(Part One of this series can be found HERE..)
are three more countries with health care systems to consider. Every single one
of them is way above us in the WHO health system rankings, and every single one
of these countries has a legal and ethical commitment to provide universal
health care to everyone residing in their countries. That is the main thing to
keep in mind here. Is it possible that our method for getting to universal
coverage is less important than just a dedication to universal coverage?
through these and see what you think. Oh, and one more thing. When you see the
term "private insurance" in the examples below, it does not mean
Say what you want
about Italy's often-chaotic government, they've been able to put together a
very credible health care system that seems to be able to withstand drastic changes in government philosophy. In the case of Italy, it's all about setting priorities.
The Italian national
health system, known as Servizio Sanitario Nazionale or SSN, for short,
provides low or no-cost health care to all EU citizens. It is designed along
the same lines as Britain's NHS, meaning that it is single-payer, socialized and it's based on the principle that all Italian
residents are entitled to free and equal access to quality health care. The
system is very efficient, due largely to its decentralized nature, as most health
care delivery is handled locally, not from the federal government. As a result,
the percentage of GDP Italy spends on health care is around 8%, or half the
percentage spent by the United States last year.
Simply everyone is
covered. Employers pay 100% of the premiums, and with a few small exceptions, health care is as close to "free" as it gets to Italian residents, and everyone else in the EU. Most
inpatient hospital treatment, including tests, medication and surgery, is covered. For
outpatients, coverage includes all or part of the cost of medications, visits to family doctors and other medical professionals, and even dental
treatment. While the system was conceived as completely free, and has remained
so, for the most part, a system of co-pays for drugs and some specialists,
although chronic, disabled and elderly patients are exempt, as are those with
Among Italians, the public hospitals
have developed a less-than-stellar reputation for various reasons, mostly
undeserved. Some of the buildings and facilities don't look as nice and modern as many others in Europe, partly due
to neglect from right-leaning governments, but mostly because the system has decided to place an emphasis on the quality of medical
care, rather than aesthetics. Italian health care is reliable, and the doctors are highly skilled.
But while the NHS dominates the UK, many Italians pay for
private health insurance over and above their guaranteed coverage. With a
private plan, you can choose any doctor or specialist, and avoid long lines
just to get an appointment. And private hospital accommodations are luxurious;
some have described them as looking like 5-star hotels. That does not mean the
medical care is better, however; by most measures, the quality of care in both
public and private hospitals is comparable.
But as private insurance becomes more popular, something else is
happening in the private health care system; perhaps you'll recognize
it. Because care at private hospitals is very expensive,
private insurance is increasingly limiting treatment coverage, and denying claims. Of course, all is not lost if a private insurer denies treatment, because the public system is still available.
The Italian system was created in 1978, and even with some of the complaints about
the public system, the results are stellar, with Italy ranking number 2 on the
WHO health care chart, just behind France. And every Italian politician who
even tried to mess with the system was tossed out of office.Of course, being that we're talking about Italy, well…
Singapore also has a
universal health care system, in which everyone is entitled to care, but the approach is actually quite unique. Many experts suggest that the Singaporean system can't be replicated most places, but it works for them. What makes it different is that the government only provides catastrophic care and guarantees basic care. They rely heavily on private
insurance and delivery. Because of their efficiencies in care and delivery, overall health care spending in Singapore only amounts
to 3% of its GDP, and two-thirds of funding actually comes from private
The government ensures
affordability through strict price controls and mandatory health savings
accounts, called Medisave. The accounts are funded through mandatory payroll
deductions and employer contributions, with employees funding one quarter and employers funding three quarters. Only certain categories of care can be
paid for with the Medisave account. Outpatient doctor visits for minor ailments must be paid
for out of pocket. The government provides a catastrophic health care plan, and
strongly regulates the supply and prices of health care services throughout the
country, in order to keep those prices in check. In addition to Medisave and
catastrophic care, many Singaporeans also carry supplemental private insurance,
which is often paid for by employers to attract employees. The private insurance pays for services
not covered by the government, although the government pays 80% of "basic
health care services." The government also provides a safety net for
low-income people "subject to stringent means-testing."
The government also
plays something of a paternalistic role with regard to certain types of disease. They put a huge premium on
controlling the spread of disease, and encourage sick people to stay home and
reduce the spread of such sicknesses.
The private health
care system effectively competes directly with the public healthcare system, to
keep prices under control. They are essentially equal in the marketplace, and
there is little or no quality difference between a public and a private hospital.
Private health care providers are required to publish prices for everything, in
order to encourage comparison shopping.
This environment, in
which government actively regulates and actively competes with private
insurers, gives Singapore the sixth best health care system in the world,
according to the WHO. They're tied with Iceland, with the lowest infant
mortality rate in the world.
And they only spend 3% of
The Spanish health
care system works very much like the British and Italian systems.
Everyone in the country who contributes to the Social Security system is entitled to free or
low cost health care for themselves and their dependents. The system features an
extensive national network of hospitals and thousands of health centers, even in small villages. The Spanish government has a goal
of creating a system in which no one in the country has to travel more than 15
miles to see a doctor.
health centers provide primary health care services and
nursing, as well as midwives, therapists and even social workers. They will also
provide service at a patient's residence, if it's required. Hospitals offer
accident and emergency services, of course, but they also house specialists,
upon referral from a primary care physician.
There are no co-pays
or claims forms. There is also no stress over health care when you lose a job,
there are no pre-existing conditions, and there is no rescission. The Social Security tax rate is
about 12%, but that amount not only includes health insurance, but also unemployment, full maternity leave coverage,
and several other benefits.
There are occasionally
long waits for an appointment to see a specialist for some procedures, but it's
difficult to argue with the results overall, as Spain is number 7 on the WHO's
ranking of OECD health care systems. The Spanish guarantee of health care to
all residents is the result of the 1978 Constitution, which was drawn up
following the Franco years. (Yes, he's still dead.) The Constitution not only
upholds the right to health care, but mandates that the state provide it. By the way, Spain also provides health care to immigrants, and doesn't ask for ID.
An excellent system of
private health care has grown and easily exists alongside the public system,
and has come to complement the public system, more than compete with it. But
more than 90% of Spanish residents opt for the public system.
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