From the Editor-In-Chief Health AffairsVol. 29, No. 8: Lessons From Around The World Lessons On Health Reform From Across The WavesSusan DentzerPUBLISHED:August 2010Free Accesshttps://doi.org/10.1377/hlthaff.2010.0743AboutSectionsView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsDownload Exhibits TOPICSHealth reformSystems of carePrimary care The United States is among the world’s leading exporters in the brisk trade of ideas for financing and delivering health care. But in this issue of Health Affairs , insights from abroad flow our way, as several of our authors reflect on health reforms in other industrialized nations. Spain is in the spotlight for having won the World Cup, but its health system scores high as well, write Jeffrey Borkan and colleagues. The nation emerged from the Franco dictatorship in 1975 socially and economically behind much of the rest of Europe. But the demise of the old order cleared the deck for sweeping changes in health care, along with much else. Planners concentrated on building an infrastructure focused on primary care. A key goal was that no citizen in this nation roughly the size of Texas—and with a population today of forty-one million—was to be more than fifteen minutes away from a primary care site.‘Leadership And Commitment’ The results have been impressive, the authors report, contributing to longer life expectancy and lower infant mortality than in the United States. The lesson for America—now embarked on its own primary care reinvention effort (see Health Affairs , May 2010)—may simply be that a modern democracy truly can plan and implement system restructuring at both the national and local levels. Spain’s example shows that what it takes is “sustained, bipartisan leadership and commitment toward health care transformation,” Borkan and colleagues write. Thus apprised of what advanced nations can do, we then head north and east to Switzerland, where Tsung-Mei Cheng interviews the former Swiss health minister, Thomas Zeltner. Zeltner recently stepped down from his post after nineteen years, during which he helped implement major reforms in the 1990s and thereafter.Rediscovered Switzerland, Zeltner notes, had at the time imported the idea of “managed competition” among competing private health insurance plans pioneered by longtime Health Affairs contributor Alain Enthoven. Zeltner notes the irony that Switzerland, with its private health plans and individual mandate, has now been “rediscovered” as a source of inspiration for the U.S. health reform. But as the Cheng-Zeltner dialogue makes clear, it’s not sensible to reduce another country’s complicated health system to just one or two bullet points. As successful as the Swiss system has been, it’s been governed by laws and regulations that place the emphasis on “management” as much as on “competition.” Specifically, Zeltner points to his nation’s requirement that health plans and providers negotiate with each other over prices—with the Swiss government watching over the negotiators’ shoulders and determining prices if negotiations fail.So most health systems are complicated, and most also face problems common across many nations. Spain struggles with rapidly rising costs. The Swiss are shocked about how much they pay for health coverage, and health care providers aren’t sufficiently transparent about the health outcomes they produce for patients. And nobody, apparently anywhere, is content with the state of the health care workforce. Spain has one of the lowest ratios in the European Union of general practitioners to population. Switzerland wants its nurses to stay on the job longer, and thinks it will need a third more personnel to cover long-term care needs within about a decade.Reforms Without EndMost important, perhaps, is the lesson that health reforms, once enacted, are never truly finished. As Zeltner puts it: “You end one reform and you start the next one. It’s a never-ending task.” Perhaps there’s another lesson there for all of us—including politicians who preach either that the Affordable Care Act is an optimal fix or that repealing it will clear the way for more perfect reforms for all time.Lest we fool ourselves that even reformed health systems will automatically produce better health, David Williams, Mark McClellan, and Alice Rivlin address underlying social and economic determinants. Williams served as staff director, and McClellan and Rivlin as panel members, of the Robert Wood Johnson Foundation Commission to Build a Healthier America.Pointing to statistics showing that many Americans’ health is slipping relative to the health of people in other countries, the authors call for major changes in “where and how Americans live, learn, work, and play.” After all, better health is among those nonimportable commodities we’ll have to create right here at home. Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article MetricsCitations: Crossref 1 History Published online 1 August 2010 Information Project HOPE—The People-to-People Health Foundation, Inc. PDF downloadCited byEl buen gobierno de los servicios de salud de producción pública: ideas para avanzarCiência & Saúde Coletiva, Vol. 16, No. 6