Edward Mendoza, M.D., calls it his "crazy obsession." It consumes three hours of reading time almost every evening and keeps him in global transit in search of fresh material.
His dream is to publish the world's largest comparative database of national healthcare financing systems. Already the author of an authoritative tome on the subject, Mendoza hopes that by the turn of the century he will have dissected healthcare delivery-from access to X-rays-in 100 countries. With 40 countries and 4,000 pages under his belt, the 52-year-old neurologist's Guinness Book-worthy ambition appears to be well within reach.
Along the way, Mendoza, a clinical professor at Atlanta's Morehouse School of Medicine, has picked up a textbook-like knowledge of various countries' strengths and quirks. In Singapore, for instance, a mandatory withholding tax goes into individual accounts to help pay for catastrophic healthcare expenses.
But don't ask him which country has the best system. "I don't think there is a perfect system," he says. "There's not enough GDP (gross domestic product) in the world to produce a healthcare system that the providers feel is adequate for everybody."
Mendoza acknowledges that "every country has positive and negative aspects to it," driven largely by each society's culture. The U.S., he says, has some of the highest-quality technology available. And while that technology can be accessed more quickly than in other countries, it's expensive, he says. The Swedish and British, on the other hand, keep costs low and have universal access. Their technology is good in certain aspects but isn't available to everyone, he says.
Common themes. Despite each country's idiosyncrasies, some common themes prevail. "Every nation is worried about cost, and every nation is changing its healthcare system." Mendoza muses at the ironies that spring from the quest for a better way. Once, when visiting Amsterdam, the Netherlands, he heard a local official say, "The Irish are here trying to adapt the system that we're looking to get rid of."
Mendoza, with co-author Bryn Henderson, D.O., began documenting the world's healthcare systems in 1993 after returning from a study tour to Berlin and Amsterdam. It was, in retrospect, a neophyte effort. "It was like a Mickey Mouse article," he jests, making light of their earnest attempt to define summarily two entire healthcare systems. "Healthcare and systems are like healthcare providers: Each has its own good parts," he concludes.
What they needed was a better mousetrap, one that would allow comparisons of parts of systems. Thus began the embryonic phase of a database that would take users through the ABC's of various countries' healthcare delivery systems. "A is for access, B is for buildings, C is for costs," Mendoza explains.
Within each section, the authors provide significant background and detail. In an analysis of South Africa, for example, the drug section explains the national emphasis on primary care and the widespread use of generic drugs.
Most of the team's material comes from previously published sources. Each week Mendoza combs Morehouse's gigantic international healthcare library for 12 articles to peruse. He sends away for another 13 references not available at the medical school. Information picked up on trips abroad-Mendoza has visited some 35 to 40 countries so far-also finds a home in the database.
"Ed is very compulsive about it," says Henderson, the project's co-author. Henderson's role is to edit and validate the material. He tracks what's happening in the news internationally to ensure that the information makes sense in a broader context. "We're striving for accuracy knowing that we'll never achieve it. All we can do is keep improving it."
Even as Mendoza and Henderson add new countries, past profiles are being updated in their book, International Health Care, A Framework for Comparing National Health Care Systems. Now in its third printing, it soon will be available on CD-ROM. Eventually, Mendoza would like to be able to provide real-time updates of the database.
"If you're interested in international comparisons in healthcare, it's just an extraordinary product," says Wesley Curry, managing editor of book publishing at the American College of Physician Executives.
Getting interested. Mendoza, the Bronx-born son of hard-toiling factory workers, says his career in medicine took shape during his freshman year at the U.S. Military Academy at West Point. Destiny called during an eight-man tackle intramural football game. Sustaining a hand injury that disqualified him from armed combat, a young Mendoza was impressed by the doctors he met while in the hospital.
"I just enjoyed the Sherlock Holmes aspect of medicine," he remembers.
In the medical service corps, Mendoza learned the ropes of hospital administration at New Jersey's Fort Dix. He earned his medical degree at Atlanta's Emory University in 1973, followed by a three-year internal medicine residency and another three-year residency in neurology at Walter Reed Army Medical Center in Washington.
Mendoza spent the remainder of his military career at Eisenhower Army Medical Center in Fort Gordon in Augusta, Ga. In 1982, he began as chief of neurology, later advancing to chief of primary care and community medicine. He also moved up the ranks at the Medical College of Georgia, first as an assistant clinical professor and then associate professor of neurology.
In 1987, a year before retiring from the military, Mendoza realized that he would need to sharpen his administrative skills to advance his career in the civilian world. So he enrolled in Georgia State University's master of business administration program. The only physician among 50 MBA-hopefuls in the Atlanta-based program, he was a rarity. "At that time it was very avant-garde, as they say."
From 1988 to 1989, Mendoza held down the post of chief of emergency services at St. Joseph's Hospital in Augusta while completing his MBA. Also in 1988, he established a physician group to provide fee-for-service primary care and neurology services at several military bases.
In 1989, fresh out of business school, Mendoza began applying his newly acquired entrepreneurial skills in numerous arenas, first establishing a billing service for physicians, then signing on as a vice president for medical affairs at Healthshield. The now-defunct Atlanta-based outfit was, according to Mendoza, among the first physician practice management organizations in the market to begin tying outlying clinics to hospitals.
Sparking an obsession. Mendoza's obsession with international healthcare was sparked by his participation in the ACPE. He joined the fledgling organization-then known as the American Academy of Medical Directors-in 1986 on the advice of a commander who said he needed more administrative experience. It was through a forum on international healthcare that he met Henderson, his future co-author.
"Both of us were wearing three-piece suits, I think, which prompted us to say hello," remembers Henderson, owner and president of International Trade Affiliates, an Orange, Calif.-based consulting firm dedicated to improving healthcare providers' profitability.
Today both are fellows of the ACPE and active leaders in the organization's annual study tours abroad.
Mendoza teaches three courses at Morehouse: financing international healthcare systems, comparative international healthcare systems, and managed care and public health. He also directs the neurology clinics at Atlanta's Grady Hospital and is a senior consultant with Alpharetta, Ga.-based Healthcare Management Advisors.
And every year, as a participant in the ACPE's annual study tours and a past chairman of its international healthcare forum, Mendoza packs his bags for foreign lands. With the world's healthcare systems in constant change, his obsession to document it all may never be completely sated. But Mendoza is giving it his military best.
"Data is king," he says. "You can't change until you understand."
