Next health generation will witness convergence of financing systems and growing standardisation

Cambridge 16 November 1999"HealthCast 2010", a report on the future of health care practice, recently published by PricewaterhouseCoopers, among other items, addresses the issues of health insurance financing and the need for further standardisation in the next decade. Health care financing trends are converging in the industrial world since the United States tends to become more governmental and privatisation efforts are being promoted in Europe and Canada. In addition, the increasing costs and consumerism are likely to spur insurance changes. Governments, health purchasers and insurers are also growing more keen on supporting cross-border standardisation because lack of common platforms and benchmarks will cause inefficiency and costs to go on unchecked.


The United States has been the only country in the industrialised world relying primarily on optional employer-based health insurance. Access to care constitutes no legal right in the United States as it does in Europe, in Canada and most other industrialised nations. However, a safety welfare net system exists for the poor and elderly. Everywhere else, access to health care is a right acquired for all citizens and paid for by social insurance funds with member and employer contributions or derived from tax funding. A majority of these systems allow for private medical insurance by opting out of state-sponsored schemes or as additional health insurance schemes which provide supplementary benefits or reimbursement.

In the European Community, there are in fact major differences between the health systems of the member states but in spite of this situation, increasing numbers of politicians and health experts are convinced that the different health systems will gradually merge in the medium term. Meanwhile, the debate continues as to the level at which this process should take place and the kind of financing terms which would be necessary to push it through. However, in the coming decade, the variety of health financing systems will start converging. The United States will more or less adopt the principles of the European and Canadian system whereas both Europe and Canada will embrace more aspects of the American system.

Results in the HealthCast 2010 report indicate that 60 percent of the United States experts selected for the survey are convinced that most employers will offer employees the option of medical savings accounts by 2010. HealthCast 2010 respondents also believe that defined contribution programmes, which have been very popular among corporate retirement plans, will transition to health benefits. Of the people who were interviewed, 64 percent expressed the opinion that employers would move to defined contribution programmes for health benefits and 56 percent of the interviewed experts predicted that Medicare would move to such a system by 2010.

In turn, the report states that consumers in Europe, Canada, New Zealand and Australia are increasingly purchasing private insurance to supplement basic coverage. The growing health consumerism will stimulate the demand for new services and products but many of those will not be paid for by basic coverage. Nonetheless, the authors of HealthCast 2010 insist that private insurers will have lots of opportunities to leverage the benefits of e-business in new models to be incorporated into their plans. On the other hand, health consumers should learn to understand the trade-offs involved in information technology and over-treatment expenditures. Therefore, the report advises to design payment mechanisms, which will encourage the consumer to be more cost-effective.

As far as health care standards are concerned, the empowered consumer will want to know everything about the proposed treatment, its effectiveness and the track record of the medical team offering the therapy. This will accelerate the demand for the standardisation of health care processes. As a result, the 21st century will abound with new rules, protocols, and care paths aiming to find the right balance in health procedures, according to the report authors. Common computer interfaces applied in other industries will lead to a more connected world, which allows health data to be exchanged, measured and updated. If benchmarks are available, patients and physicians are able to make personalised health decisions in a more objective manner without the wide variations currently existing.

To date, there are no federal organisations within the United States to design health care standards. In several Canadian provinces, organisations have been established to examine practice patterns, in order to promote standard procedures. Many European countries are striving for national standards, but there is no process to find common grounds among the European Union member states. Some European thought leaders have raised the issue of a basic health benefit package across the European Union. This product could greatly benefit governments as well as employers who are interested in the globalisation of health benefit packages.

The HealthCast 2010 team makes an urgent plea for the establishment of global standards for medical treatment. The authors suggest Health Level Seven (HL7) as a possible model for the design of software specifications that allow disparate health care applications to exchange keys sets of clinical and administrative data. In any case, shared platforms will facilitate two-way communications. In the ideal scenario, medical data will be sent, collected and analysed in a secure electronic format which both patient and provider can use. If privacy issues can be solved, this will drastically re-engineer the traditional relationships.

For more information on the aspects of health consumerism, e-business and genetic mapping, also focused by the authors of the HealthCast 2010 report, we refer to the VMW article Internet-enabled customer will radically change the face of health care industry by 2010 in this very same issue. For those who want to read the full report, please surf to "HealthCast 2010: Smaller World, Bigger Expectations".

Leslie Versweyveld

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