Friday, October 9, 2009
Health Care Systems in the Developed World by T.R. Reid
There are a few common building blocks of health care system architecture that all developed countries (except the United States) have agreed upon. Each country uses one system that applies to everybody. Young, old, employed or unemployed, military or civilian, sick or well, aboriginal or immigrant, private citizen or public minister, newborn or about-to-die- everybody is included in the same system and covered by a single set of rules. All other rich nations have embraced this principle, because they think it's fairer if everybody has the same access to the same level of care. They find that a single system is much easier to administer, with one set of forms to fill out, one book of rules, and one price list.
A unified system is a powerful force for cost control. As the only buyer of medical services, it has enormous market clout in negotiating fees with doctors, hospitals and drug companies, facilitates communication and control within those professions and makes digital record keeping easier and more effective. It also helps to eliminate the gamesmanship and cost-shifting that permeates the American health care ( forcing veterans to use only VA hospitals, charging privately insured patients more to cover the cost of those on Medicaid, overcharging for diagnostic tests to cover shortfalls in other departments, for example). Such systems also create incentives for preventive health measures- such as regular check-ups, health education and use of the most effective treatments as well.
Another basic building block in the health care systems of every country- except the United States- is the principle that financing health care must be a non-profit endeavor. The health insurance plans of all the other nations of the developed world exist only to pay people's medical bills, not to make a profit. Private Insurance companies still exist. In Germany there are at least two-hundred, in Japan over 2,000, but they must accept all applicants and pay all claims. They are allowed to sell for-profit policies to satisfy the cravings and vanities of the very rich for such things as cosmetic surgery and luxury hospital suites, but not for the basic services at fixed prices stipulated on a universal basis in the unified system. Otherwise they compete for customers by offering special services outside the standard plan- like relaxing vacations at health spas, house calls and the like.
All the health care systems of the developing world have problems delivering effective and affordable health care. In the democracies of the developed world, however, universal health care coverage creates a sense of common purpose and solidarity- the expectation of both mutual sacrifice and gain- and a political will to overcome difficulties with long-term strategies- which hardly exists at all in the United States.
By the most careful and rigorous estimates of the esteemed Institute of Medicine, more than 22,000 Americans die each year for the lack of accessible and affordable heath care. At least 700,000 go bankrupt paying their medical bills out of pocket, many losing their homes entirely. This never happens in the other developed nations of the world because they have universal health care systems.