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