New Lessons From the Old World

European health care outperforms the U.S.'s on almost every measure. A guide to what we can learn

By Eben Harrell/Copenhagen Monday, June 08, 2009
    • Illustration for TIME by Serge Bloch

    High infant mortality, low life expectancy, soaring health-care costs — the symptoms are numerous and the diagnosis unmistakable: America's health-care system is ailing. But like a patient who coughs or limps his way through an illness, the U.S. has often been reluctant to look for help.

    That's changing. The Obama Administration promises to offer universal coverage, introduce electronic records and wrestle health-care costs under control — in short, at least part of the health-care revolution that many Americans have advocated for years. ( See pictures of the world reacting to Obama's election win. )

    Inevitably, perhaps, that means Americans are looking to European models, hailed by some, dismissed as socialized medicine by others. In truth, European health care is neither the nirvana of Michael Moore's imagination, nor the publicly funded money pits that so scare conservatives. For one thing, Europeans spend less — about $4,000 a person less, in some cases — than Americans on health care annually, and often with better outcomes. The good news is that without reassembling its entire health-care system, there are many relatively simple measures that could help the U.S. get a handle on soaring costs — and keep its population healthier, too. America, here is your prescription:

    Denmark: Electronic records save money and improve outcomes

    At the Frederiksberg University Hospital in Copenhagen, there are no clipboards. Instead, doctors and nurses carry wireless handheld computers to call up the medical records of each patient, including their prescription history and drug allergies. If a doctor prescribes a medication that may cause complications, the PDA's alarm goes off. In the hospital's department of acute medicine — where patients often arrive unconscious or disorientated — department head Klaus Phanareth's PDA prevents him from prescribing dangerous medications "on a weekly basis," he says. "There's no doubt that it saves lives."

    President Obama recently pledged $19 billion to computerize America's medical records by 2014. Denmark has already made the transition. The country has a centralized computer database to which 98% of primary care physicians, all hospital physicians and all pharmacists now have access. While basic records go back to 1977, a detailed history is available of all "patient contacts" since 2000. A recent study by the Commonwealth Fund, a health-care-reform nonprofit, rated the country's health-care IT systems as the most efficient in the world, with computerized record-keeping saving Danish physicians an average 50 minutes a day of administrative work. "That's essential for [U.S.] doctors," says Jeff Harris of the American College of Physicians, who points out that U.S. family physicians have the highest administration costs in the developed world and "are already under strain from all the paperwork required to run an office." ( Read: "Denmark's Wind of Change." )

    Denmark boasts several advantages that have helped in the early adoption of electronic health records. It is small (population: 5 million) with a tech-savvy citizenry and a public sector-run health system. Trust in the government is high. Most crucially, when the health service established a National Patient Registry in 1977 — a system that required doctors to file patient visit details in order to be reimbursed for their work — the country unknowingly laid the groundwork for electronic health records by putting in place centralized record-keeping.

    But there have been slipups. After the government decided to move away from paper records in 1999, a team of officials came up with a coding system that required doctors to insert information and notes in alphanumerical form. The system was never implemented and eventually abandoned in 2006 after physicians and nurses complained. Now, instead of a single system, record-keeping utilizes various compatible systems, linking networks established by regional health agencies. "What we found is that adoption of electronic health records must be done by evolution rather than revolution," says Jens Andersen of Sundhed.dk, the state health-care web portal. "You have to work with the systems already in place."

    The latest phase of the program focuses on telemedicine. In the past year, the health-care service has piloted two home-monitoring programs for patients with diabetes and those on blood-thinning medication — groups at high risk of emergency hospitalization. At Frederiksberg Hospital, Dr. Phanareth is running a ground-breaking study to test whether patients with exacerbation of chronic obstructive pulmonary disease — responsible for 10% of all hospital admissions in Denmark — can be treated at home using telemedicine technology. "Sometimes, a lack of resistance is all you need for change to happen," Phanareth says.

    See TIME's A-Z Health Guide

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