How the U.S.'s Health Care Compares With Other Countries

         

        President Obama’s mad-dash to health care reform hit an untimely speed bump recently; when the Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) determined that if the House bill were passed-the federal deficit would increase by $65 billion over a 10-year period, even after taking into account a net cost savings of $50 billion and additional revenues of $86 billion.
        CBO’s assertion that legislation in its present form fails to slow the growth of spending is a severe setback to the president who hopes to insure 45 million Americans lacking health insurance. 
        Despite the White House’s continued optimism that a health care bill can be achieved sooner rather than later, such a gloomy assessment from CBO guarantees partisan bickering in the coming weeks ahead, with the chances of health care legislation be acted upon before the summer recess almost certainly unattainable; especially discouraging news considering time is of the essence.
        The Robert Jones Wood Foundation projects the cost of health care for businesses could double, while the number of uninsured balloon to 65.7 million over the next 10 years if legislation isn’t passed soon, with the middle-class being the hardest hit.
        In 2008, according to RJWF, the U.S. spent more than two trillion on health care—nearly 17 percent of our economy-yet nearly 50 Americans and nine million children are without health insurance, a problem that is growing more alarming the longer health care reform remains dormant.
        What’s worse, the U.S. is lagging behind other industrialized countries in the cost and quality of health care it provides to his citizens.  According to statistics from the Organization for Economic Co-Operation and Development, (OECD), total health spending accounted for 16.0 percent of GDP in the United States in 2007, more than most other OECD countries, including France (11 percent); Switzerland (10.8 percent); and Germany (10.4 percent).
        Oddly enough, despite its massive health expenditures, the United States ranks 20th in life expectancy and 27th in infant mortality compared with other industrialized countries, while having fewer physicians per capita. In 2007, for example, the United States had 2.4 practicing physicians per 1,000 population. The average for OECD countries is 3.1.
        Not even the insured in the United States, it seems, may be getting the proper medical attention they require. Studies from the Commonwealth Fund report more than 54 percent of U.S. patients do not seek recommended care, fill prescriptions, or visit a doctor because of high costs compared with seven to 36 percent in other countries.
        It’s simply unfathomable the United States is the only developed country without a comprehensive national health care plan for its society.
        How, then, are other countries able to finance their health care systems while providing basic medical necessities without increasing costs?
        For comparison sake, what follows is a brief outline of health care systems in France, Germany, the United Kingdom and the Netherlands; based on a December, 2008 report from the Commonwealth Fund.

• France

        France’s health care system or Couverture Maladie Universelle (CMU) - provides universal coverage for outpatient care, hospital care, which includes prescription drugs, and minimal care to outpatient dental and eye care. CMU is financed through employer and employee payroll taxes (43 percent); a national income tax or contribution sociale generalisée (33 percent); along with an earmarked tax on tobacco and a 2.5 percent tax on the revenue of complementary private health insurers. 
        According to 2007 data from the World Health Organization, public expenditures in France accounted for 79.1 percent of total expenditure on health in 2005.
        The majority of French residents receive private coverage through their employer; complementary private health insurance covers over 92 percent of the population.
        In France, public health insurance boards are managed by members equally represented from employer and employee trade unions.
        To ensure the highest quality of health care, France maintains an accreditation system, which requires hospitals and clinics be evaluated every four years, with the results posted on the national health authority’s website. Physicians, as well, undergo a scrupulous audit every five years by an independent body which is then approved by the national health authority or HAS.

• Germany 

       Germany’s Public (“social”) health insurance (SHI) covers preventive services; inpatient and outpatient hospital care; physician services; mental health care; dental care; prescription drugs; medical aids; rehabilitation; and sick leave compensation. SHI is compulsorily for 75 percent of the population for those making up to €48,000 ($66,610); citizens making more, (approximately 20 percent of the population), are not required to be covered.
        About 88 percent of the population is covered through Germany’s public financed health care system, with 10 percent covered through private insurance companies.
        Beginning in 2009, however, health insurance became mandatory for all Germans.
        SHI is operated by over 200 competing health insurance funds (sickness funds; SFs): autonomous, not-for-profit, non-governmental bodies regulated by law; and are funded by compulsory contributions based on wages up to a limit of around €43,000 ($59, 671) per year.  In 2008, employees contributed almost eight percent of the gross wage, while the employer (or the pension fund) added an additional seven percent on top of the gross wage, resulting in a maximum contribution of around €540 per ($749) per month.

• United Kingdom

        The United Kingdom’s universal publicly-funded health coverage: the National Health Service (NHS) covers preventative services; inpatient and outpatient, hospital (specialist) care; physician (general practitioner) services; inpatient and outpatient, prescriptions; dental care; mental health care; learning disabilities; and rehabilitation.
        Prescribed medication in the U.K. is subject to a co-payment (£6.85 per prescription; $13.79); an estimated 88 percent of prescriptions, however, are exempt from charges, according to data from the Department of Health (2007). Dentistry services are subject to co-payments of up to about £200 per year ($400).
        The U.K.’s Department of Health (2006) reports (NHS) accounts for 86 percent of total health expenditure, which is primarily funded by general taxation (76 percent), including national insurance contributions (19 percent ) and user charges (5 percent).
        The U.K. provides a combination of private insurance through profit and not-for-profit insurers. Private insurance offers citizens the benefit of a choice of specialists, the luxury of not being placed on a long waiting list for optional surgery, along with more comfort and additional privacy than NHS. Private insurance covers 12 percent of the population; and in 2004 it accounted for one percent of total health expenditures.

• Netherlands

        Beginning in 2006, residents of the Netherlands paying income taxes were required to pay for health insurance as mandated under the Health Insurance Act (Zorgverzekeringswet; ZVW), but coverage is provided by private health insurers and regulated under private law.
        By law, insurers are required to provide medical care, including care by general practitioners (GPs), hospitalization; dental care; all citizens are additionally covered by the statutory Exceptional Medical Expenses Act (AWBZ) scheme for a variety of chronic and mental health care services, including home care and care in nursing homes.
        The insured pay a flat-rate premium (set by insurers) to their private health insurer. Those insured in 2006 were eligible for a refund of €255 ($367) if they made it through the year without requiring any medical attention. If they incurred costs of less than €255, residents were eligible for the difference at the end of the year
        The insured are required to pay the first €150 ($216) of any health care costs in a given year (with some services excluded from this general rule).
        In addition, the government provides health care allowances for low income citizens if the average flat-rate premium exceeds five percent of their household income.

        So as the United States continues to struggle, mightily, in reforming a health care system that in the president’s own words is broken, other industrialized countries, although not perfect by any means, seem to be able to offer its citizens, especially the unemployed and disadvantaged, basic health services unconscionably lacking in one of the richest countries in the world.

-Bill Lucey
[email protected]

***

Websites to keep in mind:

OECD Health Data, 2009

The Commonwealth Fund

Robert Wood Johnson Foundation

The European Observatory on Health Systems and Policies 

The Congressional Budget Office

Comments

[Reggie Greene / The Logistician]

We have a tendency in America to argue for or against a concept based on our own personal philosophy or view of the world, what advances our personal interests, or the interests of our party, family, organization, or region. Perhaps viewing the issue from a management or systemic perspective might result in innovative approaches to the issue. The American national mindset, citizen philosophy, lack of citizen motivation to be proactively healthy, and governance model make the socialization of health care in America very problematic, particularly at this point in time. A country needs to know its limitations.

[Dan Lipka]

Thanks for the post, I think you found a precise way of explaining something very complicating and something people are very passionate about. I agree with you that our system is not as effective as many other countries, but that the current plan in Congress isn't the best solution. I don't think it will work well if a government plan is competing vs the private sector. Instead, I believe it would work much better if the private sector supplemented a core healthcare plan provided to all Americans by the government.

[Rose]

I could write a book about the corruption going on with the government and health care reform. This is bull. Canadians come to the U.S. for better treatment and because the line is too long there. Open your eyes. The government is taking over. Also, The healthcare bill includes racial preferences. Under the Democrats' health care bill, if a medical school wants to increase its chances of receiving many different kinds of grants and contracts from the federal government, it should have a demonstrated record of training individuals who are from underrepresented minority groups. This is because the Democrats' health care bill requires the Secretary of Health and Human Services to give preference to the entities that have demonstrated such a record in the awarding of these contracts to medical schools and other institutions. The bill does not state what would qualify as a "demonstrated record", so we can expect medical schools and the other entities to do whatever they think they can get away with to train as many "individuals who are from underrepresented minority groups" as they think they might need to have a better "demonstrated record" in this regard then other entities competing for the grants and contracts. The Democrats' health care bill creates a very significant financial incentive for medical schools and other entities to lower admission standards for "individuals who are from underrepresented minority groups" if that is what it takes to have the winning "demonstrated record".

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