Exporting Managed Care
Managed care is going global, as major U.S. healthcare companies invest in healthcare companies worldwide and U.S. consultants pitch the concept to foreign governments. In fact, managed care has already become established in various nations and has a small but growing presence in a number of others. Nonetheless, it is not being met with universal acceptance and satisfaction.
There is both a "pull" and a "push" aspect to this trend. The promises of managed care are the lure: high-quality care at reasonable prices, combined with its stated goals of keeping people well, cutting waste and measuring which treatments are most effective. At the same time, managed-care organizations, close to saturating the U.S. market and experiencing the falling rate of profit associated with that, are eager to push into greener pastures. Another factor is that international lending agencies such as the World Bank and the International Monetary Fund have required borrowing nations to cut back and privatize public-sector services, presenting opportunities to managed-care firms.
Since the problems of managed care in the U.S. have been publicized worldwide, companies often promote the export of managed care under new names, such as "evidence-based medicine," "coordinated care" and "best practices," reports the Wall Street Journal. Some nations are focusing on what they see as the best features of managed care. For example, so-called clinical guidelines -- the best ways of treating an illness based on expert advice and up-to-date studies -- are an aspect of managed care that is readily exportable and appeals to medical practitioners worldwide. New Zealand and Germany are using clinical guidelines promulgated by managed-care organizations, though both countries are adapting them to suit local needs.
Another feature of managed care that may turn out to be very useful in other nations is its emphasis on prevention. In some African nations, where the rates of AIDS and other infectious diseases are among the highest in the world, well-implemented preventive care could save many lives.
But, so far, not all managed-care reforms have been embraced. Some European countries, for example, introduced principles of managed care, market competition and privatization of public services into their national healthcare programs, but the United Kingdom, the Netherlands and Sweden have recently reversed these reforms, according to a study recently published in the New England Journal of Medicine.
Moreover, some experts are concerned that managed care can reduce poor people's access to healthcare services. Consider Latin America, where there are more HMOs than in the U.S. and an estimated 60 million enrollees. The New England Journal of Medicine reports, "In Latin America, as in the United States, concern about managed care has focused on restricted access for vulnerable groups of patients and reduced spending for clinical services as a result of spending for administration and return to investors. Required copayments have introduced barriers to care, thus increasing the strain on public hospitals and clinics." The same study claims that managed-care organizations in Latin America have attracted healthier patients, leaving sicker patients to gravitate to the public sector.
In response to such perceived shortcomings, some groups in parts of Latin America are opposing the introduction of managed care. In Ecuador, for example, a coalition of unions, professional associations, educators, and Native-American organizations is resisting the introduction of private managed-care operations in public services. In other nations -- such as Argentina, Chile and Colombia -- managed care has met with less organized resistance.
These trends show that although managed care is spreading around the globe, people's reactions to it depend on a variety of national and economic factors. "You can't just say, 'Take this and plug it in,'" says Mark Moody, vice-president of international operations at United Healthcare, a U.S. healthcare management services firm. "We're not exporting widgets." Of course, this also means HR professionals should be sure that, before their companies implement managed-care programs outside the U.S., they have a solid understanding of how managed care is viewed by employees, labor organizations, and other affected parties.
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For a perspective on the trend toward managed care in Latin America, please see a study in the New England Journal of Medicine at http://www.nejm.org/content/1999/0340/0014/1131.asp.
Other information may be found in "A Surprisingly Popular U.S. Export: Managed Care," a Wall Street Journal article published on December 20, 1999. WSJ's homepage is at http://interactive.wsj.com/home.html but Journal access requires a paid subscription.
There is both a "pull" and a "push" aspect to this trend. The promises of managed care are the lure: high-quality care at reasonable prices, combined with its stated goals of keeping people well, cutting waste and measuring which treatments are most effective. At the same time, managed-care organizations, close to saturating the U.S. market and experiencing the falling rate of profit associated with that, are eager to push into greener pastures. Another factor is that international lending agencies such as the World Bank and the International Monetary Fund have required borrowing nations to cut back and privatize public-sector services, presenting opportunities to managed-care firms.
Since the problems of managed care in the U.S. have been publicized worldwide, companies often promote the export of managed care under new names, such as "evidence-based medicine," "coordinated care" and "best practices," reports the Wall Street Journal. Some nations are focusing on what they see as the best features of managed care. For example, so-called clinical guidelines -- the best ways of treating an illness based on expert advice and up-to-date studies -- are an aspect of managed care that is readily exportable and appeals to medical practitioners worldwide. New Zealand and Germany are using clinical guidelines promulgated by managed-care organizations, though both countries are adapting them to suit local needs.
Another feature of managed care that may turn out to be very useful in other nations is its emphasis on prevention. In some African nations, where the rates of AIDS and other infectious diseases are among the highest in the world, well-implemented preventive care could save many lives.
But, so far, not all managed-care reforms have been embraced. Some European countries, for example, introduced principles of managed care, market competition and privatization of public services into their national healthcare programs, but the United Kingdom, the Netherlands and Sweden have recently reversed these reforms, according to a study recently published in the New England Journal of Medicine.
Moreover, some experts are concerned that managed care can reduce poor people's access to healthcare services. Consider Latin America, where there are more HMOs than in the U.S. and an estimated 60 million enrollees. The New England Journal of Medicine reports, "In Latin America, as in the United States, concern about managed care has focused on restricted access for vulnerable groups of patients and reduced spending for clinical services as a result of spending for administration and return to investors. Required copayments have introduced barriers to care, thus increasing the strain on public hospitals and clinics." The same study claims that managed-care organizations in Latin America have attracted healthier patients, leaving sicker patients to gravitate to the public sector.
In response to such perceived shortcomings, some groups in parts of Latin America are opposing the introduction of managed care. In Ecuador, for example, a coalition of unions, professional associations, educators, and Native-American organizations is resisting the introduction of private managed-care operations in public services. In other nations -- such as Argentina, Chile and Colombia -- managed care has met with less organized resistance.
These trends show that although managed care is spreading around the globe, people's reactions to it depend on a variety of national and economic factors. "You can't just say, 'Take this and plug it in,'" says Mark Moody, vice-president of international operations at United Healthcare, a U.S. healthcare management services firm. "We're not exporting widgets." Of course, this also means HR professionals should be sure that, before their companies implement managed-care programs outside the U.S., they have a solid understanding of how managed care is viewed by employees, labor organizations, and other affected parties.
====================================================
For a perspective on the trend toward managed care in Latin America, please see a study in the New England Journal of Medicine at http://www.nejm.org/content/1999/0340/0014/1131.asp.
Other information may be found in "A Surprisingly Popular U.S. Export: Managed Care," a Wall Street Journal article published on December 20, 1999. WSJ's homepage is at http://interactive.wsj.com/home.html but Journal access requires a paid subscription.