Managed care has marched into Europe as more nations rethink their government-sponsored universal coverage.
To improve quality and cut costs, European health plans, often called health funds, are studying and adopting aspects of American-style managed care.
Increased healthcare spending worldwide has sparked the spread of managed care, says Jonathan Lewis, president of the Academy for International Health Studies based in Davis, Calif. High unemployment and lower government revenues, combined with aging populations and increased consumer demand, contributed to cost surges in the 1980s and 1990s.
"Until very, very recently, Europe did not have an access, quality or cost-control crisis," Lewis says.
Managed care has American roots going back to the Great Depression, but it's new in Europe. In France, the first PPO was formed in 1995; in Poland, the first managed-care organization was launched this year; and in Germany, health reforms in 1997 permitted pilot projects to use some aspects of managed care, such as physician contracting.
"Utilization review, case management, coordinated care, home healthcare, pharmacy benefit management, information technology systems, physician contracting and network development are of high interest by both public and private-sector healthcare systems around the world," Lewis says.
The academy and the Washington-based American Association of Health Plans co-sponsor the Summit on International Managed Care Trends. This year, the summit will be held in Miami Beach, Fla., in December.
Many U.S. managed-care organizations-such as Aetna U.S. Healthcare, Cigna HealthCare, Health Partners, Humana, Kaiser Permanente International and United HealthCare Corp.-are trying to spread their business globally. (See related story, p. 30).
United, based in Minnetonka, Minn., has maintained a consulting presence in Europe since 1995. In Germany, United designed a disease-management program to reduce unnecessary and costly utilization.
United is now helping a German reinsurer improve the efficiency of a managed-care organization it recently purchased. The organization operates in Europe and the Middle East.
"United just finalized procurement of medical necessity guidelines," says Sid Stolz, senior vice president of United's global consulting division. "The managed-services organization will use those guidelines to determine which services are appropriate for their membership."
Despite growing interest, few of the European health funds use the term "managed care," because its negative connotations in the U.S. have spread abroad, says Susan Corning, deputy secretary-general of the International Federation of Health Funds, a 93-member global network based in Reading, England. Instead, the organizations use the terms "integrated care" or "coordinated care."
"Basically, they realize that as a buzzword, the term has a bad reputation," Corning says. "However, they see (managed care) as an absolute necessity in terms of delivering quality. The concept is inevitable, no matter what you call it."
European consumers have a different outlook on managed-care plans than Americans do. While Americans complain that managed care limits choice, Europeans choose private insurers to increase their choices and to decrease the waiting time typical of government-sponsored care, Corning says. Under universal coverage in England, patients are assigned to physicians based on location rather than personal preference.
Robert Seitz, a health economist at the University of Ulm in Germany, agrees that managed care could increase choice. "Accessibility of providers is a big problem in Germany," he says. "Usually, people can see a doctor from 8 a.m. to 6 p.m. After 6 p.m., they usually have to go to a hospital. Providers in the (managed-care) pilot projects coordinate care so patients can obtain care at any hour of the day by a network physician."