Worldview

WORLDVIEW: NPR Takes European Health Tour

Joanne Kenen — Thu, 10 Jul 2008 19:05:00 -0400

NPR's recent "Health Care for All" series went beyond a lot of the comparative reporting we've seen before, not just describing how various western European countries achieve and finance coverage for all, but also doing a few very specific case studies—comparing how a multiple sclerosis patient might fare in the U.S. versus Britain or how France treats cancer patients at home, or what the Dutch are doing about diabetes. They did take a good look at the Swiss system—often cited as a potential model for U.S. reforms. Our thanks to the Kaiser Family Foundation for assembling this list.The links will take you to both audio and text versions.

Britain

"Britain Weighs the Social Cost of High-Priced Drugs": The story examines how the British health care system limits coverage for certain treatments based on cost effectiveness to keep costs down and provide universal access to care (Silberner [1], NPR.org, 7/2).
"MS Patient Falls Into American Insurance Gap": The story examines the treatment and coverage of multiple sclerosis in Britain and the U.S. (Silberner [2], NPR.org, 7/2).

France

"France at Forefront of Free, Innovative Cancer Care": The story examines how the French health care system, which covers all residents, provides a broad range of cancer treatments, such as home care and experimental medications (Shapiro, "All Things Considered," NPR, 7/9).
"France's Model Health Care for New Mothers": The story examines how the French health care system provides women with generous paid maternity leave, in-home nurse visits at no cost and subsidized child care, a model with which the U.S. system cannot compete, according to two mothers featured (Shapiro, "Morning Edition," NPR, 7/10).

Germany

"Health Clinic Treats Germany's Few Uninsured": The story examines how German health clinics can meet the demand for care because only 0.2% of residents lack health insurance, compared with 18% of U.S. residents (Collins Sullivan, "Day to Day," NPR, 7/4).
"History of Tinkering Helps German System Endure": The story examines the history of the German health care system (Knox, NPR.org, 7/3).
"Keeping German Doctors on a Budget Lowers Costs": The story examines how the German health care system provides access to physicians, medications, technology, dental care, nursing homes and home care at a lower cost than the U.S., in part because the government requires physicians to adhere to a budget (Knox, "All Things Considered," NPR, 7/2).
"Most Patients Happy With German Health Care": The story examines how German residents have generous health insurance and often do not have to wait for elective surgeries or diagnostic tests (Knox, "Morning Edition," NPR, 7/3).

Netherlands

"In the U.S. and Holland, Diabetes Looks Different": The story examines how, although the Dutch health care system has similarities with a large HMO, the nation provides health care for all residents, with a focus on preventive care for those with chronic illness (Neighmond, NPR.org, 7/2).

Switzerland

"In Switzerland, a Health Care Model for America?": The story examines how the Swiss health care system could serve as a model for efforts by the U.S. to require the purchase of insurance while providing subsidies to those who cannot afford to purchase coverage (Rovner, NPR.org, 7/2).

WORLDVIEW: Health Care Complaints Sans Frontieres

Paul Testa — Fri, 30 May 2008 17:55:00 -0400

The Tour de France doesn't start until July, but Americans have already opened a substantial lead over some European compatriots when it comes to dissatisfaction with their home country's health care system, according to a new Harris Interactive poll, reported in today's International Herald Tribune.

Asked to describe their overall view of their country's health care system, 33 percent of Americans felt "the health care system has so much wrong with that we need to rebuild it," 50 percent believed there were some good things but "fundamental changes are needed to make it work better," and 12 percent said the system worked well and "only minor changes are necessary," (5 percent weren't sure).

Respondents from the five largest European countries were also dissatisfied with their health care systems, but they weren't as ready as some Americans to throw it all away and start over. This nifty little graph from the Tribune helps illustrate the comparison:

The poll also focused on issues of cost, standards, and efforts to improve health and wellness. Some quick highlights:

All of the countries agreed the costs of health care were rising too fast. Americans and Germans are most likely to agree (89 percent and 86 percent, respectively) that costs were rising too fast and also the least likely to feel that the standards and costs in their health care system corresponded to their needs and expectations.
The French are reasonably content (yes, you read that right). Nearly four in 10 of the French believed only minor changes were needed to their system. Further, France was the only country where a majority of the respondents believed the standards and costs of their system lived up to their expectations.
Health care is an issue of both shared and individual responsibility. Accompanying their dissatisfaction with their health care system, respondents identified on average five to seven steps they were taking to improve their own health and wellness. The most popular options: drinking more water and eating more fruits and vegetables. Americans were also focused on eating less fast food, while the Germans seemed far less worried about limiting their salt intake (19 percent) cutting out the snacks (15 percent) than their French neighbors (47 percent, and 62 percent respectively).

WORLDVIEW: Found in Translation: Examples from Dutch and German Health Reform

Paul Testa — Mon, 14 Apr 2008 21:48:00 -0400

We've always enjoyed looking at European models, and would highly recommend checking out the Alliance for Health Reform's recent briefing on approaches to health reform in Germany and the Netherlands, (a webcast of which is available here). These European States are particularly relevant to the U.S. because they are examples of reform that achieved comprehensive coverage within a private market framework.

The briefing's panel of international and domestic experts offered a sort of Fodor's guide to the health care systems of Germany and the Netherlands with a Berlitz translation of the most meaningful implications for health reform in the U.S. (with background materials available here.)

Our take-home conclusions from Friday's trip to the Continent:

Avoiding apples to oranges: When done right, international comparisons are useful for gauging a country's relative performance. The Commonwealth Fund's Robin Osborn did a particularly good job parsing out the most relevant comparisons, such as the fact that, per capita, the U.S. spends twice the OECD average on healthcare, and while the U.S. publicly finances a comparable level of health care, it finishes last on a list of 19 industrialized countries in terms of mortalities amenable to health care (deaths that could have been prevented with access to the right health care).
Models not roadmaps: When drawing lessons for reform, all the panelists subscribed to what we like to call the "lederhosen" rule: what works in one country isn't necessarily right for another. As Wharton's Patricia Danzon noted, the collective bargaining in Germany between insurers and providers might not work in the U.S., but as Osborn noted, a stronger primary care system would do a lot to help control costs and improve care in our nation.
Government has a role to play: Both Reinhard Busse, Berlin University of Technology and Wynand P.M.M. van de Ven, Erasmus University Rotterdam, were clear that governments play a crucial role in making markets work. As van de Ven said: "You need a visible hand to let the invisible hand work well." Both Germany and the Netherlands require all citizens to purchase health insurance regulated, but not run, by the government. Regulations providing for open enrollment, community rating, and risk equalization help ensure insurance is both available and affordable.
Pay for quality and value, not marketing and underwriting: Both Germany and the Netherlands have used "risk equalization funds" among payers to remove the incentives for risk selection and create an environment where insurers compete on providing value for the benefits offered. This has created rationales to invest in technologies like electronic medical records (used by 98 percent of primary care doctors in the Netherlands) and indicators of performance and comparitive effectiveness.

Nuances are inevitably lost in translation when comparing health care across nations, but some truths remain universal: primary care and medical homes can help improve the quality and control the costs of our fragmented system; the government has a role to play as a steward of our resources; and insurance market reforms could reward insurers who deliver high-value efficient care. After all, whether you're speaking German, Dutch or English, sustainable health reform sounds good in every language.