Health care gets a reasonable share of media coverage in countries like Canada, Australia and the UK where governments manage the system and are ultimately accountable to the population. However, in the US, the level of national media coverage has risen significantly since the start of the debates and political battles associated with the health reform bill that was ultimately passed there roughly two months ago. In the latest news, a study from The Commonwealth Fund ranked the health care systems of a number of countries.
Although the placement of the US in last position amongst this list of 7 countries received considerable media attention in the US and abroad, there are a number of other important observations that can be made and questions that arise from the results of this study. Some of the most interesting come from observing the individual rankings of the two laggards within the study, namely Canada and US, because of their very different health care systems.
In Canada, the health care system is socialized, is completely supported by tax dollars, and provides care to the entire population. The Federal government sets standards and strategy and provides some funding but the provinces administer and deliver the health care services. To over simplify, a tenet of the health care system in Canada is about providing security and equity of access.
In contrast, the health system in the US is based on a mix of private health insurance, public health coverage for some eligible citizens, not-for-profit health providers, private health providers and some government assistance for those at the bottom of the financial spectrum. State governments have been largely responsible for health strategy and regulation of deliver. The system is not a centrally organized health care system. To over simplify once more, the tenets of the US health care system are freedom of choice and ability to access the best care one can personally afford.
Given these differences in implementation, it was interesting to see both scoring so poorly in comparison to the other countries. Quite clearly neither of these systems is serving their respective populations as well as they could.
During the health care reform debate in the US, those in opposition to the reforms repeatedly commented on the horrible inefficiencies of the government-run medical systems of both the UK and Canada, two countries with nationalized health care systems. Much of the commentary was uninformed, partisan in nature and supported by only select news clippings appearing during the debate.
Despite this, the point that was trying to be made was that since the US Federal government has been observed as being inefficient in running other departments and programs, they would do a no better job being involved in health care.
While such a statement cannot be generalized, in the case of Canada, there may be some truth to the commentary regarding the ineffectiveness of government-run health care as the country had the second highest spending, but the least effective treatment and the least timely delivery of care. However, such inefficiency was definitely not demonstrated in the UK where treatment effectiveness was first among all 7 countries, timely delivery of care was middle of the pack, but costs in the UK were 40% of those in the US and roughly 75% of those in Canada.
Quite clearly, the differences in operation of the Canadian and US systems does not fully account for the poor delivery of health care delivered by each. If the differences between the systems in these two countries are not as important, then maybe the similarities might be in factors explaining the shared poor performance.
One such common factor that might contribute to the poor overall score in both Canada and the US is the significant decentralization of health care management and delivery by the provinces in Canada and by the states and individual health care providers in the Us. With different management in each state and province, there is administrative overlap, less coordinated attempts to adopt best practices from other regions and reduced ability to achieve economies of scale in purchases.
Another common aspect of the two systems can been seen in a very interesting finding from The Commonwealth Fund study. The study results show that two countries that had the worst ranking in patient-centered care were also those that had the best overall ranking. Canada and the US on the other hand had middle of the pack rankings in this regard. The question that arises here is whether patient-centered care impedes the ability to deliver efficient, quality care?
It is not hard to imagine that this might be the case. While involving patients in their health care is considered an important goal, there are implications that could result.
Informing a patient and their family regarding patient health and the decision-making process is definitely time consuming for health care practitioners. Listening to patients to find out which treatments best suit them is as well. Keeping family members well informed regarding the health of patient also takes effort. Any of these factors could result in less timely and less effective care. Ultimately, allowing patients to make important, informed decisions in the process could very well reduce the ability to give the best medical care.
As far as equity of care is concerned, patient-centered care might also affect this quality of care. It is quite easy to conceive that with such a model, the differences in care delivered to a patient with actively involved family members could be much better than the care delivered to a patient whose family is more passive. Such family influences would mean that the equity of care could be affected. If family members and patients are less involved in treatment decisions, the system must make the decisions and whether good or bad would likely make the decisions more consistently.
Similarly, patient-centered care might also affect the ability to deliver safe and coordinated care. Time spent interacting with the patient could mean less time is available and less focus is directed toward performing the medicine required to treat the patient safely. Mistakes could be made because attention is not entirely focused on treatment. This might also affect coordination of care because involving the patient in the process could slow down and impede the ability to maintain coordination among the health care providers.
All of these are just ideas however, but ideas that might be worth researching further.
For countries like the US and Canada, the findings of the study unfortunately highlight the ability of either a socialized health care system such as Canada's or a for-profit system such as the US's to provide relatively poor health care. This means that getting good care cannot be boiled down to a simplified argument of private versus socialist health care. Many countries with socialist care or a mix of socialist and for-profit health care did better than these two countries with their respective systems on the opposite ends of the spectrum.
However, maybe the model of patient-centered care needs to be assessed. While it is certainly a feel-good approach, the inclusion of additional parties in the process might impede the ability of the system to treat patients and as a result this goal may need to be rethought.Related Links