US and Scandinavian Healthcare System: A Comparison

The article puts it in very simple terms that Scandinavian countries’ healthcare system is for social good, and that of US is like a business (Bradley & Taylor, 2013).  Both the authors are quite accomplished.  Elizabeth Bradley is is a professor of public health at Yale University and the director of the Yale Global Health Leadership Institute.  Lauren Taylor is a Presidential Scholar at Harvard Divinity School where she teaches Health Ethics.  Together they have co-authored The American Healthcare Paradox, on which this essay is based. 

It is a know fact that United States spends most per capital on healthcare.  Against this backdrop, the authors have tried to analyze the reasons why it resists switching to publicly funded/delivered healthcare system.  It is something that has increased efficiency and coverage in other countries. 

It states that the United States in its belief to be different from other countries has consistently ignored their outcomes.  There is clear evidence that the “Scandinavian model”, when compared to US’s, outperforms in delivering better outcomes at reduced costs.  These countries spend a little more that half of what US spends on healthcare, cover 100% of their citizen, and have more physicians and acute care beds the latter.  This bring into front what we can learn from their model.  That is not to discount that they too must be having problems of their own.  Their research involving in-depth interviews and surveys with policy makers and practitioners found that both countries shared a common values, which is personal freedom.  To be more specific people of both countries value their personal freedom and their ability to control theirs as something paramount.  Also, one needs to take into account that the need for freedom and love for competition does not mean that quality and efficient care cannot be provided to the population.  Also, it does not hold true that the need for scientific innovation cannot find common ground with the belief in having humanistic approach to healthcare. 

The big question then is why is the there so much resistance to change? This is where the differences start.  Americans are less amenable to taxing the rich so as to cross-subsidize services to the poor.  This has to do with their psyche that social assistance in any form is likely to weaken the resolve of the people to exert and excel.  In contrast, the Scandinavians consider dependence on government as an assurance against their own insecurities.  These differences are prominently reflected across their respective healthcare system. 

The take away form this article is that its not the narrow comparison between the system of both the countries, but a broader view how these system evolved in the first place that is the key.  Further, it needs to be determined what is to be done in light of how the Americans view their system.  Up till now the debate on healthcare has always been restricted to ways to cut costs, increase access and improve outcomes.  And most would agree that the reforms so far have not been sufficient enough to curtail long-term costs or attain universal access.  In light of the prevailing view in US regarding government’s involvement in their daily life, a boarder debate on this required before any substantial progress can be made on healthcare.  It is only then that any comparison with Scandinavian model can have meaningful impact. 

The article is well structured, as sets the tone with usual WHO/OECD data.  Then builds upon a bit by describing the Scandinavian model.  It then tries to find a common ground between the US and Scandinavian values.  Then it moves on to more of analytical side by describing its survey and interview, which tries to go deeper into the problem.  Against this background, it tries to evaluate the reasons behind the difference in the system.  It concludes logically by bringing to front the psyche of people of respective countries, especially how they perceive the role of government in their daily lives.  Finally, how that reflects in their respective healthcare system.

After going through this article, I believe, before any further debate on healthcare, it is essential of have a broader debate about the role of government in the lives of average Americans.  It will be even tougher debate, and individual steps would be even harder to push.  Without broadening too much, they should limit the debate to health and social issues.  They should bring into forefront the need to take care of have-nots.  They should also consider promoting institutions, such as those that are typically people focused. 

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Bradley, E. & Taylor, L. (2013). US Health Care Reform Is Only Getting Started. [online] Retrieved from: http://yaleglobal.yale.edu/content/us-heath-care-reform-only-getting-started [Accessed: 11 Dec 2013].

Basis for Developing System-wide Clinical Pathways

Kinsman, L., Rotter, T., James, E., Snow, P. & Willis, J. (2010). What is a clinical pathway? Development of a definition to inform the debate. BMC medicine, 8 (1), 31.

The article talks about Clinical Pathways, which are tools that guide evidence-based healthcare.  But, there is a widespread disagreement about their impact on hospital resources and patient outcomes.  This stems from confusion among researchers and healthcare personnel regarding what makes up a clinical pathway.  In an effort in that direction, a team of Cochrane review authors decided to create a criteria to assist in the objective identification of clinical pathways studies from the literature.

In an effort to device a criteria to define a clinical pathway, the undertook a four-stage process:  do literature review to define clinical pathway; develop a draft criteria; pilot test the criteria; and modify the criteria based on over all literature review.

Literature review and their liaison with the European Pathways Association resulted in creation of five criteria used to define a clinical pathway: (1) intervention should be structured multidisciplinary plan of care; (2) it should translate guidelines or evidence into local structures; (3) it should detail the steps in the course of treatment or care or criteria based progression; (4) it should have timeframes or criteria-based progression; and (5) it should aim to standardize care for a specific clinical problem or episode of healthcare in a specific population. 

After pilot testing it was concurred that if an intervention met the first criteria, and in addition three out of the other four, then it should be considered as a clinical pathway.  Therefore, this criteria can be used as a basis of development of standardized, internationally accepted definition of a clinical pathway, and for the pathways themselves. 

The method employed is simple and credible.  It stress on the fact that there is widespread disagreement over their impact on hospital resources and patient outcomes.  I believe the disagreement comes for conflicting priorities on the management and the physicians.  However, it is not difficult to resolves as such conflicts happen across the spectrum of healthcare delivery.  Further, I believe that care pathways should have flexibility built in to allow customization based on patient’s needs and that of the providers.  So long as the patient reach the right destination within the broad parameters of pathways it is fine.  Keeping this way we will be able to balance both outcome and resources.

Also, there is need to have multi-disciplinary teams to discuss clinical pathways, so that everybody’s perspective is taken into account, and appropriate clinical pathways are developed.  These teams “should” have representation from every possible sector and profession that may be required to participate in the delivery of care.