Health Care Needs a Better System for Importing Ideas From Abroad

Read the full column on Wall Street Journal.

With political winds potentially changing the U.S. health-care system—yet again—it’s tempting to look inward, rather than outward for solutions. That means opportunities may be lost to learn from innovations abroad in the delivery of health-care services.

Other countries are confronting and—in many cases—solving some of the same dilemmas that plague U.S. health care, such as chronic disease, population aging and behavioral health issues. Some of these solutions are being implemented abroad for a fraction of the cost we’d pay here at home. Yet, there has been no systematic way to review these innovations or other international projects and programs that address our shared problems.

Such imports have had profound impact in the past. Hospice, for example, is now widely used by terminally ill Americans. It originated in post-World War II England before it was imported to the U.S.

While specialists and scientists frequently do look around the world today for medical breakthroughs, the managers of health systems and policy makers too often ignore large-scale new models of care delivery.

But some organizations are trying to change that. Recently, Ascension, the nation’s largest nonprofit health-care system, has begun experimenting with replicating an Indian approach to cardiac surgery. The Narayana Health System performs coronary artery bypass surgeries of comparable quality to developed nations at a cost of less than $2,000, compared with a typical cost of $50,000 in the U.S. Ascension has partnered with Narayana to create a facility in Cayman Islands that will serve patients from North and South America. Based on that experience, Ascension will see whether elements of that innovative model could be transferred to the U.S. mainland.

Working with 15 leading U.S. delivery systems including Ascension, Kaiser Permanente and CareSouth Carolina, the Cambridge-based Institute for Healthcare Improvement has led a global search for health care innovations that hold promise for resolving persistent problems at U.S. facilities. A variety of international models are now being tested, with the backing of my organization, the Commonwealth Fund.

Some of these systems are testing a new way of organizing hospital discharges. A so-called flipped discharge planning team greets the patient at home and makes arrangements on site for post-hospital care that is tailored to patient’s home situation. Originated in the U.K., this approach could get patients home earlier, improve post-hospital outcomes and reduce readmissions.

Other systems are experimenting with experience-based co-design, a method used in six countries to incorporate patients and their insights into the design of health-care services.  Widely used in the service and software sectors, this approach to carefully and methodically designing care services to make them work better for patients holds great promise for improving patients’ satisfaction with the health-care system.

Another health-care import—this one from Canada and being piloted in several U.S. settings—is a set of evidence-based algorithms to help clinicians “de-prescribe” medications that research suggests may no longer be benefiting patients, or could even be causing them harm.
Scientifically, we are one world, and our health system needs all the help it can get. Our physicians and scientists readily adopt new surgical approaches, medications and devices that are developed by colleagues in other countries. We should keep our eyes and ears open for comparable international innovations in the way we organize our health care services.