New manuscript in Health Affairs, “Health Care Cost Containment Strategies Used In Four Other High-Income Countries Hold Lessons For The United States“:
Around the world, rising health care costs are claiming a larger share of national budgets. This article reviews strategies developed to contain costs in health systems in Canada, England, France, and Germany in 2000–10. We used a comprehensive analysis of health systems and reforms in each country, compiled by the European Observatory on Health Systems and Policies. These countries rely on a number of budget and price-setting mechanisms to contain health care costs. Our review revealed trends in all four countries toward more use of technology assessments and payment based on diagnosis-related groups and the value of products or services. These policies may result in a more efficient use of health care resources, but we argue that they need to be combined with volume and price controls—measures unlikely to be adopted in the United States—if they are also to meet cost containment goals.
What did they do? Technology assessments = comparative-effectiveness or cost-effectiveness research. Payment based on value = value based insurance. Add in some volume or price controls (rationing or rate setting). None of these strategies are new. We’ve discussed all of them on this blog repeatedly.
It’s important to note that not all of these efforts are meant to reduce spending. Some are meant to improve efficiency. In other words, some are trying to improve quality without increasing cost. That’s still a worthy goal.
Nevertheless, all of these strategies – almost to a fault – are resisted or demonized here. Instead, we’ll likely continue to try things that have never worked or have no evidence behind them.