Is it Fair to Compare Health Systems Abroad to Those in the United States?

December 15, 2019
Chuck Fried
Chuck Fried

The U.S. needs to do better to support people in need, with improved access and cost to quality healthcare, and technology must be leveraged to meet these goals.

When people start debating the relative merits of healthcare in different countries, the discussion almost always defaults to cost versus benefit received. And because the bottom line is so important, other critical issues are often overlooked.

Are there core systemic differences between the healthcare system in the United States and those found in Canada, Sweden, and other countries? Of course there are, but the difference isn’t just a political or philosophical one. Is it possible those systems aren’t built to scale and meet the needs of the 330-plus million humans requiring care in the U.S.? This is where an approach that leverages technology might yield some valuable improvements.

The state of healthcare in the United States                                                                                                                                                    

Let’s start with the basics. For all the benefits that Americans see in our daily lives and for all our liberties, our healthcare outcomes do not map well to our healthcare system costs. According to recent studies, bureaucratic complexities, administrative overhead, and higher drug prices mean that almost all healthcare-related costs are higher in the United States than elsewhere-with universally worse results. Overall, the United States spends just over 17% of GDP on healthcare, whereas international averages range from around 10% - 12%. And still, we have a life expectancy that is measurably lower than many other countries at 78.8 years. Similar results can be found with our infant mortality, which is at 5.9 deaths per 1,000 live infant births.

Related: Fewer Americans See Healthcare in Crisis Mode

This framework is relevant in helping us answer the question, “Can technology help solve these systemic challenges?”

There is an old saying in technology departments that “a tool is just a tool and cannot fix a broken system or process.” Technology is simply a tool to help make functioning systems simpler or more cost effective. The question we should therefore be asking is this: What technology can be implemented to solve these challenges and drive down costs, while improving outcomes?

The technology challenges

The advent of urgent care centers in recent years has perhaps done more to drive down costs than any number of technology solutions combined, but that doesn’t mean that technology service providers should stop looking for new solutions that help reform the U.S. healthcare system as a whole.

Organizational change is well understood to comprise three pillars: people, process, and technology. By focusing exclusively on one pillar––technology––we can’t fully address what would be needed to change the system. Along with technology, the healthcare industry would need to update processes and train people to support this new, overhauled system, whatever form it might take. Without it, a new solution would fail regardless of how well suited it is or who supported the change.

Instead of a complete overhaul, the better option would be to find challenges at the edges of the systems where technology adoption or enhancements can improve results incrementally. We have already seen improvements in patient care through the provision of online self-care and self-management portals. Virtual healthcare providers are becoming more common, improving access to healthcare services to individuals in remote areas or those who have mobility issues. ERs have even begun implementing remote check-ins for patients prior to arrival. This much-needed solution cuts down on wait times, crowded waiting rooms, and patient frustrations.

Certainly these tools are necessary time savers. Collectively, they may not solve all of the problems in the U.S. healthcare system, but they begin to solve the issue of providing better services to patients. If we can start to chip away at problems, we can start to impact behaviors. As the U.S. population begins to age, more of these small-scale solutions will be needed to keep up with increasing demands in the healthcare industry.

Interoperability in the United States

The push for interoperability in the U.S. healthcare system has been growing for some time now, since even before the HITECH Act was introduced in 2009. This act encouraged the adoption and use of health information technology and addressed the privacy and safety concerns with electronic health records. Since 2009 though, adoption of electronic health records has improved only slightly, and not with all the benefits promised-improved care, lower cost, and better outcomes. The push in 2009 resulted in the forced adoption of complex systems that did not meet the needs of healthcare providers, let alone patients.

It is evident that the U.S. would benefit from increased adoption of interoperability standards between these complex and underutilized systems. Americans are used to having choices, which makes it unlikely that we will see a single unified physician or patient practice management system. Yet if the original dream of HL7 could be partly realized, perhaps we can ease the movement of data between disparate systems. Having a proper integrated solution in place could help transfer and unify data from competing programs into a single source of truth for patients and providers, resulting in better healthcare and reduced costs.

How we compare

While it is likely that costs can be driven down in our multi-payer system, the issue still arises with having to support more complex systems than other regions, and at a significantly greater scale-by comparison, Canada has roughly one tenth the U.S. population. The U.S. healthcare system carries many more layers of rules, administrative burdens, and complexities to ever favorably compare to other international systems that are in place.

No matter the system-whether the healthcare system is public, private, or a hybrid-the goals remain the same. As a developed nation, the U.S. needs to do better to support people in need, with improved access and cost to quality healthcare. Technology currently exists to support these universal goals; it just needs to be leveraged to meet them.

Chuck Fried is the CEO of TxMQ.