FTI Consulting’s Oussama Nicolas, Senior Managing Director and Middle East Health & Life Sciences Practice Leader, and Tara Makarem, Senior Managing Director, discuss a new Preventive Health Readiness Index designed to measure whether health systems have the underlying capabilities to prevent future health burdens, rather than simply tracking spending or outcomes. They explain why high healthcare expenditure does not guarantee readiness, how the index could apply to the UAE and Saudi Arabia, and the challenges of building a fair, transparent methodology.
1. Health systems are usually benchmarked on treatment outcomes and access. Why has readiness for prevention been so much harder to measure?
Prevention is harder to measure because its value is often delayed, dispersed and less visible than treatment. When a hospital treats a patient, the activity, cost, and outcome can usually be observed almost immediately following treatment. Successful prevention may instead mean that an illness, complication or admission does not occur, sometimes many years after an intervention.
Responsibility is also spread across the health system and beyond it. Preventive readiness depends not only on clinical services, but on policy, financing, data, access and the wider capacity to identify and address health risks. Existing international frameworks measure important elements, including health outcomes, access, risk factors or individual preventive programmes. However, the paper finds that they do not provide a holistic assessment of whether a country has the underlying capabilities to prevent future health burdens.
The proposed index is intended to address that measurement gap by focusing on the readiness of the system, rather than relying solely on current expenditure, activities or population outcomes.
2. What would it mean, in practical terms, for a country to score poorly on this index despite having a well-funded healthcare system?
It would indicate that the high healthcare spending is not necessarily translating into strong preventive capability. A country may invest heavily in hospitals, specialist care and the treatment of established disease, while having weaker arrangements for preventing health burdens before they emerge.
Based on the framework proposed in the paper, a poor score could reflect gaps in one or more areas: the strength and implementation of preventive policies; the way prevention is funded and incentivised; the availability and use of data and digital capabilities; or whether people can access preventive services supported by sufficient system capacity.
This would not mean that the country has an ineffective healthcare system overall. Nor would the index simply penalise countries with high levels of illness, because outcomes are influenced by many historical and contextual factors. Rather, it would show that the system may be better prepared to respond to disease than to reduce future risk. That distinction can help identify where reform or investment is most needed.
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3. Should the index weight structural readiness, such as infrastructure, policy and financing, as heavily as behavioural and population-level factors, such as screening uptake or health literacy?
While the final weighting between factors is currently being finalised as part of developing the index, the framework makes an important distinction between readiness enablers and health outcomes.
Policy, financing, data, access and capacity indicate whether a system has established the capabilities needed to support prevention. Population behaviours and measures such as screening participation can provide evidence of whether those capabilities are translating into practice. However, outcomes and behaviours are also influenced by social, economic, cultural and historical conditions that may not be directly controlled by the healthcare system.
Our proposed approach would therefore be to give primary emphasis to capabilities that policymakers and health-system leaders can deliberately strengthen, while using population-level measures to provide essential context and test whether readiness is being activated. This would avoid rewarding policy commitments that exist only on paper, without making a country’s score predominantly dependent on factors outside the immediate control of its health system.
4. Preventive health spans genetics, lifestyle, environment and health-system capacity. How do you weigh such different categories against each other without the result feeling arbitrary?
The paper recognises this as a central methodological challenge, and the final weighting solution is yet to be established. However, its starting point is to define preventive health broadly enough to cover all major types of health threats, including non-communicable diseases, infectious diseases and injuries, while keeping the assessment focused on capabilities that systems can build.
This creates a common basis for comparison. Rather than attempting to place genetics, lifestyle and infrastructure on an identical scale, the index can examine whether a country has the policy, funding, information, access and delivery capabilities required to understand and address risks across these areas.
Our proposition is that the eventual methodology should be transparent about the judgements involved. The selected dimensions, indicators and weights should have a clear rationale, and the results should retain sufficient detail for users to understand what is driving a country’s assessment. A composite score is most credible when it supports, rather than replaces, a more detailed examination of strengths and gaps.
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5. What role could digital health records, national platforms or AI-driven analytics play in making this kind of index more accurate over time?
The current concept is built primarily on internationally comparable, publicly available datasets rather than country-level health information systems. However, digital health records, national platforms and AI-driven analytics can improve the quality, completeness and timeliness of the evidence that ultimately feeds into those datasets.
As countries strengthen their digital capabilities, they will be better able to generate and share robust outcome data, identify emerging health trends earlier, and monitor the reach and impact of preventive interventions more consistently. Looking ahead, AI could further strengthen future iterations of the index by improving data quality, identifying patterns across multiple data sources, supporting predictive analysis of emerging health risks, and enabling scenario modelling to help policymakers understand how different preventive interventions could influence future health-system readiness.
More broadly, the paper identifies data and digital capability as a core dimension of preventive health readiness, recognising that stronger data systems enable better evidence, better decisions, and ultimately, better prevention.
6. What is the biggest technical or methodological obstacle to building an index like this, and has anyone come close to solving it?
The paper identifies several connected obstacles, which revolve around the central challenge of creating a consistent and comparable assessment from information that is fragmented, unevenly available, and organised differently across countries.
Existing frameworks and indices have made important contributions. Some assess population outcomes and disease burden; others examine universal health coverage, health security, primary care, risk factors, or particular preventive interventions. However, the paper’s literature review did not identify an existing measure that brings these perspectives together to assess whether systems possess the capabilities needed to prevent a broad range of future health burdens.
Developing such an index therefore requires choices about indicator availability, comparability, normalisation, aggregation and the relationship between system capabilities and observed outcomes. No single methodological decision resolves all of these issues. Our proposition is that the most defensible solution will be a transparent and progressively refined model that acknowledges data limitations, avoids false precision and allows users to examine the underlying dimensions rather than relying only on an overall score.
7. How would a policymaker use this index differently to how a hospital administrator might use it?
While the paper is primarily aimed at policymakers, investors and health-system leaders, its insights are relevant to anyone involved in shaping, delivering or investing in preventive health.
As a core target audience, policymakers would use the index as a strategic planning tool to benchmark performance, identify strengths and gaps in preventive health readiness, prioritise reforms, and direct investment towards the areas likely to deliver the greatest long-term impact.
Hospital administrators would apply the same insights within their own organisations. The framework can help them assess how well their organisation supports preventive health priorities, identify capability gaps, benchmark their preventive approach against leading practice, and prioritise investments in areas such as screening, early detection, digital capabilities and population health.
Although the decisions are made at different levels of the system, the objective is the same: understanding where the gaps are, where investment will have the greatest impact, and how to build a stronger preventive health system.
8. Is there a risk that healthcare providers optimise for the index itself rather than for genuinely better preventive outcomes?
This is a legitimate risk for any measurement framework, particularly if a single composite score becomes associated with reputation, funding or formal targets.
The way we seek to minimise this risk is by relying, wherever possible, on objective, internationally comparable indicators drawn from established public data sources, rather than measures that are easily influenced by individual organisations. The paper also emphasises transparency in the methodology so that users understand what is being measured and why.
That said, no index is entirely immune to unintended incentives. However, the mindset behind using this index should be viewing it as a tool to identify strengths, gaps and opportunities for improvement, rather than as an end in itself. Its real value lies in informing better policy and investment decisions that strengthen preventive health systems.
9. The UAE’s National Policy for Combating Health Risks leans on a One Health, multi-sectoral model. How well does that map onto what an international readiness index would look for?
Conceptually, the UAE’s National Policy for Combating Health Risks, with its One Health and multi-sectoral model, is strongly aligned with the paper’s broad understanding of prevention. The framework recognises that future health burdens cannot be addressed through healthcare delivery alone, and that readiness depends on governance, policies, information, resources, access, and capacity across a wider system. In that respect, the UAE’s policy reflects many of the core principles underpinning the Preventive Health Readiness Index.
Viewed through that framework, a multi-sectoral policy represents an important structural foundation for preventive health readiness, particularly within the policy and governance dimension. The index then complements that foundation by assessing how effectively policies are translated into action, whether information and resources support coordination, and whether the system has the capacity to implement preventive measures at scale. In doing so, it provides a way to measure and track how preventive health capabilities evolve over time.
10. Saudi Arabia’s Health Sector Transformation Program has pushed hard on primary care coverage and shifting incentives toward prevention. Does that give the Kingdom a structural head start, or are there gaps that do not show up in the headline figures?
Saudi Arabia’s Health Sector Transformation Program is closely aligned with several dimensions of preventive health readiness, which represent important building blocks for a prevention-oriented health system.
However, the index itself does not assign a structural head start based on individual reforms or policy initiatives. Many countries are pursuing similar preventive health reforms, albeit through different models and at different stages of maturity. The purpose of the index is to assess, using a consistent and objective framework, how effectively those reforms have translated into preventive health readiness across policy and governance, funding and incentives, data and digital capabilities, access and capacity, and health outcomes.
In that sense, the index does not assume readiness. It measures it, applying the same evidence-based approach to every country to provide a balanced view of strengths, progress, and opportunities for further improvement.
