Leveraging the best health care on offer in the UK & US

At a time when healthcare is in the headlines on both sides of the Atlantic, the seventh Care Conversation event focused on the likely impact of US healthcare reform as well as differences between the US and UK.

In the US, the NHS has been depicted as a bogeyman that restricts the availability of healthcare to the UK’s citizens and something that Americans would not want to evolve to, while in the UK there is the misperception that 46 million Americans have no access to healthcare,’ Lewis J Hoch, Partner at Blank Rome, told delegates. ‘There are misperceptions on both sides.’

The US healthcare system had three principle components, he explained – regulators, providers and payers. Regulation occurred at both state and federal level, while providers were split into hospitals, physicians and ancillary providers. The payers, meanwhile, were the federal-funded Medicare program, the joint state- and federal-funded Medicaid program and private payers – insurers who contracted primarily with employers. Most US hospitals were tax-exempt charitable organisations where physicians and specialists had staff privileges but were paid by the payer rather than the hospital itself. ‘Historically, it was viewed as unethical for a hospital to employ a physician,’ he said.

‘If you look at the best health systems in America, they have fully integrated medical staff,’ said President of not-for-profit healthcare system Lancaster General Health, Thomas E Beeman. ‘But there are a lot of laws that have prevented hospitals from working closely – and sharing revenues – with physicians, and this has led to non-alignment.’

One of the key components of healthcare reform in the US was sustainability, Lewis Hoch told delegates, alongside access, affordability, funding and savings. ‘In my opinion the only aspect of US healthcare reform that is really relevant to the UK is sustainability – the US spends 17.6 per cent of its economic output on healthcare, while the UK spends 8 per cent.’  Both systems must reign in healthcare costs so that they are sustainable over the long term.

The proposed US healthcare reform is aimed to achieve sustainability through prevention, he continued, with a focus on individual responsibility, as well as conversion to electronic healthcare records by 2015 and improved coordination of care. ‘We have an extremely bloated system in the US where there is ample opportunity for efficiencies,’ he said.

Thomas Beeman noted that the American healthcare system largely ‘pursued what it gets paid for’, which can often include unnecessary procedures.  ‘We’re doing things because we get paid for them, and that is unsustainable. We need to be talking about a system that has the ability to provide comfort and dignity for people and not have them undergoing needless medical procedures. Another key issue was that healthcare reform cannot simply focus on payment reform Issues like obesity, sedentary lifestyle and risky behaviour, need to be considered if a healthcare system is to be sustainable.

Reform would help those people with pre-existing conditions, however, said Lewis Hoch, and it also aimed to reduce the cost of health insurance. ‘Some health insurance coverage places a cap on the amount of benefit they provide, which will become illegal under the reform,’ he added.

‘One of the problems is that Americans like to talk about the US being a market system but often it is not,’ said Thomas Beeman. ‘There are rural hospitals all over America that are the sole source of hospital care for the communities they serve.  Often they provide these services with limited resources and do not and cannot respond to market forces.

‘I can’t tell you the system is perfect,’ he continued. ‘It’s the same as in the UK – we know all the good things about it, but we also know the things we have to work around.’ However, one thing that was sure, he stressed to delegates, the current economic downturn will present challenges to hospitals in the US and the UK which, in turn, will provide opportunity to those hospitals prepared to address these challenges.