Ortho Exchange Program Provides Lessons for UK, US Health Reform

Ben Cole, for HealthLeaders Media , June 2, 2009

Editor's Note: This is the second in a two-part series about the partnership between Glen Cove Hospital and the National Health Service Elect.

A few weeks ago, in this column I wrote about a program where orthopedic surgeons and anesthesiologists from the United Kingdom observed hip and knee replacement surgeries performed by Eugene Krauss, MD, chairman of orthopedics at Glen Cove (NY) Hospital, part of the North Shore-LIJ Health System.

Both Krauss and Peter Kay, MD, president-elect of the British Orthopedic Association and one of the UK's representatives in the partnership, have high praise for the program, and say it could ultimately improve joint replacement efficiency and quality in the UK.

But they also say the joint replacement program is just the beginning of a partnership where the United Kingdom and the United States could realize the benefits of aspects of the other's health systems as the countries examine sweeping reforms.

Kay notes that since Barack Obama took office, one of the president's primary goals is to overhaul the nation's healthcare system. As a result, the U.S. system could have traits that are similar to the UK's National Health Service, the publicly funded healthcare system in England.

"You've got some massive changes in your healthcare system coming—you're probably going to move more towards a system like ours, and at the same time we'd be moving more to a system like yours," says Kay, who is also a practicing orthopedic surgeon at Wrightington Hospital in the UK.

"The key of working together is to find what is best—and what might be best might not be within our shores."

Krauss notes that the U.S. health system is driven by economics: in American hospitals efficiency and throughput is of utmost regard, he says. Good hospitals are seen as those that are efficient and with quality outcomes so they can make the most amount of money, Krauss says, and the United Kingdom is examining how to move closer to that model rather than its more socialistic orientation.

"I think the opposite is occurring here in the United States," Krauss says. "We've come out of a very economically-driven model—we are now going to have to look in terms of national healthcare programs."

Kay agrees that healthcare in systems in the U.S. are much more focused on making money, which he says is not necessarily a bad thing.

"Money doesn't have to become completely evil, I don't think," Kay says. "If you use money to drive efficiency and quality, as opposed to just profit and greed, I think money can be good. The focus just has to be right."

If the ultimate goal of the U.S. federal government is to provide coverage for every American, the U.S. will have to take some lessons from the United Kingdom as well. Krauss praised the UK's national standards for healthcare, as well as their tracking of these standards via a national registry, as something that the United States could learn from to ensure quality care across the country.

The Medicare patient that comes to a hospital such as Glen Cove, with its high-ranking orthopedics program, is not necessarily going to receive the same standard of care if they sought treatment in inner cities or rural areas, Krauss says.

"We are going to have to be able to move towards a national system that reimburses doctors and hospitals based on outcomes—to do that you have to be able to measure the outcomes, and they already have those standards in place," Krauss says. "You are really aligning our government's incentives, the hospitals' incentives, the doctors, and the patients."

Both Kay and Krauss say that while the partnership between Glen Cove and the NHS is currently focused on orthopedics, they hope it can expand to include lessons that can benefit the country's entire health system. By learning about the benefits and pitfalls of each other's systems, the countries can incorporate best practices they learn from each other.

And as both countries struggle to provide quality care (and make money) during the worldwide recession, they need all the help they can get.

"We are all in the same boat when it comes to funding healthcare, finding cost effective and efficient solutions to keep going," Kay says. "We think that other areas of healthcare may benefit from this sort of engagement."

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Ben Cole is an associate online editor with HealthLeaders Media. He can be reached at bcole@healthleadersmedia.com.

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