Dr Anand Kulkarni
With various dramas still playing out about the post-Obamacare health model of the US, it is timely to consider the performance and prospects of health care in many other developed countries by way of comparison.
Defining parameters for a well-oiled system
A recent study by the Commonwealth Fund of health care systems in the developed world found many interesting and disturbing features. There were five parameters of health care used. Care process is one, which included prevention, safe care, patient engagement and coordination across the system between primary providers and other providers. Access with timeliness and affordability along with administrative efficiency–such as availability of doctors and medical records, time and effort put into paperwork–were other two parameters.
Equity–concerning performance outcomes based on income levels–and health care outcomes such as chronic diseases among nation population and mortality rates were also taken into consideration. Based on these, eleven countries were assessed. These were Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland, the UK, and the US.
Considerable room for improvement
The report shows that not one country is perfect on all parameters indicating considerable scope for improvement. Overall, the UK (1st), Australia (2nd) and Netherlands (3rd) have the best health care systems in the world. However, there is considerable variation. The UK scores the best out of the 11 countries in equity and care process, Netherlands on access and Australia on administrative efficiency as well as health care outcomes. However, the UK lags behind on health care outcomes. Australia is relatively weak on equity (7th out of 11) despite public insurance schemes and the Netherlands struggles with administrative efficiency.
Out of the remaining countries, France tends to be weak in most categories with the exception of health care outcomes while Germany is only doing good with regard to access. Sweden and Switzerland, generally considered as exemplars of social policy, are solid but with notable weaknesses.
Accessibility is a major issue for the U.S
Looking at the U.S, what is striking is that it is the weakest overall. It has particularly poor outcomes in access, equity, health care outcomes and administrative efficiency with only reasonably strong performance in care processes. Addressing equity and access were the hallmarks of Obamacare and this is likely to be at considerable risk now. In spite of Obamacare, there are still deficiencies. Hence, one can only wonder about the future. Simply put, health care is way too expensive for too many American citizens. There are many insurance gaps in its highly fragmented system and the administration is cumbersome.
Improvements in care coordination and stronger incentives for providers to more deliver health care more efficiently are needed. A key finding of the work is that the US has the highest per capita expenditure on health compared to any other country and the largest share of the GDP accounted for by health care. Yet this remains untranslated into a well-functioning health care system as throwing money around has not been satisfactory.
Lessons for the Indian health care system
Firstly, a well-functioning health system is one in which interdependent elements are integrated and one which caters to societal needs in a sustainable manner. Secondly, efficiency and equity are key drivers of the system. Both the public and private sectors have pivotal roles to play as each has responsibilities linked to measurable outcomes. At present, India’s health care is heavily private sector driven which makes universal access and affordability difficult. Targeted public investment will need to be enhanced. Health care systems must be output and outcome focused rather than being input and expenditure driven.
Dr. Anand Kulkarni is a Consultant and Principal Advisor at Victoria University, Melbourne. He is also the Associate Editor of the International Review of Business and Economics and a Fellow at the Centre for Policy Development in Australia.
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