Sunday, August 16, 2009

Around the World

I'm kind of spinning my wheels trying to figure out what the new legislative direction in Congress will actually look like -- so I thought now would be a good time to figure out how some other industrialized nations structure their health systems. There's been a lot of talk about Canada and the UK, so I'll leave them out and focus on some other nations. This is initial research, and just an attempt to put some summaries side-by-side, so leave a comment if you feel the urge to disagree. Massive oversimplifications to follow:

FRANCE -- The French system is made up generally of private practices for ambulatory care, and public hospitals for acute care; the government provides a national health insurance plan that pays 60-70% of health care costs, and almost 80% of the population supplements that with additional insurance from a private source. Although they've had cost increases similar to (although smaller than) cost increases experienced in the American system, government negotiation with care providers and drug manufacturers have helped limit prices. Because France has three times as many doctors per capita than the US, and because its citizens lead the world in use of prescription medicine (note -- not necessarily a good thing), the WHO called it the world's #1 health care system in 2000, and many Americans who have lived there or studied their policies advocate strongly for their system.

JAPAN -- In Japan, insurers are not allowed to profit from health insurance, and health insurance is guaranteed through one of two national systems, one that covers large employers, and one that covers small employers and the uninsured. While access to basic care is reasonably equitable, the system has considerable problems ranging from overutilization of some services (because doctors are paid by the service) to poor resource allocation (leading many to be turned away from emergency rooms) to insufficient oversight (doctors receive a lifetime medical certificate that requires no re-certification, and many believe they operate at an unacceptably low standard). All this having been said, Japanese citizens are actually some of the world's healthiest -- they lead the UN's list of the nations with the longest lived citizens.

GERMANY -- Germany's first universal guarantee of health care was apparently instituted by Otto von Bismarck, here seen pensive in a pointy helmet. The modern system guarantees insurance for all, paid for through a combination of payroll tax and employer support. Their social insurance system is something like the Japanese, but instead of being assigned a government option, insurance can be purchased from one of over 200 "sickness funds" which are independent, not-for-profit, and which compete with each other for clients. The government does engage in top-down negotiations to decrease costs, and these have been reasonably successful in keeping costs considerably below those in the US.

What do these systems all seem to have in common? First, all industrialized nations I've read about guarantee all their citizens at least a minimal amount of care. Second, the nations above tend to keep electronic or otherwise portable records, like the French carte vitale or the German eHealth card (which has admittedly hit lots of snags). Third, almost all these nations pay their doctors less, but cover medical training of all kinds, often completely. Finally, most of these systems, with some exceptions, were created gradually, using a series of reforms that increased coverage bit by bit.

Ok, last thing, can't resist: Around the World by Daft Punk. The video is intended to metaphorically represent the legislative process of the US Congress.

EDIT: Worst health care systems in the world. We made the list! Wooo.

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