A recent Knowledge@Emory article looks at a new book titled The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care, by author and journalist T.R. Reid. The book provides an in-depth look at the health care systems in a number of Western nations, including Germany, France, the U.K, Japan and Canada. The countries he profiles offer a mix of public and semi-public health care options.
In addition to interviewing Reid, experts from Emory Healthcare, Emoryâ€™s Woodruff Health Sciences Center and the Rollins School of Public Health Department of Health Policy and Management, weigh in on the problem of U.S. health care reform and what can be learned from the examples abroad.
According to Joseph Lipscomb, PhD, a Georgia Cancer Coalition Distinguished Cancer Scholar and a professor in the Department of Health Policy and Management, quality of care, outcomes and cost analysis must be factored into the reform process. Looking abroad, Lipscomb gives generally high marks to the outcome and cost analysis done by the National Health Service and the National Institute for Health and Clinical Excellence (NICE) in the U.K. He applauds NICEâ€™s ongoing efforts to estimate the cost-effectiveness of new, expensive technologies by using decision processes that are transparent and solicit input from private citizens, providers and industry.
Fred Sanfilippo, MD, PhD, executive vice president for health affairs at Emory, CEO of the Woodruff Health Sciences Center and chairman of Emory Healthcare, agrees that the cost, access and quality of health care are certainly interrelated, but â€œeach of these parameters must be put into context. For example, the cultural expectations and demands of the patient are much higher here than in the U.K. and most other benchmark countries. Specialized care is much more routine in the United States, and access to medical technology is greater. Clearly, these attributes of U.S. health care are an added expense.â€
While the U.S. system may get high marks for certain types of specialized care and lower marks for routine care, Sanfilippo notes that there is a need to better leverage the effectiveness of overall care to provide earlier and cheaper interventions.
â€œAn additional opportunity to change the current system will be to factor in the social determinants of health,â€ he says. Patients may come into the system with a similar ailment, but their socio-economic status can differ greatly and radically impact the effectiveness of treatment. He does see the models of nationalized and semi-public health care offering better approaches to the cost vs. quality/access question.
â€œWe need to enhance productivity and build financial incentives into the process,” says Sanfilippo. “While no one will willingly use the term â€˜rationing,â€™ we need to improve effectiveness and efficiency to move towards higher quality of care and value of care.â€ However, Sanfilippo worries that the quick push for change will have unintended consequences: â€œIf the approach is too quick and complex, the number and severity of unanticipated problems will go up.â€
Richard Saltman, PhD, professor of health policy and management at Rollins School of Public Health, believes the moves to alter the health care system are â€œwell-intentioned and laudable,â€ but they discount the complexities of the current health care setup and the financial health of the country.
â€œIt would be wonderful to be able to transpose systems, institutions and structures from other nations here,â€ he says. However, Saltman notes that the fee-for-service structure in the United States and the many interests involved in American health care delivery make it hard to replicate these programs.
Read the full story in Knowledge@Emory.