A decade ago, when the International Hospital Federation held its biennial meeting in London, the world seemed to be looking to the U.S. for answers.
Other countries, facing high costs and low productivity, just assumed that we in the U.S. would find a way to overcome the problems in our own healthcare system and then pass the big secret on to them. If it worked for VCRs and cellular phones, why not for healthcare, too?
I wasn't at the London conference, but Ken Robbins, president of the Illinois Hospitals and HealthSystems Association, was. Last month at the 30th IHF Congress in Melbourne, Australia, I asked Robbins if he thought other countries were still seeking a magic bullet from the U.S.
"Unlike in London, I didn't get the impression they were looking to us for answers anymore," Robbins said. "No one seems to be touting theirs as the ultimate system."
I put the same question to IHF Director General Errol Pickering.
Pickering agrees that in the past many countries were interested in developments in the U.S., with two prime examples being the rise of investor-owned hospitals and managed care.
But all that has changed, Pickering said.
"I get no sense anymore that anyone outside the U.S. thinks private healthcare is an answer," Pickering said. "In many places like Britain, where they tried it, they have abandoned the competitive model. I think the general feeling in other nations is that they certainly don't want to go in that direction."
Michael Woolridge, M.D., Australian minister for health and family services, put it very succinctly in the meeting's opening address: "I don't think any country in the world can say that they have got it right."
In some ways it shouldn't be surprising that other countries no longer look to the U.S. as a healthcare utopia. One Australian delegate, making a comment that managed to insult not just one country but two, said that looking to the U.S. system -- which spends nearly twice as much per capita as some other industrialized nations -- for answers about restructuring the healthcare system is like asking Korean auto manufacturer Hyundai about restructuring a car engine.
Heck, much of the U.S. doesn't even look at the U.S. as a healthcare utopia. (Some people in the U.S. even look to Canada for answers, but that's another story.)
Most other countries have unique healthcare systems that have evolved through local circumstances. It seems they've decided that instead of selling the house they are going to remodel.
"Everyone is trying to become more efficient," Pickering said. "They are trying to identify waste in their systems rather than uprooting them."
That brings us to an area where the U.S. is already under construction: integrated networks.
A recurring theme at the conference was what to do about hospitals. Everyone agrees hospitals are still needed, but many countries aren't sure in what form. They have overcapacity but can't seem to weed it out. They know there are efficiencies to be gained by coordinating care, but they are not sure about the best way to proceed. (Sounds familiar, doesn't [email protected])
"It was striking, the similarity with the debate here," Robbins said.
F. Siem Tjam, M.D., director of the World Health Organization, told the conference it was "clear that hospitals not only have a role but that they need to also do something about that role."
Woolridge, the Australian health minister, summed up the issue when he cautioned hospital executives that if they weren't willing to change they would go the way of railroads, which failed because their owners were in love with trains.
The problem, of course, is that it's very hard to export an integrated network. As has been said many times, if you've seen one, you've seen one.
But to survive, there is one thing that all networks need: quality information. That's one area where the U.S. clearly has an exportable product.
Probably the most well-attended session of the conference was one on quality management. Among the three panelists were Brent James, M.D., executive director of Intermountain Health Care's Institute for Healthcare Delivery Research in Salt Lake City, and Dennis O'Leary, M.D., president of the Joint Commission on Accreditation of Healthcare Organizations.
O'Leary announced at the meeting that the JCAHO would begin accrediting foreign hospitals as early as 1999.
Obviously, ideas about quality vary from country to country. In some places, cutting down to one patient per bed is a quality issue. But it was clear at the IHF conference that healthcare is becoming more global and that most countries, regardless of sophistication, still look to the U.S. for answers about how to collect, analyze and use data on quality.
To the committee working to develop solvency standards for Medicare provider-sponsored networks. That they all stay awake during the tedious three-day-a-month meetings would merit a thumbs up. The fact that the competing sides are working in good faith and not merely restating the party line is even more impressive. The whole thing may still go into the tank, but so far so good.
To the people who chose the bipartisan commission on the future of Medicare. The commission was supposed to take politics out of Medicare reform. Instead, those in charge managed to make even the selection of members a political process.