Most of us have been in scenarios where the subject of socialized medicine comes up. Or we have heard friends say things like “Maybe I should move to a country like Canada, at least then I would have free health care.” After spending a week in Portugal–a country with 100% universal coverage for all citizens– I can attest to the fact that it’s just not that simple and healthcare access and financing are the subject of widespread political debate in that country too! I was actually scheduled to meet with the Portuguese Minister of Health to discuss this and other issues, but he was relieved of his position the day before our appointment– and it was clear that contentious politics played a role in his dismissal.
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A shining example of public/private partnership
Portugal’s Cascais Hospital
The truth is that Portugal has a two-tiered system and so do we—the two systems are just structured differently. Here we have Medicare/Medicaid. The hospitals and physicians are private but the financing is “public.” Then on the other side is our private, employer-funded system. In Portugal the govt. generally owns all the infrastructure for their public health systems and there is a tremendous disparity in the quality and management of those facilities vs. private ones. The wealthier citizens have access to the premier facilities, and those lower on the socioeconomic scale use the public ones. Care is rationed based on urgency, age and other factors. So if you’re 75, can’t afford private care and you need a hip replacement-you might be waiting years to get it.
This is a definite challenge in Portugal, especially if you ask the people waiting years for care. But Portugal also has a shining example of public/private partnership in its Cascais Hospital. Our meeting with the CEO was nothing short of riveting, as he described United Health Group’s investment in the hospital in 2012, and the resulting Level 7 HIMSS Analytics score on the Electronic Medical Records Adaptation Model (EMRAM). It took them six years to achieve this rating—and only three hospitals in the entire EU have attained it.This hospital was a marvel of care and technology and efficiency, and a tremendous contrast to the public facility we visited the day before. In the case of Cascais, the government had the foresight to see a role for foreign investment in its infrastructure. For UHG, they are now deploying their Optum data/population/health management knowledge and scale around the globe. The UHG executives probably realized – far faster than I did – that the problems of the Portuguese health systems are similar to those in the U.S. Through these acquisitions, UHG can share lessons learned, work with local Portuguese healthcare providers to collaborate – all while diversifying their business exposures to the U.S. health care system (which I am sure the shareholders applauded).
While the local executive and clinical teams at Cascais hospital deserve the lion’s share of the credit for the HIMSS Level 7 EMRAM score, one must wonder how the capital injection of the UHG/Amil group really expedited and enabled the focus and financial resources to attain such a lofty goal. I left that tour feeling inspired and energized about the potential for similar models in the United States.
Here’s more info about the Cascais model.