Last week, the Yale Global Health Leadership Institute and the South Essex Partnership University National Health Service (NHS) University Foundation Trust (SEPT), is holding an executive management training session at Yale. Members of the NHS will examine the U.S. health care system and learn from Yale faculty. This year’s session is of particular importance with the U.K. in the midst of a major health care reform that aims to transform the NHS into a more competitive and increasingly privatized system. At the same time, recent American health reform has been aimed at eliminating disparities and moving toward the provision of increased, if not universal, access. “With current re-evaluations taking place in both the U.S. and U.K. health care systems, this session comes at a crucial time to provide insight and dialogue on major health care issues and methods for both countries,” said Elizabeth Bradley, Ph.D., faculty director of the Yale Global Health Leadership Institute.
Dr. Bradley opened the sessions on Monday with a talk entitled Health System Change: Competition and Collaboration. She focused on three features that must be considered for policy making: quality, efficiency and access. Dr. Bradley also explored the pros and cons of competition and collaboration, and discussed the conditions under which each is the optimal approach.
The U.S. health care market allows for fairly unregulated competition in an effort to achieve Pareto optimality – a state of market equilibrium where no one can be made better off without making someone worse off. However, this efficiency is only possible under certain conditions, all of which the country is unable to sustain or control. In contrast, the National Health Service favors collaboration, which allows for less money to be devoted to marketing, provider incentives and organizational profits but encourages integration of care services. Dr. Bradley highlighted the fact that competition and collaboration can coexist in the health system. Competition might most appropriately be applied in places where product is a commodity and consumers can readily judge quality or where unequal distribution is acceptable. Collaboration could be successfully applied where output and outcomes can be monitored and sanctions are possible for poor performance.
Dr. Bradley wrapped up her presentation with some comments on the current health care reform occurring in the U.S. While the need for change is clear, reform on the federal level faces many obstacles due to the size and diversity of the country’s population. Where health care reform seems to be taking form most quickly is at the state level. Here, populations are smaller, potentially making it easier to delegate resources to necessary areas.
Nina Gumkowski, GHLI Intern