Where’s the Data on Global Health Care Systems?

by JHI Staff on December 9, 2013

Improving the accessibility, quality and cost of the health care delivered by a single hospital to a surrounding community is a big challenge. It’s one that we at Johns Hopkins Medicine International (JHI) face all the time, alongside our many collaborators around the world and our parent organization, Johns Hopkins Medicine, with its domestic network of hospitals in multiple states.

But relatively speaking, we have it easy. Or so it feels when I compare the tasks we face with those faced by policy-makers and industries charged with improving not just individual hospitals, but entire national health care delivery systems. Think about just a few of the critical questions that must be tackled in that daunting endeavor. What sort of payer system best leads to good, affordable health care for tens or hundreds of millions of people? What sort of government regulation improves health care delivery without unnecessarily burdening it with costs and inefficiencies? What mix of private and public hospitals provides the best outcomes and value?

Answering these and many other crucial questions would be hard enough if decision-makers had plenty of data about how different approaches to health care delivery have worked in different countries. But, in fact, good country-by-country data on exactly how systems perform can be hard to come by in much of the world—and in many ways, studying how health care systems perform relative to one another is a nascent endeavor.

Ironically, we actually have some data on the lack of sufficient data about health care delivery systems. In a research paper on the subject published in the journal Health Research Policy & Systems, the authors note the following:

To our knowledge, there have been no efforts to develop a comprehensive profile of the available research evidence addressing topics related to governance, financial and delivery arrangements within health systems, and implementation strategies that can support change in health systems, and the products derived from them.

In other words, there isn’t even a good way to find out what data is available on this subject. Particularly lacking, the authors note, are studies that look at the impact of financial and governance arrangements, both of which are obviously critical to how health care systems perform. The authors also quote from a 2009 New Yorker article by respected physician-author Atul Gawande, who wrote:

[The U.S.] Congress has provided vital funding for research that compares the effectiveness of different treatments, and this should help reduce uncertainty about which treatments are best. But we also need to fund research that compares the effectiveness of different systems of care – to reduce our uncertainty about which systems work best for communities. These are empirical, not ideological questions.

Part of the problem is that while many researchers and organizations have been involved in international public health efforts, far less attention has been paid on a cross-border basis to formal health care delivery systems. That imbalance is becoming more and more of an issue as low- and middle-income countries, bolstered by booming growth in their middle classes, turn their attention to health care.

At JHI, we are already affected by that lack of data. Shortages of good metrics on what approaches to health care delivery work best in a given country, or across many countries, sometimes makes it harder for us and our collaborators to determine the best way to set up an individual hospital.

That’s why we’ve taken a specific focus with our collaborators on establishing useful metrics that will be invaluable going forward. As we build our own databases here, we’re also building a tool for looking on a cross-country basis at what works best where. But we still have a long way to go to develop the sorts of data assets that will really help answer these questions. And in any case, this isn’t something we can do on our own. The real solutions will come when data is successfully pooled from thousands of hospitals around the world.

As more organizations turn their attention to global collaborative health care, that goal should grow within reach. Such pooled-data efforts will certainly pay off in better decisions here in the U.S. and other highly industrialized countries. But these countries already have at least pretty good health care systems, and though we all struggle mightily to improve them, it takes a lot of work to eke out relatively small gains. In low- and middle-income countries, on the other hand, the potential exists for vast improvements, perhaps even with modest tweaks to how systems are set up. Those populations will be the real winners.

We’re determined to keep moving forward in terms of trying to get the needed data to do our part in helping to make all this happen, and we hope we can join others in that effort. I’ll keep you posted on our progress. And if you have any suggestions, I’d appreciate hearing about them.

1 Comment

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John Griswold December 9, 2013 at 1:38 pm

I have been following your blog and would look forward to a conversation around your previous leadership points with the above blog on metrics and improving results. We find in our work that these issues are intertwined and when acted on can create improvements short and long term in parallel with patient care, quality/compliance, safety/health/environment and cost control when orchestrated in tandem. An approach utiling your leadership and staff which combines a balanced scorecard/target operating model driving work process improvements will achieve multiple organizational objectives no different then a doctor treating the whole person rather than just treating the sympton. You have a substantial opportunity when focusing on better data and metrics as it will naturally bring along your people then problem solving and progress.
John Griswold
Goldstream Management


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