Different perspectives – the challenge of health reform in the UK and US

The 13th international meeting on the quality of health care took place this year in Washington DC: twenty five leading policy makers, academics and practitioners were brought together by the Nuffield Trust and The Commonwealth Fund to share ideas and strategies for health care.

On the US side, there was a palpable sense of relief that the most ambitious parts of the Affordable Care Act – the plans to extend coverage to millions of uninsured Americans – had been upheld by the Supreme Court.

With a Presidential election looming, health reform is not out of the woods yet, but as each day goes by, more people are being covered, which makes full scale reversal gradually more difficult. The biggest expansions in coverage are yet to come: states are beginning to form insurance exchanges in preparation for 2014.

The growth in insurance coverage is good news from a human rights perspective. It also sharpens the need to make health care affordable and good value. Health reform potentially puts a lot more money on the table for insurers and providers. It was for this reason that the Affordable Care Act was 'stuffed with tools' – as one participant put it – to bring down the cost of health care while maintaining and improving quality. 

This process is not being left to chance.

One of the most striking developments from the perspective of the UK participants, was the Center for Innovation that has been set up by the Federal Government's Medicare and Medicaid programme.

Innovations in payment systems, accountable care organisations (ACOs), primary care, nursing homes, mental health and maternity services are being supported by an energetic team of project managers and data analysts, with imaginative use of web-based methods to allow communication and exchange of ideas between health care leaders and providers across huge distances.

Evaluation is being built in from the outset, to ensure that the process is as evidence-based as possible, and it is underpinned by $10 billion over ten years.

US colleagues reported that there has been no shortage of enthusiasm. 154 accountable care organisations have already formed but the enthusiastic still only represent a minority of health care providers in the US.

The biggest challenge – as always – will be scaling up success. This is why innovations in payment reform are generating so much interest for the NHS as the scaffolding that can enable providers – especially hospitals – to take a much broader responsibility for the care of their patients.

But here's an interesting difference in perspective that emerged. The US participants warned against an over-reliance on payment reform as a mechanism for change. What really counts, they argued, are the ideas of those driving change in the system: clinicians, managers and health care leaders.

Health care reform will fail if mindsets and ideas don't change.

At this meeting I was really struck by how brilliant many of the US participants are at framing and communicating the challenge of health reform. Poor communication – particularly by Government ministers – has been diagnosed as one of the more obvious failings of the recent NHS Health and Social Care Act.

But while it was tempting to draw comparisons between the challenge of health care reform in the US and in the NHS – on one level they are not really the same.

If you want to look for a challenge on a similar scale to what has been tackled in the US, it might be more appropriate to think about social care funding. This can broadly be described as decades of failure by politicians to rescue individuals exposed to catastrophic care costs, with inadequate insurance models and an increasing tattered safety net.

It might be time for policy makers in the UK to take a closer look at how the US solved an apparently insurmountable policy challenge.