A different take on where all the money's gone

My funding for this work is coming from the Commonwealth Fund - a fascinating organisation based in New York. They have recently published a comparative assessment of international health systems. An intriguing graph is available here http://www.cmwf.org/chartcartcharts/chartcartcharts_show.htm?doc_id=402690 . It gives an interesting corrective to a lot of the debate around UK health expenditure. What is clear from this is that while there has indeed been an historically rapid increase in spending it is not disimilar to the increases across western health systems. This raises the interesting hypothesis that the cost of health care, independent of any governmental intevention, has increased in the last few years, and that the increases were simply what was required to meet these rising costs. In the UK we know that much of the additional expenditure went on increased pay for health care professionals and increased drug costs (including the costs of introducing new technologies). (see e.g. http://www.kingsfund.org.uk/resources/publications/spending_on.html). It would be interesting to know if similar work has been done looking at where the money went elsewhere.

It's not how you think...

So I came at this thinking that the big differences would be markets versus command economies, the profit motive versus public sector ethos, dynamisms vs sclerosis (delete according to newspaper, I guess). But I'm rapidly discovering that the differences are more about roles played than the system.

Obviously there are systemic differences and hence entirely unique problems (uninsured populations vs waits for care, unintegrated systems vs local monopolies) but it is surprising how often you can analogise. For example pay for performance systems in the US - a way of incentivizing healthcare providers to provide care of higher quality - seem to push towards certain models of working. In many ways although the incentives are different the responses and theory of how this might work does not seem so different from the use of targets in the UK. In particular, both seem, from my admittedly rudimentary reading of P4P to be open to the criticism of focusing only on a subset of care, and potentially missing a bigger picture.

In contrast the players are really different. For example large corporations here are major purchasers of care (through purchasing health insurance for their staff) and certainly seem to use their power in health arena in terms of insisting on certain things. In contrast I'm less clear what the government's role is.

This has set me thinking as to whether there is a specific governemnt role in healthcare. By which I mean something uniquely governmental and outside of the healthcare system, as opposed to government playing system role (provider, purchaser, funder, regulator etc). Another question to speculate on over the coming year.