Comparison of Large Democracy Health Systems
Continuing the informed conversation on health systems from
the previous post[1],
this table shows how the US compares to several large democracies with national
healthcare systems which include private insurance and clinics.
Criteria
|
France
|
Germany
|
Australia
|
USA
|
National mandate for healthcare access and insurance
protection
|
Insurance is provided to up to 99% of residents; hospitals are
owned by the government; clinics can be public or private; health insurance
is required, through three government run companies; workers pay up to 8% of
income and employers pay 13% as a wage tax
|
Insurance is mandated for all and residents pay up to 8% of
gross income into the nonprofit state-run insurance program;employers and employees contribute to a comprehensive health, long term care, and accident protection program; insurance may be either
public or private; group healthcare was standardized here in 1883
|
Has a national healthcare system called Social Security,
which provides hospital coverage, but not all of outpatient care; financed by 1.5% tax
on gross income (2.5% if you lack private supplemental insurance)
|
Hodge podge system, VA and private insurance varies widely
by region; medical insurance was mandated under the PPACA but was reversed by
Trump; Medicare is paid by a 1.45% payroll tax on workers and employers; lack
of hospital price transparency
|
Public versus private care hospital overview
|
62% are Public 24% are private nonprofit and 12% are
for-profit hospitals
|
50% are Public hospitals and the rest are a mix of
nonprofit and for profit
|
66% are public hospitals,
33% private; public hospital care is free to residents
|
20.% government owned hospitals, 58.5% are nonprofit and 21.3%
are for profit
|
Specialty care is readily available
|
Yes, doctors even make house calls
|
Yes
|
Yes, in western Australia, less so elsewhere
|
Yes, if you have the money to pay
|
Hospital bill per discharge
|
$11,149
|
$6,122
|
$10,874
|
$21,186
|
Private insurance is available
|
Yes
|
Yes
|
Yes
|
Yes, and is a must if you want care
|
Cost of healthcare per capita
|
$4,600
|
$5,551
|
$4,708
|
$9,892
|
Cost of care born by government
|
86%
|
85%
|
69%
|
51%
|
Average cost of health care paid by residents per month
|
10€ or $11, very small co-payments; referrals may be required for specialists in order to get max benefits
|
Germany limits cost-sharing to a 2% max of income, which
is a little over $100 per month; All Germans contribute to the healthplan, roughly 400
|
$167/person is the average cost for private
insurance/person; co-payments are limited to $25
|
CMS estimates Americans spend $267 in out of pocket
expenses and over $500 for insurance premiums
|
Per capita spend for insurance administration
|
$272
|
$255
|
$123
|
$787
|
Conclusions
The American people pay a much higher percentage of total
health system costs than residents in the other democracies. And residents of
the US are not getting better quality care for that huge disparity. Considering
the average cost for unreimbursed care and the typical insurance contribution
born by an American worker, totals $9,200 per year, this money could be
invested for a healthy retirement savings or to purchase a home. Voters of millennial-age
are realizing this rip-off, which is why they support transformation in the
government through Bernie Sanders and Elizabeth Warren. It has taken a few
decades but the majority of Americans are finally realizing the current system of
healthcare in the US is failing them.
And this is the healthpolicymaven signing off, encouraging
you NOT to sign blanket releases when you have inpatient procedures done, do
indicate that for which you consent and that for which you decline. If you are
intimidated by medical jargon and administration procedures, bring an advocate.
References
Institute for Quality and Efficiency in Health Care.
(2018). Health Care in Germany; The German Health Care System. NCBI,
NLM,National Institutes of Health.gov. Informed Healthcare.org. Retrieved
September 30, 2019, from https://www.ncbi.nlm.nih.gov/books/NBK298834/
Petersen-Kaiser Health System Tracker. (2019,
September 30). Petersen-Kaiser Health System Tracker. Retrieved from
Henry J. Kaiser Foundation.org: https://www.healthsystemtracker.org/indicator/access-affordability/percent-insured/
The Commonwealth Fund.org. (2019, September 30). International
Health Care System Profiles. Retrieved from The Commonwealth Fund.org:
https://international.commonwealthfund.org/countries/
Tikkanen, R. (2019, September 30). Multinational
Comparison of Health Systems Data, 2017. Retrieved from Commonwealth
Fund.org:
https://www.commonwealthfund.org/sites/default/files/documents/___media_files_publications_chartbook_2017_multinational_comparisons_of_health_systems_data_2017_rtikkanen_pdf.pdf
Transferwise.com. (2019, September 30). Healthcare
in France: A Guide to the French Healthcare System. Retrieved from
Transferwise.com:
https://transferwise.com/us/blog/healthcare-system-in-france
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