COUNTRY SNAPSHOTS — EIU GLOBAL ASSESSMENT ALIGNING VALUE
Around the globe, the VBHC model is being introduced incrementally. But in many places, political will is strong and policymakers are moving in the right direction. These country snapshots will show how the enabling environment and policies differ across 25 countries as well as the varying priorities among those countries.
Rising costs may create the impetus for a shift to a discussion about value, but decentralized state-based healthcare delivery presents a challenge to systematic change.
Brazil has one of the world’s largest public healthcare systems, which 75% of the population utilizes, but the 25% who buy private insurance have higher quality care. The country’s healthcare IT system is limited and doesn’t allow for tracking of outcomes or individual patient treatment costs.
Canada offers all its citizens universal Medicare, which is administered through the provinces. A nonprofit organization funded by the provincial and federal government conducts national health technology assessments, and Statistics Canada has national data registries for both researchers and the general public.
Chile provides health coverage through private insurance funds and a national insurance fund, though significant inequalities exist in the system, with low income populations having little access to higher quality private care. Data for research on disease areas is limited.
China insures its 1.3 billion people with universal coverage through the National Health and Family Planning Commission, but there are regional disparities in quality within its underdeveloped healthcare infrastructure.
Colombia offers 95% of its population health insurance through a Contributive Regime, for those who can pay for insurance, and a Subsidized Regime, which covers those who can’t afford to pay. The country has greatly reduced communicable diseases but has seen a surge in chronic diseases.
Egypt has the potential to improve access, cost, and quality of its health system but political instability challenges progress.
France has a universal public-private healthcare system that is often ranked as one of the world’s best with excellent patient outcomes despite spending less on patients than some other countries. The government is focused on controlling costs and has focused on developing stronger patient rights, better preventive care, and more important roles for general practitioners.
Germany guarantees universal coverage to all legal residents, the majority of whom are covered by sickness funds that are financed by payroll taxes. The country’s Institute for Quality and Efficiency in Healthcare produces reports on disease management programs, evidence-based studies, and clinical practice guidelines.
India has a lack of healthcare infrastructure in its rural areas, but offers modern healthcare facilities in the urban areas. The government is trying to make affordable healthcare more accessible nationwide but inequities persist.
Geographic fragmentation, funding gaps, regulatory disparities and infrastructure challenges persist, but steps are being taken to extend evidence-based care.
Japan has given its people universal health insurance for more than half a century. To face the challenge of a large, aging population, the Diagnosis Procedure Combination payment system was established to improve standards and transparency.
Mexico created the Seguro Popular, a publicly subsidized health plan, to cover 50 million people. Healthcare policymakers are aiming to reduce out-of-pocket spending and improve access to care.
There is real interest in value-based approaches from government and healthcare stakeholders, but implementation is moving slowly.
Nigeria has approximately 10% of its population on health insurance. Currently the country is focused on offering accessible primary care, but the system needs many improvements.
Poland has healthcare coverage for its people through payroll contributions or a voluntary National Health Fund. The country has disease registries but often requires written consent of the patient before it is accessible.
Russia offers employed people Mandatory Medical Insurance, a public service funded through payroll taxes, while regional subsidies cover the uninsured. Out-of-pocket spending is common, and cost-cutting in the system has led to cost cutting in several areas and closure of some facilities.
South Africa has public and private healthcare for its citizens, and while the private system has many resources and is effective, the public system spends slightly less and covers five times as many people. The country struggles with high rates of HIV/AIDS, TB, maternal and child mortality, as well as an increasing amount of non-communicable diseases.
South Korea has universal healthcare that covers its entire population through the National Health Insurance Service (NHIS), while supplementary out-of-pocket costs are covered by private insurance. Electronic records are easily available at local facilities but there is no cohesive system-wide program yet.
Despite high spending and lack of patient outcome assessments, a devolved governance structure makes a regional approach instrumental in the push toward value-based care.
Sweden has taxpayer funded universal healthcare that covers all residents and uses evidence-based treatment guidelines. Disease registries regarding individualized data and treatment outcomes are monitored annually.
Turkey started a Health Transformation Program to expand healthcare and refocus its intent on quality instead of quantity. Although a sophisticated data registry does exist, the information can’t easily be accessed, as a different branch of the government owns it.
UNITED ARAB EMIRATES
Geographic inequalities in both health coverage and quality of service exists, but the country has lofty ambitions for preventative care.
The United Kingdom offers universal health coverage through the National Health Service and a small portion of citizens also buy supplementary insurance for elective procedures. Although the NHS’s technology system needs an upgrade, the country is committed to improving it.
The United States is unlikely to offer universal healthcare and the majority of its residents have health insurance. The country has many registries on several diseases but data on patient outcomes are not interlinked, and although the use of electronic health records has been increasing, the system is still fragmented.