Literature Review: International Issues of Health Affairs

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This literature review provides citations, short summaries, and Web links for Fund-supported articles that have been published since 1999 in the international issues of Health Affairs. The articles are listed in reverse chronological order.




U.S. Health Care Spending in an International Context, Uwe E. Reinhardt, Peter S. Hussey and Gerard F. Anderson, Health Affairs, 23 (3): 10–25, May/June 2004.
This study uses the most recent data from the Organization for Economic Cooperation and Development to explore why U.S. health care costs are so much greater than costs in other countries with much older populations. The authors point to several reasons for higher U.S. health costs: the fragmented financing system entails higher administrative costs; health care providers have greater market power than health care purchasers, allowing prices to soar above levels of other countries where the government exercises collective bargaining power; and the U.S. provides a more specialized, intensive form of care.

Disease Management Programs in Germany's Statutory Health Insurance System, Reinhard Busse, Health Affairs, 23 (3): 56–57, May/June 2004.
This study focuses on the introduction of disease management programs in 2002 into the Germany's statutory health insurance pools, which cover about 88 percent of the population. An earlier reform had introduced consumer choice among the various "sick funds," resulting in adverse selection and disadvantaging the chronically ill. Disease management was introduced to help improve quality and cost-effectiveness of treatment for chronic conditions, specifically by setting evidence-based guidelines for treatment and drug formularies and by better coordinating care. The author notes that this approach may be of interest in the United States, where adverse selection has thus far hindered managed care efforts among the Medicare population.

How Does the Quality of Care Compare in Five Countries?, Peter S. Hussey, Gerard F. Anderson, Robin Osborn et al., Health Affairs, 23 (3): 89–99, May/June 2004.
This article reports on efforts of the Commonwealth Fund International Working Group on Quality Indicators to compare the quality of care among different countries. The group used 21 indicators—such as five-year cancer survival rates, breast cancer screening rates, asthma mortality rates, and others—to compare the quality of care in Australia, Canada, New Zealand, the United Kingdom, and the United States. None of the countries consistently scored best or worst overall. For example, Australia scored highly on many of the indicators (cancer survival, breast cancer screening, asthma mortality) but had higher incidences of pertussis, or whooping cough, than other countries. In Canada, 30-day case fatality rates from acute myocardial infarction were higher than Australia and New Zealand in older age groups, but kidney and liver transplant survival rates were better than in the other countries. Rates of cancer survival were not as high as other countries in the U.K., while suicide rates were notably lower than other countries. By contrast, suicide rates in New Zealand—particularly among young people—were much higher than elsewhere. Breast cancer five-year survival rates and cervical cancer screening rates were highest in the U.S., but asthma mortality rates were increasing while they were decreasing in the other four countries.

Quality Incentives: The Case of U.K. General Practitioners, Peter C. Smith and Nick York, Health Affairs, 23 (3): 112–118, May/June 2004.
This article describes an ambitious new quality measurement program recently launched in the U.K. All general practices will now be scored on 146 measures of performance. About half of the measures consider clinical quality; others consider practice organization and patient experience. The accumulated scores will determine the amount of quality payment that practices receive, with about 18 percent of practice earnings at stake. Evaluations will now seek to determine the impact of the measures, incorporate new clinical evidence, and refine the administration of the program.

Confronting Competing Demands to Improve Quality: A Five-Country Hospital Survey, Robert J. Blendon, Cathy Schoen, Catherine M. DesRoches, Robin Osborn, Kinga Zapert and Elizabeth Raleigh, Health Affairs, 23 (3): 199–135, May/June 2004.
This article reports on results of the Commonwealth Fund International Health Policy survey of hospital executives in Australia, Canada, New Zealand, the United Kingdom, and the United States. Hospitals account for 40 percent of spending on health care in industrialized nations and are at the center of efforts to improve quality and control costs. Half of U.S. hospital executives said they were very or somewhat dissatisfied with their country's health care system, while only 12 percent or fewer hospital executives from the other countries reported this. In general, American hospital executives were most negative about the health care system, even though they had more positive views about their hospitals' financial status, quality of resources, and waiting times.

Outcomes-Based Drug Coverage in British Columbia, Steven Morgan, Ken Bassett and Barbara Mintzes, Health Affairs, 23 (3): 269–276, May/June 2004.
This study draws lessons from a decade's worth of experience in pharmacy benefit management. Under British Columbia's PharmaCare program, manufacturers are required to provide scientific evidence that a certain drug offers comparative benefits over therapeutic alternatives before it becomes eligible for public subsidies. There has been widespread opposition to the program, including legal challenges, negative media campaigns, and threats to cut off research funding. But independent studies have shown that it is has effectively contained costs—estimated at $12 million savings annually—while ensuring ongoing access to needed care.

Reform Strategies for the English NHS, Simon Stevens, Health Affairs, 23 (3): 37–44, May/June 2004.
Stevens, the British prime minister's health policy adviser, describes the role of incentives and local accountability in England's health reform strategy. It considers the main reform strategies now being deployed and assesses three potentially competing assumptions underpinning them. The first implies that improvement mainly requires a sufficient supply of health professionals, properly supported. The second advocates more hierarchical control to offset self-interested provider behavior, and the third stresses the role of local incentives and accountability. How these reforms play out over the next five years will determine the future shape of English health care.

Trends in International Nurse Migration, Linda H. Aiken, James Buchan, Julie Sochalski et al., Health Affairs, 23 (3): 69–77, May/June 2004.
This article explains how the "pull" of nurses away from developing countries to jobs in wealthier nations affects global health. Predicted shortages and recruitment targets for nurses in developed countries threaten to deplete nurse supply and undermine global health initiatives in developing countries. A twofold approach is required, involving greater diligence by developing countries in creating a largely sustainable domestic nurse workforce and their greater investment through international aid in building nursing education capacity in the less developed countries that supply them with nurses.

Common Concerns Amid Diverse Systems: Health Care Experiences in Five Countries, Health Affairs, 22 (3): 106–121, May/June 2003.
A Commonwealth Fund/Harvard/Harris Interactive survey of patients with health problems in the United States and four other industrialized countries reveals disturbingly high rates of medical errors, lack of coordination in patient care, poor communication between doctors and patients, and barriers when accessing care. The findings point to widespread error, inefficiency, and missed opportunities in the health systems of Australia, Canada, New Zealand, the United Kingdom, and the United States. The authors suggest that reforms targeted to populations with health problems could reap systemwide improved quality and potential cost savings.

Whither Seniors' Pharmacare: Lessons from (and for) Canada, Steven G. Morgan, Morris L. Barer, and Jonathan D. Agnew, Health Affairs, 22 (3): 49–59, May/June 2003.
Although Canada's national health care system does not provide outpatient prescription drug coverage, Canadian provincial governments have developed a range of plans that have historically provided generous coverage to seniors. Yet, ongoing spending increases and costsharing requirements are threatening the public drug subsidies. This study suggests that the Canadian experience underscores the need for comprehensive management and political will to confront spiraling drug costs.

Reference Pricing for Drugs: Is It Compatible with U.S. Health Care? Panos Kanavos and Uwe Reinhardt, Health Affairs, 22 (3): 16–30, May/June 2003.
Reference pricing—in which insurers cover only the low-cost, benchmark drugs in a therapeutic class and patients pay the difference in price if they want higher-cost alternatives—is being used in Canada, Germany, and elsewhere in an attempt to control spending on prescription drugs. The technique has more commonly been used by insurers for such items as eyeglasses and wheelchairs, and its application to prescription drugs is relatively novel. This study explores arguments for and against reference pricing, and discusses how this approach might work in the United States.

Dilemmas in Regulation of the Market for Pharmaceuticals, Alan Maynard and Karen Bloor, Health Affairs, 22 (3): 31–41, May/June 2003.
In most pharmaceutical markets, there are well-established systems of clinical trials of drugs to determine the effectiveness of different therapies. Yet, according to this analysis, there is an emerging consensus that pharmaceutical regulation is incomplete if it does not take into account the costs of competing drugs. Moreover, drug utilization should be controlled by better education, incentives, and enforcement. The article reviews regulatory interventions from European countries and offer lessons for policymakers in the United States and abroad.

Physicians' Views on Quality of Care: A Five-Country Comparison, Robert J. Blendon, Cathy Schoen, Karen Donelan, Robin Osborn, Catherine M. DesRoches, Kimberly Scoles, Karen Davis, Katherine Binns, and Kinga Zapert, Health Affairs, 20 (3): 233–243, May/June 2001.
This paper provides a comparative perspective on health care quality from a five-country physician survey conducted in Australia, Canada, New Zealand, the United Kingdom, and the United States in 2000. Physicians in all five countries reported a recent decline in quality of care and concerns with how hospitals address medical errors. Physicians in four countries expressed serious concerns about shortages of medical specialists and inadequate facilities. U.S. physicians reported problems caused by patients' inability to pay for prescription drugs and medical care. Asked about efforts to improve quality of care in the future, physicians indicated support for electronic medical records, electronic prescribing, and initiatives to reduce medical errors.

The Elderly in Five Nations: The Importance of Universal Coverage, Karen Donelan, Robert J. Blendon, Cathy Schoen, Katherine Binns, Robin Osborn, and Karen Davis, Health Affairs, 19 (3): 226–235, May/June 2000.
This article reports on 1999 survey results on the population age 65 and older in five nations: Australia, Canada, New Zealand, the United Kingdom, and the United States. The majority of respondents were generally satisfied with the quality, affordability, and availability of health services in their nations. In many measures of access to and cost of care, the United States looks much like the other nations surveyed. However, as the elderly view their health systems, the direction they have taken in recent years with respect to caring for the elderly, and the future affordability of care in old age, U.S. respondents tended to be more pessimistic than were those in other nations.

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