In US political discourse, health care lessons from abroad, even from trusted allies with whom we proudly fight foreign wars, often seem as welcome as undocumented aliens at America’s southern border.
To talk about how the UK or France or the Netherlands or Germany cover all their populations at a fraction of what the US spends on health care is to risk being labelled un-American or even ‘socialist’ in the rough and tumble of American politics.
However, outside the searing US electoral spotlight, a more level-headed dialogue is possible and growing.
This is fortunate, because even if American political culture proves fundamentally incompatible with the national health care solutions that have succeeded elsewhere, the US health care system has much in common with – and therefore much to learn from – health care systems in other developed democracies.
These commonalities originate in at least two fundamental facts. First, health care comes down, ultimately, to well-trained professionals serving individual humans in need. When these interactions are successful, systems thrive. When they are not, systems fail.
Furthermore, the tools available to health care professionals – medical knowledge, drugs, devices, information technology – are similar throughout the developed world, as are the problems with which patients present (increasingly, chronic conditions with roots in human behavior).
Thus, all modern health care systems face the challenge of supporting the same type of work involving humans with the same abilities, tools, needs and desires.
The second basic fact is that the demand for and cost of health care is growing at rates that are considered unsustainable in every developed country. Thus, all nations face the challenge of making interactions between health professionals and patients not only successful, but more efficient. All must find ways to get humans to do the same things better.
Making the same work better is a very practical problem, and at any given time, the solution set is not unlimited.
It requires measuring what health care providers do and how patients react and are affected. It requires interventions that have a reasonable chance of changing health care work in ways that improve those measures.
Possible interventions involve changing how caretakers are incentivised, how they are organised, and the information they have available. Interventions may also involve changing how patients are incentivised, how they seek and receive care, and the information they have to improve their own health.
In the paper Jennifer Dixon and I recently published in The Lancet, we commented on some of the similarities in how the US and the UK are approaching the task of making health care systems work better – through paying caretakers to improve the value of services they provide, through experimenting with different organisational arrangements for physicians and other health professionals, and through increasing the availability and effectiveness of health information technology.
The results of these experiments will have applicable lessons to health systems around the world – if their leaders can rise to the challenge of examining those experiences objectively and openly. As the problems of our health systems increase, those leaders will have more and more pressure to do precisely that.
Dr David Blumenthal serves as Chief Health Information and Innovation Officer at Partners Health System in Boston, Massachusetts, and is Samuel O. Thier Professor of Medicine and Professor of Health Care Policy at Massachusetts General Hospital/ Harvard Medical School.
Please note that the views expressed in guest blogs on the Nuffield Trust website are the authors’ own.
Blumenthal D (2012) ‘Shared problems, shared solutions’. Nuffield Trust comment, 12 October 2012. https://www.nuffieldtrust.org.uk/news-items/shared-problems-shared-solutions