International
Comparisons
Table 15.1
U.S. health care spending per capita
highest
U.S. average length-of-stay in hospital
lowest
Table 15.3
U.S. life expectancy at birth lowest
U.S. infant mortality rate worst
CATEGORIES OF
HEALTH CARE SYSTEMS
Traditional
Sickness Insurance
Germany
National
Health Insurance
Canada
National
Health Service
United Kingdom
Mixed
System
United States
CANADA
1930s Compulsory health insurance
introduced by some provinces
1940s Strong support for National
Health Insurance from labor unions
1947 Saskatchewan Hospital Services
Plan
1956 Hospital & Diagnostic
Services Act
1962 Saskatchewan Medical Care
Insurance Act of 1962
1966 Medical Care Act
1971 Every province & territory
provides universal coverage
1977 Per capita grant to provinces
1984 Canada Health Act
NATIONAL HEALTH INSURANCE
SYSTEM
·
Administered
at the provincial level
·
Provides
comprehensive first-dollar coverage of all medically necessary services
·
Available
to all residents with no out-of-pocket charges
·
Physician
fee schedule
·
Private
health insurance for covered services illegal
·
Regionalization
of high-tech services
·
Global
budgeting
·
A
free product increases demand and increases spending
·
Waiting
lists become rationing mechanism
·
U.S.
is the safety valve
FRANCE
Per
capita health care spending 1998 -- $2,077
system
based on sickness funds.
·
Financing
Payroll Tax
Co-payments
Physicians
Private
-- Negotiated Fee Schedule
Hospital
-- Salary
Second
Tier Status
Hospitals
Public
global budgeting
Private
non-profit global budgeting
Private
for-profit per diem
Pressure to control spending has led to
Increased
copayments to dampen consumer demand
Global
budgeting limits medical technology
Erosion
of real income for physicians
GERMANY
Per capita health care spending 1998 -- $2,424
Origins in mutual aid societies of early 19th
century
1883 Sickness Insurance Act; first social
insurance program on a national level
All individuals required by law to have health
insurance. Premiums are calculated on
income; not age or number of dependents.
Germans pay no deductible or coinsurance except for prescription drugs.
Ambulatory
care negotiated fee with sickness fund
Hospital
salary
Per
diem negotiated with sickness fund
Capital
improvement funds from government
Consumers
no incentive to limit demand
Providers
no incentive to limit supply
Tendency
to use resources inefficiently
Expensive
Cost
controls through global budgets
Temporary
measures often become permanent
Wealthy
Germans have private insurance
Per capita health care spending 1998 -- $1,822
Germany was model.
Participation in insurance plan mandatory.
Premiums based on earnings.
Physicians
Clinic-based
negotiated fee schedule
Hospital-based
salary
UNITED KINGDOM
National Health Service Act 1948
Covered
entire population
Medical
care free at point of use
Paid out of
general tax revenues
GP serves
as gatekeeper
Reforms 1991
Attempt to
introduce competition and market incentives into the NHS
Reforms 1997
Focus on
quality standards established through studies of clinical outcomes and cost
effectiveness
Safety valve
Private
health insurance