The Importance of International Comparisons in Health Care
As a researcher in the field of health care systems, I am often asked the question, "Which country has the best health care?.
However, this question is misguided for several reasons. Throughout my career, I have come to understand that every health care model involves people striving to balance competing priorities with limited resources. It is important to recognize that every system has its own unique tradeoffs.
In the United States, the debate over whether to maintain a private, market-driven system or switch to fully government-funded coverage often leads to reductive comparisons. Some argue that a single-payer health care system is the key to improving life expectancy and reducing spending, while others demonize such systems, claiming that patients suffer from limited access to care and new drugs.
However, these arguments oversimplify complex metrics and fail to acknowledge the variation among countries with similar models.
For instance, countries like Switzerland, Germany, and the Netherlands, which also have private insurance systems, outperform the U.S. in terms of life expectancy and spending. Instead of fixating on the single-payer versus private insurance debate, we should direct our attention to the nearly 200 natural experiments being conducted in countries worldwide. By examining how patients fare in these different settings, we can identify areas where the U.S. excels and areas where improvements can be made.
Insights from International Comparisons
To truly understand the underlying factors contributing to high rates of infant and maternal mortality in the U.S., we need to delve deeper into the data. A closer analysis reveals that care during pregnancy, childbirth, and beyond, as well as diet, social factors, race, and inequities all play a role. By studying what other countries with lower mortality rates are doing differently, we can learn valuable lessons on how to improve care in the U.S.
One concerning issue is the high risk of premature labor among American mothers, leading to lower survival rates for preterm babies. Factors such as stress and less generous insurance coverage for young women can contribute to this problem.
However, comparative data suggests that the U.S. is actually one of the better places to give birth to a premature baby. This indicates that preventing premature births, rather than focusing solely on care during childbirth, may be key to reducing America's high infant mortality rate.
The U.S. also experiences a much higher rate of maternal deaths compared to many other wealthy countries.
However, around half of these deaths occur after delivery. Countries like Australia, France, and Japan provide continuous insurance coverage for women and offer postpartum at-home visits to support their health and their children's. These visits also serve as an opportunity to refer women to additional resources, including mental health treatment. By adopting similar practices, the U.S. could potentially improve postpartum care and reduce maternal mortality rates.
Specific Comparisons: A Source of Innovation
To gain meaningful insights and drive innovation, it is essential to conduct specific comparisons between health care systems. One research initiative that utilizes this approach is the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC). ICCONIC examines data and policies across various high-income countries to understand the care patients receive when facing medical issues such as hip fractures or complex chronic conditions. By analyzing the care millions of people receive for the same conditions across different health systems, ICCONIC identifies specific changes that can keep people healthier within their existing systems. This granular understanding has the potential to yield tangible results for patients.
A recent example of how specific comparisons can spark innovation is the Biden administration's program to allow Medicare to negotiate prices directly with manufacturers. This move follows the lead of European countries that have long used government negotiation to lower drug prices. Models from Australia, Canada, Germany, and other nations demonstrate the effectiveness of bodies that assess whether a new drug provides enough value to justify its cost. By conducting these assessments and using them as a basis for price negotiations, these countries spend significantly less than the U.S. on new brand-name drugs. This process ensures timely access to innovative treatments, covering new drugs within six months to a year.
Shifting the Focus: From Broad Generalizations to Actionable Comparisons
Instead of making broad generalizations about health care systems, it is crucial to shift our focus to specific aspects that contribute to high costs and the potential for improvement. Evaluating drug value and negotiating prices is one such aspect. By zooming in on the impact of drug prices, we can identify specific policies and processes that could lower costs.
Rather than indulging in a crude competition to determine the "best" health care system, we should leverage international comparisons as a springboard for improvement. By understanding the experiences of patients in different countries and learning from their successes, we can advance our own health care system. It is through actionable comparisons that we can navigate the complex landscape of health care and strive for better outcomes.
In conclusion, international comparisons provide valuable insights into health care systems and offer opportunities for improvement. By understanding the limitations of asking for the best health care system, examining factors contributing to high mortality rates, conducting specific comparisons, and focusing on actionable changes, we can strive for better health care outcomes. It is through the exploration of different models and the learning of best practices that we can create a more efficient and effective health care system for all.
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