This talk is related to the Brocher Foundation Alumni Meeting 2015, held at the Brocher Foundation from June 17 until June 19, 2015 (www.brocher.ch).
Beyond Bismarck and Obama – What is system innovation from a two-country perspective?
By Katharina Janus
I was born and raised in a social security system – Germany. Then I was socialized into my profession in a mostly private system – the USA. Although I know both systems very well, I sometimes feel like an alien when I switch country perspectives that largely determine peoples’ perception what innovation in healthcare actually means. I had my most recent experience as a legal alien at a so-called “innovation summit” in the U.S.’s capital. Presenters from various outstanding integrated healthcare organizations presented their approaches to innovation and to finally solve the cost and quality conundrum of America’s healthcare system after the latest reform. There were fantastic examples of how provider systems had become active in their local communities by offering shelters, food for the indigent, managing populations through healthcare workers etc. While I admired how active, driven and useful all of these, mostly privately financed initiatives were, the quintessential take-away was that you cannot look at healthcare costs alone. You have to consider health and social costs in their entirety and manage them jointly. This did not come as a surprise to me and I wondered whether this was “the innovation” or whether there was more to come. Leaving the remarkable accomplishments of the presenting healthcare organizations aside, wasn’t the take-away something Bismarck introduced in my home country Germany more than 130 years ago? On the contrary, thinking of Germany’s well-running social/health care system you would probably not find a provider organization that would voluntarily and at its own expense invest into social services because they have an impact on their bottom line. This would be considered a matter of the government.
Drawing on a historical example I will analyze the drivers of healthcare system innovation. My great-great grandaunt founded (in 1879) and managed a hospital in a small town community in the 19th century and her brother founded one of the first German sickness funds. In pre-Bismarck Germany she involved the entire community in health and social care delivery. While “healthcare for all” proved to be a challenge at that time the level of community engagement was – like in the USA of today – remarkable. A hundred years later – in 1979 – that same hospital, now owned by the state, was remodeled significantly and paid by the (anonymous) taxpayer. At that time healthcare for all had become reality in Germany, but community involvement had been reduced significantly. It almost felt like system innovation went too far and suffocated the community’s accountability and ethical engagement. Now, as the journey towards Bismarck seems to be an innovative idea in the US, how can we ensure that we do not travel too far and extinguish the sense of community that is missed today in Germany? We can learn from history, but we frequently make the same mistakes over and over gain. This case study provides the opportunity to steer the US and other systems in a truly innovative direction through learning from cross-national system innovation.