The Health Affairs April Issue examines high income countries struggling to achieve the so-called “Triple Aim” to achieve better health and better healthcare at lower cost. The April issue was supported by the Commonwealth Fund, Britain’s Nuffield Trust, and the Institute of Global Health Innovation at the Imperial College of London.
Several of the articles describe the lessons learned from other countries and how these successes can help the healthcare system. For example, faced with rising prescription drug costs, Australia instituted a strategy to cover new prescription drugs that save money without compromising quality. The article “Australia’s “Fourth Hurdle” Drug Review Comparing Costs and Benefits Holds Lessons for the U.S.” authored by Ruth Lopert and Adam Elshaug, describes how the country’s four step review links prescription drug prices with their quality and effectiveness.Australians enjoy universal drug coverage with patients contributing fixed copayments based on income. Today, after assessing new prescription medicines for safety, efficacy, and quality, the government looks at the value provided and makes coverage decisions accordingly. The government does not set or control prices, instead the drug’s manufacturer requests a price and based on this, the government assesses the value proposition.
In another article, Ewout van Ginneken of the Berlin University of Technology in Germany and colleagues evaluated insurance market reforms in Switzerland and in the Netherlands. According to the article, lessons learned include using sophisticated risk-adjustment strategies so that health plans won’t avoid helping people with health problems, designing new approaches to enrollment coverage, and making consumers aware of subsidies.
The article “Hospital Payment Based on Diagnosis-Related Groups Differs in Europe and Holds Lessons for the U.S” by Wilm Quentin, M.D and colleagues, discusses the use of Diagnosis-Related Groups (DRG) to classify patients of similar characteristics and comparable costs with hospitals paid a flat fee to treat them as originating with Medicare. The authors say that adopting some of the payment innovations used in European countries may lead to higher-quality care and lower costs for Medicare enrollees.
In Germany, the total volume of services provided by a hospital is negotiated each year. If the hospital exceeds this target, the DRG-based payment is reduced by a certain percentage. In England, payment is based for some procedures on best-practice guidelines rather than actual costs so hospitals are encouraged to follow agreed-upon standards of care.
Sarah Thomson of the London School of Economics and Political Science and her colleagues authors of the article “Value-Based Cost Sharing in the U.S. and Elsewhere Can Increase Patients Use of High Value Goods and Services”, review approaches in the U.S and eleven other nations. They found that while most countries undertake only limited evaluation of value-based cost-sharing, there was evidence that value-based cost-sharing reduced prescription drug costs in some countries, saved money and brought higher quality of care to selected groups of patients in the U.S. and Germany.
For more information on the Health Affairs April issue, go to www.healthaffairs.org or to www.commonwealthfund.org.