OBSERVATIONS - October 20, 2008
Learning From Other Nations As A Part of Health Reform
The US health care system will undergo significant examination and potentially reform in the years ahead as advocates seek to improve coverage, quality and the value of care. Even though the US spends more per capita than any other nation, international comparisons show the performance of our health care system lags a number of others in measures of outcomes, quality and even satisfaction. Even give this, parts of the US system have the reputation of being “the best in the world” which draws international visitors to train and examine how we manage care and use competition to improve performance. For example Kaiser Permanente has hosted hundreds of visitors for this purpose over the last few years.
But what can we learn from other nations? It is disingenuous to respond “not much” given the international performance differences. At the same time it is not likely that another country’s system of health care will work in the US give our unique history and culture. But those of us who have looked at other systems find that there are structures and approaches worth examining to add to potential solutions as we consider health care reform.
As one example, the Netherlands and Switzerland have been able to attain universal coverage using the private health insurance market and competition among them. Market place rules and risk adjustment among insurance carriers is one of the keys to their success which might offer the US examples of successful approaches worth considering.
We are currently debating developing a more collective approach to the evaluation of existing or even new technology. England, Germany and other nations have multiple years of experience in doing this and an examination of their methods and approaches can inform our debate. What can we learn from England’s National Institute for Health and Clinical Excellence which has a decade of experience or from Germany’s Institute for Quality and Cost Effectiveness?
Finally, other nations have developed quasi-governmental structures to carry out some important functions. In Germany, a Federal Joint Committee which represents physicians, hospitals, sickness funds (Germany’s insurance organizations) and patients make legally binding directives about what benefits and innovations are to be covered as part of their universal coverage scheme. A similar approach has been proposed by some policy analysts in the US using an independent National Health Board as an example. But Germany has done it and it creates an opportunity for us to study and learn.
The US had a unique history, values and culture which make large scale adoption of others’ approaches to health care unlikely and perhaps undesirable. But there are elements of other Nation’s approaches which may offer us ideas if not evidence of success as we consider reform of the American health care system. We should find successful tools, structures and approaches used by other nations and build them into our debate.
- Robert Crane, Senior Advisor, Kaiser Permanente and Fellow,
KP IHP
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