What American health care could learn from Finnish education

[eridani]

A lot of people have probably seen this in the Education forum. Parts relevant to health care are excerpted.

What Americans Keep Ignoring About Finland's School Success

http://www.theatlantic.com/national/archive/2011/12/what-americans-keep-ignoring-about-finlands-school-success/250564/

As for accountability of teachers and administrators, Sahlberg shrugs. "There's no word for accountability in Finnish," he later told an audience at the Teachers College of Columbia University. "Accountability is something that is left when responsibility has been subtracted."

And while Americans love to talk about competition, Sahlberg points out that nothing makes Finns more uncomfortable. In his book Sahlberg quotes a line from Finnish writer named Samuli Puronen: "Real winners do not compete." It's hard to think of a more un-American idea, but when it comes to education, Finland's success shows that the Finnish attitude might have merits. There are no lists of best schools or teachers in Finland. The main driver of education policy is not competition between teachers and between schools, but cooperation.

Decades ago, when the Finnish school system was badly in need of reform, the goal of the program that Finland instituted, resulting in so much success today, was never excellence. It was equity.

In fact, since academic excellence wasn't a particular priority on the Finnish to-do list, when Finland's students scored so high on the first PISA survey in 2001, many Finns thought the results must be a mistake. But subsequent PISA tests confirmed that Finland -- unlike, say, very similar countries such as Norway -- was producing academic excellence through its particular policy focus on equity.

Comment by Don McCanne of PNHP: When you read these excerpts from this article on the education system in Finland, what is striking is how much the philosophy behind their vastly superior system contrasts sharply with ours. What is really mind-boggling is that if you re-read the same excerpts, except substitute "health care system" for "education system," you then will have an inkling of what we are doing wrong in both education and health care.

One fundamental concept that has appeared repeatedly on the pages of Physicians for a National Health Program (PNHP) is that excellence is a product of cooperation, not competition. It is not choice between private for-profit and public systems, but rather it is equity within public systems that facilitates excellence.

In both education and health care, Americans emphasize testing, accountability, merit rewards, competition, and choice. Yet Finland does not use standardized testing (analogous to HEDIS testing in health care), nor do they demand accountability - they don't even have a word for it - but rather they expect responsibility. In Finland, all teachers are given prestige, decent pay, and a lot of responsibility. Finns are very uncomfortable with the concept of competition, especially since that interferes with the productivity induced in an environment of cooperation. Nor do they even consider choice - choice between publicly-financed and privately-financed schools - since the latter do not even exist.

So their secret is to establish equity and cooperation within the public sector. Now that it's no longer a secret, we also can have high quality education and health care systems right here in the United States. We just have to shove the MBAs aside and place control in the hands of our own publicly chosen advocates of social justice.

My comment: I've especially emphasized that equity and cooperation are specifically associated with PUBLIC goods. Not everything is a public good, and when this is the case competition and choice have important roles. "Accountability is something that is left when responsibility has been subtracted" is a way cool soundbite too.

[LeftishBrit]

1. k&r

and even relevant to OUR (British) healthcare system. The 'internal market' in healthcare has IMO done a lot of damage; and the currently proposed health reforms, which increase the role of 'market forces' will do even more.

As a strong supporter of a 'mixed economy', I also agree with:

'My comment: I've especially emphasized that equity and cooperation are specifically associated with PUBLIC goods. Not everything is a public good, and when this is the case competition and choice have important roles'

[eridani]

2. Hoping that the British people will not stand for this crap n/t

[BadgerKid]

3. Interesting comparison re cooperativity.

In my mind, teaching is fundamentally about cooperativity. The teachers I know who enjoy teaching really do help ensure that learning is a personal experience. Other teachers I know sort of blame the students for not "getting it" and therefore cut back on their expectations. The initiatives to make teachers partially accountable for students' performance seems to be the final insult after districts have been starving education for many years by cutting funding and increasing class sizes.

Health care could be fundamentally cooperative. Doctors who already care actually work WITH patients, yet it's been my impression from reading about insurance horror stories that medical care has been becoming about billable hours and getting as many insurance codes as possible. (Granted, the apparent excess of tests is related to CYA for malpractice.) I think cooperativity in health care would manifest as more prevention and treatment programs. (Example: saying someone is a bad person because he/she is obese -- how about offering them free or reduced cost programs to help make them less of a medical risk? Or, pot smokers are bad because partaking is "just wrong" (as RWers might say).)

[eridani]

4. Just remember that prevention saves lives--it COSTS money

Cooperative health care of course doesn't care about that, because healthier and longer lives are its goal.