Health Journalism 2008: What health systems of other countries can teach us Date: 04/07/08
By Lola Butcher
independent health care writer
While health care systems in other countries avoid some of the big problems experienced in the United States, it is unlikely that America can easily adopt features that work elsewhere.
After describing Canada's health care system, Andre Picard, public health reporter at The Globe and Mail in Toronto, said health systems reflect the values of the country in which it operates.
"Health care systems have to be culturally appropriate," Picard said. "We are a country that believes in collectivity as much as individual rights."
Picard was one of four speakers in a session moderated by Jonathan Cohn, senior editor at The New Republic. John Appleby, chief economist at King's Fund, described the health care system in England, one of four systems operating in the United Kingdom; Victor Rodwin, professor of health policy and management at New York University, spoke about the French health care system; and Paul Thewissen, counselor at the Royal Netherlands Embassy in Washington, discussed the system at work in The Netherlands.
The four systems have little in common except that they all provide universal access to a certain level of care and each accounts for 10 percent or less of its nation's gross domestic product.
Canada: Care is delivered privately by not-for-profit hospitals and doctors working in private practices that bill the government health plan for their services. "Medically necessary" services are covered; drugs and dental care are not covered, except for poor and elderly citizens.
Picard described a cost-effective system in which rationing is explicit; Alberta, for example, will pay for 400 bariatric surgeries this year, regardless of demand. Wait times for elective surgery and physician visits can be long, and the system is slow to adopt new technologies.
England: Now in its 60th year, the National Health Service shows no signs of instability. The public system is complemented with a small private system; most general practitioners and dentists contract with the NHS.
The system is informed by two perspectives on equity: Rich pay more than poor via a progressive tax code and equal access is provided for equal need. Every three years, a lump sum for health care is apportioned to geographic areas based on need. For example, an area with higher mortality rate or larger population of elderly receives proportionately more than a healthier, younger area.
The Netherlands: A highly regulated private health care system that is moving to managed competition, the country has an individual insurance mandate. Health insurers must accept all applicants and charge the same premium for all members; low income residents receive tax breaks to help pay premiums.
Thewissen said the system values primary care, and 90 percent of residents have a primary provider relationship. Problems with waiting lists for access have disappeared in recent years and because access to a physician is readily available, emergency departments are used for true emergencies. Prescription drug use appears to be significantly more conservative than in the United States.
France: Coverage has been growing incrementally for more than 60 years, and universal coverage was achieved in 2000. Although there are multiple health systems, the government is the single payer and reimbursement rates are uniform. Patients pay an 8 percent co-share for services and drugs.
Employers are mandated to provide coverage for workers. Physicians are not highly paid; Rodwin estimated that general practitioners make the equivalent of between $60,000 and $70,000 a year.