The United States faces major obstacles in taking advantage of "value-based healthcare"-one of the most promising developments in healthcare, according to a new study by The Boston Consulting Group (BCG).
BCG assessed the progress of 12 developed-world countries in adopting value-based healthcare, an approach to better controlling healthcare costs by improving health outcomes while maintaining or lowering cost. The results of the assessment appear in a report titled Progress Toward Value-Based Health Care: Lessons From 12 Countries.
The assessment evaluates national health systems along two dimensions, explains Neil Soderlund, a BCG partner and coauthor of the report. The first is the degree to which key supports of value-based healthcare are in place at the national level-for example, common national standards and IT infrastructure, national legal and consent frameworks, the ability to link health outcomes with costs, and high engagement on the part of clinicians and policymakers. The second is the quality of a country's existing disease registries (institutions that track selected health outcomes in a population of patients with the same diagnosis or who have undergone the same medical procedure), both in terms of the richness of the data and the sophistication of the medical community's use of the data.
"When it comes to implementing value-based healthcare, Sweden is the most advanced country of the 12 we studied, followed by Singapore, Canada, and the U.K.," Soderlund says. "By contrast, Germany and Hungary have the furthest to go."
The U.S. health system, which has the highest per capita costs of the 12 nations studied and spends 17.6% of gross domestic product on healthcare, is also one of the laggards in the group, notes Peter Lawyer, a BCG senior partner and coauthor of the report.
"The U.S. has some successful national disease registries, such as the Cystic Fibrosis Foundation Patient Registry, the Society for Thoracic Surgeons' STS National Database, and the American College of Cardiology's CathPCI Registry," Lawyer says. "And some integrated players such as Kaiser Permanente have made considerable progress in using clinical outcomes in their own patient populations to identify and disseminate best practices across their centers."
However, the fragmented nature of the U.S. healthcare system has seriously limited the collection and use of national health outcome data, Lawyer says.
"Reporting standards and clinical outcome metrics differ substantially across the system, even within the same specialty," Lawyer says. "There currently exists no national mechanism for compelling providers to report outcomes to disease registries. Nor is there a unique patient identifier in place that would enable research to combine data across different disease states to examine the effect of complex comorbidities.
"The report is one of the most detailed international comparisons of progress toward value-based healthcare, combining a top-down assessment of national enablers with a bottom-up assessment of data quality and use at existing disease registries across 12 major health conditions. It uses 35 specific assessment criteria developed on the basis of previous BCG research in the field, a comprehensive survey of the medical literature, and 139 interviews with representatives of national health departments and with international health-outcome experts, explains Stefan Larsson, MD, a BCG senior partner and coauthor of the report.
"We learned that a number of countries have begun to build the infrastructure and processes to support a value-based approach, but some are significantly farther along the learning curve than others," Larsson says. "Despite this differential in development and despite major differences in the structure and organization of national health-care systems, there is much to learn from each country."