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Thinking Global in Health Care

by Fred Fortin

Much of what I am going to say in this post can be summarized in the following three points:

  1. Our public discourse in health care is often too insular, too self-serving and thus irrelevant when it comes to the rest of the world;
  2. The world, and health care with it, is changing in dramatic ways;
  3. We are not paying enough attention to the above two points.

Health Care Isolationism
Step back for a moment and consider the overwhelming preponderance of words, time and money we spend in taking apart the U.S. health care system. Now think about how much of that talk goes toward building an understanding of our dependencies on the rest of the world for that care. Or for that matter, how much of the world’s health care, in turn, depends on us.

Not much. In fact we tend to polarize our thoughts into strict them-and-us compartments that essentially diminish any appreciation of the depth of those inter-relationships.

It also shows in our ignorance of health care systems in other countries (especially so when we boast of the superiority of either theirs or ours); in our odd blindness to the fact that, demographically speaking, the world is already living in our own house; and in our easy dismissal of international health comparisons not favorable to us. We are, to be blunt, isolationist, and to many on the planet, arrogant,when it comes to health care.

The World and Health Care is Changing
Keeping the world at an arm’s length is no longer possible or desirable. Much like an “American” car or anything you can buy at Wal-Mart, health care is fast becoming the product of a complex world-wide process. While the health care services Americans receive may appear to be local, each drug, patient record, and operating room is the culmination of a complicated international exchange we need to better understand.

Every health care issue confronting today has underlying global aspects. The U.S. health care is discovering itself inextricably caught up in international diplomacy, the throes of globalization, and even the murky dealings of illegal transnational organizations.

We’re witnessing the emergence of a new order, with its corresponding growth opportunities, intractable problems, and chaotic flash points. For example, the drug industry: new drug biologics, research, testing, manufacturing, pricing, distribution, profits, and counterfeiting — all are derivatives of active public and private global networks. International coordination and information exchange is clearly critical in controlling infectious diseases such as SARS, avian flu, or HIV.

“Medical tourism” (international hospital competition) increases every year. More of our physicians are either foreign-born or being trained in other countries– indeed our entire health care infrastructure is increasingly dependent on foreign labor. Research into other countries’ health care practices will usher a new wave of alternative and complementary care into mainstream medicine. And, of course, health care IT. Electronic claims transaction, systems installations and software testing, call centers with advanced technology –- you name it — and its major components are more and more often located offshore.

We are Not Paying Attention
Borders are increasingly, or already, irrelevant to health care. We are either getting flattened, or doing it to others. Adapting to that emerging reality is critical. But we seem to be missing the signals. Even in the grand ideas fermenting in the speeches of our presidential candidates we see little recognition of what is going on around us. So we need to start interrogating the global connection of every health care problem we face. The message has to get out: the globalization of health care is not an optional sub-specialty anymore. It is front and center required reading.


[…] my complete post over at the World Health Care Blog. Posted in WorldHealthCareBlog, Globalization, […]

  Warren Todd wrote @ May 30th, 2007 at 10:07 am

The recent Commonwealth Fund report on spending versus performance/outcomes clearly repeated prior report wherein the US is spending at almost twice the rate of European countries and NOT achieving the same results. The message was exactly what you are suggesting…..we/the United States can learn much how other countries are addressing healthcare issues. At the same time globalizing healthcare is not easy. The insurance sector tried to “export” its managed care business in the late 80’s/early 90’s and it was a disaster. More recently DM companies are also finding resistance for a number of reasons but also because we do not have a very good track record at the moment in the public sector. Notwithstanding US hospital still benefit from thousands of patient from other countries seek out the John’s Hopkins, Sloan Kettering’s, Mayo Clinic’s, etc. If we are to lead with our expertise perhaps it should be via more academic approachs or with centers of excellence.

Given increase in co-pays, uninsured, etc. we are apt to see a large surge in medical tourism in the next decade. If one looks at the credentials of the doctors in countries like India, Singapore, Brazil, Thailand, etc….you will find lots of US trained physicians. I would ask how can we attract more Americans into the medical profession. I fear that if we do not there may be no ceiling to the medical tourism trend.

  James B. Couch, M.D. wrote @ May 30th, 2007 at 10:29 am

My fellow co-founder of the disease management movement in America, Warren Todd, is absolutely correct. Based on my own experience in starting disease management initiatives on four continents, I can tell you that the health care systems of other countries have generally been more receptive to that new way of managing care than has been the American system.

Why should other OECD countries look to America as a “model” when, as Warren points out from the recent Commonwealth Fund study, our system costs twice as much per capita with (generally) worse overall health results?
The fact is that America has much more to learn from other countries, than what they have to learn from us.

  Fred Fortin wrote @ May 30th, 2007 at 1:16 pm

Thank you very much Dr. Couch and Mr. Todd for your comments. So how do we improve the awareness of the global nature of health care? I guess I am of the school that tries to find the sweet spot that avoids both the denial of our achievements or self-serving oversell. Maybe this presidential campaign will offer the country a collective “learning moment” . The question will be , how do we take advange of the opportunity?

[…] argued previously that every health care issue confronting us today has underlying global aspects. And while the […]

[…] brain drain impact is a prime example of global inter-dependencies I referred to in a previous post. The globalization of health care is a reality, in that every health care issue confronting us […]

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