Health Care Management in the Global Village

Abstract

While reform of our health care system has emerged as a major national political and social issue, concepts and systems now debated have been in place and well-established in countries for many years. Dr. Kirkman-Liff describes how health care systems in Netherlands, Germany, and Britain have evolved to address many of concerns now being raised in U.S. health care debate. He also points to many of similarities that should be of value to American health care executives and policymakers in designing systems for change. Whether by evolution or revolution, health care is being transformed from a locally managed cottage industry to large organizations and systems that integrate leadership and financing of multiple providers. In most developed nations, cost of delivery of health care and its impact on economy are stimulating changes that go beyond payment mechanisms to influence management and structure of health care organizations. These changes influence how health facilities are managed, how they relate to providers of care, and who their managers will be. While there may never be a significant market for actual delivery of health care, gobalization of information technology will make possible not only international exchange of ideas and experience, but also development of internationally scaled systems to support delivery and organization of health care. BREAKING OUT OF OUR NATIONAL COCOON It has only been recently that issues and concepts regarding health care reform have become part of national consciousness. We, as Americans, have been complacent in thinking that our health care system is the best, without real knowledge of effectiveness of national models and experiences. The question in United States now is not should we change, but how we will change. Too frequently we have used obvious differences in governmental and payment structures, culture, or technology as excuses not to seriously study and compare health delivery systems of nations. Many of issues we are only beginning to raise in health care management have already been answered, adapted, and refined in national systems. The health delivery system in each country cited in Kirkman-Liff's article is now undergoing change, and this should be stimulus to study and understand what these systems are changing and why. INTERNATIONAL EXPERIENCE FOR HEALTH CARE EXECUTIVES There is an understanding and appreciation of value and differences of national health care systems one gains only from living and working within that system. Today, many multinational companies and industries expect their top executives to gain management experience in foreign markets. As health care becomes more influenced by international communications and technology, it will become important for tomorrow's health care executive also to have similar cross-national and cross-cultural experience. My own international experience came after managing teaching and community hospitals in United States for more than 20 years. For almost two years, I had opportunity to lead and to attempt consolidation two major Canadian hospitals. The experience taught me that there is much that American health care executives can learn and apply from Canadian and systems. Some of these lessons based on my Canadian experience include: 1. These other systems can actually work, and work well, to meet objectives they establish. 2. Cultural and national expectations differ; to fully understand effectiveness of a system, one must also have an understanding of expectation that people place on their health systems. (I suspect that American consumer has developed a set of expectations that will continue to make our delivery system unique in cost and in duplication of services. …