Tag Archives: health systems

U.S., Canadian health care systems share some challenges

Lieberman recently returned from a monthlong visit to Canada as a Fulbright Senior Specialist. She lectured on the American health care system and learned much about how Canadians get their medical care. She interviewed hospital executives, physicians, academic experts, former health ministers, reporters covering health care, and ordinary citizens. Lieberman also toured hospitals and long-term care facilities. This is the second of four posts reporting on that visit. Previously, Lieberman explained misconceptions that Canadians have about the U.S. health care system and the differences in the two systems.

canada-flagBoth countries are historically and practically steeped in fee-for-service medicine, and much of the power to control prices rests in the hands of the medical establishment. While provincial governments have periodic negotiations with medical and hospital groups, and there are global budgets for hospitals that try to constrain costs, the system is relatively expensive.

In 2011, the U.S. won the dubious honor of having the most expensive system in the world, spending about $8,500 per capita. Canada spent about $4,500, making it the third most expensive country among a group of OECD-developed nations.

Still, that number needs perspective. In 1970, a few years before Canada implemented its national health insurance system, both countries were spending about 7 percent of the GDP on health care. Thirty-nine years later the U.S. was spending 50 percent more of its national income on health care, leaving its patients with the highest out-of-pocket expenses in the world. When I explained the high out-of-pocket expenses to Canadians, that notion simply did not compute. There is some talk about imposing copays for some services as a way to help both the federal and provincial governments save money. But the idea of making people pay 50 percent of a bill or a family paying $13,000 out of pocket before insurance benefits kick in is wildly unpopular. Continue reading

Gawande, Google and health systems analysis

Earlier this month, New Yorker writer and surgeon Atul Gawande brought his checklist gospel (video) to the President’s Council of Advisors on Science and Technology. Writing for AAAS’ science-policy blog ScienceInsider, Jeffrey Mervis chronicled the encounter, paying special attention to the observations of council member and Google CEO Eric Schmidt.

electronic medical recordsGoogle CEO Eric Schmidt. Photo by World Economic Forum via Flickr

To Schmidt, the challenge of creating a system that synthesizes patient history and creates a list of standardized recommendations boils down to a simple “platform database problem,” something he says computer scientists are very good at.

Gawande‘s take is that programmers don’t quite understand the vagaries of a typical clinical encounter. The technological capability may exist, but it’s going to be hard to make an information system that is able to generate recommendations brief and practical enough to be of use to a typical super-busy physician who has to suss out six different problems in one 15-minute visit.

In the course of the discussion, Gawande and the council also bemoaned the relatively low status of the health systems analyst and brainstormed ways to raise the profile and effectiveness of the specialization.