The United States lags far behind other countries in its adoption and funding of health IT, according to a study published in the May/June issue of Health Affairs. At the same time, the United States pays much more per person for health care than other rich countries do.
While governments usually pay for health IT in other developed countries, the report says, the United States has relied on the private sector, particularly health insurers. The result, according to the report, is that "the United States lags as much as a dozen years behind other industrialized countries in HIT adoption."
Though it doesnt create a healthier population or universal access to health care, the United States spends nearly two and a half times more per person on health care than the median OECD country. (The Organisation of Economic Co-operation and Development is comprised of 30 industrialized countries.) The authors are careful to point out that their study does not show a cause and effect between the United States high per capita health care spending and its lack of health information and technology; they suggest a link exists. "To the extent that HIT systems are cost-saving in the long run, the lack of an integrated, national IT system for health in the future could exacerbate the position of the United States relative to countries that are HIT leaders," the report says.
While U.S. government expenditures on health IT are well under $1 billion, Britains National Health Service has spent more than $11.5 billion on its scheme to upgrade IT in a country with 60 million people. The policy was attacked as being too costly and overpaying contractors, but many within the NHS have staunchly defended the spending, saying a big up-front investment is necessary to reap real savings.
According to the report, the United Kingdom has spent about $192 per person for health IT as of 2005; Canada spent $31.85; and Australia, with the second-lowest investment, spent $4.93 per person. Far behind was the United States at $0.43 per person.
The United States got off to a late start: While Germany had a national health IT underway in 1993 and the United Kingdom launched one in 2002, the United States did not even create a federal health IT office until 2004. Outgoing health IT czar David Brailer has long said that the U.S. government will not, like other developed countries, buy IT for its doctors. Instead, he says, the governments role is to create a business case for technology so that health care payers and providers will choose to purchase it.
In the United States, doctors offices and insurance companies have been slow to adopt health IT mainly because of fears that the investment wont pay for itself, and that systems will become obsolete quickly and will actually interfere with patient care.
Another barrier is that doctors and hospitals can actually lose money by keeping people healthier. Thats because health insurers usually pay health providers for services performed and because more complicated treatment procedures are often more profitable than simpler, preventive care.
Insurance companies have often been reluctant to fund IT projects, fearing no return on investment. They also face logistical hurdles. Health care providers see patients from many different insurance plans, limiting any single insurers influence. Anti-corruption laws can also make insurers leery of giving health IT to providers. (Organizations like Kaiser Permanente merge functions of health insurers and health providers and tend to be more comfortable adopting health IT.)
Toward that end, Brailer has backed plans for a certification program for electronic health records so that doctors will be less worried choosing technology vendors. In Massachusetts, California and other areas, insurers have banded together to reward doctors who install technology or to supply technology, particularly e-prescribing software that can help insurers control costs.
The Health Affairs report was published at roughly the same time that Brailer met with health IT coordinators for other countries, including Richard Alvarez, president and CEO of Canada Health Infoway; Richard Grander, director general of IT for the National Health Service, of England; and Ian Reinecke, CEO of National eHealth Transition Authority, in Australia.
Talking to reporters after the meeting, Brailer acknowledged that the United States faces unique challenges in crafting national health IT policy, but he said he was surprised that the issues the four countries face are strikingly similar.