PharmacoEconomics & Outcomes News 665 - 27 Oct 2012

US and UK health reforms: theimportance of learning from others

Despite having vastly different healthcare systems,the US and the UK are both are undergoing periods ofsignificant reform and could learn a lot from each other,according to Drs David Blumenthal (USA) and JenniferDixon (England) in a commentary published in theLancet.

The aim for both countries is to get more value fromhealthcare expenditure than they do currently. Reformsin the US are based around the Affordable Care Act(2010), while the drivers in the UK are the Health andSocial Care Act and other national initiatives. Three mainareas of overlap in the reform processes were identified:financial measures, organisational changes andinformation management.

In England, there is an agreed upper limit for totalNHS expenditure whereas in the US there is noprospective binding overall budget for federal spendingon Medicare and Medicaid. Analysts in the US havedeveloped complex algorithms to monitor expenditure,which have been closely scrutinised. In contrast, theEnglish £20 billion shortfall figure has not beenchallenged, and the NHS may benefit from more analyticrigour. Both health systems are looking at ways toencourage greater efficiency and quality using tools suchas pay for performance, value-based prescribing andcost-effective prescribing.

Health system structure is being more directlyaddressed by the English reforms than it is in the US.However, the latter are looking to strengthen primarycare and the co-ordination of services, particularly forhigh-cost patients with chronic illnesses, which will gosome way to catching up with the strong focus Englandalready has on primary care.

Central to the enhancement of healthcare forindividuals is good information about the quality andcost of care. The primary care sector in England is wellahead of the US in its utilisation of electronic healthrecords, which are crucial for the effective exchange ofinformation and assessment of care. Nevertheless, bothsystems will be able to learn from each other as reformsprogress, particularly in ensuring good electronic linksbetween inpatient and outpatient care.

The authors suggested that "policy makers and health-care managers in both countries should miss noopportunity to make progress by learning from oneanother, and from other international examples".Blumenthal D, et al. Health-care reforms in the USA and England: areas for usefullearning. Lancet 380: 1352-1357, 15 Oct 2012. Available from: URL: http://dx.doi/org/10.1016/S0140-6736(12)60956-8 803078894

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PharmacoEconomics & Outcomes News 27 Oct 2012 No. 6651173-5503/10/0665-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved