- Private delivery ranges from being the norm (Sweden) to a minority but accepted element (Netherlands, France).
- Sometimes a flat levy (Netherlands), at others strictly proportional to income (France), all systems but the Swedish have a direct contributory principle at their heart, in addition to taxation funding.
- Co-payments are entirely common, with costs either co-paid on the spot (Sweden), or the patient's cost being defrayed later (France).
- The multiplicity of providers ensures in all four systems that patient choice is real and occurs, from insurer where.
Thursday, May 12, 2011
Choices for the national patient
The wicked old Tories want to abolish National Health, I hear. One would be made to think that they intend to replace it with National Sickness. The choice their opponents would set before us is the NHS or the US model. Left-wingers are often fond of accusing the US of forgetting about the world beyond its doorstep; it is ironic that those same left-wingers should forget about the Continent beyond our own doorstep.So let's leave the angry hordes of British lefties for more Continental climes, and ask ourselves how some other countries organise their healthcare systems. I'm going to draw most of this from Wikipedia, but I'm sure it's basically accurate.Bear in mind that the opponents of reform invariably cast their concerns in terms which imply that what they really want is a centrally directed healthcare system: one giant super-hospital, with multiple branches throughout the nation, paid for entirely out of taxation.First on our round-Continent trip, then, it's off to Sweden, that social-democratic paradise so beloved of the left (W). It has, like us, what is termed a 'Beveridge' system, as opposed to the other three we shall inspect, which have 'Bismarck' systems (src). The national Ministry of Health sets general policy and provides funding. County councils commission care from private providers, and raise most of the funding from local income taxation (how very Liberal Democrat!). Every doctor's visit and prescription has a small charge attached, but there is an annual cap on the amount that patients pay.Next off, let's go to the place where everything is always in order, Germany (W). Here, they have an insurance system, where the government offers a sort of basic insurance policy which you can take, or you can opt to take private insurance instead. 85% of Germans take the government plan. Co-payments are a feature of the system, and a little over half the hospital beds in Germany are provided by public sector hospitals (ppt), with the rest being a mix of charitable and for-profit private provision. The private provision is growing, while the public provision is shrinking.Well, let's follow the historically-usual route out of Germany and skip past the Maginot line by heading into the Netherlands (W). The Dutch have a system of "social insurance", in which policies cannot be priced according to age, medical history or other factors; instead, insurers pool the risks and charge roughly the same premium. About half the finance for the system comes from premiums, with the other half coming from taxation. Most of the healthcare system, including the insurers and hospitals, is privately run on a not-for-profit basis. Interestingly, the Dutch allow opt-outs (some Christian groups object to insurance), and so have a small, parallel healthcare savings system as well.Finally, we'll enjoy some of the finer things in life by visiting la belle France (W). Widely regarded as having the best healthcare system in the world, the French are required to buy insurance from a public insurer according to their income. Doctors mostly form private practices, while provision of hospital beds is about two-thirds public, a fifth profit-seeking and a sixth charitable. French people pay up-front for their healthcare and then get typically about 70% back from the insurer: so much for free at the point of use!Four major European countries. Four different healthcare systems. But all far more similar to each other than to the UK system, and all have the following key points: