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June 22, 2012 | Daniel Vasella

The lesson from abroad: spending more doesn’t always lead to better care

Growing demand and the cost of health care are stretching the budgets not just in Massachusetts, but all over the world. Governments everywhere are faced with a stark choice: leave the health care system as it is and face rising taxes and declining quality of care, or start to do things differently.

Towards this end, many nations and states are resorting to sweeping legislative reforms. The hurdles faced by Affordable Care Act in the US are a reminder that improving health care through ambitious legislation can be protracted, complex, and highly contentious.

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What is the alternative? “Doing more with less” is a mantra from Capitol Hill to the corporate sector. A Novartis-McKinsey joint study has found evidence that can make it a reality, making health care more affordable, and therefore more accessible.

We saw striking differences in the way patients with the same disease condition are managed across nations. No one health care system is better than the others: almost every system is good at managing certain diseases. Breast cancer patients in the US lived the longest. High blood pressure was most effectively treated in Canada. The United Kingdom has a low disease burden of diabetes. Stroke was most effectively treated in Switzerland. Patients with chronic obstructive pulmonary disease (COPD) have the best outcomes in France.

The real surprise, though, was that these nations that provided the highest quality of care spent less on managing that disease than their counterparts.

Take the case of COPD, which is the third leading cause of death in the US. Compared to the US, France spends eight times less on treatment per patient, and yet French patients achieve better results. That’s because French doctors routinely use spirometers to measure lung function. This helps them to make accurate diagnosis and tailor individualized treatment plans. This often includes administering seasonal flu vaccines to prevent secondary infections and expensive emergency room admissions. Yet only 24 percent of primary care physicians in the US adhere to spirometry guidelines. As a result, COPD remains under-diagnosed and the outcomes put a greater strain on in-hospital care.

Conversely, in the case of breast cancer, the US provides the best value for money. Rigorous screening helps to identify cancers early on and provide easy access to advanced treatment, often through specialty cancer centers that treat lots of people. This is important. It should be no surprise that when hospitals perform more breast cancer surgeries, they deliver better results. Specialism is important: in fact, in US hospitals that perform fewer than 10 breast cancer surgeries a year, the risk of patient death is 60 percent higher.

For diabetes, the United Kingdom offers high quality care with lowest cost. Primary care doctors in the UK are incentivized to monitor weight and place people with a high body-mass index on diabetes watch list. That triggers individualized treatment and regular monitoring. In the US, it’s still not routine to regularly monitor blood sugar of people at risk of diabetes. In fact, 35 percent of adults in the US are pre-diabetic, but only 4 percent are aware of it. Diabetes often leads to complications that can affect the eyes, kidney, limbs, skin, brain, and heart. Patients will be served by multiple specialties and the care has to be well coordinated. Primary care doctors in the UK are also incentivized and trained to excel in care coordination. On the other hand, an average US Medicare patient with multiple complications can have 17 separate doctors with very little care co-ordination.

What are the lessons from this study?

We see that the best way to spend health care budgets is to invest in prevention. We should reward people for healthy eating, regular exercise, and seeking vaccinations. When prevention fails, early screening is important as we saw with breast cancer, COPD, and diabetes. And when people do get sick, one should follow the treatment protocols that bring the best results. Focusing on quality and integrated care for chronic diseases eventually saves costs. Since health care is largely locally delivered, we tend to look locally for the best treatment strategies. But often, as we have seen, the best protocols are practiced in another country. By adopting these best practices we would be achieving a higher quality of care with lower costs.

It is time that we held ourselves to account for our health care spending. There is a simple and pragmatic way to open a discussion in this direction. The World Health Organization publishes country level disease burden data for all major diseases. Take this and match it with what a country spends to manage that disease. This simple ratio will tell us what is the value received for our health care spending. This data should be made public so that we can benchmark health care system performance for every disease. The resulting public scrutiny will force a debate that will speed up the adoption of better practice.

Changes like these don’t require the politically impossible — like abandoning the private system or creating a single-payer system. In fact, many of them don’t require government action at all.

So while legislative reform is important, it’s not the easiest route, or the whole story. Finding affordable ways of meeting the ever expanding demand for better quality, more accessible health care seems to be the toughest question in politics; yet in truth many of the answers exist elsewhere, in plain sight. It’s time to deliver them.

Daniel Vasella is the chairman of Novartis and was formerly a practicing physician.
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