Changing the Health Care System Models from Here and Abroad (1994) / Chapter Skim
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Commentary: Some Thoughts on the Development and Diffusion of Medical Technology in Europe
Commentary: Some Thoughts on the Development and Diffusion of Medical Technology in Europe
Pages 17-30
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From page 17... ...
Lohr In the previous chapter, Jan Blanpain has presented a thought-provoking picture of the evolution of European health care systems. His remarks indicate how widely health and health care still vary in a European continent that is steadily, although hesitantly, moving toward greater homogeneity in politics and finance.
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From page 18... ...
As Uwe Reinhardt has observed, such public macromanagement differs from the American tendency to micromanage physicians and patients, especially in the private market, through both fine-tuned financial incentives and direct interventions in clinical decisions.2 What are some of the consequences of the difference between macromanagement and micromanagement for the diffusion of medical technology in Europe and the United States? Figures 1 and 2 and Table 2 show TABLE 1 Alternative Cost-Containment Strategies in Health Care Strategy Micromanagement Macromanagement Supply Encourage efficiency in production Plan and regulate health of medical treatments through care resources .
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_ CO n C~ C) IL (n FIGURE 2 Percutaneous transluminal coronary angioplasty (PTCA)
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is a form of capital-intensive equipment; its diffusion per population demonstrates a better than eightfold difference between the United States and the United Kingdom. Percutaneous transluminal coronary angioplasty (PTCA)
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For example, it is no coincidence that beta blockers emerged in the United Kingdom, whereas calcium channel blockers found their origin in Germany. Beyond cultural variables and medical tradition, the specific character of the health care system is another critical factor.
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Consequently, medical and professional priorities often drive the system without overt regard for cost. According to Williams, concerns about costs are left to managers in health authorities or hospitals, who, because they have little information, make rather arbitrary decisions about increasing or decreasing capacity to balance their publicly set, fixed budgets.~° In short, at the heart of the priority-setting process is the information void that fan Blanpain discussed in the previous chapter.
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From page 23... ...
Still, one should bear in mind that some European countries have successfully implemented public policies to counterbalance the innovation-suppressing effects of excessive regulation. For example, it is well-known that most Europeans regulate their drug prices, as shown in Table 2, but it is less well-known that the British National Health Service and the French Government retain explicit incentives for innovation in their pricing formulas.
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As Lester Thurow recently observed in Head to Head when he compared the prospects of Germany with those of the United States: the fundamental difference is between the communitarian German economy and the individualistic American economy. It is logical to expect such basic differences to be reflected in the medical technology structures of public macromanagement and private micromanagement that we described above.
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1992. The Role of Percutaneous Transluminal Coronary Angioplasty in Coronary Revascularization: Evidence, Assessment, and Policy.
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. GELIlNS: As you know, in The Netherlands there is enormous radical change going on in the health care system, in which they are basically changing from a private and public system of insurance to providing a basic health care package for the whole population, and then the population can privately insure themselves for other elements of care that are not provided in the basic package.
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Then it was realized that the physicians were the major determinants of health care expenditures and service utilization. And so the question was how to control the numbers of physicians, because the more physicians you have the more utilization there will be.
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Even if a country has stringent policies for controlling entry into medical school, EC regulations allow students free access to other schools. Belgium does not block access to medical schools by its own nationals, so it cannot block access by other EC nationals.
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I personally believe that it is a cultural phenomenon. QUESTION: One of the transformations that is going on in the United States is the movement from inpatient acute care to outpatient care and the creative use of the ambulatory environment.
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30 THE EUROPEAN EXPERIENCE FELONS: In the United States, as you said, the reimbursement system drives people and their behavior to get out of the more strictly controlled setting of the hospital. That does not happen in Europe as much, and I think that there is less movement to ambulatory care, freestanding surgical units, diagnostic centers, and home care than you see in this country.
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