Health Economics & Policy 3 rd Edition James W. Henderson Chapter 16 Medical Care Systems Worldwide

International Comparisons l Who’s got the best system l Key statistics l Health care spending l Medical outcomes

WHO Health Care System Performance, 1997

Key Statistics

Health Care Spending Annual Compound Growth Rates

Health Outcomes, 2000

Total HCE/GDP,

Mortality Ratios - Cancer

Canada l Evolution of the Canadian system l Single-payer concept l Cost-control measures –Binding fee schedules –Global budgets for hospitals –Regionalization of high-tech services l Canada’s safety valve—private travel health insurance

Germany l Evolution of the German system l Sickness fund concept l Cost-control measures –Institutional framework –Linking health care spending to income –Binding fee schedules –System-wide global budgets l Germany’s safety valve—private health insurance for upper income population

Japan l Evolution of the Japanese system l National health insurance l Cost-control measures –Uniform fee schedules –Service distortions l Japan’s safety valve—”gifts of appreciation” to secure treatment

France l Evolution of the French system l System-wide goals –Spirit of egalitarianism—solidarity –Respect for individual freedom—liberty –Minimal state intervention—laissez faire l Cost-control measures –Binding fee schedules –Global budgeting restricting adoption of high-tech services l France’s safety valve—supplementary private insurance

United Kingdom l Evolution of the National Health Service l Single-payer concept in a socialized system l Cost-control measures –Binding fee schedules –Hospital trusts –PCG budgetholders l British safety valve—private health insurance for wait-listed patients

Promoting Equality

Lessons From Europe l Germany –System of comprehensive, universal coverage is expensive –Cost control that includes binding fee schedules must also control utilization l France –Promoting system-wide goals requires tradeoffs –Strict budget controls leads to lower investment l United Kingdom –Strong primary care covers all sorts of ills –Strict cost controls can lead to long waiting lists

The Economics of a Safety Valve

Summary and Conclusions l National health insurance does not guarantee public satisfaction l Health care provided at zero cost offers no incentive to limit demand l Eliminating financial barriers to care does not insure equal access to care or eliminate health differences across subgroups l If prices are not used to allocate scarce resources, something else must do so. In health care it is often waiting lists and limited access to technology l Safety valves are critical

Public Opinion Polls