International%20Health%20Care%20Systems

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International Health Care Systems

• Kao-Ping Chua
• Jack Rutledge Fellow, 2005-2006
• American Medical Student Association

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Structure of systems
Insurance Delivery Examples
National health service Mostly public Mostly public U.K.
Entrepre-neurial Mostly private Mostly private U.S.
Mandated insurance Mostly public Public and private Germany
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The influence of values on systems

• European social ethic public good, social
  solidarity
• American individualistic ethic individual good,
  social fragmentation

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Three categories of analysis

• Organization insurance pools, public/private mix
• Quality, choice, and access
• Problems

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Outline

1. U.S.
2. Japan
3. Germany
4. France
5. U.K.
6. Canada

THINK BIG PICTURE!!!
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U.S.
WHO Ranking for Health Attainment 24 WHO
Overall Ranking 37 GDP spent on health care
15 (OECD median 8.6)
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US Organization
This refers to the non-elderly population
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US Quality, choice, access

• Quality depends on plan often gaps for
  prescription drugs, dental, vision
• Choice Restricted choice of providers
• Access Waiting lines relatively rare, huge
  amount of uninsurance

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US Problems

• 45 million uninsured
• Skyrocketing health care costs
• Significant health disparities by race and income

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Japan
WHO Ranking for Health Attainment 1 WHO
Overall Ranking 10 GDP spent on health care
7.9 (OECD median 8.6)
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Japan organization
12
Japan organization

• Most providers and hospitals are in the private
  sector
• Hospitals are the center of care

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Japan quality, choice, access

• Quality huge amount of technology, comprehensive
  benefits
• Choice free choice of doctors and hospitals
• Access few waiting lists except at the very best
  hospitals

14
Japan problems/reforms

• Kenpo associations in debt (cross-subsidizations)
  rapidly aging population
• Over-prescription of drugs
• High cost-sharing

15
France
WHO Ranking for Health Attainment 3 WHO
Overall Ranking 1 GDP spent on health care
10.1 (OECD median 8.6)
16
France organization

• Multi-payer system
• 3 main payers are the Sickness Insurance Funds
  (SIFs) cover most health care costs
• Profession determines which SIF a citizen is
  automatically enrolled in

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France organization

• Most ambulatory care physicians are in private
  practice
• Sector I charge at national fee schedule but get
  government benefits
• Sector II charge above fee schedule but dont
  get government benefits
• Hospitals both private and public
• Complementary health insurance for cost-sharing
  (90 of the population)

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France quality, choice, access

• Quality very comprehensive, good safety net for
  the poor
• Choice Free choice of doctors
• Access Can usually see GP on same-day

19
France problems

• Nursing and physician shortages
• Increasing health expenditures, mainly from drugs
  (19 of all expenditures)
• 90 of physician visits end up with
  prescriptions!

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Germany
WHO Ranking for Health Attainment 22 WHO
Overall Ranking 25 GDP spent on health care
11.1 (OECD median 8.6)
21
Germany organization

• Multi-payer system
• Social Health Insurance (SHI) network made up
  of 192 private, occupation-based "sickness funds
• High-income may opt-out of SHI and purchase
  voluntary health insurance
• Free government care

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Germany organization

• Ambulatory physicians are mostly private
• Hospitals are both public and private

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Germany quality, choice, access

• Quality Extremely comprehensive benefits
• Generous sick pay policies
• Choice Free choice of GP and specialists, must
  use closest hospital
• Access Waiting times not usually a problem

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Germany problems/reforms

• Expensive health care system
• High cost-sharing
• Excessive numbers of physicians (60 of areas are
  closed off to more doctors)

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The United Kingdom
WHO Ranking for Health Attainment 14 WHO
Overall Ranking 18 GDP spent on health care
7.7 (OECD median 8.6)
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UK organization

• National health service (NHS) publicly financed
  and delivered
• Supplemental private insurance for dental and eye
  care
• Growing sector of substitutive private insurance

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UK Quality, choice, access

• Quality Comprehensive except dental and eye
• Choice Free choice of doctor
• Access major problems with waiting lists
• Specialist (2.5 months)
• Elective procedures (3 months)

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UK problems

• Underfunding
• Waiting lists
• Health care delivery capacity is insufficient for
  many services
• Facilities need updating

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Canada
WHO Ranking for Health Attainment 12 WHO
Overall Ranking 30 GDP spent on health care
9.9 (OECD median 8.6)
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Canada organization

• Single-payer system
• 13 provincial/territorial governments administer
  health care plan (Medicare)
• Federal government regulates the
  provincial/territorial health care plans by
  offering transfer payments contingent upon
  pre-specified criteria

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(No Transcript)
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Canada organization

• Providers are mostly private hospitals mostly
  public
• Most Canadians have complementary private health
  insurance for non-covered services

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Canada Quality, choice, access

• Quality Coverage for medically necessary
  services
• Gaps for dental care, long-term care, outpatient
  drugs ? complementary private insurance
• Choice Free to choose GP and hospital
• Access
• No waiting lists for GP visits or emergencies
• Waiting times can be problematic for certain
  ELECTIVE procedures

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Canada Problems/reforms

• Underfunding
• Gaps in coverage
• Tension between provincial and central
  governments

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Points to remember, part 1

• Every country is dealing with increasing health
  care costs
• ANY system can have problems if it is
  underfunded, no matter how good it is
  theoretically
• Privatization exists to various degrees in each
  systembut no country allows private elements to
  price people out of health care

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Points to remember, part 2

• UHC can be achieved while maintaining
• Comprehensive benefits for everyone (every
  country but U.S.)
• Free choice of providers (every country but U.S.)
• High levels of technology (Japan, Germany)
• Few waiting lists (France, Germany, Japan)

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Parting thought

• The U.S. is the only industrialized country
• in the world without UHC
• but we can achieve high-quality, affordable
  health care for EVERYONE if we used the vast
  amounts of money in our system more efficiently