Before We Save the World, We Need to Know How to Pay for it.


The United States, of course.

Oh, no, wait, it’s Canada.

Actually, I think it could be Germany.

Geez, now I think it might be the UK.

You could go on and on like this.  But you know what?

No matter how good or bad your system is, there are certain universal truths.

Here are four of them that might make you look at global health care a little differently.

First, health care is getting more expensive, all over the world.  A new study by the global consultant, Towers Watson (disclosure: Towers Watson is a Best Doctors client) found that the average medical cost trend around the world will be 10.5% in 2011.  In the advanced economies costs will rise by an average of 9.3%.  While Americans tend to think of rising medical costs as a uniquely American problem (they’ll rise by 9.9% here), it’s just not true.  Canadian costs will rise by 13.3%.  In the UK and Switzerland, they will increase by 9.5%, and in France by 8.4%.

Why is it happening?  As ever, the main drivers are the increasing availability of new medical therapies – and inappropriate use of care.  We see the same phenomenon at Best Doctors in our global experience.  Across the world, our data for 2010 showed that just over 20% of patients had an incorrect diagnosis, and about half were pursuing inappropriate treatment plans.

Second, consumers are increasingly dissatisfied with their health care experience.  The Commonwealth Fund’s 2010 survey on views of health care found that 68% of Americans think their health care system needs to be fundamentally changed or completely rebuilt.  But 61% of Canadians thought the same thing, as did 58% of French people, 52% of Swiss, 48% of the Dutch, and 75% of Australians.  All of these places have remarkably different systems, and yet none of them are very well-liked at all.

Third, time spent dealing with insurance restrictions is a major barrier to quality care in the United States – but it’s becoming a problem elsewhere, too.  According to the Commonwealth Fund, 48% of American doctors said that coverage restrictions were a “major problem” getting in the way of delivering needed care.  While it’s less of a problem outside the U.S., nearly 20% of Canadian doctors reported the same problem.  As other countries adopt U.S.-style cost controls to deal with the rising cost of care, it’s likely that doctors in those countries, too, will start to report the same trouble.

Fourth, some employers, insurers and governments are looking for a better way.  The Towers Watson study reflected something we found in our own study.  Payers are increasingly implementing programs to get people to take better care of themselves and be more involved in their health care decisions.  Programs like wellness and prevention and higher deductible plans are part of an overall approach to getting consumers more engaged in their health.  But one of the fastest growth areas is still what some call “second opinion” – programs like what Best Doctors provides – where the goal is to help make sure that every person gets the right diagnosis and treatment.  Towers Watson found that 25% of health care payers across the globe have implemented these programs.  They help make sure each person is dealt with as a patient, regardless of how good or how bad their health care system might be.

So, who really has the worst health care system?

I don’t think there’s an answer to that question, except for this: don’t get sick.

Evan Falchuk is President and Chief Strategy Officer of Best Doctors, Inc. Prior to joining Best Doctors, Inc., in 1999, he was an attorney at the Washington, DC, office of Fried, Frank, Harris, Shriver and Jacobson, where he worked on SEC enforcement cases.


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