What 11 countries can teach the U.S. about value-based health care

Value-based health care is one of the most promising developments in the health industry, but the United States trails behind several developed nations in its implementation, a Boston Consulting Group (BCG) report finds.

Study methods

According to report author Stefan Larsson, the report offers "one of the most detailed international comparisons of progress toward value-based health care." It assesses the infrastructure of 12 countries' health care systems, as well as their outcomes data for 12 major health conditions. BCG further reviewed medical literature and interviewed 139 representatives of national health departments and international health outcome experts.

The BCG report evaluates each of the 12 countries' health systems along two dimensions, according to report coauthor Neil Soderlund. The first dimension examines the degree to which fundamental components of a value-based health care model are in place, including:

• National legal and consent frameworks;
• Common national standards and IT infrastructure;
• The ability to tie costs with health outcomes; and
• The degree of engagement among clinicians and policymakers.

The second dimension evaluates the richness of the disease registries in each country and how well their medical communities use the data in the registries.

Findings: Sweden tops the charts, United States lags behind

"When it comes to implementing value-based health care, Sweden is the most advanced country of the 12 we studied," Soderlund says. "By contrast, Germany and Hungary have the furthest to go."

The United States—which spends 17.6% of its GDP on health care and has the highest per capita costs of the 12 nations studied—is also among the countries further behind in implementing value-based health care, says report author Peter Lawyer.

Lawyer attributes the United States' lagging adoption to its fragmented health system, which limits the collection and use of health outcome data. "Reporting standards and clinical outcome metrics differ substantially across the system, even within the same specialty," he adds.

What the U.S. can learn from other developed nations

Despite the different level of progress that each nation has made on value-based health care implementation and the systems' different structures, "there is much to learn from each country," Larsson says.

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For instance, the analysis indicates that the United States should champion the widespread systematic use of disease registries. "National medical societies, in particular, have a leadership role to play, both in creating uniform standards for data collection and in securing broad support and participation of practicing clinicians," says BCG's Martin Silverstein (Health Leaders Media, 10/12; BCG report, June 2012; BCG release, 6/6).