Word: systemic
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...imagination, nor the publicly funded money pits that so scare conservatives. For one thing, Europeans spend less - about $4,000 a person less, in some cases - than Americans on health care annually, and often with better outcomes. The good news is that without reassembling its entire health-care system, there are many relatively simple measures that could help the U.S. get a handle on soaring costs - and keep its population healthier, too. America, here is your prescription...
Denmark boasts several advantages that have helped in the early adoption of electronic health records. It is small (population: 5 million) with a tech-savvy citizenry and a public sector-run health system. Trust in the government is high. Most crucially, when the health service established a National Patient Registry in 1977 - a system that required doctors to file patient visit details in order to be reimbursed for their work - the country unknowingly laid the groundwork for electronic health records by putting in place centralized record-keeping...
...there have been slipups. After the government decided to move away from paper records in 1999, a team of officials came up with a coding system that required doctors to insert information and notes in alphanumerical form. The system was never implemented and eventually abandoned in 2006 after physicians and nurses complained. Now, instead of a single system, record-keeping utilizes various compatible systems, linking networks established by regional health agencies. "What we found is that adoption of electronic health records must be done by evolution rather than revolution," says Jens Andersen of Sundhed.dk, the state health-care web portal...
...challenge is finding the funding to implement such schemes. In America's health system, there are few financial incentives for providers to take proactive measures to keep people healthy: the longer and more extensively a doctor or hospital treats a patient, the more income they recoup. That's why the American College of Physicians and others are calling for reform in health-care reimbursement, with the Federal Government and large insurance companies setting up "Patient Centered Medical Homes" in which a portion of doctors' pay will be linked to performance targets. As in Germany, these homes will target chronic diseases...
...only does the equation make hard-nosed sense in a public-health system, its use can reduce costs in other ways. Eager to gain NICE's approval, drug companies have started giving away portions of expensive treatment for free in Britain in order to ensure their drugs meet the threshold. Sir Michael Rawlins, chairman of NICE, believes that if the U.S. adopted a similar system, it would revolutionize the culture of major pharmaceutical companies, many of which spend more on marketing than research and development. A 2008 study in the New England Journal of Medicine predicted that incorporating information about...