Inspiration abroad

Stuck in a rut? Take a global view of health care reform.

March 26, 2019

We are not alone in our quest to reform the health care system nationally toward better outcomes and cost efficiency. Countries all over the world are facing similar dilemmas to the US- combatting chronic diseases, incorporating new technological advancements, expanding access across geographies, cultures, incomes, and perhaps most crucial: lowering costs.

In many European and Asian countries, the government is the primary provider and payer of health insurance policies, with private health insurance companies existing for supplemental policies. In these global cases, innovative reform efforts to control costs and improve quality  abroad may look slightly different than we’re used to and can act as springboard to reframe our thinking in the US- especially when we’re stuck in a rut.

Take Germany for example, home to the world’s first national health insurance system. Germany’s health care system traces back to the Middle Ages based on the principle of solidarity. Today, Germany’s health care system is structured similarly to the US, a multi-payer system in which health plans compete for enrollees. The majority of the population, jointly with their employers, contribute about 15% of their monthly salary toward public sickness funds. A notable difference between the US and Germany’s systems, relates to drug pricing, as published in a Health Affairs blog last week.

In Germany, the pharmaceutical pricing system is “based on evidence-based assessments of comparative clinical assessment” and on testimonials and documents from patient advocates, physician organizations, and various other stakeholders. This pricing system results in drug prices substantially lower than for those in the US- with prices being accurately reflective of the clinical benefits of each drug. In a similar vein, CPR explored how employers can leverage the Institute for Clinical and Economic Review (ICER) to address high pharmaceutical costs, which, like Germany’s example, can help the U.S. move toward more transparent drug prices.

Or consider China’s advancements to strengthen its primary health care system. China has gone through system upheaval and insurance reform since 2003, achieving universal health insurance coverage in 2011. China has the largest population in the world, with the majority of the population living in rural areas and working in agriculture. In China’s reform efforts, the government recommitted to a similar principle of social solidarity, or equalized access to public services. In reform efforts, the Chinese government has prioritized data and evidence-based reform initiatives. As a result of the central government’s investment in health care, the Chinese population’s health has improved, especially measuring population health in rural areas.

One of the most important measures of China’s journey to improve quality and access is maternal mortality. Maternal mortality in China dropped from 80 to 25 per 100,000 lives births from 1991 to 2012, and was reported even lower at 19.6 per 100,000 live births in 2017. China has a goal to reduce the maternal mortality rate to 12 per 100,000 live births as a part of the Healthy China 2030 initiative. Meanwhile, recent research from the Commonwealth Fund found that American women have a significantly higher rate of maternal mortality compared to other high-income countries. Where other countries, like China and England, have invested time and money into reducing the risk of maternal mortality, rates in America have continued to rise, more than doubling in the last 20 years. Maternity care and reducing maternal mortality is near and dear to CPR’s heart and agenda- a topic we wish we saw more progress on, and maybe an area we could learn from abroad on.

So, when the constant twists and turns of U.S. health care market leave you feeling in a rut, take the time to look at innovations around us- whether its policy solutions in the US or bigger scale reforms abroad, there may be lessons to learn from our international neighbors who are also searching for best practices to optimize national health while effectively minimizing costs.

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