http://content.nejm.org/cgi/content/full/359/17/1751?query=TOCSlowing the Growth of Health Care Costs — Learning from International ExperienceKaren Davis, Ph.D. High health care expenditures and the growing number of people without health insurance set the United States apart from all other industrialized countries. The United States spends twice per capita what other major industrialized countries spend on health care1,2 but is the only one that fails to provide near-universal health insurance coverage. We also fail to achieve health outcomes as good, or value for health spending as high, as what is achieved in other countries.
The United States has been slow to learn from countries that have systematically adopted policies that curtail spending and enhance value. Chief among these are mechanisms for assessing the comparative cost-effectiveness of drugs, devices, diagnostic tests, and treatment procedures; implementation of information technology, including electronic repositories of patient medical information, across sites of care; easy access to primary care, including organized systems of off-hours care; a strong role for government in negotiating payment for care; and payment systems that reward preventive care, management of chronic conditions, care coordination, and health outcomes rather than volume of services.
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The issue, therefore, is not so much whether we know how to slow down the escalation of health care costs. Abundant international evidence, and even examples in the United States, demonstrate that higher quality, better access, and lower costs can be achieved simultaneously. Rather, the United States has been paralyzed by partisan divisions at the level of the federal government and by organized opposition from those who benefit from the status quo. The key to progress may lie in both a presidential administration committed to transformation of the health care system and a new policy process that is better insulated from special-interest political pressures. At a recent summit sponsored by the Senate Finance Committee, both Chairman Max Baucus and Federal Reserve Board Chairman Ben Bernanke raised the possibility of a "Health Fed" or a "MedPAC
with teeth," which would be delegated by Congress to make specific payment and policy decisions under a broad policy framework established by Congress. This approach, applied first to Medicare, could accelerate the diffusion of policy innovations throughout the country and provide a testing ground for broader application to Medicaid and commercial insurers.
The status quo is unacceptable. Without serious commitment to change, health spending as a percentage of the gross domestic product will rise from 16% currently to 20% by 2017; and Americans without adequate insurance and access to essential services will continue to suffer avoidable health consequences. American resources and ingenuity are adequate for the challenge. What is required is national leadership and commitment to moving toward a high-performance health care system.
Source Information
Dr. Davis is the president of the Commonwealth Fund, New York.
References
American College of Physicians. Achieving a high-performance health care system with universal access: what the United States can learn from other countries. Ann Intern Med 2008;148:55-75.
Schoen C, Osborn R, Doty MM, Bishop M, Peugh J, Murukutla N. Toward higher-performance health systems: adults' health care experiences in seven countries, 2007. Health Aff (Millwood) 2007;26:w717-w734.
Nolte E, McKee CM. Measuring the health of nations: updating an earlier analysis. Health Aff (Millwood) 2008;27:58-71.
Schoen C, Guterman S, Shih A, et al. Bending the curve: options for achieving savings and improving value in U.S. health spending. New York: The Commonwealth Fund, 2007.
Orszag PR, Ellis P. Addressing rising health care costs -- a view from the Congressional Budget Office. N Engl J Med 2007;357:1885-1887.
The New England Journal of Medicine is owned, published, and copyrighted © 2008 Massachusetts Medical Society. All rights reserved.
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