New center at Brown to study health care systems across countries

A discussion comparing health policy challenges facing the U.S. to those faced by other high-income countries illustrated how the Center for Health System Sustainability aims to improve health care systems through research.

PROVIDENCE, R.I. [Brown University] — It’s an often-cited fact that the United States spends more money on health care than other high-income countries yet still faces enormous challenges in cost, quality and access to care, says Dr. Ashish K. Jha, dean of the Brown University School of Public Health.

What’s less understood, Jha notes, is how health care systems in other nations function to serve their people, and how different strategies for operating health systems can impact population health.

To uncover insights for the benefit of all countries into how health systems work and how they struggle, a new center at the School of Public Health will bring together researchers to analyze health systems across the globe. Jha introduced the premise behind the new Center for Health System Sustainability at a Tuesday, April 23, panel discussion about health policy challenges around the world.

“There’s a ton to be learned across countries,” he said. “This center really tries to get at, in my view, the heart of that question of, ‘How can we all learn from each other, and how can we all do better?’”

The dean formally launched the center during the event among faculty and students from the School of Public Health, as well as researchers, scholars and international partners. Jha moderated a discussion that offered local and global perspectives, beginning with pressing health policy challenges facing Rhode Island and other U.S. states, and then expanding to the challenges in high-income countries in Europe and Asia, as well as the policies used to address them.

Countries around the world have similar objectives, said Irene Papanicolas, a professor of health services, policy and practice at the School of Public Health who will direct the new Center for Health System Sustainability: Improve people's health, deliver care that's responsive to personal needs, treat all people with respect and dignity — and accomplish this in an equitable and financially sustainable way. At the same time, she said, there are shared global challenges: aging populations, chronic disease and illness, prohibitively expensive new treatments, pandemics and climate change.

It’s a missed opportunity that case studies from different countries haven’t been used to compare strategies and understand how health policy decisions affect population health outcomes, said Papanicolas, who recently came to Brown from the London School of Economics.

“And now we're at this interesting juncture where international comparisons are a necessity,” said Papanicolas, who has worked closely with governments and organizations to inform policymakers on issues related to health system performance assessment. “New systems need to be more cooperative, more global, in terms of the solutions that they find. Ultimately, we need to change what health systems look like and think beyond artificial national boundaries if we're going to improve health globally.”

According to Papanicolas, the Center for Health System Sustainability will leverage patient data and global partnerships to produce comparative insights and actionable policy recommendations to help countries learn from one another. The goal is to optimize patient care and build resilient, sustainable health systems across the globe.

The center will house the International Collaborative on Costs, Outcomes and Needs in Care, a partnership of 15 collaborators from North America, Europe, Asia and the Pacific committed to advancing the development of methods and measures in comparative health systems research. Papanicolas and Jha are among the co-leaders of this collaborative.

The center will include faculty, staff and researchers from Brown as well as international research partners, including Jon Cylus from the European Observatory on Health Systems and Policies and Luca Lorenzoni from the Organisation for Economic Co-operation and Development. Cylus, who is based in Barcelona, and Lorenzoni, who is based in Paris, joined Papanicholas and Jha at the launch event.

Complicated comparisons

Through a wide-ranging discussion and Q&A session, it became clear that health system strategies that might work in other parts of the world don’t always have global relevance, and also have variability in success even within countries of origin.

“The answer is not that everyone has figured it out, and America hasn’t,” Jha said.

The panelists cited areas where the United States falls short, including health care affordability. Yet the tools used by other high-income countries to control health care spending, such as budget-setting, are developed, practiced and enforced with differences according to different political systems in each country. In other words, Cylus said, there’s much more to the strategy than simply making a budget.

Papanicolas addressed the idea of American pharmaceutical innovation. Earlier this year, she led an analysis of medication prices across countries and found that people in other high-income countries pay one half to one third of what people in the United States pay for basic medicine “that everyone should have access to.” She added that over time, prices decrease in other countries but not in the U.S.; and other countries are more likely than the U.S. to use evidence about effectiveness to negotiate prices with pharmaceutical companies.

A country’s health system cannot be divorced from that country’s policy system, and researchers can’t understand the health system if they don’t understand the populations those health systems serve, Jha said.

As for the issues facing Rhode Island, Martha Wofford, CEO of Blue Cross Blue Shield of Rhode Island, shared that the state has done “a pretty god job” of managing health care costs (through rate caps), and that the rate of uninsured people in Rhode Island is just 3%. But compared to Massachusetts or Connecticut, more of a Rhode Islander’s paycheck goes toward health care, Wofford said.

She also said that while access to primary care in Rhode Island is better than many people think — it’s one of the top five states in the country in terms of access — a closer analysis of the data reveals that many primary care physicians are near retirement. The state needs to prioritize investing in primary care, she said, as well as increasing access to specialist care and raising the Medicaid reimbursement rate.

Collaboratively digging into the health care data, conducting analyses and understanding nuances and other complicating factors can help researchers identify areas of opportunity, Wofford said

“If we get together and see the data, we can push for policy changes,” Wofford said. “We’re so fortunate to have Dean Jha and Brown University to bring data to these hard problems in order to make progress in an informed manner.”