Report of ICCONIC research to the Health Foundation.

Health systems across high-income countries have similar goals, which include maximizing quality of care, offering services responsive to patient needs, and ensuring efficient health care delivery. Health systems also face similar challenges, such as changing demographics, limited national resources, and ongoing rising health care costs.3 In response, national policy makers are working to identify effective strategies to address these challenges, which are heavily influenced by existing health system features. A group of particular concern is the growing number of high-need, high-cost (HNHC) patients, a clinically diverse set of patients with multiple medical needs, frailty, and multimorbidity. While constituting a relatively small proportion of the population, these patients account for a disproportionate share of medical expenditures across health systems.

Although there are cross-country differences in the availability and structure of data sources, countries had the ability to effectively identify comparable HNHC personas for international study. This work serves as the methodological paper for six accompanying papers examining differences in spending, utilization, and outcomes for these personas across countries.

ICCONIC work featured in a CMWF To The Point blog.

Distribution of health care consumption in different settings varies within countries, but there are also some common treatment patterns across all countries. Clinicians and policy makers need to look into these differences in care utilization by sex and care setting to determine whether they are justified or indicate suboptimal care.

Across seven countries, we find important variations in end-of-life care for patients who sustained a hip fracture, with some differences explained by sex and age. Our work sheds important insights that may help ongoing health policy discussions on equity, efficiency, and reimbursement in health care systems.

Across 11 countries, there are meaningful differences in health system outcomes for two types of patients.

In this comparison of LTC services following a hip fracture, we found international differences in total use of institutional and noninstitutional care, longevity, and total expenditures. There exist opportunities to organize postacute care differently to maximize independence and mitigate costs.

Across 11 countries, there is substantial variation in health care spending and utilization for a complex multimorbid persona with heart failure and diabetes. Drivers of spending vary across countries, with the United States being the most expensive country due to high prices and higher use of facility-based rehabilitative care.

The United States spent approximately twice as much as other high-income countries on medical care, yet utilization rates in the United States were largely similar to those in other nations. Prices of labor and goods, including pharmaceuticals, and administrative costs appeared to be the major drivers of the difference in overall cost between the United States and other high-income countries. As patients, physicians, policy makers, and legislators actively debate the future of the US health system, data such as these are needed to inform policy decisions.

nternational comparisons of health system performance exert major influence on the public and on policy makers. These comparisons allow for reflection on and evaluation of national performance, provide empirical bases to drive reform, and serve as a way to promote accountability. Most international comparisons seek to identify high performers, often conceptualized as health systems with the best outcomes or most value for money. Even though these notions seem relatively straightforward, operationalizing them is difficult. There are at least 3 key challenges of conducting international comparisons: drawing the boundaries of the health system, managing limitations of data, and accounting for different values inherent in national systems. Without understanding and addressing these challenges, cross-national comparisons will fail to improve health policy and may lead to misinterpretations and poor policy making.