The U.S. health system is in a period of transformation. Public and private efforts to improve quality and patient safety are under way across the country. New ways of delivering care—such as patient-centered medical homes and accountable care organizations—promise to improve quality and patient experience, enhance coordination and care management, as well as achieve savings. Technological innovations, such as electronic medical records and telemedicine, may broaden both the scope and the efficiency of what health care can accomplish. At the same time, enormous challenges remain.
The U.S. is not alone in trying to develop approaches to confront these challenges—we are in an era of health reform around the world. Many developed nations are striving to improve health system performance and slow the rise of health care spending. Across the world, innovations in health care policy and practice are being tested. These international innovations offer lessons and a fresh perspective for U.S. policymakers and providers—particularly given that virtually all other wealthy nations manage to provide universal health care coverage while spending far less than the U.S.
The shared challenges and opportunities for learning touch all aspects of health care. They include improving the coordination and seamlessness of care for the chronically ill; reforming payment so physicians and hospitals receive appropriate financial incentives; strengthening the capacity of primary care practices; ensuring access to urgent and specialized care; reducing disparities and improving care for vulnerable populations; building the evidence base for health services and translating that evidence into practice; developing fair and effective value-based insurance designs; and ensuring rational pricing for medical goods and services.
To encourage learning from shared experience, The Commonwealth Fund has launched a new publication series on international innovations, available in the International Health Policy Center. These publications summarize of major health reform initiatives from around the world and provide links to further reading and details. The topics covered thus far include:
- Innovations in providing access to after-hours care in the Netherlands, Denmark, and Germany. In the Netherlands, adults are half as likely to report difficulty getting after-hours care as in the U.S.
- Incentivizing quality and efficiency through pay-for-performance in England, Australia, and Germany, and bundled payments in the Netherlands and Germany. Large-scale payment reforms in these countries are rewarding physicians for keeping their patients healthy and improving patient experience.
- Efforts to use comparative effectiveness research to inform policymaking in England, France, Germany, and Australia, where new drugs and treatments are compared against those already existing to see if they provide additional benefit.
- Administrative systems, or "health courts," for compensating injured patients in New Zealand, Sweden, and Denmark. Patients in these countries receive compensation far more quickly than in the U.S., and without the strain to the patient–doctor relationship that accompanies threat of litigation.
- Insurance exchanges to govern health insurance markets in the Netherlands and Switzerland, similar in many respects to those that states are creating around the U.S. as part of health reform.
Learning from other nations is not a simple matter of transferring an international approach to the United States, as a nation's health systems reflects its own history and culture. Nonetheless, looking at international innovations can spark creative thinking about how to move the U.S. health system toward high performance.
