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State: Ntl. Gavin: U.S. System Lags in Back Pain Treatment: [2017-03-29] |
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The U.S. health care system is, in a word, dysfunctional. We know this. Many of us have experienced it firsthand. We spend a lot and have relatively little show for it. Click here for a visual representation created by OurWorldinData.org. There are many reasons for this that will require a plethora of future blog posts (political reasons, economic reasons, cultural reasons, etc.) But today, we'll take a quick look at what happens in a country that adopts evidence-based guidelines in a rigorous, widespread, methodical way and tracks the results of those changes over time. The Netherlands is a relatively small country northwest of Germany, making up the southern border of the North Sea. Known for the laissez-faire reputation of its largest city, Amsterdam, the country's health care system has a few notable features that are anything but: health insurance is mandatory, the country has a well-established and well-organized network of 160 primary care centers, and both insurers and hospitals are mostly for-profit and compete for business among consumers. Back in 2011, Netherlands decided to address the rising cost and complications associated with low back pain. It did so by essentially mandating adherence to evidence-based guidelines (through highly differential reimbursement — pay for the things that work, pay little/nothing for things that don't), and simultaneously incentivizing return-to-work within the social security and disability programs available to citizens. Because of its relatively small size and well-organized primary care system, the country was able to gain real traction around evidence-based guidelines within the clinical community. Netherlands reduced spend by 20% over five years (this included both direct spend, such as clinical services, and indirect spend, such as social insurance and disability payments). The closing paragraphs of a recent story addressing this study found in the pages of one of my favorite public health newsletters, The Back Letter, summarizes the potential obstacles and opportunities that the U.S. health care system presents:
Who knew health care was this complicated? Michael Gavin is president of Prium, a medical managed care provider for the workers' compensation industry. This column was reprinted with permission from the firm's Evidence Based blog. |