By Michelle Ries
The Commonwealth Fund’s 13th International Symposium on Health Care Policy, "Achieving a High Performing Health Care System: Realizing the Promise of Health Reform," was held this month in Washington, D.C., and brought together health ministers and leading policy thinkers from Australia, Canada, France, Germany, New Zealand, the Netherlands, Norway, Sweden, Switzerland, the United Kingdom, and the United States. The meeting examined approaches to address problems shared by many health care systems, showcased policy innovations, and highlighted opportunities for learning from other countries.
The symposium kicked off with a presentation of the findings from The Commonwealth Fund's 2010 International Health Policy Survey in 11 Countries. This year, the annual survey explored the public’s views of their health care system and experiences with financial barriers to care, insurance complexity, access to primary and after-hours care, wait times, coordination of care, and equity. The 2010 survey includes Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, the United Kingdom, the United States, and, for the first time, Switzerland.
Susan Dentzer, editor-in-chief of Health Affairs, invited participating government officials to comment on the survey findings in two roundtable discussions.
Participating officials were:
Carolyn M. Clancy, Director, Agency for Healthcare Research and Quality, Department of Health and Human Services, United States
The Honorable Simon Burns MP, Minister of State for Health, England
Laurent Degos, Chair, Haute Authorité de Santé, France
The Honorable Pascal Strupler, Secretary of State for Health, Switzerland
Karin Johansson, State Secretary, Ministry of Health and Social Affairs, Sweden
Robin Martin Kåss, State Secretary, Ministry of Health and Care Services, Norway
Kerry Flanagan, Deputy Secretary, Department of Health and Ageing, Australia
On November 17, The Honorable Simon Burns MP, Minister of State for Health, England, delivered the opening keynote address, "In Search of Equity and Excellence: Liberating the NHS," focusing on the ways in which the new coalition government’s health reform plan will improve quality of care while cutting costs in the U.K. National Health Service.
On November 18, The Honorable Robert A. Petzel, M.D., Under Secretary for Health, U.S. Department of Veterans Affairs, delivered the John M. Eisenberg, M.D., International Lecture, "Transforming Health Care Systems: A Vision for the Future." Dr. Petzel discussed the ways in which recent reforms in VHA health care have fostered greater care integration, with a focus on improvements in multidisciplinary teams, performance measurement and transparency, patient-centered and evidence-based care, and telemedicine. During the Nov. 17 Commonwealth Fund survey presentation, Commonwealth Fund Vice President Robin Osborn and Fund Senior Vice President Cathy Schoen reviewed the key findings. According to the report, U.S. adults are most likely to forgo care because of cost, have trouble paying medical bills, and also have the highest out-of-pocket costs and most negative health insurance experiences, with one of three spending a lot of time on insurance paperwork and disputes, being denied payment, or not being reimbursed as much as expected. The report authors concluded that the findings highlight the need for Affordable Care Act reforms that will ensure access to health care, protect people from medical debt, and simplify health insurance.
"We spend far more on health care than any of these countries, but this study highlights pervasive gaps in U.S. health insurance that put families’ health and budgets at risk," Schoen said. "In fact, the U.S. is the only country in the study where having health insurance doesn’t guarantee you access to health care or financial protection when you’re sick. This is avoidable—other countries have designed their insurance systems to value access and limit out-of-pocket costs."
The survey also found substantial differences among countries on access to same- or next-day appointments when sick, as well as to after-hours care, and wait times for specialist care and elective surgery. Overall, U.S. income differences in access to care were generally the widest, even after adjusting for health, age, and insurance status.
Additional Symposium discussion themes included:
- national priorities for reform and the nature of policy changes already undertaken;
- approaches to ensuring financing sustainability in light of the current economic crisis, expected long-term budget deficits, and the
- anticipated increase in the burden of chronic illness from an aging population;
- national leadership and governance structures in support of health system reform;
- payment systems to support and incentivize quality, efficiency, and coordination of care;
- the design and regulation of insurance markets to expand access, ensure competition, and drive value-based care; and
- lessons for integrating care across the continuum of health and long-term care.