and Development. Health at a Glance 2023: OECD Indicators. Paris, France: OECD Publishing; 2023. doi:10.1787/7a7afb35-en (OECD)
  3. Centers for Medicare & Medicaid Services. NHE Fact Sheet. Page last modified June 24, 2025. (Centers for Medicare & Medicaid Services)
  4. World Health Organization. Health workforce. (World Health Organization)
  5. World Health Organization. Self-care for health and well-being. Fact sheet. Published April 26, 2024. (World Health Organization)
  6. World Health Organization. WHO guideline on self-care interventions for health and well-being, 2022 revision. Published June 28, 2022. (World Health Organization)
  7. World Health Organization. New WHO report reveals governments deprioritizing health spending. Published December 12, 2024. (World Health Organization)
  8. Bayer; Global Self-Care Federation; Business Council for International Understanding. Untapped Potential: Unlocking Self-Care for Global Health Progress. 2024. (Bayer)
  9. Global Self-Care Federation. Groundbreaking global research: “Economic & Social Value of Self-Care.”  (Global Self-Care Federation)
  10. World Health Organization. Health literacy. Fact sheet. Published December 22, 2025. (World Health Organization)
  11. Sørensen K, Pelikan JM, Röthlin F, et al. Health literacy in Europe: comparative results of the European health literacy survey (HLS-EU). Eur J Public Health. 2015;25(6):1053-1058. doi:10.1093/eurpub/ckv043 (OUP Academic)
  12. Global Self-Care Federation; Global Health Literacy Academy. Self-care literacy: policy brief. 2022.
  13. Global Self-Care Federation. WHO Resolution on Self-Care. (Global Self-Care Federation)
  14. Confident Strategy Group. Self- Care  (CSG)
  15. Confident Strategy Group. About Jeanette Fielding. Accessed December 29, 2025. (CSG)

 

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