(Part One of this series can be found HERE..)
Here
are three more countries with health care systems to consider. Every single one
of them is way above us in the WHO health system rankings, and every single one
of these countries has a legal and ethical commitment to provide universal
health care to everyone residing in their countries. That is the main thing to
keep in mind here. Is it possible that our method for getting to universal
coverage is less important than just a dedication to universal coverage?
Look through these and see what you think. Oh, and one more thing. When you see the term "private insurance" in the examples below, it does not mean for-profit.
Italy
Say what you want
about Italy's often-chaotic government, they've been able to put together a
very credible health care system that seems to be able to withstand drastic changes in government philosophy. In the case of Italy, it's all about setting priorities.
The Italian national health system, known as Servizio Sanitario Nazionale or SSN, for short, provides low or no-cost health care to all EU citizens. It is designed along the same lines as Britain's NHS, meaning that it is single-payer, socialized and it's based on the principle that all Italian residents are entitled to free and equal access to quality health care. The system is very efficient, due largely to its decentralized nature, as most health care delivery is handled locally, not from the federal government. As a result, the percentage of GDP Italy spends on health care is around 8%, or half the percentage spent by the United States last year.
Simply everyone is covered. Employers pay 100% of the premiums, and with a few small exceptions, health care is as close to "free" as it gets to Italian residents, and everyone else in the EU. Most inpatient hospital treatment, including tests, medication and surgery, is covered. For outpatients, coverage includes all or part of the cost of medications, visits to family doctors and other medical professionals, and even dental treatment. While the system was conceived as completely free, and has remained so, for the most part, a system of co-pays for drugs and some specialists, although chronic, disabled and elderly patients are exempt, as are those with low incomes.
Among Italians, the public hospitals have developed a less-than-stellar reputation for various reasons, mostly undeserved. Some of the buildings and facilities don't look as nice and modern as many others in Europe, partly due to neglect from right-leaning governments, but mostly because the system has decided to place an emphasis on the quality of medical care, rather than aesthetics. Italian health care is reliable, and the doctors are highly skilled.
But while the NHS dominates the UK, many Italians pay for private health insurance over and above their guaranteed coverage. With a private plan, you can choose any doctor or specialist, and avoid long lines just to get an appointment. And private hospital accommodations are luxurious; some have described them as looking like 5-star hotels. That does not mean the medical care is better, however; by most measures, the quality of care in both public and private hospitals is comparable.
But as private insurance becomes more popular, something else is happening in the private health care system; perhaps you'll recognize it. Because care at private hospitals is very expensive, private insurance is increasingly limiting treatment coverage, and denying claims. Of course, all is not lost if a private insurer denies treatment, because the public system is still available.
The Italian system was created in 1978, and even with some of the complaints about the public system, the results are stellar, with Italy ranking number 2 on the WHO health care chart, just behind France. And every Italian politician who even tried to mess with the system was tossed out of office.Of course, being that we're talking about Italy, well...
Singapore
Singapore also has a universal health care system, in which everyone is entitled to care, but the approach is actually quite unique. Many experts suggest that the Singaporean system can't be replicated most places, but it works for them. What makes it different is that the government only provides catastrophic care and guarantees basic care. They rely heavily on private insurance and delivery. Because of their efficiencies in care and delivery, overall health care spending in Singapore only amounts to 3% of its GDP, and two-thirds of funding actually comes from private sources.
The government ensures affordability through strict price controls and mandatory health savings accounts, called Medisave. The accounts are funded through mandatory payroll deductions and employer contributions, with employees funding one quarter and employers funding three quarters. Only certain categories of care can be paid for with the Medisave account. Outpatient doctor visits for minor ailments must be paid for out of pocket. The government provides a catastrophic health care plan, and strongly regulates the supply and prices of health care services throughout the country, in order to keep those prices in check. In addition to Medisave and catastrophic care, many Singaporeans also carry supplemental private insurance, which is often paid for by employers to attract employees. The private insurance pays for services not covered by the government, although the government pays 80% of "basic health care services." The government also provides a safety net for low-income people "subject to stringent means-testing."
The government also plays something of a paternalistic role with regard to certain types of disease. They put a huge premium on controlling the spread of disease, and encourage sick people to stay home and reduce the spread of such sicknesses.
The private health care system effectively competes directly with the public healthcare system, to keep prices under control. They are essentially equal in the marketplace, and there is little or no quality difference between a public and a private hospital. Private health care providers are required to publish prices for everything, in order to encourage comparison shopping.
This environment, in which government actively regulates and actively competes with private insurers, gives Singapore the sixth best health care system in the world, according to the WHO. They're tied with Iceland, with the lowest infant mortality rate in the world.
And they only spend 3% of their GDP.
Spain
The Spanish health care system works very much like the British and Italian systems. Everyone in the country who contributes to the Social Security system is entitled to free or low cost health care for themselves and their dependents. The system features an extensive national network of hospitals and thousands of health centers, even in small villages. The Spanish government has a goal of creating a system in which no one in the country has to travel more than 15 miles to see a doctor.
The health centers provide primary health care services and nursing, as well as midwives, therapists and even social workers. They will also provide service at a patient's residence, if it's required. Hospitals offer accident and emergency services, of course, but they also house specialists, upon referral from a primary care physician.
There are no co-pays or claims forms. There is also no stress over health care when you lose a job, there are no pre-existing conditions, and there is no rescission. The Social Security tax rate is about 12%, but that amount not only includes health insurance, but also unemployment, full maternity leave coverage, and several other benefits.
There are occasionally long waits for an appointment to see a specialist for some procedures, but it's difficult to argue with the results overall, as Spain is number 7 on the WHO's ranking of OECD health care systems. The Spanish guarantee of health care to all residents is the result of the 1978 Constitution, which was drawn up following the Franco years. (Yes, he's still dead.) The Constitution not only upholds the right to health care, but mandates that the state provide it. By the way, Spain also provides health care to immigrants, and doesn't ask for ID.
An excellent system of private health care has grown and easily exists alongside the public system, and has come to complement the public system, more than compete with it. But more than 90% of Spanish residents opt for the public system.
