Mary Claire Wohletz

	Healthcare financing and delivery in the United States have undergone several modifications over the past several decades. There are a few key points in history when notable changes were introduced, such as post World War II when the employer gained influence as a financier of healthcare; during the 1970s and 1980s with the rise of

 managed care; and after 2006 with pharmacy coverage for Medicare Part D. 

	We are now facing another significant transition in our evolution, with implementation of aspects of the Affordable Care Act (ACA).  Because of impending changes to healthcare financing and delivery, it is important for those who are in decision-making roles to study how other countries address healthcare financing and delivery so as to bring the best initiatives of the studied country to the healthcare systems they oversee.

	In spite of continued increases in spending, the United States lags in achieving greater population-based health scores. In a 

 published in 2013, the Institute of Medicine found that the U.S. population has poorer healthcare outcomes as compared to several other countries, and has recommended that studies be conducted of healthcare in other countries, to find useful policies that might be adopted in the U.S.

Similar to the United States, other countries have been experimenting with their healthcare systems, some since the 1940s. As we look to solve our healthcare challenges, there is much we can learn by studying the financing and delivery of healthcare in other countries.

	One opportunity to do this is provided by TPG International Health Academy, which has been conducting trade/study missions around the world for U.S. healthcare leaders for more than 20 years. On each trip attendees learn about the history and the current state of healthcare in the host country, the challenges it faces, as well as the solutions attempted and found to be successful. Participants learn about each country from those who are responsible for planning the financing and delivery models, and from those who directly provide care to patients. Being in the host country allows participants an unusual vantage point into the country’s healthcare system.

	In an informal, intimate setting, participants are encouraged to ask questions of each presenter and to hear their professional and personal opinions about how their healthcare system is working and the difficulties encountered. The format allows time for observations and questions as well as insights that would not appear in a published document. In addition, attendees are able to speak with users (citizens) of the host country to gain an understanding of perception and usage of the system.

Regional health systems as part of the solution

	As we continue to learn more about the requirements of the ACA, health systems, especially regional health systems, must play a key role in finding efficiencies. Partly because of their size and scope of services, regional health systems offer some of the best opportunities to implement solutions and many are pursuing improvements in care delivery through quality-based provision of care. The U.S. government is also playing a significant role in influencing quality improvement initiatives for healthcare delivery, by creating quality ratings and incentivizing improved quality rating scores in Medicare plans, managed Medicaid, and the health insurance market.

Perry Cohen, PharmD, is co-founder and chief executive officer of The Pharmacy Group (TPG). He is a member of the Managed Healthcare Executive editorial advisory board. 

Mary Claire Wohletz, PharmD, is a pharmacist with experience in managed markets, specialty pharmacy, Medicaid and medical writing. 

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Those who are in decision-making roles must study how other countries address healthcare financing and delivery so as to bring the best initiatives of the studied country to the healthcare systems they oversee.

Author | Mary Claire Wohletz

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