Healthcare Revisited Systems compared
Our
Healthcare System is the most expensive in the world and at the same time ranks
only 37th Solving this issue will not only improve the affordability
and quality of healthcare it will vastly improve the financial condition of our
country. The solution is extremely simple to implement, but next to impossible
to enact politically. Why not you ask? The reason is that there are too many
powerful “special interests” that are making hundreds of billions each
off the current system.
The
simple solution is to evaluate other countries’ systems that are providing
superior quality of care at a much lower per capita cost. This process is
called “baselining” The following chart show 5 of the top 10 countries in
quality of care and their per capita cost.
Best Quality of Care Ranking 2012 Per Capita Cost
1 France $3,974
2 Italy
2,962
7 Spain 3,076
9 Austria 4,395
10 Japan
3,035 37 USA
11,000 (3.1x
top 10 average)
Average per capita cost of top 10 in quality $3,481
The procedure would be to have unbiased experts examine the
systems of the five countries that rank in the top 10 on quality of care. And
take the best of each that makes good sense and redesign our system from the
ground up. It will be critical to use a team of “experts” that are independent
of the following industries: The AMA, drug companies, health insurance
companies, the legal profession, and hospitals. We need an unbiased view of all
of these components of a healthcare system. I am not qualified to evaluate the
systems of the “base-line” countries, but the following are top line summaries
for each:
France: (Source: https://about-france.com/health-care.htm)
“The French health care
system is generally recognized
as offering one of the best, services of public health care in the world.
Above all, it is a system that works, provides universal cover, and is a system
that is strongly defended by virtually everyone in France.
The health care system in France is made up of a
fully-integrated network of public hospitals, private hospitals, doctors and
other medical service providers. It is a universal service providing health
care for every citizen, irrespective of wealth, age or social status.”
Italy: (Source: https://healthmanagement.org/c/it/issuearticle/facts-figures-the-italian-healthcare-system)
“Italy has a national
health plan (Servizio Sanitario Nazionale), which provides universal coverage for hospital and medical
benefits, however about 30% of the population has contracted additional private
health insurance. The Italian public healthcare system is decentralized and is
based on three levels: the State, region and local health boards. The State is
responsible for issuing general system guidelines, establishing work contracts,
handling international relations and financing research hospitals. The 20
regions of Italy control the functioning of the health services within their
areas of jurisdiction and finance independent hospitals. Finally, the local
healthcare units provide daily management of services and finance public and
private hospitals under contract with the regions. The remaining private
hospitals are financed by their patients.”
Spain: (Source: https://healthmanagement.org/c/hospital/issuearticle/overview-of-the-spanish-healthcare-system)
“The Spanish National Healthcare System (“Instituto
Nacional de la Salud”), founded in Spain’s General Healthcare Act of 1986,
guarantees universal coverage and free healthcare access to all Spanish
nationals, regardless of economic situation or participation in the social
security network.
In 1998 the Sistema Sanitario Público (public health service)
brought in an official mandate for both doctors and patients outlining the
service to which they are entitled, explained in the Carta de Derechos y
Deberes (Charter of Rights and Obligations).
Management: The national system
has been decentralized since 2002, which has given the regional healthcare
authorities the autonomy to plan, change and upgrade the infrastructure,
leading to enormous development in the healthcare technology scenario,
especially in the usage of information technology. The reforms, which regionalized
the system, were implemented in order to provide greater and equal access to
the population, thus avoiding the concentration of health services in urban
areas. This has also improved response time and increased the participation of
the target community in the development and management of the national
healthcare system at regional and local levels.”
Austria:
(Source: https://en.wikipedia.org/wiki/Healthcare_in_Austria)
“The
nation of Austria has a two-tier
health care system in which virtually all
individuals receive publicly funded care,
but they also have the option to purchase supplementary private health
insurance. Care involving private insurance plans (sometimes referred to as
“comfort class” care) can include more flexible visiting hours and
private rooms and doctors. Some individuals choose to completely pay for their
care privately.
Healthcare in Austria is universal for residents of Austria as well
as those from other EU countries. Students from an EU/EEA country or
Switzerland with national health insurance in their home country can use the European Health Insurance Card.
Self-insured students have to pay an insurance fee of EUR 52.68 per month.
Enrollment in the public health care system is generally automatic
and is linked to employment, however, insurance is also guaranteed to
co-insured persons (i.e. spouses and dependents), pensioners, students, the
disabled, and those receiving unemployment benefits. Enrollment is compulsory,
and it is not possible to cross-shop the various social security institutions.
Employers register their employees with the correct institution and deduct the
health insurance tax from employees’ salaries. Some people, such as the self-employed, are
not automatically enrolled but are eligible to enroll in the public health
insurance scheme. The cost of public insurance is based on income and is not
related to individual medical history or risk factors.
All insured persons have issued an e-Card, which must be presented
when visiting a doctor (however, some doctors only treat privately insured
patients). The e-Card allows for the digitization of health claims and replaces
the earlier health insurance voucher. Additionally, the e-Card serves as a
valid ID.
Hospitals and clinics can be either state-run or privately run.
Austria has a relatively high density of hospitals and physicians; In 2011
there were 4.7 Physicians per 1000 people, which is slightly greater than the
average for Europe. In-patient care is emphasized within the Austrian
healthcare system; Austria has the most acute care discharges per 100
inhabitants in Europe and the average hospital stay is 6.6 days compared with
an EU average of 6.”
Japan: (Source: https://en.wikipedia.org/wiki/Health_care_system_in_Japan)
“The
health care system in Japan provides healthcare
services, including screening examinations, prenatal
care,
and infectious disease control, with the patient
accepting responsibility for 30% of these costs while the government pays the
remaining 70%. Payment for personal medical services is offered by a universal health care
insurance system that provides relative equality of access, with fees set by a
government committee. All residents of Japan
are required by the law to have health insurance coverage. People without
insurance from employers can participate in a national health
insurance program, administered by local governments. Patients are free to
select physicians or facilities of their choice and cannot be denied coverage.
Hospitals, by law, must be run as non-profit and be managed by physicians.
For-profit corporations are not allowed to own or operate hospitals. Clinics
must be owned and operated by physicians.
Medical fees are strictly regulated by the government to keep them
affordable. Depending on the family’s income and the age of the insured,
patients are responsible for paying 10%, 20%, or 30% of medical fees, with the
government paying the remaining fee.[1]
Also, monthly thresholds are set for each household, again depending on income
and age, and medical fees exceeding the threshold are waived or reimbursed by
the government.
Uninsured patients are responsible for paying 100% of their
medical fees, but fees are waived for low-income households receiving a
government subsidy. Fees are also waived for homeless people brought to the
hospital by ambulance.”
Changing the System will go a long way towards improving the quality
of care, but it will only have a limited impact on costs. We need to examine
each element of the costs involved. We need to determine why they are so much
higher in our country when compared to five base line countries (in the
following chart I have substituted Germany for Austria since I could not find
the exact comparison for Austria, but they should be about the same).
