Today at Brown

American healthcare: The view from Europe

Recently Italy ranked second in overall healthcare services in a study conducted by the World Health Organization. In stark contrast,, the United States came in 37th with the lowest score of any industrialized nation.

Italy’s Prodi: An inherent right to healthcare Divergent approaches to healthcare in the United States and Europe were the topic of a lecture by former Italian Prime Minster Romano Prodi, professor at large at Brown’s Watson Institute for International Studies, on October 22. Americans tend to view health reform in terms of economic viability, Prodi pointed out, while Europeans assume health coverage to be an inherent right. Prodi expressed surprise that some U.S. citizens choose not to be covered. For these 40 million uninsured Americans, “disease is a personal and financial disaster,” he noted.

Debates about the economics of American healthcare have included comparisons with the so-called “socialist” systems of European countries. Adjunct Professor Flavia Franzoni of the University of Bologna deconstructed this label in her lecture following Prodi’s remarks. She pointed to the great variety of healthcare structures in the E.U., most of which are traceable to two early schemes: the Bismarck and Beveridge models.

The adoption in 1883 of the Bismarck model in Germany marked “the beginning of the ideal workers’ state,” where employers and employees jointly contributed to nonprofit insurance funds. The Beveridge plan, known for its “cradle to grave” protection, granted universal coverage to the British public through taxation. European countries have instituted hybrids of these models, Franzoni said, mixing systems to adapt to changing demands. – Watson Institute student rapporteur Zak Leonard ’10

A cautionary tale from Massachusetts

Elizabeth Roberts ’78: Increased demand for doctors The following Friday, October 30, Rhode Island Lt. Gov. Elizabeth Roberts ’78 said during a forum at Sayles Hall that the current Massachusetts health-insurance model offers an early warning for a problem few in the national healthcare debate have discussed yet. To date, healthcare reform efforts have focused on expanding access, she said, but they have little to say about the increased demand for services the proposed federal legislation would generate.

Not long after the Bay State’s health reform passed several years ago, officials realized the state lacked enough primary care doctors to meet surging demand. That shortfall continues today in Massachusetts. “It is very important to recognize we are going to see this around the country,” Roberts said.

Roberts spoke at this year’s first Alpert Medical School Levinger Lecture series event, titled “Health Care Reform: How Can We Improve Service, Delivery?” The forum drew several dozen physicians, teachers, Brown employees, and students. Other speakers included Fox Wetle, associate dean of medicine for public health and public policy; Thomas O’Toole, associate professor of medicine; Chima Ndumele, a biomed graduate student; and fourth-year medical student Zachary Ginsberg.

Now is the time, Roberts told the group, to talk about the merits of evidence-based medicine, which places priority on treatments shown to be the most effective. With costs continuing to increase, the use of technology such as electronic medical records will become vital.

Any discussion of healthcare delivery must also address ethical questions, Roberts continued. Americans need greater consensus on topics such as the merits of palliative end-of-life care versus expensive medicines and treatments, she said.

In introducing the forum, Edward J. Wing, dean of medicine and biological sciences, asked the audience to think about how Brown’s medical school can play an active role in healthcare reform and also in training the next generation of physicians. “I am a fan of primary care,” he said. “It is the heart and soul of medicine.” – Mark Hollmer