0
Editorials |

Learning from the Health Care Systems of Other Countries FREE

Harold C. Sox, MD, Editor
[+] Article and Author Information

Acknowledgment: An address by Donna E. Shalala, PhD, on 8 October 2007 in Washington, D.C., was a source for part of this editorial.

Requests for Single Reprints: Customer Service, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106.


Ann Intern Med. 2008;148(1):78-79. doi:10.7326/0003-4819-148-1-200801010-00197
Text Size: A A A

At the beginning of an election year in the United States, many are hoping that the election returns will be a clear mandate for health care reform. Not since 1992 has this prospect seemed so within reach. Then, many stars seemed to be aligned: The United States had been dealing with 14% annual increases in health spending and drug spending—and even greater increases in Medicaid spending. According to the polls, half of the country wanted health reform and felt it should be 1 of the 2 top priorities of the country. The incoming president had made health care reform his top priority, and his party controlled Congress. Indeed, the president followed through, and health care reform seemed inevitable. In the summer of 1993, a legislative aide to a prominent Republican congressman told me that his party felt as if it was in the path of a legislative avalanche. At best, it hoped to be at the bargaining table, to have a voice on issues that were important to their constituencies. The administration developed a complex plan. Many features of the plan seemed to reflect a memorable American College of Physicians (ACP) position paper on health reform, which Annals published (1). In the end, the president's plan went nowhere. Johnson and Broder's wonderful book The System tells the story of its downfall (2). It should be required reading during election season.

In some respects, the portents for action are less favorable in 2008 than they were in 1992. The rates of increase of health care premiums, drug spending, and Medicaid spending are considerably lower. The polls say that health care is still a major concern of the country, but fewer people believe that it is 1 of the top 2 issues facing the country. The situation may have to worsen before health care reform at the federal level has any serious prospects.

In fact, the outlook is pretty disturbing. The country seems headed for an unprecedented fiscal crisis if it can't control the costs of health care (3). Patients starting to feel the effects of the growing scarcity of primary care physicians, as fewer medical students choose careers in primary care and primary care physicians leave their practices (4). The number of uninsured Americans has risen by about 5 million since 1992, and the employment-based health insurance system is weakening under pressure from rising costs.

Of note, compared with 1992, the United States is farther down the path toward an infrastructure to support better care. The country has recognized the importance of electronic health records that can talk to each other, which was a key element in the remarkable success of health care reform in the Veterans Administration. The Internet, e-mail, and cell phones give us a communications infrastructure for better-coordinated health care. As a nation, we have become alarmed about poor-quality and unsafe care. Many health care provider systems are trying hard to get better, spurred on by the need to remain competitive in a world in which bad news about health system performance travels fast.

Reforming health care will not be easy, but it's not impossible. Other countries have done it, and they have lower costs and better overall system performance than the United States (57). That we can learn from their experience is the premise of an ACP position paper in this issue (8). This premise rejects the concept of American exceptionalism (the belief that the United States is unique among developed nations because of its historical credo, its evolution as a nation, and its unique institutions), as the authors rightly claim that we can and should learn from other countries. Written by ACP staff and J. Fred Ralston Jr., MD, for the ACP Health and Public Policy Committee and approved by the ACP Board of Regents, the article describes the U.S. health care system, compares it with those of other industrialized countries, and proposes changes that have worked in other countries. The article also recommends that the country seriously consider a single-payer system as another way to provide universal access to health care. Although countries have achieved universal access with pluralistic insurance systems, not unlike our own, both can achieve the greater end that should be our highest priority: equal access to basic health care for every citizen.

Annals will reprise the theme of learning how other countries are approaching the universal problem of high-quality health care at a reasonable cost. During 2008, we will publish a series of articles that describe the health care system of some exemplar countries. We will accompany each article by a commentary written by someone who knows the country's health care system and the U.S. health care system.

Successful national health care systems have taken several routes to paying for health care, but they share one essential characteristic: The government guarantees that every citizen will have health insurance. They have solved a problem that grows worse every day in the United States. Why do Americans tolerate a system that leaves one sixth of its citizens with poor access to basic medical care? When will we elect leaders who will erase this stain on our national character? Perhaps the example of other countries will motivate Annals readers to join ACP in demanding decisive action on universal coverage.

Harold C. Sox, MD

Editor

References

Scott HD, Shapiro HB.  Universal insurance for American health care. A proposal of the American College of Physicians. Ann Intern Med. 1992; 117:511-9. PubMed
 
Johnson H, Broder DS.  The System: The American Way of Politics at the Breaking Point. Boston: Little, Brown; 1996.
 
Orszag PR, Ellis P.  The challenge of rising health care costs—a view from the Congressional Budget Office. N Engl J Med. 2007; 357:1793-5. PubMed
CrossRef
 
Lipner RS, Bylsma WH, Arnold GK, Fortna GS, Tooker J, Cassel CK.  Who is maintaining certification in internal medicine—and why? A national survey 10 years after initial certification. Ann Intern Med. 2006; 144:29-36. PubMed
 
Davis K, Schoen C, Schoenbaum SC, Doty MM, Holmgren AL, Kriss JL, et al.  Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care. New York: The Commonwealth Fund; May 2007.
 
Schoen C, Osborn R, Doty MM, Bishop M, Peugh J, Murukutla N.  Toward higher-performance health systems: adults' health care experiences in seven countries, 2007. Health Aff (Millwood). 2007; 26:w717-34. PubMed
 
Anderson GF, Frogner BK, Reinhardt UE.  Health spending in OECD countries in 2004: an update. Health Aff (Millwood). 2007; 26:1481-9. PubMed
 
American College of Physicians.  Achieving a high-performance health care system with universal access: what the United States can learn from other countries. Ann Intern Med. 2008; 148:55-75.
 

Figures

Tables

References

Scott HD, Shapiro HB.  Universal insurance for American health care. A proposal of the American College of Physicians. Ann Intern Med. 1992; 117:511-9. PubMed
 
Johnson H, Broder DS.  The System: The American Way of Politics at the Breaking Point. Boston: Little, Brown; 1996.
 
Orszag PR, Ellis P.  The challenge of rising health care costs—a view from the Congressional Budget Office. N Engl J Med. 2007; 357:1793-5. PubMed
CrossRef
 
Lipner RS, Bylsma WH, Arnold GK, Fortna GS, Tooker J, Cassel CK.  Who is maintaining certification in internal medicine—and why? A national survey 10 years after initial certification. Ann Intern Med. 2006; 144:29-36. PubMed
 
Davis K, Schoen C, Schoenbaum SC, Doty MM, Holmgren AL, Kriss JL, et al.  Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care. New York: The Commonwealth Fund; May 2007.
 
Schoen C, Osborn R, Doty MM, Bishop M, Peugh J, Murukutla N.  Toward higher-performance health systems: adults' health care experiences in seven countries, 2007. Health Aff (Millwood). 2007; 26:w717-34. PubMed
 
Anderson GF, Frogner BK, Reinhardt UE.  Health spending in OECD countries in 2004: an update. Health Aff (Millwood). 2007; 26:1481-9. PubMed
 
American College of Physicians.  Achieving a high-performance health care system with universal access: what the United States can learn from other countries. Ann Intern Med. 2008; 148:55-75.
 

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Topic Collections
PubMed Articles

Want to Subscribe?

Learn more about subscription options

Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)