“You get what you pay for” most aptly summarises the UK’s position in recent international comparisons published by the King’s Fund.1 Compared with the health systems of 19 high income countries, the UK spends just below average per capita on health and is “neither a leader nor a laggard” in overall performance, but “more of a laggard than a leader on health outcomes.” As the authors note, these findings are not so different from a series of comparisons published around the time of the 70th birthday of the NHS, five years ago.23 This indicates a lack of progress at best, but given that international data often come with a lag, the full effects of the pandemic on the health system are also not fully reflected.

Report identifies striking lack of progress relative to peer countries.

COVID-19 has demonstrated the serious threat pandemics pose to both health and health systems. Pandemic preparedness plans are key strategic tools that enable policymakers to limit the severity of a disease outbreak but plans also need to build resilience into the health system to withstand pandemic shocks.

Health system performance assessment can be applied to pandemic preparedness planning to identify those strategies that improve health system resilience.

Which pandemic preparedness strategies strengthen health system resilience? Can health system strengthening and pandemic preparedness align? How can we use health system performance assessment to support pandemic preparedness? Join us to find out!

Jonathan Cylus and colleagues argue that inflationary pressures mean the NHS may have reached the limit on its ability to contain costs for goods and staff without affecting care.

The need for cardiac transplantation (CT) in eligible patients with advanced heart failure has continued to grow, with a substantial mismatch between organ availability and demand. As the demand for transplantable organs has risen in the United States,1 so has the prevalence of major cardiometabolic risk factors, including diabetes mellitus (DM), among the current and emerging pool of potential donors.2 Although the cardiovascular complications of DM are well recognized, donor DM status has not been shown to adversely impact post-CT outcomes in older analyses.3 However, this has not been evaluated in the contemporary era or over longer-term follow-up.

One of the most pressing challenges facing most health care systems is rising costs. As the population ages and the demand for health care services grows, there is a growing need to understand the drivers of these costs across systems. This paper attempts to address this gap by examining utilization and spending of the course of a year for two specific high-need high-cost patient types: a frail older person with a hip fracture and an older person with congestive heart failure and diabetes. Data on utilization and expenditure is collected across five health care settings (hospital, post-acute rehabilitation, primary care, outpatient specialty and drugs), in six countries (Canada (Ontario), France, Germany, Spain (Aragon), Sweden and the United States (fee for service Medicare) and used to construct treatment episode Purchasing Power Parities (PPPs) that compare prices using baskets of goods from the different care settings. The treatment episode PPPs suggest other countries have more similar volumes of care to the US as compared to other standardization approaches, suggesting that US prices account for more of the differential in US health care expenditures. The US also differs with regards to the share of expenditures across care settings, with post-acute rehab and outpatient speciality expenditures accounting for a larger share of the total relative to comparators.

This policy brief is one of a new series to meet the needs of policy-makers and health system managers. The aim is to develop key messages to support evidence-informed policy-making and the editors will continue to strengthen the series by working with authors to improve the consideration given to policy options and implementation.

Book edited by Irene Papanicolas, Dheepa Rajan, Marina Karanikolos, Agnes Soucat, Josep Figueras. Health Policy Series 57.

ICCONIC findings featured in a Guardian article.

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.

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.

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 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.