CONTENTS OF THIS ISSUE
Winter 2017 Issue |
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In the News
Comparing National Healthcare Systems
By Joe Mason, MD, MSW, DFAPA
As we continue to fight about what kind of healthcare financing system we are going to have, I was reading an article in the New York Times that was a fairly succinct explanation of several national systems and thought it did a good job of summarizing some of the different ways countries have dealt with the economics of healthcare delivery. I want to emphasize that when we speak of reform, we are primarily talking about changing the way healthcare is paid for rather than the way healthcare is performed, though it seems easier to simply refer to this battle as “healthcare reform.” We, in the U.S., pay around 75% more than the next most expensive countries in the world as a percentage of GDP, though the quality of care certainly isn’t 75% better and, by many measures, is worse.
The Times selected a panel of five economists and healthcare policy analysts with diverse political persuasions, then picked eight countries which represented different ways of structuring systems and created a playoff for the best one overall. Each system was explained in some detail, but I will give a fairly cursory overview of how it played out.
The first round matchups were as follows:
- Canada versus England – this was a face off between the two big single-payer systems. Canada has a publicly financed program with most of the care provided at the private level, similar to our Medicare and England is socialized, publicly financed and providers are mostly government employees. The winner was England four to one with the deciding factor of better and quicker access.
- France versus Australia – this was a comparison of the two “all-covered” programs. France was considered to have the best access, everything but the kitchen sink is covered, it has a mandatory purchase, but is more expensive than the Aussie program. The winner was France by four to one score.
- U.S. versus Singapore – an unusual battle between an old program and a new one, each considered examples of “blended” systems with a mix of public and private strategies. Singapore has a good idea on paper and only spends 4.9% of its GDP on healthcare, compared with 17.2% for the U.S., but there was not enough transparency or data available to really give it a fair grade, so the winner was U.S. by four to one.
- Germany versus Switzerland – Germany has both private (14%) and public insurances (86%), but it is very regulated, including doctor salary caps, whereas Swiss system has mandatory purchase, guaranteed issue, community-rated pricing and is seen as the most similar to our ACA exchanges. Switzerland won three to two on the basis of having the best outcome data.
In the second round:
- Switzerland beat England by a score of three to two on the basis of better and quicker access.
- France beat the U.S. by three to two on the basis of broader access.
The overall winner was Switzerland over France three to two. This system was thought to be the one among them all that would be most familiar and perhaps the easiest type to convert to if there were any chance of consensus in Congress. It is much cheaper, but would involve a concession to more regulation of costs than what private insurers are familiar with.
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