Lessons From Ghana: U.S. Health Care Reform Driving on the Right Side
Jul 23, 2013 1:00 PMAs part of our Utah outreach program to Ghana this month, I was asked to give a lecture on U.S. Health Care Reform to physicians and physician assistants in Kintampo.
In my lecture, I shared information from the Institute of Medicine’s report from last year highlighting the excessive waste and fraud in our U.S. health care system—leading to more than $750 billion a year in unnecessary health care spending. After spending time in Ghana, we all found ourselves wondering whether that remarkably large number is in fact grossly underestimated.
A comparison of our health care system to Ghana’s demonstrates much of this potential discrepancy. Last year, Ghana spent just under 5% of its GDP on health, which works out to $30 per person per year. Contrast this to the U.S. where we spent 18% of the GDP on health—or over $8000 per person—about 300 times as much. Are Ghanaians as healthy as Americans? On the whole, no. Sanitation, clean water, electricity, roads and other infrastructure challenges remain major barriers to Ghanaian public health. Nevertheless, life expectancies in Ghana (65 yrs.) are dramatically on the rise, and are among the best on the continent. In some parts of our country however, rates are in fact declining. By comparison at a base level, our outcomes are certainly not 300 times better than Ghana’s.
How do we think about this remarkable difference?
In almost every clinical lecture delivered by our Utah group at the courses in Ghana, the faculty would discuss interesting cases and protocols, and then inevitably offer an apologetic, “…to confirm this diagnosis, we can order [expensive diagnostic test, not available in Ghana]… but actually, it’s probably not really necessary”. In Ghana, our neurology faculty emphasized the art and science of the neurological physical examination, which at home has been relegated to second-class citizen behind the mandatory brain MRI for diagnosis. In Ghana, prevention and primary care represent more than ¾ of the practitioners, physician assistants and nurses play roles of major responsibility for the health care of the population, and health care providers—deeply envious of our fee-for-service models—are salaried.
Who would have guessed that a discussion of American health care reform in Ghana would lead to so much food for thought?
Despite obvious differences, there are remarkably many parallels between Ghana and Utah. Ghana leads most of Africa in their health. Mortality in the past 20 years has declined by a remarkable 48%. Vaccine programs are wildly successful. Malaria is way down. Their government’s mantra—“Wealth Through Health”—resonates strongly with our visiting team.
The current rhetoric in the world of health care reform in the U.S. is around the need to shift the direction of the entire health care system, to make fundamental changes in the ways in which physicians and hospital systems are paid and reevaluate how we value health care. Here in Utah, we have seen dramatic improvements in our patient satisfaction scores and in our quality measures over the last few years, but we have a long way to go.
During our visit to Ghana, we learned what radical change truly means: As a British colony, Ghana had been a country that drove on the left side of the road. After significant preparation by the government and over one night on August 4, 1974, Ghana successfully changed to driving on the right-hand side throughout the nation.
U.S. health care has been driving down the “wrong” side of the road for too long. Now it’s time for us to shift health care in the U.S. to the right side.
"Utah House" a specially dedicated guest house for our visit.comments powered by Disqus