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Monday, August 3, 2009

WHICH HEALTHCARE SYSTEMS ABROAD HAVE MODEL-LESSONS FOR US REFORMS?

Today's Buggy Topic

When Congress returns from its vacation, the debate on reforming our existing health-care system will be at the center of its concerns . . . the reform looming as the biggest change in American social policies since the "Great Society" programs of Lyndon Johnson in the mid-1960s.  It helps to know which healthcare systems in Europe seem to offer some guidelines for our reforms in this country.

Two kinds of different healthcare systems exist in Europe:

(I) Strictly Private Insurance, Carefully Regulated by Governments 

In West Europe, three healthcare systems --- the Dutch, German, and Swiss --- rely exclusively on private-insurers, with the government role restricted to requiring universal coverage of basic services for all citizens and permanent residents . . . plus close regulation of the  fees of those healthcare services (physician, hospitals, nurses, drugs, and so on.)  

Dozens of different insurance companies compete to offer basic plans in those countries with different costs.  The companies are not supposed to earn profits on those plans; they can, of course, pay their employees at all levels whatever they individually want.  Above and beyond these basic insurance plans, the companies offer all sorts of supplementary plans full of different options for better rooms in hospitals, certain health services not covered by the basic plans like alternative medicines, and so on.  Lots of choice; lots of high-quality services; and generally all three countries manage to cover their citizens' healthcare needs at about 25-30% lower expenditures yearly as an overall percentage of GDP than the US does.   (We are currently spending over 16% of GDP on our healthcare services.)

(II.) The Alternative Systems in Europe: A Bigger State Role

 In Britain, Sweden, Denmark, Austria, and France, the healthcare systems are funded mainly out of taxes --- as, say, Medicare, Medicaid, and Veterans' Hospitals are in this country.  In all of them, private insurance companies offer supplementary plans and added healthcare options in the private market.  In France, for instance, about 90% of the population opts for additional coverage this way.  

The range of individual choice among physicians varies too in this countries.  Traditionally, for instance,  the individual Frenchman could go to any doctor of his or her choice, including a specialist; pay the doctor the required fee (for which the citizen is then quickly compensated, minus a co-payment of usually 30% . . . though with limits on financial liability for lower-income and mid-income persons or families); and go as often as they wanted.  Recently, though, as a cost-cutting measure, the French system is moving toward a HMO-like access-model.  That limits choice of specialists, as is the case for HMO services in this country too.  (Other private insurance plans in the US, of course, allow the patient to choose seeing any doctor who will accept the insurance coverage.)

Still, direct and indirect taxes fund most of the healthcare systems' costs in these systems.

Remember Here When It Comes to Reform:

 The current US healthcare system --- largely private insurance, funded mainly by contributions of both employers and employees; some individual acquired insurance policies; and government programs like Medicare, Medicaid, Veterans' Hospitals, Federal and State Employee-coverage, and coverage for active military members --- has a number of strengths.

  • In the World Organization rankings in 2000 of 191 countries' healthcare systems, the US was ranked overall 37th --- mainly because of problems of fairness in access and overall cost --- but ranked first in overall patient views of responsiveness.  The latter was one of the 8 measures used to rank countries.  It covered about seven or eight criteria, all based on survey data: how patients felt they were treated with dignity by healthcare professionals; timely access to doctors, including referrals to specialists; views of the pleasantness of offices, hospitals, food in them, and so on.

 

  • And the WHO noted that the US system was the most innovative technologically, including in drugs, and US citizens were subsidizing the costs of drugs and new medical technologies for other systems.

 

A further study, linked to by prof bug, was a panel-discussion between European and American healthcare specialists on the question of medical innovations and whether Americans were subsidizing the healthcare systems of others.  A Dutch specialist, both a physician and a scientist who runs an important consulting services for healthcare throughout the EU, agreed without reservation that the US healthcare system was far and away the most innovative, and not just in drugs and technologies but in HMO networking and so on.  He did dispute whether such innovations were subsidizing EU systems, noting that such innovations were generally profitable for American companies.)

 

  • And Americans --- while agreeing in the range of about 60% or more that our healthcare system needs an overhaul --- were found to be generally overwhelmingly satisfied with their health-care insurance plans if they had them.  And even the 14% or so of Americans not insured were, in large majority, satisfied with the healthcare they did receive, though many mentioned the problems of costs

So what are our main problems?  Two stand out:

  • As a country, we spend a little over 16% of GDP on healthcare. That's far more than other healthcare systems spend. Some of that, of course, is reflected in the R&D for new technologies and drugs. Still, insurance plans have risen in costs to employees and employers and others at a rate about double to triple that of annual general inflation, and for well over 15 years now. Something needs to be done here.
  • Access is a problem for the non-insured . . . even if the figure of 46 million is misleading, and on several scores: not least, only about half to 3/4 of that figure was found in a CBO study to mirror accurately those Americans and residents who were uninsured for any one whole year. There are also lots of uninsured with incomes 2 to 4 times higher than the poverty-levels for families or individuals.

For Prof Bug's Views

Click here.  Note that there are three or four bugged out posts in the thread.