WASHINGTON – The globalization of health care is creating challenges for health care systems worldwide. Though the systems themselves may be very different in terms of financing and administration, the problems they must address–aging populations, increasing chronic disease, shrinking budgets, extreme mobility of both patients and health care professionals–are very similar.
Health care analysts, administrators, and providers compared notes on these challenges at the fourth annual World Health Care Congress, sponsored by the Wall Street Journal and CNBC.
“Despite the fact that health care may be organized and financed very differently in different countries, and there may be cultural differences, there are … a lot of common themes, and shared objectives for high-performing health care systems, innovation, and sustainability,” said Robin Osborn, director of the International Program in Health Policy and Practice at the Commonwealth Fund.
Simon Stevens, who served as a health care advisor in U.K. Prime Minister Tony Blair's cabinet, said the United States is not alone in confronting a major health care crisis. Single-payer national health systems of the sort found in the United Kingdom and all over Europe make the dynamics a bit different, but they certainly do not avert the crises.
“Despite differences in financing mechanisms, the challenges are similar across all industrialized nations. Tobacco, bad diet, lack of exercise are driving the conditions that result in the greatest consumption of health care resources, and tensions are erupting across [health care] systems due to changes in financing. The U.S. is not the only country debating these issues. The challenges are the same regardless of how you choose to finance the health care,” said Mr. Stevens, now the CEO of UnitedHealth Group's Ovations, a health plan for individuals over age 50.
Aging populations are the juggernauts straining health care systems in nearly all industrialized countries. Over the next 30 years, the dependency ratio, an expression of the number of elderly nonworking dependents versus younger working people, “will grow rapidly in the U.S., Western Europe, Japan, and China. And this will radically change how health care is financed,” Mr. Stevens said.
He added that while American corporate leaders have been screaming the loudest, the issues around employer-funded health care are not uniquely American.
In several European countries, corporations are footing the bill for significant chunks of health care spending. “In the U.K., 52% of spending is private sector spending, despite the fact that the delivery systems are government funded.”
Around the globe, health care is increasingly a transnational endeavor, with immigration, relocation, medical travel, and multinational business blurring borders. The establishment of the European Economic Community has created an interesting health care quandary, Mr. Stevens said.
In the earlier days of the EU, many hoped that the confederation would lead to harmonization of health care benefits, but that has not happened. “Per capita spending on health care in Eastern and Western Europe is fourfold different,” he said. “Western Europe spends way more.”
Migration also has an impact. More people are living outside their countries of origin, and this makes for some peculiar health care dilemmas.
Mr. Stevens noted that in many parts of the world, national borders are blurred. “In California, for example, we know there are 8 million Hispanics living in border counties. Many have dependents across the border in Mexico. How do we handle that? Can we mandate that dependents of U.S. employees only be treated in clinics in Mexico?”
At the other end of the socioeconomic spectrum are thousands of retired U.S. citizens living in Mexico, Costa Rica, Panama, and other Central American countries. They're eligible for Medicare but unable to get coverage for medical services or drugs they obtain where they live. “Does this mean these people must fly back to the U.S. every time they need medical care?”
Physicians, nurses, and other medical personnel also have become highly mobile. Citing only one example, Mr. Stevens said there are more Filipino nurses, born and trained in the Philippines, working in the United States than there are in the Philippines. In the EU, there are significant migratory flows of health care professionals from east to west.
This can result in shortages of qualified professionals in many countries, hindering the growth and development of their medical systems.
Ironically, it is the influx of international patients seeking lower-cost health care that will be an important driver for the development of hospitals and the retaining of health professionals in countries such as Thailand, India, Hungary, and many Latin American countries.
Health plan administrators are struggling to figure out ways to do business without borders. The challenges are daunting, said UnitedHealth Group's Ori Karev. Referring to coverage for Americans obtaining care outside the United States, he said there are many complicated issues involved, including those around transportation, authorization, and taxes– in terms of the ways in which the IRS will treat medical travel expenses.