It may sound like a tired truism that healthcare leaders from different countries around the world can learn from each other, and collaboratively accelerate healthcare system change globally, but at an educational session at HIMSS18 Thursday morning, the truth of that idea sprang to life, as international healthcare leaders shared valuable insights and perspectives with one another.
“Creating Healthy Incentives to Improve Integrated Care: Lessons Learned from Around the World,” brought together leaders from Canada, the United Kingdom, Australia, and the United States, to discuss some of the common challenges and opportunities facing the healthcare systems of all the advanced industrialized nations, with insights from extensive international experience shared all around.
Anne Snowdon, Ph.D., a professor of strategy and entrepreneurship at the Odette School of Business at the University of Windsor in Ontario, Canada, and the chair of the World Health Innovation Network, a consortium of healthcare leaders from several nations, introduced a series of brief presentations, and then led a panel discussion among all the presenters.
Dr. Charles Alessi, a senior advisor to Public Health England, a government agency in the UK that “exist[s] to protect and improve the nation's health and wellbeing, and reduce health inequalities,” spoke first. “I don’t think many of us really appreciate how similar our health systems really are,” Dr. Alessi said. “There are different payers; we have the NHS [National Health Service] and a single-payer system. You have a mixed system,” he said, addressing the American healthcare leaders in the audience. “The Germans do, too. But ultimately, they’re all the same time. There are some differences in who pays, and how they’re administered. But in essence, we’re all on a common journey, with some common pain points. And we can learn from each other by not making the mistakes again and again and again, so that we can learn from each other in what not to do.” In sum, he said, “There’s much, much more convergence than we appreciate.”
Indeed, Alessi continued, “The struggles are very similar. Two weeks ago, I was in Japan,” he noted. “They’re going through a demographic time bomb, with 33 percent of their population over 60, with dementia increasing dramatically. And a lot of European countries are following them very, very quickly; and a lot of Asian countries are starting to follow them, too, demographically; Singapore is one example.”
Among the common challenges he cited: “struggling demographics and financial challenges”; “a problem with marrying ‘medicine by body part’ with the person”; “struggles with medical errors”; “struggling with workforce issues,” particularly shortages of key types of clinicians; “struggles with the consumerization of healthcare”; and, struggles with “how we’ll work with digital, and create ‘digital practice and extenders,’” to meet new staffing and care delivery needs.
At the same time, Alessi said, all the countries he’s aware of are also inevitably moving in the same broad direction around certain general goals. “Inevitably,” he said, “everyone is moving towards person-centered systems. We call them integrated care systems, you call them ACOs [accountable care organizations] here.” Also, “There’s a shared understand that the non-health determinants of health are at least as relevant” as strictly medical factors, in overall health. “Do people have a home, a job, purposefulness?” And, of course, the digitization and automation of society, and the continuous advancement of technology, are going to be major factors in moving all healthcare systems forward.
In addition, Alessi said, the shift from volume to value is not only evolving forward in the United States, but in all the healthcare systems of the advanced, industrialized nations. In all this, he said, “There are significant implications here; there’s much more that binds us than is different.” Even in some of the particulars, there’s more similarity than difference, he noted: “We all face similar challenges around data integration and data governance laws, and everyone is adopting data-driven solutions to drive better outcomes.” And, he added, “The emphasis on common standards in data systems is increasing and likely to increase even further.”
Alessi was followed by Dorothy Keefe, M.D., professor of cancer medicine and clinical ambassador for the Transforming Health initiative, at the University of Adelaide, in Australia. As Keefe put it, “The good news is that Australia has some of the best healthcare outcomes in the world, which is lovely. And we live a long time.”
Meanwhile, Keefe said, “We have a mixture of public and private funding, which is actually quite complicated. We have a universal system we call Medicare, which is federal, and which covers everyone. We also have very blurred lines between federal and state systems, and very complicated funding and regulatory models.”
The good news? “We spend 9.5 percent of our GDP on healthcare, and about $6,000 per patient per year, about half the cost per patient per year in the United States. The bad news? We have a rate of overweight and obesity that is among the highest in the world, perhaps higher than in the U.S. We also have low rates of mammographic screening, and our post-operative infections are the second highest among OECD countries. We also have terrible outcomes for indigenous Australians; and our cancer outcomes are actually getting worse. We also still have a volume incentive.”
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