Where in the World?
Did you miss me? Whether you noticed or not (hopefully you noticed) @FaceValue has been on a bit of a hiatus as other projects took my attention. However, while I’ve been off gallivanting I have managed to sneak some sideways glances at the world of Value Based Healthcare and what sort of things have been evolving in VBH in general. As I looked around, I saw much of the same things I’ve seen over the last couple years: small steps and big ideas. This was good to see since steady progress is being made in redesigning healthcare to focus on quality and values rather than volume of services. If you haven’t read anything I’ve written here before the short version of my take on VBH is any progress is good progress and the sooner it comes, the better.
As I was examining a few news articles and press releases it occurred to me that I was taking a very narrow view in my interests and that I was probably missing out on some interesting viewpoints by making my focus the healthcare environment of the United States only. There are almost 200 countries in the world and I was only considering one. The math and data side of my brain screamed something about bias but I quickly hushed it up and started looking at what I could find about other countries and their adoption of value based models in lieu of more traditional volume-based (such as fee-for-service) payment models.
The World Economic Forum indicates that worldwide heath care costs reach about USD 6.5 trillion and are on the rise due to expected population growth around the globe. They also estimate that anywhere from 30-50% of that rather hefty bill is “wasted” as a result of the current payment schemes and traditional methodologies of patient care. Even at the low end, it is hard to accept that perhaps almost USD 2 trillion is unnecessarily spent due to a changeable system. Heath care numbers are staggering no matter where you look but something like that makes one take a step back and think. As a reference point, the United States spends well in excess of that amount (estimated at about USD 4 trillion in 2017) coming to around 17-18% of the entire nation’s GDP. We are talking major money here and while the U.S. is the “worst” offender in terms of overall health care costs, the world in general is beginning to realize the advantages of reducing the financial burden volume based models can have.
In a 2016 report by The Economist that evaluated countries on their adoption of value-based methodologies, some very interesting results came about. First many countries evaluated in this study also have some form of centralized or government regulated universal health care system. These countries scored significantly higher in the evaluation because of the necessity for those governments to collect data about expenditures that are not the norm for countries like the U.S with a less centralized system. That is not necessarily enough though. Only two countries (the U.K. and Sweden who both coincidentally have highly centralized health care systems) received a score of “High” or “Very High” by the study. The U.S. sits at a “Moderate” along with many other countries with some form of centralized system that have begun to adopt value-based methodologies. The take-away here? Everyone is struggling with this problem and it’s not that easy to just jump in and make it work.
Even an advantage like readily available data didn’t seem to have much of an impact. In fact, the only real advantage that centralized healthcare countries might have over the U.S. in this area is the fact that they can push comprehensive change more completely as the healthcare system is not only governed but directed by a single entity. That being said the U.S. (at least 3 years ago) was not doing too badly, with no area rating below “Moderate”. I encourage you to take a look at that study. Very interesting stuff.
So what’s my point with all this? Pretty simple really – we are not alone. There are others like us. We obviously have a huge interest as a country to get our health care costs under control but so does everybody. That means we have the benefit of seeing how different methodologies or schemes work in other countries as we develop our own. It’s a win-win. Everybody gets better when multiple entities all set out in the same direction on different paths. Will they all get it right? No. Will everyone else’s methods work for the U.S.? Certainly not. In the end, leveraging ideas and foundations from other countries can only help the U.S. to make better decisions about where and how to take us to this new paradigm. Stay tuned to find out how it works out in the end.