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The World is Flat author Thomas L. Friedman coined the phrase in terms of the world's economy, pointing out how India, China and other developing countries with emerging economies have joined the highly industrialized western countries to create a global supply chain for manufacturing and services.

Friedman's model has evolved to include the global standardization of health care services, according to Ori Karev, CEO of UnitedHealth International. After all, most of health care is science, and science does not discriminate based on country of origin, culture or ethnicity. It doesn't matter whether a man in China or a woman in the United Kingdom has liver cancer; they both have liver cancer. Period. And all things being equal, there are best practices for treating liver cancer. Modern medicine has the science behind such condition-based treatment, and these practices are being disseminated across the global medical community. "The fact is," says Karev, "effective health care delivery is a system that best follows the rules of science, and thus it can be managed. Whether we apply this to developed western countries using socialized medicine or emerging economy countries in Asia, Africa and South America with little health care structure, systemic rules have developed that apply to optimizing health care delivery."

In the United Kingdom, the nationalized health care system is being challenged. Care is a limited commodity, patients sometimes have to wait for treatment and service, and outcomes--at the societal level--are not consistently at predictable levels. Although the UK usually is considered the standard-bearer for nationalized health care, the reality is that privatization has increased dramatically in the last decade because the system has not always met people's care needs. At the same time, costs of care have the potential of reaching unsustainable levels. This has motivated increasing numbers of people in the UK to look outside their government-sponsored health system for treatment they are willing to purchase with their own money or through private insurance. Surprisingly, private health spending in the UK is now roughly equal to public spending--and perhaps even more surprising is that the same holds true in the US (although in the US the shift is from private to public).

On the other side of the world, increasing numbers of newly middle-class and wealthy people in emerging economies are using their personal wealth to purchase health care simply because they have very few other options. Over the past decade, China and India have emerged as true world economic superpowers. With that, a middle class with disposable income has begun to demand comprehensive health care services. But this dynamic is playing out in a health care delivery and financing environment that has not yet caught up with the new demand. The result is a rapidly emerging, private cash economy for health care services, but within the context of a somewhat disjointed, developing delivery system.

These scenarios are playing out in one form or another in many of the countries of the world: from the Netherlands to Brazil, from Canada to South Korea. Personal health consumption is rising as the world grows in wealth and people increasingly are willing to pay a larger portion of their personal income to purchase it. And the systems in which this is taking place are, in many cases, struggling to keep up with the rapidly changing demand.

Why should Americans care? America is no longer an insular economy. Many American companies either have employees living and working outside the country permanently or on assignment, or executives who frequently travel overseas. Some 50 percent of the earnings of the Standard & Poor's 500 companies alone come from outside of the United States. These global companies are faced with the same issues every American company is faced with--how to keep its workforce healthy and productive.

All these factors speak to the essential nature of health care. Are there universal dimensions of health care that transcend geographical and cultural borders? Are there core elements of maintaining good health and treating illness and disease within certain economic principles? "The empirical data suggest there are, especially as you move up the pyramid of health care from basic health and safety requirements to more sophisticated clinical treatment," says Karev. There are elements of health care that simply obey the laws of science, regardless of language, location, culture or tradition."

During this time of rapid development and change in health care infrastructure around the world, the issues of quality, consistency of care, and standards for diagnosis, treatment, and follow-up are beginning to look similar across borders and cultures. Because knowledge sharing is also subject to the flattening world, we now have health care providers sharing clinical best practices and more consistent medical school curricula around the globe. Add the globally converging similarity of the supply curve to the globally converging similarity of the demand curve, and we have a perfect set of circumstances for a paradigm change. It is precisely that perfect storm which is producing a new phenomenon of a flat world when it comes to health care.

Can this massive phenomenon be managed? Yes. The tools, the technology and the talent exist to provide the best health and health care delivery possible within every kind of medical system in the world. What is needed from people in positions of leadership in health care around the world--whether on the public funding side, the private insurance side, or the delivery side--is first, recognition that health care delivery is a process; and second, the management discipline, the will to maintain it and the ability to sustain it.

The ultimate goal is extraordinarily simple: to manage resources and to use systems to make and keep people around the world as healthy as possible, as cost-effectively as attainable.

In doing so, the world will become flatter still.

For more information about UnitedHealth International's health benefits programs, please contact Kristin Herrera at (646) 728-6406.

(The above piece is part of our continuing Insights series designed to highlight key products and services to our readers. This paid-for Insights was written and edited by Risk & Insurance® on behalf of our marketing partner. Additional Insights can be found on our Web site at www.riskandinsurance.com/.)

March 1, 2010

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