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5 myths about health care around the worldBy T.R. Reid -- Five Myths About Health Care in the Rest of the World http://www.washingtonpost.com/wp-dyn/content/article/2009/08/21/AR.
As Americans search for the cure to what ails our health-care system, we've overlooked an invaluablesource of ideas and solutions: the rest of the world. All the other industrialized democracies have facedproblems like ours, yet they've found ways to cover everybody -- and still spend far less than we do. I've traveled the world from Oslo to Osaka to see how other developed democracies provide health care.
Instead of dismissing these models as "socialist," we could adapt their solutions to fix our problems. To dothat, we first have to dispel a few myths about health care abroad: 1. It's all socialized medicine out there. Not so. Some countries, such as Britain, New Zealand and Cuba, do provide health care in governmenthospitals, with the government paying the bills. Others -- for instance, Canada and Taiwan -- rely on private-sector providers, paid for by government-run insurance. But many wealthy countries -- including Germany,the Netherlands, Japan and Switzerland -- provide universal coverage using private doctors, private hospitalsand private insurance plans.
In some ways, health care is less "socialized" overseas than in the United States. Almost all Americans sign upfor government insurance (Medicare) at age 65. In Germany, Switzerland and the Netherlands, seniors stickwith private insurance plans for life. Meanwhile, the U.S. Department of Veterans Affairs is one of the planet'spurest examples of government-run health care.
2. Overseas, care is rationed through limited choices or long lines. Generally, no. Germans can sign up for any of the nation's 200 private health insurance plans -- a broaderchoice than any American has. If a German doesn't like her insurance company, she can switch to another,with no increase in premium. The Swiss, too, can choose any insurance plan in the country.
In France and Japan, you don't get a choice of insurance provider; you have to use the one designated foryour company or your industry. But patients can go to any doctor, any hospital, any traditional healer. Thereare no U.S.-style limits such as "in-network" lists of doctors or "pre-authorization" for surgery. You pick anydoctor, you get treatment -- and insurance has to pay.
Canadians have their choice of providers. In Austria and Germany, if a doctor diagnoses a person as"stressed," medical insurance pays for weekends at a health spa.
As for those notorious waiting lists, some countries are indeed plagued by them. Canada makes patients waitweeks or months for nonemergency care, as a way to keep costs down. But studies by the CommonwealthFund and others report that many nations -- Germany, Britain, Austria -- outperform the United States onmeasures such as waiting times for appointments and for elective surgeries.
In Japan, waiting times are so short that most patients don't bother to make an appointment. One Thursdaymorning in Tokyo, I called the prestigious orthopedic clinic at Keio University Hospital to schedule aconsultation about my aching shoulder. "Why don't you just drop by?" the receptionist said. That same By T.R. Reid -- Five Myths About Health Care in the Rest of the World http://www.washingtonpost.com/wp-dyn/content/article/2009/08/21/AR.
afternoon, I was in the surgeon's office. Dr. Nakamichi recommended an operation. "When could we do it?" Iasked. The doctor checked his computer and said, "Tomorrow would be pretty difficult. Perhaps some daynext week?" 3. Foreign health-care systems are inefficient, bloated bureaucracies. Much less so than here. It may seem to Americans that U.S.-style free enterprise -- private-sector, for-profithealth insurance -- is naturally the most cost-effective way to pay for health care. But in fact, all the otherpayment systems are more efficient than ours.
U.S. health insurance companies have the highest administrative costs in the world; they spend roughly 20cents of every dollar for nonmedical costs, such as paperwork, reviewing claims and marketing. France'shealth insurance industry, in contrast, covers everybody and spends about 4 percent on administration.
Canada's universal insurance system, run by government bureaucrats, spends 6 percent on administration. InTaiwan, a leaner version of the Canadian model has administrative costs of 1.5 percent; one year, this figureballooned to 2 percent, and the opposition parties savaged the government for wasting money.
The world champion at controlling medical costs is Japan, even though its aging population is a profligateconsumer of medical care. On average, the Japanese go to the doctor 15 times a year, three times the U.S.
rate. They have twice as many MRI scans and X-rays. Quality is high; life expectancy and recovery rates formajor diseases are better than in the United States. And yet Japan spends about $3,400 per person annually onhealth care; the United States spends more than $7,000.
4. Cost controls stifle innovation. False. The United States is home to groundbreaking medical research, but so are other countries with muchlower cost structures. Any American who's had a hip or knee replacement is standing on French innovation.
Deep-brain stimulation to treat depression is a Canadian breakthrough. Many of the wonder drugs promotedendlessly on American television, including Viagra, come from British, Swiss or Japanese labs.
Overseas, strict cost controls actually drive innovation. In the United States, an MRI scan of the neck regioncosts about $1,500. In Japan, the identical scan costs $98. Under the pressure of cost controls, Japaneseresearchers found ways to perform the same diagnostic technique for one-fifteenth the American price. (AndJapanese labs still make a profit.) 5. Health insurance has to be cruel. Not really. American health insurance companies routinely reject applicants with a "preexisting condition" --precisely the people most likely to need the insurers' service. They employ armies of adjusters to deny claims.
If a customer is hit by a truck and faces big medical bills, the insurer's "rescission department" digs throughthe records looking for grounds to cancel the policy, often while the victim is still in the hospital. Thecompanies say they have to do this stuff to survive in a tough business.
Foreign health insurance companies, in contrast, must accept all applicants, and they can't cancel as long asyou pay your premiums. The plans are required to pay any claim submitted by a doctor or hospital (or healthspa), usually within tight time limits. The big Swiss insurer Groupe Mutuel promises to pay all claims withinfive days. "Our customers love it," the group's chief executive told me. The corollary is that everyone ismandated to buy insurance, to give the plans an adequate pool of rate-payers.
The key difference is that foreign health insurance plans exist only to pay people's medical bills, not to make aprofit. The United States is the only developed country that lets insurance companies profit from basic healthcoverage.
By T.R. Reid -- Five Myths About Health Care in the Rest of the World http://www.washingtonpost.com/wp-dyn/content/article/2009/08/21/AR.
In many ways, foreign health-care models are not really "foreign" to America, because our crazy-quilthealth-care system uses elements of all of them. For Native Americans or veterans, we're Britain: Thegovernment provides health care, funding it through general taxes, and patients get no bills. For people whoget insurance through their jobs, we're Germany: Premiums are split between workers and employers, andprivate insurance plans pay private doctors and hospitals. For people over 65, we're Canada: Everyone payspremiums for an insurance plan run by the government, and the public plan pays private doctors and hospitalsaccording to a set fee schedule. And for the tens of millions without insurance coverage, we're Burundi orBurma: In the world's poor nations, sick people pay out of pocket for medical care; those who can't pay staysick or die.
This fragmentation is another reason that we spend more than anybody else and still leave millions withoutcoverage. All the other developed countries have settled on one model for health-care delivery and finance;we've blended them all into a costly, confusing bureaucratic mess.
Which, in turn, punctures the most persistent myth of all: that America has "the finest health care" in theworld. We don't. In terms of results, almost all advanced countries have better national health statistics thanthe United States does. In terms of finance, we force 700,000 Americans into bankruptcy each year becauseof medical bills. In France, the number of medical bankruptcies is zero. Britain: zero. Japan: zero. Germany:zero.
Given our remarkable medical assets -- the best-educated doctors and nurses, the most advanced hospitals,world-class research -- the United States could be, and should be, the best in the world. To get there, though,we have to be willing to learn some lessons about health-care administration from the other industrializeddemocracies.
T.R. Reid, a former Washington Post reporter, is the author of "The Healing of America: A Global Quest forBetter, Cheaper, and Fairer Health Care," to be published Monday. View all comments that have been posted about this article.
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