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Learning internationally, revisited

by Emily DeVoto

Thanks, David, for your question:

They say “necessity is the mother of invention.” How have budget-constrained, socialized health care systems managed to do more with less? In particular who’s done a good job at combining universal access, low cost, high quality and low waiting times? What lessons can we apply here?

Backtracking a half step, I think it’s safe to say that every country is budget-constrained when it comes to health care costs, whether there’s an organized, socialized system or not. The four outcomes you mention are but a few of the many dimensions on which to measure health care. Waiting times, wow - that’s a complicated one, because it reflects supply and demand of doctors of various specialties, which reflects referral patterns, as well as overall access. (I think it’s safe to say that, despite popular belief, plenty of Americans do wait for health care…). According to this paper from the Commonwealth Fund, comparing the US with four British commonwealth countries, no one is best or worst consistently on quality. I’m not sure the data have been compiled for all the dimensions you point out. I also think that putting lessons into place is going to involve priority-setting (e.g., is reducing cost in order to improve overall access a more important goal than reducing all waiting times?), at least for the time being.

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