Saturday, September 19, 2009
Cheaper, Better and Fairer Health Care
I heard an interview with T.R.Reid and can't wait to read his book The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care. He traveled the world and compared how developed countries manage health care. He makes the point that all other developed countries have universal coverage. No-one is left out.
He found four basic systems (some named after their founders):
The Beveridge Model: Health care is provided and financed by the government through tax payments, just like the police force or the public library. Some clinics, hospitals and doctors are government employees (like the Veterans Administration in the U.S.), and some are private doctors who collect their fees from the government. The government is the sole payer and the patient never, ever gets a bill. Preventive care is exceptional because health care is paid from cradle to grave and keeping the population healthy is a priority of the government. There are no stockholders to pay so health care dollars are used solely on health.
(Great Britain, Spain, most of Scandinavia, New Zealand, Hong Kong, Cuba)
The Bismark Model: It uses an insurance system financed jointly by employers and employees through payroll deduction. There are about 240 different insurance funds in Germany but they have to cover everybody and they don't make a profit. There is tight regulation so government has much of the cost-control clout that the single-payer Beveridge Model provides. Doctors and hospitals are private and patients can choose any provider they want.
(Germany, France, Belgium, the Netherlands, Japan, Switzerland and some Latin America)
The National Health Insurance Model: This system uses independent providers but payment comes from a government-run insurance program that every citizen pays into. There is no profit, no marketing and no financial motive to deny claims so these insurance programs are cheaper and easier to administer. ( This runs like U.S. Medicare). National Health Insurance plans control costs by limiting the medical services they will pay for.
(Canada, Taiwan, South Korea)
The Out of Pocket Model: In all of the other developed countries everyone is covered. The rest of the world (including 47 million Americans) are too poor and too disorganized to provide health care. If you don't have the money to see a doctor, you do without and get sicker or die. That's it...survival of the financial fittest.
The United States is unlike every other country because it maintains many separate systems for different classes of people. We have parts of every model but we are the only developed country that allows investor profits to dictate our health care. We are the only developed country that does not focus on primary care.
Posted by Toni Brayer, MD at 8:22 AM