What nations deliver consumer-centric health care? The top five destinations for consumer-friendly health systems would be Austria, the Netherlands, France, Switzerland, and Germany, at least according to the latest iteration of the Euro-Canadian Health Care Index (ECHCI). The US is not part of this analysis.

The concept of consumerism in health care has migrated to Europe. The Health Consumer Powerhouse, a self-described “do-tank” (as opposed to “think-tank”) based in Brussels and Stockholm, innovated and perenially updates the ECHCI. This year, the Powerhouse has added sister-nation Canada to the mix, and the results are fascinating. A key objective for the Index is to promote transparency across health systems in Europe; transparency is a major initiative in the European Union.

The Powerhouse points out that the top 5 countries all have “Bismarckian” health systems; that is, they were founded on the principles of social insurance where many health plans compete in markets and are also independent of the delivery system. This is in marked contrast to a system such as the UK’s National Health Service, founded on “Beveridge” principles where financing and delivery are organized within one system (that would include Canada).

Canada’s performance as a consumer-centric system ranks in the bottom quarter of the 29 countries measured: somewhere south of Greece, Slovenia and Malta, and above Slovakia, Hungary, Romania, Lithuania and Poland.

While indices such as these can’t be taken without lots of context around them, they’re still interesting to deconstruct and do provide insights.

The ECHCI is designed to be a composite measure of how consumer-centric a nation’s health system is. The Powerhouse calculates the Index based on what it calls a “pentathlon” of five measures: patient rights and information; waiting times for treatment; outcomes; generosity; and pharmaceuticals. Within each of these five pillars are several indicators which, taken together, comprise the Index.

HCP developed the first Index to describe the Swedish health market in 2004. In 2005, HCP expanded the Index to Europe which included 12 European countries. By 2007, the EHCI expanded to all 27 EU members, as well as Switzerland and Norway. This year, HCP added Canada into the statistical stew, which the team now dubs as the Euro-Canada HCI (ECHCI).

Health Populi’s Hot Points: When I ponder the five components of the ECHCI’s pentathlon of consumer-friendly measures, the one that is most surprising from the US perspective is “generosity.” I peeked under the hood of generosity and found the following metrics: cataract operations per 100,000 citizens; infant disease vaccination rates; kidney donations per million people; and, dental care as part of the public health offerings.

What is consumer-centrism in American health care? Is it “generosity?” To a colleague with whom I met yesterday, consumer-centrism was being seen on-time at a physician appointment. To me at my daughter’s last visit to her pediatrician, it was spending sufficient time discussing the health challenges of a tween girl in 2008. When it’s about you, the consumer, it’s the micro-details of your experience with health providers, payors, products.

When your lens is the public’s health in aggregate, it’s vaccinations and dental health.

This analysis is useful to put in the context of the currrent debate around reforming health care in the US. Will we opt for “Beveridge” — that is, integrating payment with services such as a Canadian or NHS? Or will we choose “Bismarck?” The response to that will shape the eventual character of American health care.

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