Aaron Carroll, President and CEO AcademyHealth, writes about our broken health care system on the Commonwealth Fund blog and explains how other wealthy countries do better for their citizens and offer them near total protection from health care costs. He suggests that if we look to other countries, we can find ways to fix our health care system without moving to single-payer or keeping things as they are. Hmmmm….
Carroll points out that insurance is designed to pool resources so that we share the cost of unforeseen health needs. With insurance, we should be able to afford our care and not face financial ruin. In the US, even with the Affordable Care Act, we have 26 million uninsured Americans. Every other wealthy and many middle and low-income countries have universal coverage.
In Switzerland, Carroll says that there is no program like Medicare or Medicaid but rather private insurance only throughout the course of each citizens’ life. They have insurance independently of their employment. Insurers are prohibited from profiting from this “basic” insurance. People have high out-of-pocket costs. It’s not clear from Carroll’s description whether the government mandates these costs. Insurers can profit from supplemental insurance.
Singapore offers its citizens catastrophic coverage to protect them against financial ruin. People largely pay for doctors’ visits and other outpatient care themselves. They are required to contribute some of their earnings to health savings accounts, which they can then use to cover their outpatient care. For inpatient services such as hospital care, Singapore offers different insurance coverage levels. The basic level is relatively inexpensive to ensure essential health care needs are met. For a higher cost, you get better coverage, such as faster access to care.
Canada covers everyone directly through the government; it’s a single-payer system called Medicare. Taxes cover most costs. The government sets the rules of coverage. Medically necessary inpatient and outpatients services, as well as dental services are covered, but not prescription drugs or vision care.
Australia, like Canada, covers everyone directly for citizens who use the public delivery system. It’s a single-payer system that is also called Medicare. It covers most inpatient and outpatient care as well as preventive care and community services. However, people can forego public care in favor of private care, better care access, and improved benefits such as vision care, at additional cost; about one in three Australians do. Taxes, based on income, along with copays, cover the costs of the single-payer system.
New Zealand offers government coverage, much like Australia, though it focuses more on community-based care and public health initiatives. It covers inpatient and outpatient care and prescription drugs. Taxes cover most costs, along with copayments. People can opt for a private system that delivers speedier access to non-urgent care as well as improved benefits; about one in three New Zealanders do.
France offers government coverage of inpatient and outpatient services as well as long-term care and prescription drugs. It’s system is called Social Security. Payroll taxes and other taxes cover the cost. Regional health agencies are charged with arranging coverage and care delivery. Patients pay coinsurance, copayments, and physician charges above what the government covers. Virtually everyone buys private supplemental insurance, mostly from nonprofit companies, which pick up a lot of the out-of-pocket costs. Supplemental insurance also covers dental, hearing, and vision care.
England‘s National Health Service (NHS) offers health care to all residents. It covers inpatient and outpatient services with no out-of-pocket costs. Taxes cover most costs and there is a global health care spending budget. No one is at risk of bankruptcy.
Here’s more from Just Care:
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