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Think and Act Globally: Health Affairs' September Issue

Bethesda, MD--The September issue of Health Affairs emphasizes lessons learned from developing and industrialized nations collectively seeking the elusive goals of better care, with lower costs and higher quality. A number of studies analyze key global trends including patient engagement and integrated care, while others examine US-based policy changes and their applicability overseas.
This issue was supported by the Qatar Foundation and World Innovation Summit for Health (WISH), Hamad Medical Corporation, Imperial College London, and The Commonwealth Fund.
The US leads the global pack in hospital bureaucracy, no matter what type of health care system.
David U. Himmelstein of the City University of New York and coauthors analyzed hospital cost accounting data across eight diverse nations and found that 25.3 percent of all hospital expenditures in the US are attributable to administrative costs, while the lowest of these costs occurred in Scotland and Canada (about 12 percent). They also found that US administrative costs are on the rise, without any direct 
correlation between those increases and better care. The authors attribute these trends to the complex, varying billing and rate requirements for multiple insurers in the US, as well as the need for hospitals to channel profits or surpluses toward modernization efforts necessary to compete. They point out that the administrative costs were highest at for-profit hospitals, and suggest single-payer reform as a mechanism to help eliminate bureaucratic waste and improve quality of care.
How is accountable care taking shape internationally? Mark McClellan of the Brookings Institution and coauthors seek to offer a global description of an accountable care system and a mechanism to assess related reforms. They suggest five components for a framework applicable internationally: population, outcomes, metrics and learning, payments and incentives, and coordinated delivery. They also define an accountable care system as "one in which a group of providers are held jointly accountable for achieving a set of outcomes for a prospectively defined population over a period of time and for an agreed cost." The authors highlight the fundamental nature of the shift from a supply-driven system to a demand-driven one, and the importance of data and collaboration during this transition. They suggest that policy makers in all countries begin to take a more holistic view through a population health lens, reward outcomes, foster collaboration and support interoperability to help accountable care achieve its promise.
Fighting the global obesity epidemic--one instant message at a time. Approximately six percent of
global health care budgets are linked to the obesity crisis, and in the United States alone, the cost of obesity is expected to rise to $957 billion by 2030. Hutan Ashrafian from the Institute of Global Health Innovation at Imperial College London and colleagues conducted a review and meta-analysis of twelve studies involving 941 patients following The World Innovation Summit for Health (WISH) 2013. They found that body mass index (BMI) can indeed be reduced through the use of interventions using social
networking, by a modest but significant .64 percent. They found an optimal duration of the interventions to be 6 to 12 months, with no significant effects before or after this timeframe. The authors suggest social networking techniques can be applied to other noncommunicable diseases associated with obesity, and highlight the importance of ease of use and simplicity to maximize effect.
Hospital to home transition interventions can keep people out of the hospital longer, especially for older patients. Kim J. Verhaegh of the Academic Medical Center Amsterdam and colleagues examined whether readmission rates for chronically ill patients from a variety of countries could be improved with interventions targeted at the discharged patients and their informal caregivers. They found a readmission rate reduction in both the intermediate (31-180 days) and long term (181-365 days), yet a reduction in the short term only after high-intensity interventions. With high-intensity approaches including a home visit within three days of discharge, care coordination by a nurse, and hospital-primary care coordination, the absolute risk reduction was 5 percent in the short term, 7 percent in the intermediate-term and 13 percent in long-term readmissions. The authors conclude that countries around the globe with aging, chronically ill patients should consider these interventions as a method of reducing preventable and costly readmissions, and study new ways to improve short-term readmissions in particular. 
Jeremy Laurance of Imperial College London and coauthors offer four case studies on the promise of patient engagement in lowering costs and improving outcomes from regions including the United Arab Emirates and the United Kingdom.
Also in the September issue:
We know the ACA extended health care benefits to more young adults, and it turns out it slowed their Emergency Department use, too. Tina Hernandez-Boussard of Stanford University and colleagues analyzed state administrative records from 2009-2011 from California, New York and Florida and found an overall reduction of more than 60,000 Emergency Department (ED) visits from young adults ages 19-25 compared to an older population of 26-31 not eligible for parental insurance under the ACA. They saw the largest relative decreases in women (-3.0 percent) and within the black population (-3.4 percent). The authors conclude that the drop was a result of fewer visits among ED users versus the overall number of people going to EDs, and posit that expansion of ACA coverage to other populations could have a net effect of a reduction in ED use.


About Health Affairs

Health Affairs is the leading journal at the intersection of health, health care, and policy. Published by Project HOPE, the peer-reviewed journal appears each month in print, with additional Web First papers published periodically at The full text of each Health Affairs Web First paper is available free of charge to all website visitors for a one-week period following posting, after which it switches to pay-per-view for nonsubscribers. Web First papers are supported in part by a grant from The Commonwealth Fund. You can also find the journal on Facebook and Twitter. Read daily perspectives on Health Affairs Blog. Download our podcasts, including monthly Narrative Matters essays, on iTunes. Tap into Health Affairs content with the new iPad app.