Global health reform

WORLDVIEW: Evidence-Based Medicine vs Russian Salt Dust

Joanne Kenen — Wed, 18 Jun 2008 17:30:00 -0400

If you think we've got problems here in the U.S. developing evidence-based medicine, just think about the challenge in a place like Russia. Health writer and blogger Merrill Goozner just spent two weeks reporting in Russia, and we were fascinated by his piece on the Scientific American website.The problem, he writes, begins in the medical schools, where "young doctors receive almost no instruction on biostatistics, epidemiology and methods of decoding the evidence generated by clinical trials." Russian doctors make about $800 a month, meaning getting access to western medical literature is often out of reach (besides, it's in English). So while neither our health system nor our lawmakers have yet figured out how to stimulate more comparative effectiveness research (and how to get the research acted on), at least we aren't treating pulmonary patients with aerosolized salt dust in "cave-like rooms"—a practice that's been common in Eastern Europe for two centuries, but according to Goozner, never systematically studied.

COST: Crossing the Border for Better Health Care Value

Joanne Kenen — Tue, 01 Apr 2008 05:11:00 -0400

Medical tourism is no longer just the province of the uninsured and desperate. As health care costs soar in the United States, it is also the insured and their insurers who are scouring the globe for quality at a bargain. This is further evidence that one of our main tenets is true: reforming our delivery system to increase the value of our health care dollar is just as important as covering all Americans.

Medical tourism, or as some prefer to call it "Global Health Care," could become a $150 billion market, according to Wouter Hoeberechts, CEO of WorldMed Assist, a company that assists Americans in accessing overseas care. He was among the experts who took part in a panel on the topic at the recent Association of Health Care Journalists conference just outside Washington.

Going overseas for health care makes sense, he argued, if the care is not urgent, if it doesn't require a lengthy foreign stay or prolonged follow-up care, and if it's relatively expensive, say $15,000 or more. Hoeberechts sees patient demand for orthopedic and spinal surgery, weight loss surgery, cosmetic and dental procedures, some cardiology and even transplants. Heart bypass surgery, for instance, can cost $149,000 in the U.S. (although insurers usually negotiate steep discounts) compared to $10,000 in India including airfare and lodging.

Businesses, including but not limited to companies that offer Health Savings Accounts and High Deductible Health Plans, are eyeing foreign hospitals, and at least one major U.S. insurer, a division of BlueCross BlueShield of South Carolina is not only helping clients find quality foreign care, it is making sure a network of doctors is available for follow-up back home. "It's not about cheap, cheap," BlueCross executive David Boucher said. "It's about safe, safe."

No one is quite sure how many Americans have gone overseas for such procedures; estimates range from 150,000 to as high as 400,000. But whatever the numbers, the trend looks like it's here to stay. That doesn't mean that people (including celebrities and dignitaries) don't come to the United States for treatment; of course some do. But it does say a lot about the dwindling faith tens of thousands of Americans have in their ability to get top quality health care here at home, at a price they can afford. This dwindling faith corresponds to one our of general arguments for comprehensive reform: if we don’t increase value per dollar spent within our delivery system, not only will middle class Americans lose access to insurance and care, but American physician specialists will be subject to increased global competition as well.

Julius Karash, who also took part in the journalism conference panel on the topic, did a nice piece on this in the Kansas City Star a few months ago, including web sites where patients can get information, and a discussion of some of the risks or obstacles.(Sunday dec 9 2007)

WORLDVIEW: Swedish Boomers Not Busting Health System

Joanne Kenen — Fri, 14 Mar 2008 18:13:00 -0400

We all hear the conventional wisdom about how the aging Baby Boomers are going to bankrupt the country. Well, Sweden has Baby Boomers too, but their spending on health is lower than ours per capita and stable. How do they do it?

The answers range from free preventive care to widespread adoption of electronic medical records (95 percent of doctors and hospitals use EMRs).

Maggie Mahar at Health Beat blogged about the World Health Care Congress Europe in Berlin and she had a chance to talk to a top economist, Mona Heurgren, on Sweden's National Board of Health and Welfare. Sweden has the oldest population in the European Union but its health costs haven't been rising. "Over the last 15 years or so, the share of our citizens who are older has been growing, yet health care spending has stayed level at about 9 percent of GDP," Heurgren told her.

Of course Sweden's national health care package is financed through income taxes, and we believe our country is more likely to reach a bipartisan consensus on health policy through a mix of public and private solutions. And Sweden is a more homogenous, middle-class society. But we can still draw some lessons from Sweden's experiences, mixing old-fashioned primary care and prevention and the high-tech tools of the 21st century.

By the way, our own population isn't aging quite as quickly as we tend to think, Mahar noted. In the next quarter century the median U.S. age will rise three years, to 39. The aging of America does accelerate after that but the problems are not just how many old people we have, it's how wisely we treat them. We particularly liked Maggie's choice of slides (taken from a presentation by Uwe Reinhardt) to illustrate this point: