The School of Public Health’s new Center for Health System Sustainability (CHeSS) is delving into health care costs, access, and outcomes in different countries to understand what various health systems can learn from each other. By examining different health care models worldwide, the article explores the intricate balance between access, cost, and quality within these systems. The differences in patient out-of-pocket expenses often lead to varied wait times and access to care, illustrating the complex challenges that exist in reforming national health care systems.
The Trade-offs in Health Care Systems
One critical theme in the analysis is the trade-off between medication subsidies and availability. For example, the UK’s National Health Service (NHS) significantly subsidizes medication costs, but this sometimes limits the availability of certain drugs due to budget constraints. On the other hand, in the U.S., Medicare is prohibited from negotiating drug prices, resulting in higher costs. President Biden has highlighted the need for negotiation rights, specifically for the top ten costliest drugs.
Those opposed to government intervention in the pharmaceutical market argue that such policies could hinder innovation. A noteworthy case spotlighted in the article involves the NHS turning down a new breast cancer medication over cost concerns, even though it was accessible in Scotland and the U.S. This example underscores the difficult decisions health systems must face when balancing cost and innovation.
Federated Research and Methodological Approaches
Under the direction of Irene Papanicolas, CHeSS emphasizes providing empirical data to foster nuanced policy improvements rather than simplistically labeling one health system as superior to another. Countries such as Switzerland, Germany, and the Netherlands have private insurance systems that yield better life expectancy and spending outcomes compared to the U.S., but no single system consistently excels across all performance metrics.
A vital technique in this comparative research is the “federated research” approach developed by Enrique Bernal-Delgado. This method maintains the privacy of each country’s data while allowing for the production of comparable findings, thereby enhancing the accuracy of global data comparisons. The COVID-19 pandemic acted as a “natural experiment,” testing the robustness of health systems worldwide and revealing diverse responses based on their underlying capacities.
Insights from Global Health System Comparisons
One of the main goals of CHeSS’s research is to glean insights on best practices in patient care continuity during crises. For instance, comparing hip fracture patients in various countries has highlighted the importance of minimizing polypharmacy to reduce fall risks and revealed differences in medication use across health systems. This comparative analysis helps improve both policy and practical outcomes, such as patient preferences for rehabilitation settings after hip fractures, thereby fostering more integrated and patient-centered care systems.
An illustrative example of this work’s practical implications comes from British critical care physician Ritesh Maharaj. His research endeavors to better integrate acute and long-term care by studying U.S. models for equitable and integrated funding structures. In another case, Liana Woskie from Tufts University analyzes transnational data to understand U.S. reproductive health policies, with a specific focus on the regulation of mifepristone post-Roe v. Wade. This comparative analysis sheds light on how various regulatory frameworks impact accessibility and outcomes.
Addressing Global Health Care Challenges
The School of Public Health’s new Center for Health System Sustainability (CHeSS) is investigating the intricacies of health care costs, access, and outcomes across different countries. Their goal is to uncover what various health systems can learn from one another. By scrutinizing diverse health care models globally, the center aims to shed light on how different systems achieve a balance between access, cost, and quality. This comparative analysis reveals that disparities in patient out-of-pocket costs often result in varying wait times and access to care. These differences highlight the complex challenges faced when attempting to reform national health care systems. Factors like geographic location, economic conditions, and cultural attitudes significantly impact each country’s approach to health care. Through its research, CHeSS hopes to provide insights that can lead to more equitable and effective health care reforms worldwide. Understanding this complex landscape is crucial for policymakers who aim to enhance both the efficiency and equity of their national health systems.
