International Health System Comparisons

The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care is a New York Times bestseller from journalist T.R. Reid. The book contrasts health care systems in several different countries with the health care models in the United States.  Here is an overview:
Businessweek Review:

Many Americans boast about having the best health care in the world, even though the U.N. ranks the U.S. system 37th, based on a broad range of measurements. Reid, a former Washington Post correspondent, decided to take his reporter’s curiosity and examine the health-care systems of higher-ranked nations to determine what works and what doesn’t.

He also took his aching shoulder. To give him more movement and less pain, an American surgeon had recommended replacing it with one made of titanium—major surgery with all the attendant risks. The cost, though covered, would be astronomical, and there was no guarantee he would feel any better. So Reid got opinions from top orthopedists in Britain, Canada, France, Germany, India, Japan, Switzerland, and Taiwan. None recommended such a radical solution.

Slate’s Review:

And Reid’s shoulder? His U.S. doctors recommended extensive reconstruction, at likely cost of “serious pain, months of rehabilitation, and tens of thousands of dollars.” In the other countries, reconstruction was often offered as an option, but doctors told him he’d be much better off with steroid injections (Japan); physical therapy (France, where insurance will pay for a spa); acupuncture (Taiwan); a regimen of herbs, yoga, massage, and spiritual meditation (India); and merely learning to live with it (the U.K.). Reid opted not to get reconstruction, had some success with the steroids, and got no relief from acupuncture. The only treatment that led to “significant improvement,” oddly, was the folk medicine in India, for which he paid out of pocket. Reid does not make too much of this, and neither should you.

From Wikipedia with additional edits and additions from PBS

Major forms of international health care systems:

The Bismarck Model

This is the model followed in Germany and in its rudimentary form was laid out by Otto von Bismarck. The system uses private initiatives to provide the medical services. The insurance coverage is also mainly provided through private companies. However, the insurance companies operate as non-profits and are required to sign up all citizens without any conditions. At the same time all citizens (barring a rich minority in case of Germany) are required to sign up for one or the other health insurance. Government plays central role in determining payments for various health services, thus keeping a decent control on cost. The Bismarck model is found in Germany, of course, and France, Belgium, the Netherlands, Japan, Switzerland, and, to a degree, in Latin America.

The Beveridge Model

This model adopted by Britain is closest to socialized medicine, according to the author. Here almost all health care providers work as government employees and government acts as the single-payer for all health services. The patients incur no out-of-pocket costs.  This tends to be the cheapest system. Countries using the Beveridge plan or variations on it include its birthplace Great Britain, Spain, most of Scandinavia and New Zealand. Cuba represents the extreme application of the Beveridge approach; it is probably the world’s purest example of total government control.

The National Health Insurance (NHI) Model

Canadian model has a single-payer system like Britain, however the health care providers works mostly as private entities. The system has done a good job of keeping costs low and providing health care to all. The classic NHI system is found in Canada, but some newly industrialized countries — Taiwan and South Korea, for example — have also adopted the NHI model.

The Out of Pocket Model

Only developed, industrialized countries, about 40 of the world’s 200 countries, have any kind of insurance like the above three systems. Most of the nations on the planet are too poor. In these countries the rich get medical care; the poor get little or none and stay sick or die.  Hundreds of millions of people in poor countries go their entire lives without  seeing a doctor. People mostly pay for the services they receive ‘out of pocket’. However, this leaves many underprivileged not getting essential health care. Almost all countries with such a system have much lower life expectancy and high infant mortality rates. The author gives his experience with the system in India, and a brief description of ancient medical system of Ayurveda.

The American Model for Health

The United States follows many of the international systems in bits and pieces.

  • For most working people under sixty-five: The model is closest to Bismarck system adopted by Germany and Japan.  Unlike in Germany and Japan, health insurance companies can be for-profit enterprises in America.
  • For Native Americans, military personnel, and veterans: America follows the Beveridge Model of Britain, where the government acts as both the payer and provider.
  • For those over sixty-five: The American model here is very close to Canadian single-payer model. The government ends up acting as the insurer, while the private sector provides the medical service.
  • For uninsured Americans: Americans with no health insurance experience health care world of poor people in various underdeveloped countries. Most of the medical facilities are too expensive for these people and they are left with virtually no health care.
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