Can we learn anything from health care in the United States?

Summary

• Some aspects of health care in the United States would be beneficial to Australia and New Zealand, but others should be avoided.
• Positive aspects, which should be emulated, include:
  • ➢ health care reform that is focused on the continuum of care and patient-centred care
  • ➢ trials of new models to organise, deliver and pay for health care services, where quality of care is rewarded over quantity of services
  • ➢ an integral view of, and strong support for, health services research as a means of evaluating reforms aimed at improving patient outcomes and systems-level efficiencies
  • ➢ physician engagement in reforms — for example, participating in the Choosing Wisely initiative, and trialling and implementing new payment models that are not fee-for-service.
• Negative aspects, which should be avoided, include:
  • ➢ increasingly fragmented provider and financing structures (funding provided by state and federal governments, private insurance and out-of-pocket costs) that cause frustration in terms of access and care coordination and increase administrative waste
  • ➢ an overemphasis on technological solutions, with insufficient acknowledgment of the importance of addressing value in health care
  • ➢ a focus on hospital and doctor-based health care rather than environmental and social inputs into health.