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Comparison of the U.S. Health System
to that of Fifteen Nations
EINO presents 15 comparisons to the US system are taken from a more detailed
discussion at the PNHP website. You might also like to learn more about the European
models CLICK HERE.
QUALITY ISSUES:
Also keep in mind the extreme injustice of health care in the USA and that the "average" care situation
is far far better than the care available to many, or even most, working Americans. For example, consider the
international comparison on the basis of infant and child mortality.
But isn't the extra cost in the USA because we don't want to have the long waiting lists for care that other nations
have and also due to our extreme costs for malpractice and litigation?
Even if the "long lines" is industry propaganda, we all know that the advanced technologies and treatments in the USA bring us much higher quality in care than other industrialized nations have, don't we?
And aren't we also paying twice as much for improved patient outcomes on difficult procedures like arterial
bypass?
Of these 15 comparisons (all of which provide health care universally) just
5 are clearly single-payer with no out-of-pocket expense and with no section of the
population purchasing health insurance privately. The ten others have
mixed systems of financing where some expenses are out-of-pocket or some people
are buying their insurance privately. The average country (of the 15) would be a
mixed payer system, would provide coverage to the entire population for 46% of
what we spend per capita to insure just a portion of our population. This
"average country" would have an infant mortality rate 32% less
(better) than ours and life expectancies about 2% greater (better), even while spending less than half what we do to cover just a priveleged section of our
population.
The United States has a population size of about
270 million people, an infant mortality rate is 7.2 per 1,000 live births, and a
life
expectancy at birth is 73.9/79.4 years for men/women. The U.S. currently spends 13.6% of its GDP on health care and in 1998, the U.S. had a
$4,178 per capita level of health care spending. The mean per capita expenditure in 2003 for 18 other OECD nations was $2958 as opposed to the $6711 per capita in the USA (more than twice as much). See OECD study. Why are Americans satisfied to spend twice as much per capita?
Compared to the U.S., Australia with a population
about the size of Texas has an infant mortality rate which is better by +30%
than the U.S. with life expectancies better by 3% and all that at a cost of 49%
what we pay per capita.
Since 1941 Australia has had universal health
care.
The government administers the compulsory
national health insurance program. National health insurance is
funded by a mixture of general tax revenue, a 1.5% levy on taxable income , state revenue, and fees paid
by patients. The government funds 68% of health expenditures (45% federal and
23% state) and has control over hospital benefits, pharmaceuticals, and medical
services. States are charged with operating public hospitals and regulating all
hospitals, nursing homes, and community based general services. Additionally,
the states pay for the public hospitals with federal government assistance
negotiated via five yearly agreements. Mainly not-for-profit mutual insurers cover the gap between Medicare benefits and schedule fees
for inpatient services. Private insurance covers 1/3 of the population and
accounts for 11% of health expenditures.
Compared to the U.S., Austria with a population
about the size of North Carolina has an infant mortality rate which is better by
32% than the U.S. with life expectancies better by 1.5% and all that at a cost
of just 47% what we pay per capita. The country has
universal access to health care through a compulsory system of social insurance.
A system of private insurance also exists. About 8.2% of Austria's GDP is spent
on health care, and the 1998 per capita expense was $1,968-US.
Private doctors with contracts to the social
insurance funds are paid on a fee-for-service system with expenditure limits
based on the case and per doctor per pay period. Hospital physicians are
salaried. Approximately 50% of the health expenditures are funded by progressive
payroll taxes, 25% are financed by non-specific taxes, and the rest is funded
directly out-of-pocket or through private insurance companies. The contributions
to the health insurance funds (payroll taxes) are split between employers and
employees on a parity basis.
Compared to the U.S., Belgium with a population
about the size of Ohio has an infant mortality rate which is better by 17% than
the U.S. with life expectancies better by 1.7% and at a cost of just 50% what we
pay per capita. The country has
universal access to health care through a compulsory system of social insurance.
A system of private insurance also exists.
The health care system is funded primarily
through sickness funds. Belgium's health insurance program operates at four
distinct levels: the central government, national associations, federations of
local societies, and local mutual aid societies. The general attitude in Belgium
is that the pluralism of the health insurance system stimulates each local fund
to work hard to attract and satisfy its members.
Compared to the U.S., Austria with a population
about the size of North Carolina has an infant mortality rate which is better by
33% than the U.S. with life expectancies better by 2.5% and all that at a cost
of just 55% what we pay per capita. The country has
universal access to health care through a compulsory system of social insurance.
A system of private insurance also exists.
National health insurance had been discussed in Canada at
the federal level since 1919, but no real action was taken until 1944. Today,
Canada's health system is characterized by single-payer national health
insurance, and the federal government requires that insurance cover "all
medically necessary services."
Compared to the U.S., Denmark with a population
about the size of Wisconsin has an infant mortality rate which is better by 35%
than the U.S. with life expectancies worse by 0.5% at a cost of just 51%
what we pay per capita. Denmark has had a single-payer national health
system since 1961.
The Danish health care system is funded by
progressive income taxes, and is publicly administered. Hospitals are run by the
14 counties and the City of Copenhagen.
Compared to the U.S., Finland with a population
about the size of Maryland has an infant mortality rate which is better by 42%
than the U.S. with life expectancies better by 1% and at a cost of just 36% what
we pay per capita. In 1964, national health insurance was enacted in Finland.
The Finnish health system is primarily funded
(80%) by general tax revenues collected by the local and national governments.
The basic administrative levels in Finland are divided into communes and
municipalities. The local authorities in Finland number 445, averaging about
10,000 people each.
Compared to the U.S.,
France with a population about the
size of the U.S.' midwest has an infant mortality rate which is better by
35% than
the U.S. with life expectancies better by 2.2%, at a cost of just 50% what we pay per capita.
The country has had a national health insurance system since 1928, but
universal coverage did not occur until 1978.
The French health care system is primarily funded by
Sickness Insurance Funds (SIF's), which are autonomous, not-for-profit,
government-regulated bodies with national headquarters and regional networks.
They are financed by compulsory payroll contributions (13% of wage), of
employers (70% of contributions) and employees (30% of contributions). SIF's
cover 99% of the population and account for 75% of health expenditures.
Compared to the U.S., Germany with a population
about 1/3 of the U.S.' has an infant mortality rate which is better by 35% than the U.S. with life expectancies better by
1.1% and all that at a cost
of just 58% what we pay per capita. In 1883, Germany was the first country to
establish the foundations of a national health insurance system and has since
gradually expanded coverage to over 92% of the population.
Everyone in Germany is eligible for health
insurance, and individuals above a determined income level have the right to
obtain private coverage. The German health care system is predominantly
characterized by Sickness Insurance Funds (SIF's), which are funded by
compulsory payroll contributions (14% of wage), equally shared by employers and
employees. SIF's cover 92% of the population and account for 81% of health
expenditures. The rest of the population (the affluent, self-employed, and civil
servants) is covered by private insurance, which is based on voluntary,
individual contributions. Private insurance accounts for 8% of health
expenditures.
Compared to the U.S., Japan with a population
about half that of the U.S. has an infant mortality rate which is better by 50% than the U.S. with life expectancies better by
5.2% and all that at a cost
of just 44% what we pay per capita. The Employee's Health Insurance System is
financed by compulsory payroll contributions (8% of wage), equally shared by
employers and employees, and covers employees and their dependents. The National
Health Insurance System covers the self-employed, pensioners, their dependents,
and members of the same occupation.
The local governments act as insurers, and
premiums are calculated on the basis of income, the number of individuals in the
insured household, and assets. Premiums account for 57% of health expenditures.
The federal government contributes 24% to medical care expenditures and local
governments contribute 7%.
Compared to the U.S., the Netherlands with a population about the
size of Florida has an infant mortality rate which is better by 28% than
the U.S. with life expectancies better by 1.7% and all that at a cost of just
49% what we pay per capita. In
1997, 72% of the population had government-assured health insurance coverage.
The remainder have priate insurance.
Compared to the U.S., New Zealand with a population
about the size of the city of Atlanta has an infant mortality rate which is better by
6% than the U.S. with life expectancies better by 1.5%, at a cost
of just 34% what we pay per capita. In 1941, it achieved universal
coverage and was the first country with a free-market economy to do so. Radical
health sector restructuring occurred in 1993, which introduced a set of
market-oriented ideas. However, the new system performed poorly and was
thus restructured 3 years later.
The health system is funded through taxation and
administered by a national purchasing agent, the Health Funding Authority
(HFA). Health care is provided by 23 hospital provider organizations, GP's and other noncrown providers of child
care, disability support services, etc. These parties compete for
the provision of health services. Public funding accounts for 76% of health
expenditures. Complementary, non-profit, private insurance, on the other
hand, covers about 1/3 of the population and accounts for 7% of
health expenditures. It is most commonly used to cover cost-sharing
requirements, elective surgery in private hospitals, and specialist
outpatient consultations. New Zealand's government is a purchaser and provider
of health care and retains the responsibility for legislation and general
policy matters.
Compared to the U.S., Norway with a population
about the size Washington D.C. has an infant mortality rate which is better by
54% than the U.S. with life expectancies better by 2.3% and all that at a cost
of just 58% what we pay per capita. Norway has had a
single-payer national health insurance system since 1966. The National Insurance
Act guaranteed citizens universal access to all forms of medical care. Norway's
health system is funded by progressive income tax, and from block grants from
central government.
Patients are responsible for co-pays for some physician visits,
approximately $15. Patients are also responsible for co-pays for prescription
drugs, up to $216 per year. Once that level of expense has been reached,
prescription drugs are covered at 100%. All hospital care is covered at
100%.
Compared to the U.S., Spain with a population
about the size of New York and Texas together has an infant mortality rate which is better by
31% than the U.S. with life expectancies better by 2.3% and at a cost
of just 29% what we pay per capita.
The Spanish health care system is funded by
payroll taxes through the National Institute of Health program (INSALUD), which
in 1984 was 75% financed by employers and 25% financed by employees. Those with
higher incomes have the option of obtaining private medical care. Public
hospitals are run by one of the provinces or municipalities.
Compared to the U.S., Sweden with a population
about the size of New York City has an infant mortality rate which is better by
50% than the U.S. with life expectancies better by 3.6% and all that at a cost
of just 42% what we pay per capita. Sweden has had its current universal health care
system since 1962.
The Swedish health care system is financed by
both incomes and patient fees. County councils own and operate hospitals, employ
physicians and run the majority of general practices and outpatient facilities.
Other physicians work in private practice and are paid by the counties on a
fee-for-service basis.
Compared to the U.S., the U.K. with a population
three times that of Texas has an infant mortality rate which is better by 21% than the U.S. with life expectancies better by
0.7%, but at a cost
of just 35% what we pay per capita. Britain has had a National Health
Service (NHS) since 1948. The British government is a purchaser and
provider of health care and retains responsibility for legislation and general
policy matters.
The government decides on an annual budget for the NHS, which is
administered by the NHS executive, regional, and district health authorities.
The NHS is funded by general taxation and national insurance contributions and
accounts for 88% of health expenditures. Complementary private insurance, which
involves both for-profit and not-for-profit insurers, covers 12% of the
population and accounts for 4% of health expenditures.
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CHILD AND INFANT MORTALITY
"In 2003, 40 countries had infant and child mortality rates lower than or equal to those in the United States." Source: Journal of the American Medical Association, April 13, 2005
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But isn't the extra cost in the USA because we don't want to have the long waiting lists for care that other nations
have and also due to our extreme costs for malpractice and litigation?
Not at all. These so-called "widespread misconceptions" [more accurately industry propaganda] are completely
without merit. First total litigation and malpractice costs, while widely different between the US and other
industrialized nations is a minute part of health care costs even in the US (less than 1%). And it has been shown that even where increases are occurring in the costs of malpractice insurance, this is not at all related to increased costs of lawsuits.
Furthermore, Americans do not in
general have access to more needed resources whether hospital beds, or technicologically advanced instrumentation.
Even in those procedures where there are waiting lists in other nations, the US expenditures in these areas
specifically is also minor. The 15 procedures with the greatest international waiting lists, all together,
account for less than 3% of US health care spending. More details on this subject and the reference.
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And aren't we also paying twice as much for improved patient outcomes on difficult procedures like arterial
bypass?
Actually no. Our twofold cost differential over Canada for a coronary arterial bypass graft, for example,
actually comes with an shorter stay in the hospital for US patients and similar outcomes. See more details and
reference.
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Hasn't recent techonolization in the USA led to care in the USA outpacing all rivals though,
especially during the last few years?
Not at all. A 2005 survey of sicker adults in Australia, Canada, Germany, New Zealand,
the UK and the USA found sizable shares of patients in all six countries report safety risks, poor care
coordination, and deficiencies in care for chronic conditions, however the USA stood out for inefficient
care and errors and is an outlier on access/cost barriers. For more details CLICK HERE.
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