© 2008 Delmar Cengage Learning. Chapter 19 American Health Care in International Perspective Joe White

© 2008 Delmar Cengage Learning. 2 Comparing Possibilities Range of comparison –Offers insight on just what is possible in the field of health care –This is particularly useful when America, or any other country, contemplates health care reform

© 2008 Delmar Cengage Learning. 3 Comparing Cause-and-Effect Pooling experiences in health care worldwide –Shows how certain actions lead to predictable (or unpredictable) reactions

© 2008 Delmar Cengage Learning. 4 Comparing Cause-and-Effect For instance: –Successful adoption of national health insurance appears linked to making insurance compulsory for a broad sector of society (based on income)

© 2008 Delmar Cengage Learning. 5 Comparing Cause-and-Effect For instance: –Aging does not raise health care spending per se Far more important is how much a society pays in health care costs

© 2008 Delmar Cengage Learning. 6 Comparing Preferences Preferences often dependent on one’s position in a society –Especially one’s professional affiliation

© 2008 Delmar Cengage Learning. 7 Comparing Preferences Many health care positions and popular conceptions –Actually arise from the opinions of established groups –Cost-savings arising from preventive care are, for instance, often stressed by public health workers

© 2008 Delmar Cengage Learning. 8 Comparing Preferences Shape of a particular national health care system –Often contingent on just which views, and therefore interests, are valued over others

© 2008 Delmar Cengage Learning. 9 “International Standard” of Health Care Just about every major industrialized country offers health coverage to nearly all citizens U.S. stands out (negatively) in this regard –40 + million lacking coverage today

© 2008 Delmar Cengage Learning. 10 “International Standard” of Health Care Most other countries cover all “medically necessary” procedures –With the definition thereof differing between systems

© 2008 Delmar Cengage Learning. 11 “International Standard” of Health Care While many in other countries receive “decent” care –Some others more –Many in the U.S. also receive decent care, with some receiving far more But with many others receiving minimal or no care

© 2008 Delmar Cengage Learning. 12 “International Standard” of Health Care In other countries: –Insurance is not purchased, but financed by the State through any number of mechanisms In American context: –ACCESS TO CARE is often determined by the ability to pay –Infirm often pay more than others, as do larger families

© 2008 Delmar Cengage Learning. 13 “International Standard”’ of Health Care Cost control is handled differently in other countries –Number of payers strictly circumscribed, and savings coming from the pooling of buyers Plethora of buyers exist on the American market –Few effective cost control measures

© 2008 Delmar Cengage Learning. 14 Limits of Comparison Nations and peoples are unique in some ways –Therefore comparisons aren’t always foolproof

© 2008 Delmar Cengage Learning. 15 Limits of Comparison International comparison does little to reveal alternatives in health delivery systems –As there is such diversity within the U.S. on this count

© 2008 Delmar Cengage Learning. 16 Chapter 19 Summary Efficacy of international comparisons in health care arises from their capacity to offer insights on possibilities –Cause-and-effect relationships, and preferences United States diverges considerably from the “international standard” in health care

© 2008 Delmar Cengage Learning. 17 Chapter 19 Summary Far higher health spending: –Does not seem to translate to significantly better health outcomes in U.S. When compared to those in other nations

© 2008 Delmar Cengage Learning. 18 Chapter 19 Summary Those in similar (professional) positions worldwide –Tend to have similar preferences –But different systems can shape broader political positions Just which interests have the upper hand in policy debates