Ano is a Justmeans staff writer for health, and an instructional designer for the newly created Master of Health Care Delivery program (mhcds.dartmouth.edu) at Dartmouth College. Ano brings over a decade of evidenced-based health research and writing, and a Masters of Public Health from Dartmouth Medical School to the Justmeans Editorial section. Special interests include health policy, conflict ...
Is European health care leaning towards privatization and specialization?
There are many differences between the way health care is delivered in the US and Europe, but two that may have the largest impact on patient experience and costs are the role of specialists and presence or absence of a single payer. Europe has historically taken the single payer road for financing health care: The government generally serves as the largest insurer. This has begun to change in Sweden, of all countries, which is looking to reform its government-dominated payment model towards one that includes more for-profit, competitive elements. You can read more about that in this previous posting.
The role of specialists is fascinating, and has been brought to the for-brain by a series of papers in The Lancet looking at the Intensive Care Unit. ICU's are of course very complex, uncomfortable and expensive places, generally reserved for the very ill. And there's more than one way to manage and improve that care. A succinct and well-stated Lancet commentary has pointed out the divergent ways that the US and European health care systems appear to be tackling the complexities of ICU care. Increasingly, deficits in ICU care hinge around how care is delivered, not on a lack of technology. Indeed, managing the confluence of hands-on care, sophisticated technology, and information flow may the key challenge. It's a management challenge more than a medical one.
In the US, the emphasis has been to move away from specialists towards "physician extenders," nurse practitioners, and technologies such as telemedicine. Overarching these efforts is an awareness of the importance of being patient-centered, rather than provider-centered.
Europeans, on the other hand, are looking towards an increased role of specialists as the route towards improving ICU care. This includes ramping up the pipeline for training more specialists in intensive care medicine. The European Society of Intensive Care Medicine recently worked with 60 national societies to sign the Declaration of Vienna pledging to make quality improvement of patient care a priority. This month, in an effort to maintain a patient-centered focus, they are launching the Linking Intensive Care to Family Experience (LIFE) campaign.
Remember, the US is generally viewed as the land of the specialist, while the Europeans often thanks their robust primary-care-centered system for their robust health. Do such changes reflect a slow continental drift of health care systems towards each other? Will the US evolve towards the more dispersed care provision centered around patients and physician extenders while Europe consolidates care around specialists? Time will tell.