I was planning on writing an in depth (maybe in a couple of parts) analysis of different health care systems in other countries. However, I really don't have the time (its hard to find time for much of anything when you're in the lab for 55+ hrs a week). Besides I just watched Sick Around the World a PBS Frontline special that did a great job of it (better than I could ever do). So I will just do a brief one analyzing a couple examples (two from the frontline show) and then a brief analysis of how I think health care reform should be approached in the US.
I will start with the health care system that so many people that grew up during the cold war are so afraid of: Socialized Medicine. All ideas for universal health care in the US always get labeled as socialized medicine to scare people, even if they are not really socialized medicine. Actual socialized medicine is where the government owns the hospitals. The most well known example of this is the National Health Service in the UK. Since it is socialized medicine all of the hospitals are owned by the government, and all of the health care workers are government employees (the department of health is actually the 3rd largest employer in the world).
Some information on funding:
Except for set charges applying to most adults for prescriptions, optician services and dentistry, the NHS is free for all patients "ordinarily resident" in the UK at the point of use irrespective of whether any National Insurance contributions have been paid.
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NHS costs are met, via the PCTs, from UK government taxation, thus all UK taxpayers contribute to its funding.
Perscription drugs are set at around $14 us dollars, and people over 60, under 16, or with low incomes do not have to pay this price.
All medical care starts with general practitioners. You can not see a specialist without seeing a GP first.
Advantages:
Universal: everyone is covered.
No out of pocket costs at the doctors.
Emphasis on preventative care: this is due in large part to having to see the GP first, and it keeps the cost down.
The NHS is a fairly cost effective system.
Disadvantages:
The biggest one that most people hear bout is waiting time. Care is rationed based on need: no waiting for emergency procedures, but non-emergency/optional procedures (Laminectomy, hip replacements) can have a waiting period sometimes up to a couple months. Though they are trying to get rid of this problem with the 18 week delivery program.
As with all health care programs access to certain medications, procedures (ones that are not very effective, or if there is a cheaper alternative)are limited to cut costs.
The other system I will mention is the one they have in Taiwan. When Taiwan started to become a richer country they wanted to reform their health care system.
T.R. Ried:
Hongjen Chang was one of the officials in charge back then. Walking through Taipei's imposing Chiang Kai-shek Memorial Park, he recalls how they did it.
"Taiwan is a small island," he says. "We always look abroad internationally for ideas."
Chang quotes a Chinese saying: "'The track of the previous cart is the teacher of the following cart.'"
In other words, if someone else's oxcart has found a good route to universal health coverage, follow those tracks. "If they were trapped in trouble, avoid that track. Find a new track," Chang says.
The government consulted experts from around the world, like Taiwanese American health economist Tsung-mei Cheng.
Basically everyone buys into a government run health insurance program. They make payment agreements with Doctors and hospitals for services. Basically it amounts to expanded medicaid for everyone.
What I find most intriguing about this system is how they cut administrative costs. Administrative costs in the Us amount to about 20% of health care expenses:
From Wiki
However, broader studies also factor in billing and insurance-related (BIR) costs borne not only by insurers but by physicians and hospitals. One study of these costs in California found that BIR among insurers, physicians, and hospitals represented 20-22% of privately insured spending in California acute care settings.[83]
In Taiwan they created a Smart card which cuts administrative costs to about 2%.
There are a lot of other examples. T.R. Reid talks about Japan, Germany, and Switzerland in Sick around the World. France was Ranked #1 for efficiency by the WHO. None of these systems are perfect and they all take different approaches. However, they do have some concepts in common. Reid mentions them at the end of his special and I will summarize them here because I believe that they are fundamental for a universal health care system.
- In my opinion the most important concept for universal health care: No profit for basic health care insurance. Universal health care systems can have private insurance providers(Japan, France, Germany) but they have to be non-profit. Insurance companies can sell supplemental insurance for a profit, but profit needs to be taken out of basic insurance coverage.
- Everyone is covered. People can not be denied coverage.
- The Government pays for coverage of anybody who can not afford for insurance themselves.
- Standardized prices. Government (like in Japan and the UK) or all private insurance providers (like in Germany) negotiate standardized prices for procedures. This way the cost for any procedure is the same no matter where you go to get it.
- Mandates: Mandate that everyone is covered. I do think mandates are required for universal health care, however, I don't think you can have mandates until you meet the first three concepts.
In my opinions those are the 5 fundamental concepts of any universal health care system. Thats where we need to start in order to reform the health care system here in the US. But how do we go about reforming health care?
I think we need to follow Taiwan's example and create a panel of experts; people who have studied, worked in, or helped create the universal health care systems in other countries. They all have benefits and disadvantages, so why not learn from these examples when trying to come up with a system that would work in the US. One example in particular would be worth looking into when trying to reform our system; Switzerland who until recently had a (non) health care system like we do here. I believe this is most likely what any health care reform in the US will look like. Indeed the Swiss system is similar to the proposals of Clinton and Obama (minus the mandate).