Lessons From Abroad:

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Lessons From Abroad

• International Efforts to Improve Quality, Reduce
  Costs and Increase Transparency

Robert S. Galvin, MD Bipartisan Congressional
Health Policy Conference January 13, 2007
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Lessons From Abroad

• Where The U.S. Is Different
• Much Larger, More Heterogeneous Population
• Health System Much Less CentralizedBy Design(?)
• - Federal vs. State vs. Private Sector
• No Consensus On How To Control Costs
• Very Medical Innovation-Technology Friendly

• Where The U.S. Is Most Similar
• Common Belief Driving Value vs. Cost Containment

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U.S. Has Been Improving QualitySlowly
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Strategic Framework Board - 2003
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The Power Of Transparency
Death Rate (RAMR)
Hospital
Columbia Presbyterian 3.93 Lenox Hill 2.26 NYU
Hospitals Center 1.95 Weil Cornell NYP 0.95
Surgeon
RAMR
State Total 2.25 Smith, C 4.15
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Payment and Improvement
MedPAC 2004 (2004)
Institute of Medicine (2001)
Purchasers shouldRemove Barriers thatImpede
Quality Improvement And Build In Stronger
Incentives For Quality Enhancement
Current Payment Systems . . . Are at Best
Neutral and at Worst Negative Towards Quality
Glen Hackbarth
If I keep getting better, Dr Galvin, Im going
to improve myself right out of business
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Health Costs Lots of Opportunity, Little Focus
Immutable Desirable
Ageing Technology
Unhealthy Lifestyles Malpractice End of Life Care
Cultural
Uninsured Administrative Costs High
Prices/Specialist Incomes Waste and Quality
Shortfalls Lack of Accountability/Transparency
System of Care