Can we learn anything from health care in the United States?

Matthew H R Anstey, Adam G Elshaug, Lesley M Russell and Susan Wells
Med J Aust 2014; 200 (9): 526-528. || doi: 10.5694/mja13.11357


  • Some aspects of health care in the United States would be beneficial to Australia and New Zealand, but others should be avoided.
  • Positive aspects, which should be emulated, include:
    • health care reform that is focused on the continuum of care and patient-centred care
    • trials of new models to organise, deliver and pay for health care services, where quality of care is rewarded over quantity of services
    • an integral view of, and strong support for, health services research as a means of evaluating reforms aimed at improving patient outcomes and systems-level efficiencies
    • physician engagement in reforms — for example, participating in the Choosing Wisely initiative, and trialling and implementing new payment models that are not fee-for-service.
  • Negative aspects, which should be avoided, include:
    • increasingly fragmented provider and financing structures (funding provided by state and federal governments, private insurance and out-of-pocket costs) that cause frustration in terms of access and care coordination and increase administrative waste
    • an overemphasis on technological solutions, with insufficient acknowledgment of the importance of addressing value in health care
    • a focus on hospital and doctor-based health care rather than environmental and social inputs into health.

Please login with your free MJA account to view this article in full

  • Matthew H R Anstey1
  • Adam G Elshaug2
  • Lesley M Russell3
  • Susan Wells4

  • 1 Intensive Care Unit, Sir Charles Gairdner Hospital, Perth, WA.
  • 2 Menzies Centre for Health Policy, Sydney School of Public Health, University of Sydney, Sydney, NSW.
  • 3 Australian Primary Health Care Research Institute, Australian National University, Canberra, ACT.
  • 4 School of Population Health, University of Auckland, Auckland, New Zealand.


Matthew Anstey, Adam Elshaug and Susan Wells were previously supported by Harkness Fellowships in Health Care Policy and Practice from the Commonwealth Fund. The views presented here are ours and should not be attributed to the Commonwealth Fund or its directors, officers or staff. Adam Elshaug holds a National Health and Medical Research Council Sidney Sax Public Health Fellowship (ID 627061) and is supported by the HCF Health and Medical Research Foundation.

Competing interests: Susan Wells has received research funding from the Health Research Council of New Zealand, the Heart Foundation (New Zealand) and Roche Diagnostics. She has a Stevenson Foundation Fellowship in Health Innovation and Quality Improvement.

  • 1. Schouten LM, Hulscher ME, van Everdingen JJ, et al. Evidence for the impact of quality improvement collaboratives: systematic review. BMJ 2008; 336: 1491-1494.
  • 2. Delbanco T, Walker J, Bell SK, et al. Inviting patients to read their doctors' notes: a quasi-experimental study and a look ahead. Ann Intern Med 2012; 157: 461-470.
  • 3. Cassel CK, Guest JA. Choosing wisely: helping physicians and patients make smart decisions about their care. JAMA 2012; 307: 1801-1802.
  • 4. Elshaug AG, Watt AM, Mundy L, Willis CD. Over 150 potentially low-value health care practices: an Australian study. Med J Aust 2012; 197: 556-560. <MJA full text>
  • 5. Selby JV, Beal AC, Frank L. The Patient-Centered Outcomes Research Institute (PCORI) national priorities for research and initial research agenda. JAMA 2012; 307: 1583-1584.
  • 6. National Health Performance Authority. Hospital performance: length of stay in public hospitals in 2011–12. Canberra: Commonwealth of Australia, 2013.$FILE/NHPA_HP_Report_LOS_Report_November_2013.pdf (accessed Feb 2014).
  • 7. Wennberg JE. Time to tackle unwarranted variations in practice. BMJ 2011; 342: d1513.
  • 8. Cutler DM, Ly DP. The (paper) work of medicine: understanding international medical costs. J Econ Perspect 2011; 25: 3-25.
  • 9. Woolhandler S, Campbell T, Himmelstein DU. Costs of health care administration in the United States and Canada. N Engl J Med 2003; 349: 768-775.
  • 10. Yusuf F, Leeder SR. Can't escape it: the out-of-pocket cost of health care in Australia. Med J Aust 2013; 199: 475-478. <MJA full text>
  • 11. Thomas PE. Reflections on the role of less-than-comprehensive (exclusionary) private health insurance hospital products in the Australian healthcare system. Aust Health Rev 2012; 36: 273-276.
  • 12. Lopert R, Elshaug AG. Australia's ‘fourth hurdle' drug review comparing costs and benefits holds lessons for the United States. Health Aff (Millwood) 2013; 32: 778-787.
  • 13. Schroeder SA. Shattuck Lecture. We can do better — improving the health of the American people. N Engl J Med 2007; 357: 1221-1228.
  • 14. Woolf SH, Aron L, editors. US health in international perspective: shorter lives, poorer health. Washington DC: National Academies Press, 2013. (accessed Sep 2013).
  • 15. Cooper R. Inequality is at the core of high health care spending: a view from the OECD. (accessed Oct 2013).
  • 16. Organisation for Economic Co-operation and Development. Crisis squeezes income and puts pressure on inequality and poverty: new results from the OECD Income Distribution Database. (accessed Sep 2013).
  • 17. Food and Agriculture Organization of the United Nations. The state of food and agriculture: food systems for better nutrition. Rome: FAO, 2013. (accessed Feb 2014).
  • 18. Access Economics. The economic value of informal care in 2010. Canberra: Access Economics and Carers Australia, 2010. (accessed Sep 2013).


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Responses are now closed for this article.