Guest Post: What the United States Can Learn from Healthcare Delivery Abroad – And at Home

Tuesday, September 23rd, 2014
This post was written by Shan Padda

How can the United States provide its citizens with the best healthcare in the world, while also managing costs?


Many reports over the years have pointed out how much more Americans pay for medical procedures versus those in other countries. The European model functions in a way that less care provides more outcomes for patients, whereas the U.S. model offers more care, but yields fewer outcomes.

What drives such a divide in care systems between all of these nations? In this guest post, Shan Padda, CEO of Health Integrated, details the strategic care coordination that is essential for a balanced healthcare system and how healthcare outcomes can become streamlined between the United States and European nations.

As a healthcare company executive who has traveled extensively and observed healthcare delivery in a variety of regions, including Cuba, France, Germany, the Middle East, Switzerland and the Asia-Pacific area, I’ve had an opportunity to see what works—and what doesn’t—from an outcomes and efficiency perspective.

Most healthcare executives know that the United States spends twice as much per capita as any other nation on healthcare without a corresponding realization of outcomes. Clearly, we need to change the way we deliver healthcare, and via the Affordable Care Act (ACA) and other reform measures, efforts are underway to achieve improvement.

Singapore and New Zealand Healthcare Models

But have we learned the right lessons? And are we following the appropriate models? Of all the healthcare delivery systems I’ve had the opportunity to observe, two stand out as models for excellence that are worthy of emulation: New Zealand and Singapore. Both maintain public and private systems. The public systems aren’t built on a single-payor model yet manage to provide a baseline level of care to their populations.

Through a combination of community-based care and other delivery methods, both New Zealand and Singapore make certain their citizens have the full spectrum of non-acute care, including preventive treatment. This ensures that treatable conditions don’t worsen and require a costly ER visit or hospitalization.

To provide access to basic care, Singapore creates coverage pools and makes healthcare coverage purchases mandatory, much like the controversial individual mandate in the ACA. People in Singapore who want to upgrade their plans at their own expense can purchase additional health insurance coverage on the free market.

The Singapore healthcare system also features elements of consumerization. For example, all hospitals in Singapore are required to post costs for common procedures on their Web sites. Since the mandatory baseline health coverage has coinsurance features that give patients a financial stake in the pricing, they have an incentive to review hospital information from a cost perspective as well as from a quality of care standpoint.

Israel’s Centralized Records Model

Outside of the New Zealand and Singapore models, another country that has handled one facet of the healthcare delivery process particularly well is Israel. That country has successfully transitioned to an electronic, centralized medical records model. This enables medical professionals in Israel to instantly access their patients’ entire medical history, which streamlines care coordination and enables better population health management. EMR adoption in Israel also allows for longitudinal collection and evaluation of one’s medical record both on an individual basis for the physician and on a de-identified manner for research and innovation purposes

Americans are rightly proud of their achievements in healthcare: U.S. innovators have made invaluable contributions to medical research, vaccine development and technically advanced treatment tools. But we still lag behind the rest of the world in delivering access to healthcare coverage for our population and in optimizing healthcare data to improve treatment.

Despite its error-prone rollout, the ACA is now expanding access to coverage, and some of the effects can already be seen: A recent Gallup poll shows that the uninsured rate in the United States fell to a historically low 13.4 percent in the second quarter of 2014 as millions of people received coverage under exchange plans and Medicaid expansion. A Commonwealth Fund survey in California found that ACA coverage cut the number of uninsured Californians in half.

Improving access to coverage and preventive care is an excellent first step in controlling overall costs, as it can promote early intervention to prevent treatable conditions from worsening. But as the experience of other countries demonstrates, there are additional techniques the United States could adopt to improve outcomes, including encouraging patients to take a more active role in managing their care and accelerating the adoption of electronic medical records, which would generate data that is invaluable for both population health management initiatives and for individual treatment plans.

One of the most important elements of healthcare reform is the shift away from a fee-for-service model to a system that emphasizes quality. Countries that have embraced this model, including New Zealand and Singapore, have experienced better outcomes and have controlled costs far more effectively than the United States currently does.

Acknowledging this, U.S. healthcare reformers are focused on achieving a similar shift by offering incentives for population health improvement and establishing Accountable Care Organizations (ACOs). Provider groups and plan administrators are also exploring innovative new ways to improve patient compliance, such as identifying and addressing the individual psycho-social factors that increase a patient’s sense of isolation and negatively affect their ability to actively manage their own care.

By combining the lessons we can learn from how other nations successfully manage healthcare delivery with America’s legendary spirit of innovation, there’s no reason we can’t come together and provide our citizens with the best healthcare in the world, while also managing costs.

About the Author: Shan Padda is chairman and chief executive officer of Health Integrated, where he provides the overall strategic leadership and visionary direction for Health Integrated and has a consistent track record of leadership and success in the healthcare industry. Before joining Health Integrated, Shan cofounded and directed a number of companies in the medical technology area, one of which approached $70 million in annual sales and had market capitalization of approximately $450 million. Shan currently sits on a number of private company boards and is a graduate of Harvard University.

HIN Disclaimer: The opinions, representations and statements made within this guest article are those of the author and not of the Healthcare Intelligence Network as a whole. Any copyright remains with the author and any liability with regard to infringement of intellectual property rights remain with them. The company accepts no liability for any errors, omissions or representations.

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