Australia

From the report: "The Australian government has introduced a number of reforms to care for older people aimed at improving financial sustainability, quality, and consumer choices. The independent Aged Care Quality and Safety Commission, established in early 2019, will bring together previously disparate functions of quality assurance, complaints, and regulation of the aged care sector. The government has also started conducting unannounced audits of aged-care (or nursing) homes for reaccreditation.

"The Australian government is also investing more funding to help people remain in their own homes as they age. One example is the Community Visitor scheme, which supports the 70 percent of elderly people who receive aged care at home and experience loneliness."

"In 2017, the Australian government launched Head to Health, a one-stop electronic resource to direct people experiencing mental health issues to services and resources, supporting them in taking control of their health by reaching out to high-quality, reputable providers."

(Photo: Taras Vyshnya/Shutterstock)

Canada

From the report: "At the federal level, there are signs of renewed interest in a pan-Canadian system of drug coverage. In 2018, the Advisory Council on the Implementation of National Pharmacare was established, and an interim report was produced in 2019. If a national program moves forward, it will be the biggest expansion of public funding and coverage since Canadian Medicare was introduced.

"[I]n 2017 when Saskatchewan replaced its 12 regional health authorities with a single provincial health authority. This initiative reflects a national trend toward greater administrative centralization. Similarly, as part of an evolving reform effort, Manitoba established a single provincial organization — Shared Health — to centralize some clinical and administrative services."

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England

From the report: "In October 2014, NHS bodies, led by NHS England, published the Five Year Forward View, which sets out the challenges facing the NHS and strategies to address them. These include pilot programs across England to test new models of care, among them:

• scaled-up multidisciplinary primary care
• enhanced health care in long-term care homes
• vertically integrated hospital and community care
• networks to improve emergency care.

"Five-year strategies have also been published for improving cancer and mental health services, and better prevention, including a diabetes prevention initiative."

The 10-year NHS Long Term Plan "sets out a vision for local integrated care systems to improve population health, new national strategies on cardiovascular and respiratory disease (in addition to cancer and mental health), and new primary care networks to better link together general practices."

(Photo: Melinda Nagy/Shutterstock)

France

From the report: "Experiments with new payment mechanisms are in their early stages. These experiments are inspired by the creation of accountable care organizations. At the national level, bundled payments are to be tested in 2019–2020 for orthopedic and colorectal surgeries. In addition to the national program, regional initiatives are encouraged, with the objectives of integrating care and improving quality, relevance, efficiency, and prevention. These five criteria will be considered when decisions are made as to whether to allow regional pilots, which will run for a period of five years and benefit from funding of care not currently covered by SHI. Disease types selected are stroke, heart failure, and acute coronary syndromes. A total budget of EUR 20 million (USD 25.3 million) is earmarked for 2019 for the payment pilots."

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Germany

From the report: "After a period of active health reform in several areas between 2012 and 2016, new reform debates and proposals stagnated until spring 2018. One of the reasons is that after the federal elections in September 2017, it took six months of difficult talks and political insecurity to again form a grand coalition between political parties (Christian Democrats and Social Democrats). The first new bill introduced in 2018 (the SHI-Contribution Relief Law, or GKV-Versichertenentlastungsgesetz) aims to reduce the mandatory contributions that individuals in SHI pay every month. While the general contribution of 14.6 percent has been equally shared between employers and employees since 2015, the supplementary contribution is paid by employees only. The law plans to reinstate the equal split of general and supplementary contributions between employers and employees. ... Furthermore, the Ministry of Health has recently issued a decree on minimum staffing requirements for nurses in hospitals. The maximum number of patients per nurse has been defined for hospital units where nursing staff is particularly needed — intensive care, geriatric, cardiology, and trauma surgery — to guarantee patient safety. The regulation went into effect January 2019. To further expand the capacities of nurses in hospitals and in long-term care and to reform salaries and working conditions for nurses, the Nursing Staff Strengthening Act was enacted in September 2018."

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Italy

From the report: "In 2017, Parliament introduced compulsory vaccinations for all infants and children up to age 16, following an increase in the number of deaths due to infectious diseases (mainly mumps) and the antivaccination movement. Children who do not comply with the prescribed vaccination are not allowed to attend kindergartens, nurseries, and schools.

"In January 2017, the government approved an updated version of essential covered benefits, with significant changes in the outpatient specialist services that can be delivered by the National Health Service and a further shift of hospital care into outpatient settings. The government estimates an additional expenditure of EUR 800 million (USD 1.1 billion) per year for this reform."

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Japan

From the report:, "The Social Security Council set the following four objectives for the 2018 fee schedule revision:

• developing efficient and comprehensive care in the community
• developing safe, reliable, high-quality care and creating services tailored to emerging needs
• reducing the workload of health care workers
• making the health care system more efficient and sustainable."

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Singapore

From the report: "In late 2017, the Ministry of Health launched its Beyond Healthcare 2020 strategy to move more care to the community, encourage health promotion, and ensure value.

"In 2018, the ministry launched the Licensing Experimentation and Adaptation Program, a regulatory “sandbox” for identifying and understanding new health care innovations, such as telemedicine and mobile medicine, through industry partnerships. The program seeks to develop an appropriate regulatory approach to facilitate such innovations while prioritizing patient safety and welfare.

"To provide better protection against long-term care costs, the ministry will launch CareShield Life in 2020 to replace ElderShield. The new scheme will have higher cash payouts, starting at SGD 600 (USD 438) and increasing over time. There is no cap on payout for as long as the policyholder remains severely disabled. CareShield Life will be mandatory for citizens and permanent residents born in or after 1980. "

(Photo: HTU/Shutterstock.com)

Taiwan

From the report: "Since June 2016, the NHIA has stepped up efforts aimed at strengthening primary care through delivery system integration and the establishment of a referral system. The six components of this new strategy are:

• Enhancing the capacity of primary care
• Incentivizing the public to use the referral system through adjustments to the copayment system
• Raising payments to hospitals for critical care to incentivize hospitals to reduce services related to treating minor illnesses
• Strengthening cooperation between hospitals and clinics to provide continuous care
• Strengthening the public's capabilities in self-care
• Strengthening the governance of hospitals.

(Photo: Wayne 0216/ Shutterstock.com)

United States

From the report: "As of 2020, most of the [Affordable Care Act]’s provisions remain the law of the land. However the Trump administration has canceled some consumer protections through regulatory and executive actions. For example, in 2019, the individual mandate, the financial penalty for not having health insurance, was removed. In addition, through executive orders enacted in 2017 and 2018, the administration allowed states to offer alternative, lower-cost, minimally regulated insurance plans in their marketplaces that do not meet the minimum requirements of the ACA.

"The administration has also announced efforts to address high health care prices, especially concerning prescription drugs. Two bills passed in 2018 banned so-called “gag clauses” in contracts between pharmacies and pharmacy benefit managers. These clauses prevented pharmacists from informing customers when the cash price (without billing insurance) for a drug is lower than the insurance-negotiated price. In addition, to address hospital price transparency, federal rules require all hospitals to post their charges for medical procedures online and update the list at least once a year."

(Photo: Steven Bognar/Shutterstock.com)

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Health care reform continues to be a fiercely debated topic in the United States, primarily around the subject of single-payer vs. our current system. Several reforms and innovations have taken place in this country, from Medicare and Medicaid innovations to employers joining together to form their own nonprofit health care corporations. But how do American innovations measure up to the rest of the world?

Related: In ranking of healthiest countries, U.S. comes in at 35

The Commonwealth Fund, a private U.S. foundation that supports independent research on health care issues, has updated its International Profiles of Health Care Systems. The study delves into the systems of 20 countries, covering subjects from the organization and financing of health care to controlling costs and spending.

Newly added sections reveal how medical education is funded, and the different levels of patients’ out-of-pocket expenses for basic services.

See our slideshow above for highlights of the innovations and reforms that have taken place in ten of the 20 surveyed countries, and click here for the full report.

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