From institutions to homes: Achieving the triple aim requires reorienting health systems around home-based care

Health system reforms in high-income countries continue to pursue better population health, improved care experiences, and greater efficiency. However, most systems remain organized around institutions that require individuals to adjust to fixed sites of care. Achieving the Triple Aim requires a structural reorientation: the home should become the default locus of care, with hospitals and other facilities serving as extensions when specific clinical or technical capacities are required. Organizing care around the home strengthens longitudinal coordination, aligns services with the everyday contexts in which health is produced and managed, and sharpens accountability for outcomes over time. At the same time, it exposes critical policy trade-offs-privacy, caregiver burden, equity in domestic resources, professional responsibility, and sustainability-that must be addressed through regulation, financing, and workforce redesign. Reorienting health systems around home-based care is therefore not a marginal delivery innovation, but a necessary structural condition for achieving the Triple Aim.