Why is it that the system of community clinics in underserved areas in the US is never mentioned as part of our system? It is federally funded and device is free to people who need it.
1
Our middle daughter has lived abroad since 2000, seventeen months in Italy; the rest of the time in the UK. Three other members of our family have been treated in England while having medical issues arise there. Our youngest daughter developed a rip-roaring urinary infection and was hospitalized. No private rooms like here, but a ward that looked like a 1930s movie. EXCELLENT care; excellent staff, and no cost at all to us even though my husband TRIED to give them insurance information or cash! Both my husband and I have been treated for more routine problems at our daughter’s primary care provider. We may have had to pay a little, around 15 pounds as I recall. But we also have been given prescription drugs at no cost whatsoever.
But it is the care our daughter and grandkids who live there receive that impresses me the most. EXCELLENT prenatal care and AMAZING home health support for newborns and young children. Our youngest daughter (who has a BSN and was a NICU nurse in suburban Denver for twelve years) said any pediatrician in Denver who developed a practice like was routine in England would become the most popular pediatric practice in all of Colorado almost overnight!
Our “English” daughter does have private insurance through her employer that allowed her to “jump the queue” for two knee surgeries. She is hesitant to ever leave the UK because of the disparity she sees between US and UK health delivery.
6
In france you never think about money. We are all covered and most have reasonable supplemental plans. My total insurance costs $1000 a year with almost no out of pocket costs. Insurers negotiate with providers to keep costs low. Care is good although specialists are fewer outside large cities. We choose our providers. I could not afford to live in America financially or emotionally as health care is precarious capricious and expensive.
7
I lived in British Columbia, Canada, from 2003-2009. One thing that rarely gets discussed is that each province has its own system, paid partially by a national sales tax, and partially by citizens of the province through local taxes. My experience in BC was, as a foreign visitor, difficult to access. Once we obtained a work permit after two years, the cost for a couple 55 was $57/month, which would disappear after three years. Access to care was unlimited. Quality of care was excellent. Toward the end of my stay, I got very ill with a lung infection. Tests and specialists and care were delivered without hesitation. A US friend had a brain tumor removed, plus rehabilitation, free. In the US, he learned his out of pocket would have been $1 million.
There’s a lot of talk about waiting for elective procedures in Canada. One dr. There told me that people wait till the very last minute to seek help, thereby making the waiting much more painful.
I’ve lived in both the U.S. and Canadian systems. Canada, at least in B.C., wins hands down.
5
Incentives should be given to individuals who maintain physical fitness, healthy weight levels, and minimum utilization, as well as use of natural, homeopathic, and herbal treatments which have fewer side effects and often lower expense than pharmeceuticals. Patients must have some personal incentive to be proactive and keep health care usage lower.
In the 80's I worked for a small, statewide, very innovative hmo that focused on health promotion equally as much as medical care. The company was highly profitable with statistically low utilization rates and built up large cash reserves. After several years of successful operations, the company was purchased by a large national company which absorbed its subscribers, bled out all the cash, and discontinued the whole person health initiatives that made it great.
1
I grew up in the US, gave birth snd had cancer in Norway, had spirts injuries and small childrren in Switzerland, had even more injuries, one operation and small children in the UK, and am now middle age in Norway. Comparisons, the US offers the best for those who can afford it. Insurance and drug companies have pushed costs out of the range of middle lower paid people and previous conditions. Switzerland is telyant on an insurers playing field, but choose the wrong one and you loose. It is a gamble. UK, bless them, do well by children and try their best, but lines are long, and in the end, if you have money, you will get better faster treatment privately. Norway, lines can be long but cradle to grave top quality. The state makes a point of making sure that complicated and cutting edge treatment should be delivered by the state, and private services supplement for people who want expedited treatment of simplere things. Its working very well actually. Mental health care can improve ( more proffesionals) and less rigidity in long term and cronic care facilities.
1
My mother broke her foot in England. An ambulance was sent, taking her to an ER. They casted her leg and provided crutches. They took us to the train station. Put us on the train before anyone else, and arranged for a wheelchair at our destination. When we inquired about payment, they said it was free. Here there would be copays (assuming you even have coverage) for the ER, physician, xray, casting and crutches. Oh, and any medication given. Our health outcomes are significantly worse than other industrial nations at a much higher cost. Health care is for profit here, beholden to shareholders. This, I believe is the root of the problem.
3
Not sure my good fortune to fall ill in Milan when I travel. As I am a visitor of that country, the government has the best facilities when it comes to healthcare system. Compared to US its almost 7 to 8 times less in expense with insurance, feels great!!! Amazing thing was the invoice just a single page with some number showing "PAY This" at bottom. I told my colleagues of Everydayhealth, is that better cared in US? else I would have been financially ruined.
I lived in France for 12 years and loved the healthcare system. It had universal coverage/access, reasonable costs, minimal administrative costs, super doctors and hospitals, minimal waiting times,low drug costs and state of the art care. Can you imagine never worrying about healthcare? Doctors and therapists even came to your home! Of course, the system has evolved since I was there but it was the highest rated system by the WHO World Health Organization when I lived there in the 60s,70s and 90s. Vive La France!
2
Disclosure: I’m Mexican, did medical school in Mexico, my surgical residence in Barcelona, a fellowship on Image Guided Surgery in Strasbourg and I currently work for Siemens Healthineers helping develop the field of IGS, which has given me uncommon access to other systems (like Italian, Swede, Dutch and American). Unfortunately I have also been a patient in Mexico, France and Germany.
All European systems work very well for the majority of problems, obviously the systems in richer countries like Germany, Netherlands and Sweden have more access to cutting edge technology (which is available only in very few hospitals of countries like Spain and Italy). As professionals go, I wouldn’t have a problem with being treated in any of those countries. Sadly, in Mexico and USA you only get really good care if you can afford it, the top being much better in USA than in Mexico.
The Spanish system has comprable outcomes costing half of what the French and the German cost, and a small fraction as that of the US.
So far as a patient the personnel from German hospitals has been the kindest to me, but never had any bad experience really.
I pay more or less the same in insurance in Germany as my parents pay in México for a top tier insurance plan, the difference being, I don’t lose my insurance if I lose my job and it would cover all my family if my wife would not have her own.
My advice to Americans, healthcare in these countries work well because everyone is sharing the cost. So, share
6
To those of you who praise the American healthcare system, just go to the doctor and try to deal with the administration involved. Every doctor visit is a nightmare with “referrals”, “holds”, and something else missing. And then there is the billing process of random $ amount for services that cannot be compared or verified.
3
I have lived in Colombia the last two years and participated in their single-payer system, EPS. The government sets coverage and premiums, and pays 90% of the premium. Employers or "independent" enrollees choose from about a dozen providers, depending on locality. If enrolled through your employer, they pay 6%, leaving you 4% to pay. EPS does not cover dental, eyeglasses, elective, ambulance, much choice of doctors or self-referral, or private room. There are supplementary policies available to cover those. Outcomes in Colombia are better than the U.S.according to WHO but it's a no-frills system (think Spirit Airlines). They have no problem making you wait hours for an urgent situation like a broken bone, or even a month or more to see a specialist. That rarely changes the outcome, but Americans accustomed to being pampered would have a hard time adjusting. As an independent, I pay about $39/month for EPS, plus a $3 copay. Almost all providers are private. Doctors are respected and compensated in Colombia but it is not a way to get rich. They seem more modest and often answer there own phones.
I believe Japan has the longest life expectancy among Industrialized countries. Shouldn’t Japan be the ncluded among your comparisons? Likewise Sweden was for decades held up as a benchmark for judging health care delivery. I would be interested in adding this to your “panel” of countries.
3
I'm an Australian who lived in Britain for 10 years - and I'm also in email forums with Americans so I get to witness their struggles with health insurers, the details of which always astound me.
When my son was born in Sydney he was in NICU for four weeks with world class care. No charge. He was born with a hand anomaly, which he had surgery to correct at 6 months. No charge. At the time I came across a blog by a US mother whose child had the same issue but they could not afford surgery so he was going to live with it. It strikes me as incredible that the US considers itself a first world country when I see stories like that.
My son had a facial laceration from an accident - we were seen at Emergency within the hour and he had plastic surgery the next day. No charge.
A few years ago I had an accident with a severe leg fracture - spent 10 days in hospital, had excellent orthopaedic surgery, no charge.
Of course I do pay a small percentage of my taxes to our health system but I get back many times over what I put in. That's what a public system can do, distribute the risk.
I could tell many more stories about the largely free excellent health care I can take for granted (except that conservative politicians here are in league with insurance companies to try and push privatisation.)
7
I appreciated your recent comparison of health care systems. But, I would like to know what our health care costs, as a percentage of GNP, would be if two
adjustments were to be made, as follows:
1. Adjust for the cost of malpractice and preemptive testing, which is paid for
by the medical industry here, but is absorbed by governments elsewhere. My guess is this is about 5% of our costs.
2. Adjust for the fact that Healthcare professionals have to pay for their education (college, then medical or professional school) For a doctor,
this could amount to ~ $500k plus interest if borrowed. Loans are repaid in after tax dollars, so the amount becomes ~ $700k. In other countries, these costs are born by the government, but are not included in health care expense. My guess is these charges amount to ~ 7% of costs.
3. Not all costs are for personnel, so the total 12% probably works out to about 8% of total costs. If these estimates are correct, then our 17% of GNP
would come down to say to about 15.5%. This is still considerable above France's 11%.
1
The article does not address the elephant in the room that would preclude these systems from working in the USA - liability, the ability to sue for a poor health outcome and malpractice insurance. I lived in Switzerland and received excellent care for myself and my family. The cost was ridiculously low compared to what we paid in Los Angeles. My cousin was grossly misdiagnosed and spent eight weeks in ICU (upon returning to the US) with a blood infection. A simple blood test and question that every doctor in the US asks (Have you had dental work recently?) would have caught it early. There is ZERO recourse for a family when a doctor in Switzerland makes a mistake. Doctors in the US over test for fear of being sued; I’m afraid that those elsewhere may under utilize resources to control costs, and lousy doctors can never be called out. In America people want and expect to sue and be compensated when outcomes are not perfect and there is someone or something with a deep pocket to blame. In Switzerland people do not and cannot sue their doctors, hospitals, etc.
1
@Raphaelle Cassens
I am a retired contractor. In California, in the early 2000s, Workers Compensation costs ran completely wild, due to unlimited suing. I moved to Florida in 2009. Workers Comp was 1/3 the cost and very stable. Why? Liability cases were capped at $1 million. Enough to compensate loss, but not enough to keep the ambulance chasers happy. Good result.
2
From 1991 to mid-1994 we lived in British Columbia and were eligible for the Canadian health plan. We loved it--show your card, and everything is paid for--no deductibles or copays. We never had to wait for appointments or procedures. My husband had surgery during that time and I had ex-rays to diagnose a severely sprained knee. One family member suffered a severe depression during that time. All mental health care (psychiatrist, hospitalization, psychologists and group therapy were) was covered.
Dental was not covered; and prescriptions were covered by a deductible and copay type of plan from BC.
Just before we returned to the US, a "Reform" political party was formed, promising lower taxes. They declined to mention that cutting taxes would necessitate cutting services. I believe that's when Canadians began having to wait longer for non-emergency procedures.
Parallel and competing health insurance was not allowed. You could buy individual or group plans for any services not already covered by the government plan. This is essential for the success of a government plan--the rich can't get private treatment and then complain about supporting the public plan.
Improve and expand Medicare for all!
2
I have 2 questions about Switzerland and Germany. 1) In Switzerland, the voluntary for-profit insurance plans “can deny coverage to people with chronic conditions.” Based on other articles about health care, I thought that feature would result in an overload of chronic patients in the basic non-profit plans, which would make them unsustainable. 2) In Germany, private premiums “can be higher for people with preexisting conditions.” Without serious regulation of how much higher premiums can go, expensive charges for pre-existing conditions would seem to be a deal breaker for the U.S. It’s the one feature most Americans want to keep.
2
I read your recent analysis, and I must respectfully say that it's both quite mistaken in choosing the U.K.'s health care system as being superior over Canada's. The best evidence is how satisfied each country's citizen's are with their respective health care systems, and this is something you did not consider.
A recent study published in the Guardian found that, for the first time, more respondents were unhappy with the NHS than were happy with it. This is consistent with what I hear from British colleagues. The survey found: "The latest poll shows 43% of respondents are dissatisfied with the NHS, and 33% are satisfied – a doubling of dissatisfaction in two years." (see https://www.theguardian.com/society/2017/jun/26/uk-public-are-more-dissa...
By contrast, recent polls found the total opposite in Canada: "Most Canadians (85.2 percent) aged 15 years and older reported being ‘very satisfied’ or ‘somewhat satisfied’ with the way overall health care services were provided, unchanged from 2005.” (See https://www.healthcare-now.org/blog/new-poll-shows-canadians-overwhelmin...
Let's also not forget that in 2013, U.S. health-care spending accounted for 17.1 per cent of GDP, versus just 10.7 per cent in Canada, according to an October 2015 report from the Commonwealth Fund.
3
While in Florence, Italy, I contracted what I thought was bronchitis and thought I needed an antibiotic. (I am an advanced practice nurse.) Through a quick look on-line I found a MD nearby with some walk-in Saturday hours who spoke English. The MD was by himself, no paraprofessionals to help or mix things up, no computers to feed information, so I was seen as soon as he finished talking with a patient on his cellphone. I received the most thorough physical exam I'd gotten in years, and my usual care is at a well=-known academic center in the USA. The directions for recovery were extensive and clear. The MD even knew how American treatments for bronchitis differed from Italian ones. He gave me his cellphone number in case I needed him later. I paid 50 Euros with no insurance needed.
Then I took the prescription to the pharmacy, and instead of being given a number and told to wait 20 minutes or come back in two hours while I continued to spread my infection to others, I was handed the antibiotic as if it were a pack of gum. No data entry, no stickers being put on the pack. Quick and easy--and just pay 7 Euros, no insurance needed. I was back to my rented apartment in less than an hour for both stops on foot.
How much provider and patient time and money do we waste in the USA with computers and auxiliary personnel and record keeping that defies common sense?
4
I'm American, moved to the UK five years ago as student. I was entitled to NHS coverage for no charge, though new rules mean subsequent visas include an NHS surcharge of £150 ($190)/year. I happily pay this plus reasonable deductions from my pay and I think it's worth it.
I am healthy, but have received satisfactory and timely care from my GP as needed. In Scotland, prescriptions are free, and regular eye exams. In America, I paid $150/year for contact lenses, with insurance; here I pay £66 ($86). Some are eligible for dental coverage, and as a private patient I pay £108 ($140) for semi-annual exams and cleanings; this is without insurance. Returning to America and having a family would be prohibitively expensive. When my mother-in-law was diagnosed with cancer, we were concerned about her but it was only my American perspective that noted no one was worried about how to pay for it.
The NHS is not perfect, and it is overburdened. Much of this is to do with a decade of spending cuts and pay freezes under Conservatives, who still don't dare to overtly threaten it. It is absurd that Americans don't want to pay for others' care when the burden of chronic illness ultimately rests on society. I have never called the police or fire department but I do not expect to receive a refund for services unused, or for others who have been burgled to be charged more. Why should cancer be different? I fully support a single-payer system, we're all in this together.
8
I visited a small town clinic in Cuba. It was clean, crowded and basically 1960s. The X-ray machine was film and nobody used lead shielding.
I also visited a clinic specific to government workers. It was modern but dirty. Go figure.
I man fell in the stairwell of the hotel, he later died. It took 45 minutes for the ambulance to arrive and when it did there was no stretcher or ambu bag for ventilation. The health worker did not wear gloves......whew!
thank you for your attempt to explain the different options. its still somewhat unclear, but you've made me realize that obamacare, if it hadn't been sabotaged from the right, probably would have worked. also, there are other systems besides single payer that can work. and democrats should do something about Bernie sanders. single payer will never pass and if Democrats go with it, they will give Republicans a victory. Bernie is also misinforming the public.
My experience with healthcare outside the US was in China. to go to the doctor for a simple visit was $2. Usually visiting the ER was fast. But we always used people we knew (guanxi) from our business to bypass lines and find superior doctors. Hospitals were not so clean. They loved dispensing antibiotics like it was candy.
1
the "small tournament" was shockingly out of touch. It mixed completely different systems to compare: Canada versus Britain, claiming that both were "single-payer systems." Completely wrong. While Canada runs a single-payer system, Britain operates the Beveridge system, in which all healthcare providers are government employees: doctors, nurses, and hospitals. In Canada, doctors and hospitals are private sector entities. So The Times was comparing apples with oranges.
Britain's Beveridge system should be compared with similar systems, such as Italy and Spain. Canada's system is the same as in Japan and Taiwan and Korea.
The Upshot should have begun by explaining the major types of system. Sadly, it appears that The Times writers who set up the "tournament" had no idea of the startling differences between them.
13
I broke my wrist while visiting Germany. I was given instant care, cast, and xrays to take home to my US doctor. Total cost - $100. Back in the states, removal of cast by technician, over $3,000.
11
Must get rid of the Chargemaster. Health care for profit is killing people.
2
I've lived in Holland for 6 years. Quality of care is excellent, Wait times are short. All basics including dental and vision are covered in basic policy. Cost is predictable at about $150 per month, with a $385 deductible. Everyone is required to buy insurance.
Until 10 years ago the system was tax based. All free care for all. Now, under an insurance based model, the rentiers are slowly nibbling away at the concept of health, in favor of profit. I saw this happen in the US in my lifetime and see precisely the same trajectory here. It's a shame, even in the short run.
But the Dutch have far more control of their government than the Americans do, and I trust that they will put a stop to it soon. It's the number one political issue.
The conclusion is obvious. Profit and health do not mix. The patients always lose. The Dutch know that healthcare is a a right, have no qualms about society's responsibility to it's citizens, and will right the ship.
The consensus here is that an American style system is anathema in our wealthy world.
15
Any discussion of singapore's healthcare system vs other countries should also consider the relative cost of the healthcare to the people in the form of taxes. I dare say Singapore has the lowest tax rates among all the countries (an individual making USD50k a year only pays on average 2.5% of total income as taxes in this progressive tax scheme) involved in this study and this attests to the unprecedented efficiency in utilizing resources in the Singapore system among developed countries.
5
I am answering the question at the end of the article.
I had great insurance (provided my my husband's American employer) when we lived in the UAE. The UAE's medical care is excellent at treating symptoms, but, from my limited experience and hearsay, is rather poor at treating serious disease. Therefore, it is one of those 'where do you go when you are sick? to the airport" countries.
2
As a Canadian, I agree that the public health care system is imperfect. I waited 12 months to see an allergist for a non-life threatening but worrisome problem. (The wait had zero negative impact on my health.) My parents, in comparison, were both admitted the hospital immediately when they had acute life-threatening problems, and are now healthy and well - and still living in their own homes.
A for-profit health care system is unlikely to resolve the challenges of delivering both efficient and state-of-the-art health care in a country with a low population density and a huge geographic area to cover. (In comparison with Switzerland, that has possibly the highest individual purchasing power on the planet and a very small square footage to cover).
Many of the headline-making problems here are due to pharmaceutical companies charging up to $100K/month for a prescription drug, which provincial health care just can't afford to pay. I agree that innovation and hard work deserve financial reward. But letting another human being die so you can finance your yacht is is an abominable failure of humanity, and of the for-profit health care system.
Yes, there are challenges here, but I would choose them in a (publicly funded) heartbeat, over living in a country that cares more about having weapons to harm their neighbor than paying taxes in order to help them.
11
As an NHS doctor, I'm curious to know how that Canadian system is "easier to understand?" No understanding is required to access NHS services!
It's also worth noting that increasing competition has not improved NHS services one iota. An economic model in which more competition = better quality and better value simply doesn't work in healthcare.
I simply could not work in a system where I had to consider a patients ability to pay before treating them. We are under-funded, over-stretched, and working conditions can be pretty brutal. But I will fight for healthcare to remain free at the point of use and accessible for all as long as I live.
16
Congratulations to the NY Times for finally dealing with international comparisons in health care for readers. Usually we get these only from some reader comments to articles and columns from people who have lived abroad.
TV cable news ignores it---strange since it's a big story to say the least, that the US, land of the Bill of Rights lags dozens of countries in this basic human right. The democracy Americans are taught to be so proud of actually works better in other countries--countries where not too long ago they had kings and aristocracies and class systems that we were so proud to reject.
Our media has kept the American public ignorant of the various long standing systems working abroad.
One media exception stands out--Ali Velshi on CNN stated recently that in no country on earth do market systems work for health care. He grew up in Canada and says his family was very satisfied with their system.
Also a few years ago I happened to catch Sen Bernie Sanders holding hearings on how h/c is financed and used in 4 countries. People from Canada, France, Taiwan and Denmark gave testimony. This was likely a 1st in Senate hearings.
But the media and the Times didn't cover it at all that I could find.
Msnbc had 1 quick clip of a witness from Canada telling a Gop senator that Canadians don't all try to come to the US for treatment, but what about the excess American deaths documented in a Harvard study, due to lack of access to care in their own country?
8
Strange that in Sanders' whole 2016 campaign he never mentioned his senate hearings with witnesses from 4 nations with h/c systems he could use as role models for the US. And so far he and other Dems still havn't mentioned that, even after proposing his Medicare for All bill. Why is this?
In one the debates with Hillary, Bernie very briefly mentioned Denmark regarding something. And Hillary proudly answered -- "But America is not Denmark!" No follow up by Bernie or the media. That's what we get for factual debate in our politics.
4
Could you comment on care in the Italian system- for residents vs tourists?
I've heard polarized experiences-excellent care to abysmal. Thanks.
1
I have a diagnosis of terminal brain cancer. I am currently in the third stage of post surgery, post radiation (five days a week for 6 weeks of treatment ) and am half way through the third phase of a six month home based chemotherapy, which is scheduled to be completed in December of 2017. After that, I will wait for the end of life which will occur up to approximately 18 months. Given my initial seizure was in late February 2017, that leaves me half way through my expected remaining time.
I have been following daily NYT updates on Sen. John McCain and wish him well for his journey. This is despite me being I suppose what you in the United States would call on the other *side*.
Just a few words about my personal experience of the Australian medical system; I have Private Insurance and have been provided with fully free General Practitioner care, free Comprehensive Hospital Cancer treatment and free quality Palliative Care. Given the NYT reports of unclear financial burden for cancer patients in the US, which is proposed to vary from State to State and be reliant on the outcome of individual negotiations with state based private insurance companies, which can have different coverage outcomes, I can only be thankful for the Australian federal system of cover.
16
I wish you well on this final journey and am glad that financial ruin will not have to be a concern for you.
That would not be the case here in the USA. Medical bankruptsy is all to common here and was not addressed. The alternative to financial ruin is to opt out of treatment even if you have insurance.
Again peace and healing keep you comfortble and safe. My inlaws live in Warnbro WA. I envy their much better healthcare.
3
I lived in England and found the NHS to be outstanding! I also lived in Singapore where people love their system and are very healthy with solid lifestyles. Fat people in Singapore are very rare. Great incentives to be healthy. In China I sprained my ankle badly, had x-rays and treatment for only $7.
8
Having been born and raised in Britain, and now a resident of California, I would give my left arm to have America's healthcare system reformed.
What the NHS lacks in shiny waiting rooms and "innovation", it makes up for in the fact that you'll never have to pause before seeking care. You'll never have to wade through mind-boggling calculations - while sick or injured - to work out how much an Urgent Care visit might cost you. You'll never have to wake up to a bill, or wail into the phone trying to reason with an insurance company. And these benefits are available to ALL your fellow citizens and residents.
While any kind of affordable-medicine-for-all system for America feels untenable, I hope that more and more Americans shake off these strange libertarian aversions to "socialised" medicine, and instead orient themselves to the idea that obtaining medical care can be simple, stress-free, and cheap, for every single person who needs it.
15
One key differentiator for France that has real value but I did not see mentioned is that freedom of choice of health providers and practitioners is guaranteed by law (article 1110-8 of the public health code), as a fundamental right in health service provision. HMOs and other structures which limit choices are thus illegal.
11
I spend a lot of time in Geneva and have some experience with the health care. The most apparent first impression is that healthcare is one of the few things in Switzerland that is cheaper than in the US, so the universal coverage does work. Also, the decoupling of insurance from employment is a major advantage. Insurance shouldn't be an obstacle to changing jobs. Still, when I needed an MRI, my doctor advised crossing the border, since France's socialzed medicine makes these quite inexpensive, a fraction of the cost in the US. France still has very high quality facilities, and I think the greater access makes it better than the Swiss system. The Swiss system would be an easier sell to conservatives, especially if steps were taken to cut the link between employment and insurance (perhaps by taxing the benefit).
8
I don't understand why the AMA and hospital systems aren't mentioned as often for being culpable for the Healthcare mess in the USA.
Doctors as paternalistic gatekeepers to healthcare doesn't work. A common theme seems to be that medical school education and salaries are regulated in other countries. Half a million dollar to a million dollar salaries for surgeons who are incentivized by their employers to operate as much as possible is bad for patients. The Times has covered this in detail from unnecessary MRIs to unnecessary knee surgeries. The message to patients is that doctors are just as bad as car mechanics and lawyers if not worse.
7
I moved to the USA & became familiar with the concern of medical care in your country. "How do you plan to pay today?" My Canadian system, with my choice of doctor, focused on wellness, versus only treating urgent care issues. I worked with a woman who's husband developed cancer , was hospitalized & insurance ran out. Forced to sell their only asset, the family home. In preparation for the sale she painted the kitchen, fell, critically breaking her arm & wrist. She minimized doctor appointments when her husband was being treated for cancer to "save". While in hospital she was found to have breast cancer. The house sale money went to her treatment. When I met her she was living in a tiny cabin after declaring bankruptcy in the state she had lived in. In Canada this would never happen It was shocking to hear the story. Thankfully, I am back home and once again part of the Canadian system. We have excellent care. Maybe there are waits for some elective issues but we only have reports of excellent care from people who have been treated. My brother just had major surgery for a fractured neck.We know from experience the Canadian system works & works well. The US system is tiered...wealthy people get treated well but poor people who don't go to doctors because they have not been able to afford it are often in critical condition when treatment is urgent and potential results dire.
In a humanitarian world health care for wellness is a right from birth to death.
18
I think this is extremely egocentric. Dismissing Singapore purely for "limited data" or saying "the US innovates more" is not evaluating the healthcare system.
Furthermore, the examples are cherry-picked. In Singapore, there is an overall older population (longer lifespan) and stroke and heart attack are traditionally conditions older folk suffer (and die) from. While in the US, obesity-related diseases like diabetes and hypertension occur in vastly higher amounts- and overall mortality rate is higher, infant mortality rate is higher, and the method of payment is unaffordable for a lot of Americans. These panellists must be able to afford healthcare, and that's why they can confidently dismiss these pointers and instead focus on things like data.
I do like the NHS system, but it is severely over-taxed and the govt is trying to privatise it. I am strongly against this. Clearly a complete overhaul starting from education-level is needed. I've seen my fellow students drop out from medicine or nursing because of unrealistic hours, lack of welfare and support, along with low pay and unsustainable numbers.
7
I have experienced the Swiss health care system. I am impressed by the focus on wellness from an early age through older years and even in disease treatment.
5
I was travelling in the UK several years ago when I experienced a very sharp pain in my back at about 6am on a Saturday. I went to the nearest hospital (St. Mary's in London). The wait in the emergency room was only about 10 minutes. A nurse examined me and decided that it was most likely a kidney stone. But she also noticed that my heart rate was only about 40 so she rolled in an EKG machine to confirm nothing else was wrong. (A low pulse is normal for me.) Satisfied that my heart was OK They performed an MRI to confirm the kidney stone. The stone was too small to warrant anything other than waiting for it to pass so I was given a prescription for a (non-opioid) painkiller. I told the doctor that I was just visiting so he gave me a prescription for enough painkiller to last the trip and put the MRI and EKG results on a CD for me to give my doctor at home. The whole process lasted between one and two hours. All for no charge.
If this had been the U.S. they likely would have needed insurance company approval for the EKG and again for the MRI and the medical staff would have spent half their time filling out forms. The experience in the UK was far more efficient than any I have had in the U.S. (And I have very good private insurance.)
22
It would have been interesting to have a breakdown of medical expenses across countries, e.g. relative costs of medication ; we know the US is ridiculously high thanks to big Pharma or even standard operations..(although I recognize this might have been beyond the terms of reference of the panel)
3
I have used both our US healthcare system and the Ontario Canada provincial healthcare system, named OHIP. I have nothing but praise for OHIP even though until your a senior, it doesn't cover drugs and has never including dental care. I determined very early on all Canadian systems are run by each province which facilitates management and handling of deficit spending as all are in deficit. Canadians cling to it as their culture as it is worry free that it won't break someone as everyone has access. Doctors manage the weight times based on how critical the need. Canadian and US standards are identical as our drugs prescribed .
5
Some note "these other countries are homogeneous/closed societies that cater to their own citizens" (A universal system by definition is open to all residents, not just "citizens"). So lets look at the Foreign born resident population ranking numbers :
=============================
..................................Singapore 42%
..........................Switzerland 29%
..........................Australia 28%
..................Canada 20%
............US 14%
...........Germany 12%
...........France 12%
=============================
The US has barely more immigrants per capita than the largest European countries, so the suggestion health universal systems depend on "homogeneous" societies is patently false.
22
The health care industry should operate like any other industry within the general legal framework. That is the only way innovation can happen freely. Who ultimately foots the bill should not be a concern to the hospital. They should not discriminate against any patient and should be obligated to treat anyone who comes to their door. A government should protect the weak and has to make sure everybody has adequate health insurance in the first place, wether it is private or public. No family should go bankrupt because their child has a rare disease that is not covered.
8
On a side note: the graphic accompanying the article is ridiculous - that's France (represented by a horseman with a fleur-de-lis on his cape) attacking the US (represented by the Statue of Liberty).
Having a better healthcare than us is an act of aggression?
The guiding subtext: to think the US may have something to learn from the French healthcare system is unpatriotic folks. I mean maybe the British system, or the German one, but France? Thank God (in whom we trust) the "experts" declared Switzerland the winner of this fun little competition.
2
This panel should compare the insurance system in the US for people 65 and over to the insurance system in the US for people under 65...
8
As a Canadian who has been working in the Bay Area for the last 3 years, and spent most of my adult life in Toronto, working and raising 3 children, I would never trade the Canadian healthcare system for the U.S. one. And I am appalled every time I hear Canadian healthcare being used to drive fear into the hearts of Americans.
My Canadian experience:
• I can see any doctor or specialist I choose
• I never hesitate to see my doctor or wait for something to get more serious due to co-payments or deductibles
• Pregnancy, childbirth, urgent care: High-risk pregnancy requiring hospitalization, burst appendix, meningitis scare, etc. etc. Never had to worry about cost or quality of care. Only the health of my family.
• Chronic condition – A child with diabetes type 1 will never have to worry about not receiving the treatment he needs for the rest of his life.
• Diagnostics: 3 MRIs; never waited more than 10 days.
• Prevention: Cardiac stress tests, etc.
• What’s not covered: Prescriptions, vision, and dental. This can mean financial hardship to many with lower incomes. Wish this would change.
• Wait times: Longer wait times but only for elective, non-life-threatening surgeries. When I underwent elective surgery in California, it was scheduled within a month. But I paid more than $4,000 out of pocket, which could represent financial hardship for many others. Trade-offs.
Look at this list – which would be longer except for word count – and tell me. Which would you choose?
20
The US also has a highly litigious population that drive up the cost of providing healthcare. Did the panel take into consideration the legal framework of the various countries?
3
Drug regulation isn't any less onerous in Europe (for good reason) so malpractice insurance doesn't come close to accounting for well over 1 trillion dollars more spent on inferior coverage and poor health outcomes (8% higher GDP spending on average in the US)
3
I have experience of the Irish system. It's a mix of public & private in the same hospital.
For electives it can generate long waits for the public system, especially for non- standard ops. Though if you want, you can use the EU system (the EHIC) to receive (mostly free) treatment anywhere in the EU. A lot of the population have private cover which reduces public lists.
If there's emergency everyone is treated immediately with cover in a public ward (including non EU) private cover can get post-op additions such as a private room etc.
Lots of complaints about delay etc but for emergencies and old age, seems pretty good.
After 40 years under French Healthcare ( Sécurité Sociale) I have nothing but praise for a system which my family and I ( through caesareans, broken bones, cancer, and the mundane childhood maladies) have always found to be affordable, effective, easy to negotiate and truly "humane." My niece, who is a doctor in the U.S., has spent extended periods of time in France and has had first hand experience of French "medicine" (including emergency care) tells me she is ashamed that a modern industrialized country like America continues to fail so many of its citizens. I couldn't agree more.
12
I am American and have lived in France for over 30 years. I have a house both in France and in Florida, USA.
The French system is amazingly efficient due to centralized coding and a Carte Vitale. Even though I have to pay 23 euros to see my GP, I am reimbursed 70% by the government and my private mutual insurance pays the rest. My Mutuelle costs me 102 euros a month. When compared with my experience in the States, bedside manners and patient empathy are not high on the list of provided services, but medical care, coverage and access are efficient and cost effective.
When my husband was hospitalized in the USA for an emergency, we paid out of pocket close to $10 000 for a 3 day visit. A beautiful hospital room with all the amenities imaginable. We were reimbursed through travel insurance and French medical insurance but what was amazing were the individual bills we received for over a year. A bill for an X-ray, another for the CT scanner, anesthesia, etc. Can you imagine checking out of a 4-star hotel and receiving separate bills for clean sheets, towels, min-bar and room cleaning?
When I wanted to return to USA as an American resident and citizen, I was quoted $660 dollars a month with a $6000 deductible. For one, healthy (thank goodness) 61 year old. I returned to live in France. I think the centralized cost efficiencies are key to keeping costs down and the implicit belief by French doctors that their job is a vocation not a money-making investment.
29
I lived in Paris for 6 years and in Sydney for the other 40 odd so have experience in both systems.
In France the system is very difficult to understand and involves paying out of pocket for your gp with no option to not pay (although the amounts are small).
Going to hospital in France is great but you get these weird again unfathomable bills for small amounts of money.
I found the majority of people in France didn't underatand the system but the level of care is fantastic aside from always having to pay for your gp.
In Australia its transparent if you go to a public hospital its free. That's it free no weird bills no confusion just free. If you have private health insurance you can use it if you don't you don't.
Cancer treatments, kidney transplants , giving birth is just free.
You can pay to go to your gp but also there are myriad of options if going to a 'bulk billing' doctor which just means free for the patient.
I prefer the Australian system its easier to navigate and simplier.
9
"I found the majority of people in France didn't underatand the system but the level of care is fantastic aside from always having to pay for your gp."
I come from Canada, where all you do is show your healthcard. Despite that, the French system is fairly simple to comprehend and requires administratively. So your comment on complexity is simply false and amounts to the usual "it's not what I'm used to!" expat whinging.
A visit to a GP in France is 25€. Copays for a simple GP visit in the US can and frequently are several times that. Xrays, tests, cost in the tens of euros or to low 3 figures (an outpatient MRI is 500€, 200€ out of pocket if you don't have private insurance. No charge as an inpatient)
So if all "health care" meant was paying the gp and a few tests now and again I wouldn't even bother with insurance at all and go 100% out of pocket. If your preference is really based on something as superficial paying for the gp and that it's "confusing" then you I suspect you have had the very good fortune of never actually needing health care at all. Keep it up!
4
I picked the French system, However, I would have picked any one of them before the American "Healthcare System." For an advanced country to allow some of its people to go without health insurance or be under-insured should be unacceptable.
While the ACA was a good start, the lack of competition in all of its markets, the rapid consolidation in the Industry, allowing the healthiest and youngest among ourselves to forego insurance for a laughable fine work against keeping the premiums and deductibles affordable.
Even without the efforts by the GOP, the latest one coming today, to kill the ACA I believe it would have failed eventually by just being unaffordable to many.
12
I moved to the UK for a while (dual citizenship) and got my NHS card before I could open a bank account. As soon as I started working, within a few weeks of arriving, something was triggered and I was called for a NHS interview and got my card a week or so later. I was working but couldn't get paid because everything was digital banking and the money laundering laws are so strict that it took six weeks of meeting, calls, etc to open a bank account. A few years after I moved back to the States, I was back in the UK, and fell. Went to a clinic, presented my NHS card and was taken care of. No worries at all.
10
I have lived in Canada most of my life and for a short time in France. Both systems are excellent with some differences. I liked the free prescriptions and quick cate I received for a broken foot after a motorcycle accident in France. In Canada, we do have some wait times but really only for elective surgeries and even then most are not unreasonable. For acute care, we are well taken care of. My husband had severe pain at 2 am recently and after deciding to go to the hospital, we arrived there at 3am. Within 45 minutes of arriving at the hospital, he had an MRI. The results were sent electronically to a doctor in Australia as the hospitals had an agreement to share services. The report came back an hour later with a diagnosis of kidney stones. He got medication for it and, after a little time to make sure he was ok, we were on our way home by 7:30am.
12
So, after reading the comments, all/none of the above wins hands down, eh?
Why not include the Netherlands' health care system in the discussion? Ranked #1 in Europe in this report: healthpowerhouse.com/publications/euro-health-consumer-index-2016/
5
American health care isn't just convoluted and inequitable, it's downright loony. An example: I went back to the US after a few years overseas and wanted to establish a relationship with a doctor, maybe get a physical. I went to a nearby provider, Aurora Healthcare to sign up. I went to the reception desk, and here's how the conversation went.
Me: "Hi, I've been overseas for a couple of years, and now that I'm back I'd like to have a doctor and maybe get a physical."
Receptionist: "What kind of insurance do you have?"
Me: "Um, well, I don't have insurance. I haven't arranged for it yet, I just got here."
Receptionist: "You need to show proof of insurance."
Me: "I just want an appointment to see a doctor."
Receptionist" "You need insurance."
Me: "I understand, but I can pay cash."
Receptionist: "You still need insurance."
Me: "You mean I can't pay cash?"
Receptionist: "You can pay cash but only after showing proof of insurance."
Me (thinking): "Am I in a Monty Python skit?"
29
I had the misfortune to fall and shatter my elbow on the first day of vacation in Passau Germany. While the fall was unfortunate the location was fortuitous. Klinikum Passau is a wonderful teaching hospital. I was seen immediately, had X-rays, an MRI and was admitted for surgery. I did have travel insurance as well as insurance through my employer but was told that due to many bad encounters with US insurance companies I would be responsible for the bill. When all was said and done I had 2 MRI s., a four hour surgery for the implantation of a titanium elbow, X-rays and wonderful nursing staff and incredible doctors over my 9 day stay. I was panicked when I asked for the itemized bill. I received a one page bill totaling just over $10,000 . One can only imagine what this stay would have cost in the US. My one complaint was the length of the stay. There was absolutely no "rush" to discharge me. Healthcare is "free" for all Germans and a single payer system. We all know that nothing is free and taxes are significantly higher than in the US....but it must be very reassuring to know that all you need to do is produce your healthcare card to receive truly first class care and no monstrous bills will appear in your mailbox. I was truly thankful and impressed.
14
I don't understand the panel's single-minded focus on "innovation" and what have you. As if only the United States "innovates" in the medical field. Is everyone else just borrowing America's work? Is that why your healthcare is so expensive? It's used to "innovate"?
The previous commenter "Jethro" clearly shows that by America's own estimates (and Newt Gingrich's!) the cost of healthcare in the US is not the price to pay for cutting edge innovation, which significantly comes from publicly funded research anyway.
Frankly, with the fact that America's healthcare costs are double the next country in per capita measurements, your healthcare system should have "innovated" its way out of mortality! Except it hasn't. What it has given you are a life expectancy slightly higher than Cuba's, an infant mortality rate meandering between Slovakia and Hungary's, and a maternal mortality rate close to that of Lebanon's. All with dozens of millions of uninsured (with more to follow if the Republicans can help it).
Innovation is entirely possible without price gouging. In fact, if price gouging were not a possibility, I suspect you would be very surprised how the healthcare and pharmaceutical industries will somehow still manage to survive this devastating blow and still innovate, especially considering how much the public funds of this innovation anyway.
Even the United Kingsom, the most "socialized" system on this list, still somehow innovates. Somehow.
36
"The Australian system is basically two-tiered: a public insurance-and-delivery system, and another based on private health insurance, each of which cover roughly half the population"
Unless I am misunderstanding, the last part of this statement is untrue. Australia's public insurance covers 100% of the population, regardless of whether or not you have private health insurance. For example, I have private health insurance but when I went to the GP the other day, I was covered by Medicare.
I don't think it's correct to say that public and private insurance each cover roughly half the population.
10
Agree. Private healthcare here in Australia is kind of an adjunct for extras physio etc anything serious is free
4
I'm a life long Canadian who is very proud of our system. Is it perfect? No, especially after reading this article. To me it boils down to this; as someone who could afford private faster/better care, I would rather that money go to people who can't afford it. They could be my family, friends, neighbours or co-workers that need it! There are longer waits here for less serious conditions but if you need quick and acute care - it will come swiftly. It makes me sad that the US Gov. could easily afford to help out citizens who can't afford care, spend much less GDP but can't get it done.
21
My primary care physician in New York is paid $167 for a 15 minute visit. That's an hourly rate of $668. If my PCP works a 40 hour work week, he brings in over $1,300,000 in revenue. Say he pays $100,000 for a nurse (which allows him to see even more patients), $70,000 rent, $60,000 for a biller, $50,000 for a secretary, $50,000 for accounting, $10,000 malpractice insurance, $10,000 utilities, $65,000 uncollectible accounts, $65,000 depreciation, $20,000 miscellaneous. Total costs equal $500,000, subtracted from $1.3 million revenue... um, is my PCP netting $800,000 per year?
11
That is still a lot to take home in a society where the level of inequality can't even be measured. Our healthcare system is incomparable with most European nations, for instance Finland where I spent almost a decade. Even one no matter the status is insured by the state. In all those years I never happened to see a prescription medication advertised on TV. If doctors do their homework why should pharmaceuticals influence people's choices??? All that counts to the reason why we know what cam benefit many but refuse to make it happen here in the States.
13
Is that what the insurance actually reimburses? When is there time to write notes, return calls etc Paperwork takes 50%? of doctors time. You also underestimated cost of employees ( payroll taxes, medical insurance in many cases etc) The internists I know don't make that kind of money at all..
4
A primary care physician who nets $800K per year? This doesn't sound right. A specialist maybe, but not a PCP.
By the way you should factor in vacation time and holidays.
2
I have worked in Canada and the United States, in two states and three provinces, for both large corporations and small companies. My family has been insured by quite a range of public and private insurers.
I can state unequivocally that the quality of medical care in the United States is far better than it is in Canada. More doctors, quicker access, and a better range of treatments, especially in the area of mental health.
The problem in the U.S. is affordability and consistency. If you have a good income and a good insurance plan, you'll be fine. In Canada, you're protected against medical bankruptcy, and although this is no small thing, you pay for it with longer wait times and shoddy consultations.
In terms of overall security against the risks of life, the Canadian system is probably better. U.S. doctors are greedy, but they also grasp that the patient is a paying customer. Canadian doctors are largely indifferent.
The Times should be commended for doing this kind of comparative study. However, health statistics only give a partial view. More effort should be put into gathering the experiences of people who have lived with multiple systems, because they're a lot different in real life than they look on a spreadsheet.
7
None of the comparisons dealt with the most concerning issue: long term health care. This is what bankrupts nearly everyone and the regulations on type of care varies wildly depending on geographic location. The other scary issues: high cost (and continuing to spiral upwards) of prescription drugs as well as chronic disease's cumulative costs.
Another area, briefly touched on is medical personnel. The regulation of the number/ type of specialties is determined by an artificial barrier .by medical schools This plus the lack of public tuition funding of those going into medical fields result in more specialists whose earnings are higher than the generalists (family, geriatric, and internal medicine). These cause disincentives for the latter: where the need is the greatest, pay is the lowest and recruitment is harder for communities (especially rural) clinics, and hospitals.
These need to be part of the comparisons.
4
I lived in the U.K. for five years and got to know the British health care system well. On the positive side, the NHS is great at minor emergencies. For example there was a hotline you could call and get an RN who would do an initial assessment based on your description. If necessary she could have a doctor call you back or could make you an appointment at an acute care facility. We used this service many times and were always well taken care of. With supplemental private insurance (I had it through work but you can buy it on your own and it's not that expensive) there was essentially no wait when you were referred to a specialist. On the other hand, the NHS does not do preventive care. We had to pay out of pocket for private doctors to perform annual physicals and regular checkups for our son (the NHS does not see babies after they go home from the hospital until they are 2 or 3). Communication was also terrible. I had some tests done and the GP's office made no effort to get the results to me, there is no electronic record keeping and communication between different NHS facilities is done by regular mail. I heard horror stories from friends about giving birth in NHS hospitals and having to recover in a ward with 20 other women and the lights on 24 hours a day with families constantly coming and going (private insurance does not cover pregnancy and childbirth so unless you are very wealthy you are stuck). All in all I do not miss the UK system one bit.
2
Just to clarify and correct a couple of things here. Declaration of interest, I am a physician working in the Emergency Department and intensive care department in the NHS.
Babies are seen numerous time after they come home from hospital. In fact GPs (PCP) do a number of baby checks!
Secondly there is little to no evidence that annual check ups do anything other than cost money. There are screening programs in the UK for certain cancers etc and GPs (PCP) have programmes to keep cholesterol/BP levels low etc and also do check ups for those with chronic diseases but there is no evidence an annual health check up for well young and middle age people does anything to help their health.
7
I am British and gave birth in the U.K., although I now live in the USA. All new mothers are visited at home by community midwives, and often receive months of regular visits from a health visitor. They can also attend weekly clinics with a health visitor for as long as they want, for weighing, advice etc. They will also be called in to their GP's surgery for vaccinations, and a baby check at around eight weeks. They can of course make an appointment with their GP at anytime to discuss a particular problem or concern. The US system of annual health checks to tell me that my healthy, normal child is healthy and normal seems like an unnecessary money-spinner.
It is, however, undoubtedly true that British maternity wards are very noisy!
2
I had the good fortune to fall gravely ill in Italy some years ago. Although merely a visitor, thanks to the government-run health care system, the bill I was presented with upon discharge was 1/10 or less of what I would have faced in the US even with insurance. And the bill was a single page, with one "pay this" number at the bottom. Might I have received better care in the US? Doesn't matter -- I would have been financially ruined.
21
Same here. The bill was optional, too. Of course, we gladly paid for the care, particularly as it was as good as the stateside care but a tenth the price.
7
I live in Portugal which uses a similar system to France and Germany. We have global access to healthcare at 9%of GDP while we have the option to complement with health insurance for a better experience. I have had 2 kids, one born in a private hospital and another at the public hospital (we were on vacations and he decided to come out early). The difference? The private hospital costs 4K USD, a great private room and an hospital that resembles an hotel . The public hospital had 4 mothers in a room, the facility was older but care was still great, my wife and son had to stay over for 10 days and the bill was a surprising zero. I am sorry to say this but your system is horrible, depriving millions from healthcare and still spending 2-3x more? Are you kidding me? Even though I am an user of the private system via insurance I contribute with my taxes to the state health system and I do so happily because I know I am helping others and life has its twists and i will always be safe
13
You couldn't find one woman to participate in this panel? Isn't that what health advocates have been slamming Congress for?
6
The Best Health Care System I've experienced "outside" the U.S. U.S. Army Medical Department Care. "Everybody In, Nobody Out" (including POW's). The best healthcare system in the U.S.? If you have money, all the hospitals and clinics. That includes veterinary hospitals & clinics if you are a dog with a owner with enough money.
5
That's cute that you think the US has a better system than Singapore. Cute and tragic...
9
The fact that you have exactly zero practicing physicians on your panel makes your survey essentislly worthless! These are the people who actually deliver healthcare, and by the way, with the hospital takeove of outpatient care, a colossal waste of money, 6o% of physicians are experiencing burn out, you are wasting your time!
4
Maybe your average GP doesn't have the global view needed for these kinds of questions.
1
Physicians can bring their experience to the discussion but the conflict of interest of being part of the system means their views are inherently biased to their corporation rather than patient outcomes. Any objective outside observer must conclude physicians aren't qualified to evaluate health care as a system.
1
I grew up in Canada and went to college and law school there before moving to the US. I have a very intense job and pay for a great health care plan. While I love Canada, the health care system is one reason I would not want to go back. Wait times are very long - even if your condition is serious - and even though you don't pay for medical care with money, you pay with time. I like having a safety net for everyone, but if I work hard and can afford a better plan, I should be free to take that option. I wish Bernie supporters had more insight into the Canadian system before touting it as so amazing. They are as ill informed as their counterparts on the extreme right.
2
I love the idea of having a joust of world health systems, and all the more because it's interactive and enables readers to engage. However, I got halfway through and realized that there was not one woman on the panel. Good grief, for an article trying to bring different world views and systems to light, you couldn't find enough (or any) female panelists to represent the other half of the American population? Yeesh.
2
While Australia's system has points that could be improved, one of the stark contrasts to the US (possibly others?) is that private health insurance rates are community-rated. This means, one price fits all and the rates are relatively low. Denial of insurance is not permitted.
I have experienced the US system in different decades - 90's and now. Now is better. Just. Each time, when seeking insurance on the open market in the US, my age medical history and other factors are used to calculate a (huge) price - the poorer your health (possibly impacting income), the more you pay.
While community rating may not sit well with a doctrine of rugged individualism, it does provide affordability to a wider group. Less are left behind.
6
This article may have provided worthwhile information about other healthcare delivery systems in the world, however, I take offense at the exclusion of even one woman on the panel of experts. Half of the US population are female and our needs, whether the same or different than males, should be represented in a discussion of health insurance distribution systems, here in the US. We're all in this together, but sometimes, you wouldn't know it.
8
The US government disagrees with the claim that there's a connection between America's costly, free-market medicine and innovation:
“Higher prescription drug spending in the United States does not disproportionately privilege domestic innovation, and many countries with drug price regulation were significant contributors to pharmaceutical innovation.”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2866602/Why the claim that the US especially innovative in medical matters?
Indeed, around half of the major pharma companies are European, and per head of population the US is strictly average in Nobel Prizes for medicine, falling between France and Germany. (The outlier is one of the few countries with socialized medicine: the UK, which per capita has almost twice as many Nobels in medicine.)
http://stats.areppim.com/stats/stats_nobelxmedxcapita.htm
Even within the US the real breakthrough research is done in government labs, as Newt Gingrich (of all people) told the NYT: "When it comes to breakthroughs that could cure — not just treat — the most expensive diseases, government is unique. It alone can bring the necessary resources to bear. [The federal government funds roughly a third of all medical research in the United States.].”
11
I'm a Canadian living in the US for the past 2 years (as a student). I must say that I have anxiety about not being able to go to a doctor if I need to (I'm currently no longer a student and am unemployed and uninsured)...the 'what if' thinking. Something I've never felt. That is the biggest difference I've noticed in living here.
Other than that, the rest is the same...in Canada I have to pay for medication, I have to pay for optical, and for dental care (a lot in this case as I have cavity-prone teeth). Employers offer coverage of a portion of these services but there is still usually an out of pocket expense.
I've noticed that continuity of care and access are dependent on the company you have insurance with. This seems terribly inefficient and unfair. I'd like to see a single-payer system here in the US with more control at the federal level...but then again I'm biased.
3
It's astonishing that the professionals used reasoned logic to pick France over the UnitedStatea by60%-40%, but the apparently far more prescient NYT readers went 91%-9%. This leads me to conclude that a bunch of readers have a less than rational perspective of their own healthcare system. But this isn't a topic the generates a lot of thoughtful discussion.
PS: I've received healthcare in Singapore and my brother has in France. After comparing notes, it is clear that as one element of a aocial welfare system, Singapore is decidedly superior. A quick check of comparative median income and life expectancy might indicate which bation gets the superior result from its social welfare policies.
3
France, clearly.
2
Right, the winner is the country that earns less and dies younger ... France.
1
40% of the professionals picked the US because they decided to emphasize innovation for some reason. Yes, the US's system might be better for innovation but in terms of access, they are way behind.
2
Will no one point out that these countries are fairly homogenous? I think a great deal of their systems' success can be attributed to that. Although, Europe won't be homogeneous for much longer.
Definition of homogeneous, outside Singapore?
1
Having lived in Singapore, twice, and now a loyal fan and frequent visitor, I can assure you that the population mix of chinese, malay, asian indian and european people is NOT homogenious. Singapore is light years ahead of the US in transportation, health, education, infrstructure, housing.....for ALL of her citizens.
4
Eh? Homogenous?
I lived in France from 1987 to 1992. The French system made good sense. Insurance costs were part of payroll deductions. I could then choose a doctor or dentist. If he or she charged more than covered amount, I paid the difference. Access was quick and I was able to shop for the provider I liked best. I never needed hospital care, but friends who did thought it was good and rehabilitative care was excellent.
I have lived in the UK for 25 years where access to doctors is free, but I often have to wait a week or more to see a GP. Time with each patient is limited to 10 minutes. I rarely see the same GP.
Surgery for hip/knee replacements can entail waits of 6 months in the UK. Physiotherapy and aftercare are scarce. Patients have to pay for rehabilitation privately for the most part and services are nowhere near the standard in the US or France.
Private medicine outside London is not readily available, because specialists work for the NHS and devote a few hours a week to private patients, so long waits are involved to get an appointment. Private insurace costs increase with age and medical history and are quite expensive.
Good points of the NHS are for critical care such as cancer treatment, where care is excellent, rapid, compassionate and invoves no filling of insurance forms and settling numerous bills. Emergency care is also good, but stretched to the limit.
2
Most of these societies are closed systems and their health care services are limited only to its citizens. What would those systems look like with respect to cost, access to care, and quality if they were opened to all residents? What would those systems look like if the US cut back on innovative services, which would likely happen under a Sanders system? Until we focus on those questions, as healthcare processionals, we really misrepresenting the true cost to the American public.
The European systems are open to all residents. One can even fill a form to get the European insurance card and get access to another country.
I am also not sure about the innovation merits of the healthcare system in the US. In part it might foster some innovative treatments but in part the system just seems broken - why a baby delivery in San Francisco costa over 20k while San Diego costs 3k?
5
The NHS is free at point of use to everyone ordinarily resident in the UK.
1
In Ontario Canada, a person on a temporary resident visa can have public health insurance after 90 days. Different provinces may have different rules. Nationwide in Canada, refugees are granted health care with no waiting period.
3
Market cries for hybrid solution of medical "tourism" between Mexico and USA. Unfortunately, insurance and pension plans are captives to AMA and KStreet locks.
Having lived in and used health systems in multiple European countries, I agree with most commentators that all are equal or superior to the US system in terms of docs and facilities. One point not mentioned is the wonderful feeling of not having to argue with insurance people, chase them, show credit cards before care, and generally deal with large amounts of confusing paperwork. I feel like that's added 5 years to my life!
25
More than a good point, it's absolutely vital.
When you are at you lowest, you can do without a kick in the gut!
4
I couldn't agree more about the bliss of no or little paperwork, in both France and the UK.
4
I'm a long-time Kaiser patient, now on Kaiser Medicare, and their system aggressively promotes prevention and health maintenance while limiting costs, in ways that I understand European systems try to learn from. That said, I think a better "competition" would be to figure out what elements the US can use to construct a universal system. We'll never have an NHS, an accident of the post-war period in Britain. And as experts I'm sure you know that these systems were all built on what currently existed, like insurance pools. So the question is what the US can evolve into, not whose system we like better. Medicare/Medicaid for all with optional supplemental private insurance like Kaiser, which we have under Medicaid, is an achievable option. The financing through the tax system--payroll taxes will be necessary--is the biggest sticking point in our anti-tax political system.
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Medicare works And the ACA would work if the premiums were substantially lower The problem with the ACA is that it finds itself seamped by older sicker patients while younger patients dont enroll So lets allow medicare to cover everyone 55 and older removing older sicker folks from the exchanges and then have everyone else not on medicaid covered by a leaner less expensive ACA with lower deductables and conpays
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Canada Seniors do get a sudstantial amount of
Free Drugs
1
I heard Switzerland has highest rate of Prostate cancer in world. explanation?
Relevance?
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Switzerland has one of the highest longevity rates besides Japan. Therefore, the older men get, the more likely they develop prostate cancer.
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An explanation for how/why you heard that, or an explanation of your still-hypothetical assertion? On the former, I can't comment, and on the latter I won't comment.
It is worth remembering the numbers. The US sytem is around 3 times more expensive than Britain, Germany or France. Where does that difference go? Into the runnng costs and profits of the insurance companies.
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It's actually about twice, perhaps less.
1
and paying high compensation to Drs
1
I'm from the US but live in Paris now, where I pay for health care out of pocket and am reimbursed by private insurance. I've had a baby here (3500 euros) and spent four days with the baby in the ICU (5000 euros), both of which would have bankrupted me if I'd been home in the US and didn't have coverage. The care is very good. I can have an emergency house call from a doctor for about 85 USD any time of day or night. It's an amazing system and I wish the US would take a few pointers.
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Having had 2 children in the US, delivery costs
four times higher than in Australia for the 3rd child, the biggest shock was the cost of the first
"newborn" visit with the pediatrician. $300
in 1990/1992 vs AUD 50 in 1996. That last charge was 40% reimbursed by the Australian Health Service.
Americans call their insurance companies, are happy to wait on line for customer service and fight for reimbursement, but don't want "socialized" medicine. I'll take caring community payer provided medicine over corporate payer greedy medicine every time!!
Americans need a website where they can plug in the details of their medical bill, press the button, and see how they would fare under each of the medical systems covered in this article. Thank you NYT for a good start.
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The conclusions regarding Singapore are underpinned by a factually inaccurate understanding of the Singapore health care system.
While it is true that Singaporeans age 55 and under must fund a mandatory savings scheme with 37% of wages, the employer contributes 17% and the employee contributes 20%. The annual employee contribution from salary is capped at the equivalent of US$10,700 per year. And only 10.5% of the 37% is allocated to the health savings account.
A Singaporean at the ordinary wage cap therefore contributes US$3,000 per year to his or her health savings account - about 5.7% of salary, not the full 37% suggested in the article. Clearly, this is not the "huge mandatory savings requirement" that "would be a nonstarter to most Americans," as Mr. Carroll states.
Additionally, government hospitals provide a care at subsidized rates and Singaporeans are covered by a national insurance scheme. Co-pays and deductibles are payable from the health savings account. The current premium is about US$200 per year for a Singaporean age 55 or under. Reasonably-priced private insurance can be purchased and "integrated" with the national insurance for enhanced coverage.
Finally, it is worth mentioning that the income tax rate in Singapore starts at 0% and increases progressively to 22% on income above US$237,000.
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Thank you for a great briefing on health care in other countries. The panel considers innovation a benefit of the US system. I have mixed reactions: the innovation is important but high prescription costs have become a focus for companies and patients trying to control costs. I am heavily incentivized to choose the generic over the more innovative branded medication.
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If you are using generic drugs, then you are a beneficiary of innovation. Generics are usually copies of expensive brand-name drugs whose parents have expired. If there was no incentive to innovate, then there would be no new drugs for generics to copy. Innovation eventually helps everyone, around the world, rich or poor, despite the fact that the rich are usually the first to gain access.
Brian, Patents are a state sanctioned distortion of markets. Everything about patents is up for discussion. What isn't up for discussion is the unending economic rent patents provide.
Education, Brian. And critical thinking. Both will lead you to the conclusion the drugs and treatments will continue without making outrageous money at the price of your compatriots' lives.
2
I'm a currently healthy 77 year old American who spent a significant portion of his business career abroad. I've experienced the healthcare systems of France, Germany and Great Britain and am currently a member of the US' Medicare System. I've received excellent care in all four countries but my access, quality of care and the affordability of my were far better in Europe than in the US. I prefer the French system by a narrow margin over the German system but want to stress that even Britain's much maligned system is far superior on every measurable metric to the US system. When I was on a private gold plated US health insurance policy (long before the ACA) and became very ill, my major US health insurer refused to renew my insurance policy and I was unable to find a replacement policy at any cost. Fortunately, I was still qualified to be a member of the French healthcare system as I was and am a French taxpayer in addition to my US tax obligations. So instead of being both bankrupt and dead more then 30 years ago my life was saved by the excellent care I received in France. I was able to go on to a productive life, including founding several companies that have provided thousands of jobs for both American and international employees. The US healthcare "system" is an expensive farce that only provides quality care to a minority of our citizens.
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Congratulations on being a "job creator" in the best sense ie with a conscience.
4
This is all well and good, but there really should be an emphasis on what really matters: longevity and health-based quality-of-life, expressed as a ratio to cost. Provide life expectancy for these nations - hard to beat that as a measure of a good healthcare system.
Some examples of the quality-of-life benefits of universal coverage?
In Canada, the waits may be long for elective procedures or tests, but not for emergencies. Canadians live longer than Americans, and income-adjusted survival is far better than the USA - for much lower per capita cost.
In France, new mothers get government-subsidized childcare and they get their salary covered during an appropriately long maternity leave.
There are other objective measures of quality than what are used in this exercise.
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I've lived in Canada and France, and depended on both health care systems.
Hands down, France wins it. There's a whole lot more to access to health care than price point and here, France MAY beat EVERYONE.
Canada is nice, but only compared to the US.
11.2% of GDP may sound expensive to some but there's a reason for it : income replacement. Half of health care spending goes to medical leave. I don't know about you, but there's no way I could financially survive months off work without income. Could you survive 6 days, or 6 months off work (or longer!)? Which of course means, I would take my chances. I'm in the "more" category here.
I might literally be dead today otherwise, and in the absence of information or a discussion on this topic, there's absolutely zero chance I'd trade it for "superior *perceived* quality of care" in Switzerland and certainly not in Germany. The rest aren't even worth considering.
7
I'm an American living in London. I had Kaiser in the US. I was surprised by how disconnected the NHS is -- there is nothing like the Kaiser electronic health record, where any doctor treating me can review my health background. I've never had a doctor I could name -- my local surgery has 30 GPs and a three-week wait for the next available appointment.
Also, there is a "post code lottery" -- health services are selected and paid for by a local council, so when I moved one mile across London, my health services got worse because in my new neighborhood the council is poorer. Also surprising that the NHS depends so much on faxes, letters, and pagers.
As a middle-class earner, I would say the care I've received in NHS is worse than Kaiser, but overall, I like being part of a system that provides care for all people, not just people on good salaries.
5
I am an American who has lived in France and Australia and accessed healthcare in Sweden and Germany. I prefer Germany. It is cutting edge, science-driven medicine that is accessible to all. Of course, any of these is preferable to the current US system. I am on Medicaid but also pay $650 per month for private insurance to access specialists. That is on top of the Indian Health System, which I use as a primary provider and for dental care.
2
Excellent article. It's a debate Americans must have openly to inform them of the realities of other first world countries. I've experienced the efficient and preventative care of kaiser in California through work based insurance fortunately and the orderly and effective Australian system. Americans must be willing to pay for a health care system through a Medicare levy and dismiss the notion of every man for himself
3
Measuring healthcare spending relative to GDP is good for making comparisons between countries, but keep in mind that it doesn't accurately express the healthcare burden. For example, the US spends around 18% of GDP on healthcare, but it costs the average family around 30% of their income ($18,000 cost of healthcare for an average family / $59,000 median household income).
4
I have lived with the Australian, French and German systems in addition to the US. I find the US the worst, in part because of its complexity (and incomprehensibility) but also due to level of care.
Australia was the most no-nonsense in terms of baseline procedures like vaccines and the like. The US is somewhat there thanks to ACA -- you can get a free flu shot, for instance. But you sometimes have to know who takes your insurance.
Something France and Germany really do very well is home care. My dad was visiting us in France (on his way from visiting India) and appeared to have malaria. The blood lab came by to our house to take the sample because he was not well enough to walk. They didn't charge extra. The neonatal care was excellent ad detailed as well when compared to our experience in the US.
In Germany home visits to my mother in law after cancer treatment were covered by insurance. As she approached the end of her life due to Stage 4 cancer, the home care came twice a day to change her dressings, and more often the sicker she got. She was able to stay in her home and die in the same room where she was born, instead of in a hospital or other strange location.
18
Try France. I have known the Danish single payer system for 30 years. It has excellent formal access, as it is free at point of use (dentistry and glasses excepted, yearly co pays on drugs). However the practicing physicians tend to be complacent and more interested in brushing the patient off and getting him out the door. Their is little preventative care. I got a one time health check at age 50 only because I screamed and yelled. There was a battery of blood tests but nothing else. The kind of care and testing common in US is unheard of. Acute care is almost impossible because they have introduced a gatekeeper phone system and forbid you to go directly to the emergency room. There have been scandals of phone waits of 45 minutes, indifference, gross misdiagnosis of lifethreatening septicemia and meningitis, etc. Deaths can and do result.
On the other hand some practicing physicians and most specialist and hospital doctors are dedicated snd competent but the government undermines them. Costcutting and bureaucracy are now so bad that nationally known spwcialists leading departments at tertiary teaching hospitals are resigning, and not quietly, either. The decline has become alarming. It costs half the US system, but life expectancy is poorer than many developed countries.
1
Denmark spends less than 11% of GDP on healthcare, while the US spends 18%. If Denmark were to increase healthcare spending by over 50% to match US spending, would that improve the patient experience? If yes, why don't people vote to increase the healthcare budget?
1
Keep in mind, the US spends over 50% more on healthcare relative to GDP than each of these countries. The difference is over a trillion dollars per year. If the British system increased their budget by over a trillion dollars per year for medical research, would they see more innovation? If the Canadian system doubled healthcare spending relative to GDP, would they see reduced wait times?
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