Health insurance is a complicated topic and few people can agree on a single “best” type of system. The United States, for example, has a combination of a privatized system and a public system. Other countries like Canada, Japan, and most European countries have universal health care, which means that all its citizens receive a basic level of coverage, though the governments of the countries can choose to run the program in a variety of ways. Each of these systems has its own benefits and drawbacks.
In America, the elderly are typically covered by the government’s Medicare program, and low-income individuals are covered through the government’s Medicaid program. Most other people rely on their employer to provide health insurance, and some Americans buy their insurance on their own. The Affordable Care Act has helped to increase the number of people who receive health insurance, provided stipends to help pay the high premiums for those who can’t afford it, and has made it easier for those who have pre-existing conditions to get coverage. Unfortunately, millions of Americans are still uninsured, and many more are “underinsured.”
Countries with Universal Health Care
Universal health care can be a broad term that describes a country that provides all of its citizens with health care. The way each country implements coverage to everyone can vary significantly and can be described by who is covered, what services are covered and how much of the costs are covered.
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The big question when it comes to health insurance is “Who is going to pay for it?” Healthcare expenses are definitely high, and the full cost of coverage is difficult to bear. This is one of the areas where countries differ on how they handle insurance for citizens.
In a single-payer system, the government, and not insurance companies, pays for the costs associated with health care. By being the only organization that purchases things related to health care, proponents of this system believe that costs are more effectively kept at reasonable levels. Health care providers may be private companies, such as in the case of Canada, or government-managed entities, such as in the case of the United Kingdom.
In a multi-tiered system, some of the costs are paid by the government and some are paid by individuals or employers. Both America and the Canada could be considered multi-tiered systems by some, but they are a bit different in practice. For example, only certain Americans are eligible for government-sponsored health insurance. Those who do not qualify for Medicare or Medicaid must turn to other insurance plans and pay for them on their own or look for an employer who will cover those costs. In contrast, the Canadian system provides all citizens with basic health coverage from birth, but some citizens choose to purchase additional private insurance. This private insurance accounts for about 30 percent of the healthcare costs in Canada.
Some programs, such as the one in Germany, are funded by employers and employees who pay into a “sickness fund” that then pays for the healthcare costs. These funds are sometimes managed by the governments and sometimes managed by non-profit organizations.
The “out of pocket” system means that individuals pay directly for their medical costs without an insurance or government middleman. These systems primarily exist in developing nations, but Americans who don’t qualify for Medicare or Medicaid, don’t receive employer-sponsored health insurance, and don’t feel that the monthly premiums for an individual plan are affordable may be forced to pay out-of-pocket if they need to receive medical care.
Many people are naturally worried about the amount of time it takes to see a doctor. With the introduction of the Affordable Care Act, many Americans feared that the increased number of people with insurance would mean that people would have to wait longer to see a doctor. Occasionally, people in countries with universal health care have complained that it takes much longer to get in. Of course, everyone’s experiences can vary, and the wait time for different situations depends on a lot of factors.
In both the United States and countries with other types of health insurance plans, it’s usually possible to make an appointment with your primary care physician within a day or two, if the need is pressing. This might include situations like a suspected urinary tract infection or a high fever that may require antibiotics. A less pressing problem, such as hip pain that’s been going on for a few months, may require the patient to wait a week or two.
Wait times to see specialists are also of concern to all citizens. However, there does not seem to be significant differences in wait times across the board between Americans and those with national health care programs. Citizens in all countries can experience wait times of up to a few months to see a specialist. In general, the office workers scheduling appointments will attempt to find a balance. Most specialists reserve certain time slots for new patients and certain time slots for those who have an immediate need. For instance, a toddler who has an undescended testicle might have to wait a month for an appointment with a urologist. Though the situation may seem concerning to the parent, it’s actually quite common. On the other hand, a child who has been drinking but is not urinating would probably get an appointment quickly.
The goal for countries with universal health coverage is to provide a basic level of health care for all of its citizens. Most countries with this goal meet it or come close to meeting it. For example, 100 percent of the citizens in countries as varied as Australia, Greece, Israel, and South Korea have coverage under their national plans. With a national health plan, most citizens receive coverage from birth. However, with private insurance plans, you typically have to add the child to the policy after he or she is born, though coverage will be retroactive to the day of birth.
Costs for those who are not citizens seeking medical care in a particular country can also vary widely. In some cases, a tourist who experiences an emergency and has to go to a hospital in a country with a nationalized health system may not have to pay. Other countries do require people to pay out of pocket, but the costs can be much less than would be expected in the U.S. For example, an American visiting a hospital in Japan might receive treatment and medicine, and get a bill for just $100 or $200. On the other hand, a European tourist who needs to go to an emergency room in the United States may find themselves with a bill that’s thousands of dollars. Lower medical costs in other countries are part of the reason why “medical tourism” is popular. Some people have found that it’s less expensive to fly to another country, stay in a hotel, and have a procedure done there than it is to have the same procedure done in the U.S., even if the person has insurance.
Access to Coverage
In a universal health plan, everyone has access to the same types of coverage. This includes things like annual physical exams and preventative screenings for cancer, treatment for illness or broken bones, treatment for chronic conditions, hospitalization when necessary, and other types of medical care.
With tier based medical coverage, the type of care a patient receives is often based upon how much the patient can pay. For example, on the American “health care exchanges,” individuals are allowed to select from “gold,” “silver,” and “bronze” plans. The gold plans are more expensive, but generally cover a wider variety of services with lower prices for the consumer. For instance, a gold plan might cover name brand medications, treatment for mental health, and alternative medicine like acupuncture, while the bronze plan may not. Coverages also can vary from company to company, and a person receiving coverage from their employer doesn’t necessarily get a better package than someone buying their own policy. These sometimes large variations in coverage mean that consumers need to carefully consider plans before making a selection to ensure that the plan they choose is the one that best meets their needs.
There’s two types of costs to consider when thinking about healthcare, average total cost spent on services, no matter who’s paying for it, and the out of pocket costs for the consumer. In America, average spending per person is a bit over $8,000. This is significantly more than other countries. For example, spending in the countries that are the next highest spenders, the Netherlands and Switzerland, are about $3,000 less per year, and the average spending of all the OECD countries except for the United States is around $3,300. Despite the higher spending and the frequent assumption that “America has the best healthcare in the world,” the object truth seems to be that the care Americans receive is not significantly better than the care received by those living in other countries.
Countries with nationalized healthcare programs typically have higher tax rates than in the United States, and this money goes toward paying for the citizens’ healthcare. However, most of those citizens don’t really view this money as a direct payment for healthcare. It’s simply “taxes.” The cost of care in these countries is also often limited. Citizens may be required to pay small co-pays or a small percentage of the total cost, but the rates paid are nowhere near the amounts that Americans can experience.
Consumer costs in the United States can be quite complex. Many have to pay monthly premiums, though these are sometimes picked up by an employer. When visiting a doctor, though, the person is likely to have to pay a co-pay, ranging from $10 to $50. Beyond that, there are also deductibles, which are a minimum amount the person has to pay before insurance will start paying, and co-insurance, which is a percentage of the total cost that the consumer is required to pay. For instance, a person might have a $1,000 deductible, and a 20 percent co-pay. When receiving care, the person would have to first pay $1,000, and after that, 20 percent of the total cost. This is a lot of money for the consumer if the total bill is $100,000. In general, plans that have lower monthly premiums tend to have higher deductibles, higher co-pays, and higher co-insurance rates.
Choice of Provider
In the age of “Dr. Google,” many people appreciate the ability to select a doctor on their own and easily schedule an appointment with a specialist if that seems warranted. This can be a factor when it comes to looking at healthcare programs.
Some programs, such as the national programs in Norway and the Netherlands, and the “HMO model” in the United States require a person to have a “home doctor” or “primary care physician.” The person will see this doctor for regular checkups and will need to schedule an appointment with this doctor in order to get a referral to a specialist. In theory, this system can reduce costs by limiting unnecessary trips to the specialist. Most programs allow the person to choose this doctor, though it’s also possible to be assigned to a doctor if no preference is stated.
Other programs, such as the national health program in France and the American “PPO model” allow consumers to freely schedule appointments with specialists when needed. From a consumer perspective, this system can be better because it can reduce wait times.
Healthcare in general can be a complex process, but some things make it easier than others. For instance, in a universal system, doctors and patients generally have a good idea of what will be covered and how the process can work. This saves a lot of time when it comes to filing paperwork and making decisions.
A multi-tiered system, on the other hand, can be difficult to work with. For example, a doctor may make a recommendation like sending the patient for an MRI or to physical therapy, but troubles might arise if the insurance plan doesn’t cover that type of treatment. If the patient is unable to pay for those services out of pocket, he may decline them, or the doctor may need to look into alternatives.
Information sharing between doctors and hospitals can also be easier with a nationalized program. In most cases, doctors will easily be able to look up the patient’s records to see what types of medications she’s tried or what procedures she’s had in the past. In multi-tiered systems, it can be more difficult to get this information. The patient needs to sign a waiver requesting release of the files. Fortunately, advances in healthcare information systems are starting to make it a lot easier for patients to develop a health profile that follows them around no matter where they receive services.
Pros and Cons
It’s easy to see how complex the issue of healthcare can be around the globe. Many people assume that their country’s system is the best because it’s what they have experience with and it’s comfortable to them. Experiencing health care systems in other countries sometimes makes it easier to see what types of things work well and what aspects of the healthcare programs can be improved.
The high cost of healthcare is probable one of the biggest things Americans complain about. An unexpected medical event can easily put a family in such a bad financial situation that they might have to file for bankruptcy. This type of situation just doesn’t happen in other places.
Though Americans typically think of Europeans complaining about high taxes and long wait times, this isn’t always the case. For example, in Germany, money for the “sickness funds” comes from employees and employers, not taxes. Employees pay about 8 percent of their income into the sickness fund. In exchange for this, most Germans feel that they get top-quality care.
Despite the general satisfaction and lower costs expected in countries that offer universal healthcare, it’s unclear whether those things would carry over to the states if implemented. The United States is an incredibly large country with a racially diverse population. Higher obesity rates also tend to equal more chronic conditions that require management. These types of things can cost much more money. Critics also point out that the American system is more likely to spark research and develop new advances that other countries can then take advantage of. There’s a worry that research won’t progress as quickly if there isn’t the financial advantages.
Ultimately, countries need to learn from each other about what things work and what don’t. By taking the best aspects of various programs, societies can perhaps come closer to developing the most beneficial system for all its citizens.