10 Health Care Systems Around the World

Health care reform in the U.S. is a highly divisive issue. See more protesting pictures.
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In 2008, the Harvard School of Public Health and Harris Interactive conducted a survey that asked U.S. citizens whether their country had the best health care system in the world. Overall, 45 percent of the respondents believed that the U.S. did in fact have the best system, but when the results were broken down by political party affiliation, the differences were stark. Sixty-eight percent of Republicans claimed U.S. superiority, compared to only 32 percent of Democrats. More than half of Democrats -- 52 percent -- believed that other countries had better health care systems, a belief shared by only 19 percent of Republicans (the remainder of participants claimed not to know). Participants from both parties admitted that the U.S. was particularly weak in factors like making sure everyone had affordable health care and controlling health care costs [source: Harvard School of Public Health].

In the contentious debate about health care reform, the U.S. system is often compared to other systems around the world. Some are concerned that the U.S. spends twice as much per person, while others are willing to pay that price to have choice of providers and shorter waiting times. Myths abound about what health care is actually like in other countries, so let's go around the world and see for ourselves.

10

France

In 2000, the World Health Organization (WHO) ranked France first in its survey of health care systems. French citizens have universal health coverage that's provided by the government. Funds come from required contributions from citizens based on income. In return, the country reimburses about 70 percent of most medical bills [source: Shapiro]. The French people are allowed to see any health provider they choose, and about 42 percent can get a same-day appointment [source: Cohn].

To cover the balance, most citizens have supplemental insurance with either a public or a private plan. This supplemental plan might be provided by an employer, as most U.S. health insurance is. Because those that can afford a private plan often take it, supplemental insurance is something of a tiered system divided by class [source: Harrell].

One criticism of France's system is the high rate of government spending; the program is frequently over budget. The French government spends about $3,300 per person on health care (the U.S. spends twice that amount) [source: Shapiro]. However, as the WHO ranking demonstrates, the French receive a tremendous amount of care for that money. In one study of 19 industrialized nations, France had the lowest rate of deaths that could have been prevented with adequate basic health care (the United States had the highest) [source: Harrell]. France is also renowned for treating the very sick; if you have a serious condition like cancer, all your costs are covered by the government, even expensive and experimental drugs or surgeries. But the French also understand that good care starts early. Working moms receive lengthy paid maternity leaves, and new moms with low incomes are provided financial incentives to attend prenatal and early childhood appointments.

9

Germany

German doctors protested in 2006 for higher wages.
German doctors protested in 2006 for higher wages.
Associated Press/Roberto Pfeil

All citizens must have health insurance in Germany, which they purchase from private, nonprofit funds. There are about 200 of these plans, none of which is allowed to deny coverage for a pre-existing condition [source: Reid]. To finance this system, Germans pay 8 percent of their salary into a sickness fund; employers match it [source: Knox]. Those who can't afford the plans are eligible for public assistance, and children are covered by taxpayer funds. The wealthiest 10 percent of citizens are allowed to opt out of the system and use a for-profit plan, though the non-profit plans provide very generous benefits, such as time at a spa.

Germany has introduced a series of disease management programs that have proven quite successful. The country found that when patients received more counseling from their doctors as well as regular phone calls from nurses, the rates of hospital admissions and deaths related to conditions like heart disease and diabetes were substantially lowered [source: Harrell].

However, some German doctors feel they're underpaid in this system [source: Neel]. Rather than charging per test ordered or appointment made, as many U.S. doctors do, German doctors receive a quarterly budget that's determined by how many patients they see [source Neel]. Still, doctors are very accessible, and citizens report short waits for tests or surgeries.

8

Britain

Thanks to the current health care reform debate, most Americans know Britain as the home of socialized medicine, complete with rationed health care -- in other words, two things that many Americans fear. Both counts are true. Britain has socialized medicine, which means that in addition to paying for all citizens to have insurance, the government also hires and pays the doctors and runs the hospitals. British citizens pay taxes, which the National Health Service (NHS) allocates to providers. When a citizen shows up for an appointment, all services that he or she receives are paid for, with the exception of prescription drugs.

The National Institute for Health and Clinical Excellence (NICE) is an administrative organization charged with evaluating what treatments the NHS will pay for. The organization does this with a fairly precise formula that takes into account how much the treatment will improve a person's life, how long the patient can expect to reap the proposed benefits and the cost of the treatment per year. To put it simply, if this formula yields a cost of more than $45,000 per year, then NICE won't approve it; this $45,000 threshold had been previously established by work done by the British Department of Transport [source: Harrell]. A year of life is deemed valuable for all -- a 12-year-old with his entire life ahead of him won't be judged any differently than a 90-year-old woman.

Some of NICE's decisions have proved controversial, particularly in terms of cancer treatment, which can be quite expensive. Britain does lag behind the U.S. in rates of cancer-related deaths.

7

Canada

Want a knee replacement? You might have a slightly longer wait for one in Canada.
Want a knee replacement? You might have a slightly longer wait for one in Canada.
Barry Austin/Digital Vision/Getty Images

In a 2008 survey, Canadians named universal health care as one of the 10 most defining factors of Canada [source: Austen]. Such definition may be a bit of a mixed bag, if you consider some of the scary commercials currently running in the U.S. that hint that health care reform will turn us into Canada. What would such a thing mean?

All Canadian citizens have health care that is funded by income taxes and sales tax. The national government has oversight for members of the military and native people on reserves, but the 10 provincial and three territorial governments take care of the rest. The doctors and hospitals are private entities, which distinguishes the Canadian system from the British socialized medicine system, in which doctors are employees of the government. Canadian health care providers bill the government, so that citizens never see a bill or fork over a copayment for anything other than dentistry, optometry and prescription drugs. While health care costs are rising in Canada, the country currently spends less than the United States [source: Arnquist].

The most common criticism of the Canadian system is long waiting times. In the 1990s, Canada spent billions of dollars to improve these statistics, which are posted online. Wait times are longest for elective procedures such as a knee replacement [source: Bash, Jensen]. Some Canadians claim that the situation isn't as dire as it may sound on a commercial; while certain people may have had extremely bad situations, it's not representative of the country [sources: Bash, Jensen; Varney]. Other doctors, fed up with having to wait for the limited medical equipment to become available, have started rogue private enterprises to treat patients who can pay more quickly, even though such actions are illegal in Canada [source: Krauss].

6

Switzerland

In the U.S., both Republicans and Democrats can find something to like about Switzerland's health care system. Democrats may like that the Swiss have had universal coverage since 1994, though 95 percent of citizens already had it before the official designation. Republicans may like that this universal coverage isn't provided by the government, but rather by private insurance. Unfortunately, neither party may like the cost: Switzerland has the second most expensive system of health care in the world after the United States [source: PBS].

Unlike in the U.S., insurance in Switzerland isn't tied to one's employment. Rather, all citizens choose from a selection of private plans; those who can't afford to buy one may receive subsidies from the government. Everyone's premium for one of these private plans is the same. Another crucial difference from the U.S. is that private insurance companies in Switzerland aren't allowed to make a profit on basic health care, basic health care being a rather comprehensive set of services. The companies are allowed to operate at a profit for providing services such as dental care, alternative medicine or the guarantee of a private hospital room [source: Rovner].

5

Taiwan

Before seeing a doctor, this Taiwanese couple will need to present their smart cards.
Before seeing a doctor, this Taiwanese couple will need to present their smart cards.
Associated Press/Jerome Favre

In 1995, Taiwan adopted a single-payer system of national health insurance, in which the government pays for all its citizens' coverage. In doing so, the country accomplished something that might seem impossible: Taiwan expanded coverage to cover 40 percent of the population while significantly cutting rising health care costs [source: PBS].

Much of the credit for this phenomenon is due to Taiwan's smart card. All citizens have a smart card encoded with their entire medical history. Present it to any doctor, and he or she will know every health concern you've had since you were born. Using these cards also cuts down on administrative paperwork, as medical providers can use it to bill the government directly for their services. It's worth noting that in many countries, people aren't willing to hand so much information over to their government.

Workers and their employers pay for this system, while those who can't afford the costs and veterans are provided subsidies. In return, Taiwanese are allowed to see any doctor or specialist they so choose on a plan that includes everything from traditional medicine to vision benefits [source: Reid]. Costs may be kept a little too low, though. Thanks to low administrative costs, Taiwan's system currently does not take in enough money to fund itself, and politicians are none too eager to increase premiums for fear of voter reprisals [sources: Reid; PBS].

4

China

Chinese citizens line up to receive services or pay medical bills at a local hospital.
Chinese citizens line up to receive services or pay medical bills at a local hospital.
Associated Press/Qin peng xj

For many years, China had a fairly successful cooperative medical system. When that system was dismantled, costs rose dramatically and no one paid them. As a result, 100 million people lost their insurance coverage [source: Lowrey]. The cost of going to the hospital was often enough to put people paying out of pocket into bankruptcy. Particularly stark was the difference between health care in rural and urban areas. The rural farmers were more at risk for conditions such as avian flu but lacked the resources of the urban professionals to pay. Clinics outside of major cities fell into disarray, and even a plan to have farmers pay the equivalent of $1 for a year of medical care failed, with the Chinese complaining that such a fee was too expensive [source: French].

Now, China is in the midst of a major health care reform initiative aimed at these problems. While reforms will continue until 2020, there are some immediate goals. The government is paying $124 billion (850 billion yuan) to ensure that 90 percent of the population has health insurance by 2011 [source: The Economist]. The country will also build 700,000 new clinics [source: Lowrey]. According to the Economist, one major hurdle on the road to reform will be who ultimately foots that $124 billion bill. Right now, only 40 percent of the funds are slated to come from the central government, and provincial governments may be unwilling to pay the rest [source: The Economist].

3

Cuba

In his 2007 documentary "Sicko," filmmaker Michael Moore took American citizens to Cuba to make a rather dramatic point about the quality of care anyone could receive there. As with most things involving Cuba or Michael Moore, this move was not without controversy. While all citizens -- and all visitors -- are entitled to free medical treatment in Cuba, some critics say that the quality of care differs dramatically for a typical Cuban and an American, particularly one who has a camera crew in tow [sources: DePalma, Scott]. It's also possible that Cuba's encouraging statistics are a bit fudged. For example, while Cuba touts a low infant mortality rate, doctors within the country say they're encouraged to perform abortions if something is wrong with the fetus in the womb [source: Scott]. It's also possible that doctors may not count infants who lived for a very short time as alive at all [source: Scott].

Still, even when the controversy is stripped away, most agree that there is something that Cuba does extremely well: preventive care. Major advertising campaigns tout the importance of exercise, eating right and proper hygiene to fight off germs. Cuba has a high number of general practitioners, and every citizen is subject to a surprise home inspection by one of these doctors, so that doctors can stay abreast of a patient's overall health situation.

Because Cuba's health system prevents disease, the country doesn't have to shell out the big bucks to treat it. Cuba spends only $260 per person on health care each year; the United States spends more than $6,000 [source: Carroll].

2

Brazil

A protestor holds a sign reading "Public Health in Rio, National Shame" at a 2005 protest in Brazil.
A protestor holds a sign reading "Public Health in Rio, National Shame" at a 2005 protest in Brazil.
Associated Press/Renzo Gostoli

In the early 1980s, the people of Brazil demanded change. Previous military regimes had left behind health care systems that served the haves while ignoring the have-nots. When the country established a new constitution in 1988, universal health care was one of its core tenets.

In Brazil, there is a public and a private option for health coverage. The public option is the government-funded Sistema Unico de Saude (Unified Health System, or SUS). SUS receives funding from multiple tax sources, including taxes on income, property and banking transactions. These multiple taxes have been unable to keep up with the rising cost of health care, though, which could bankrupt SUS in just a few years [source: Gomez]. Because SUS was an important part of the constitution, it likely won't be shuttered even if it verges on collapse. Already, the system is troubled: Corruption is widespread, and the country lacks basic infrastructure and personnel to provide health care to all.

As a result, more people are using private insurance. The private market is regulated separately from SUS. Though Brazil attempted to create universal health coverage in 1988, it still has a system that is divided by class [source: Alves, Timmins].

1

Russia

In a 2009 article in "Foreign Policy," Russia was named as having one of the four worst health care systems in the world (the United States also made the list) [source: Lowrey]. In the World Health Organization's survey of health care systems, Russia ranked 130 out of 191, putting it on par with countries that are far less industrialized or developed [source: Danilova]. How can such a wealthy country go so wrong?

When Russia dismantled its Soviet socialized system, it tried to create a public/private combination system. Theoretically, 90 percent of Russian citizens have health insurance through the government, but the system is underfunded, even after a $3.2 billion reform project in 2006 [source: Danilova]. To compensate for the shortage of funds, doctors and hospitals have been known to demand "donations" for care, a system that essentially amounts to blackmail and extortion [sources: Lowery, Rodriguez]. Wealthier citizens usually opt for private coverage.

The World Health Organization recommends that countries allot a minimum of 5 percent of their total spending to health care; Russia spends 3.4 percent [source: Lowrey].

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Sources

  • Alves, Denisard and Christopher Timmins. "Social Exclusion and the Two-Tiered Healthcare System of Brazil." Inter-American Development Bank. December 2001. (Sept. 2, 2009)http://www.iadb.org/res/publications/pubfiles/pubR-436.pdf
  • Arnquist, Sarah. "Health Care Abroad: Canada." New York Times. Aug. 14, 2009. (Sept. 2, 2009)http://prescriptions.blogs.nytimes.com/2009/08/14/health-care-abroad-canada
  • Austen, Ian. "How Does Canada's Health System Actually Work?" New York Times. July 7, 2009. (Sept. 2, 2009)http://economix.blogs.nytimes.com/2009/07/07/how-does-canadas-health-system-actually-work/
  • Bash, Dana and Lesa Jansen. "Reality Check: Canada's Government Health Care System." CNN. July 6, 2009. (Sept. 2, 2009)http://www.cnn.com/2009/POLITICS/07/06/canadian.health.care.system
  • Carroll, Rory. "First world results on a third world budget." The Guardian. Sept. 12, 2007. (Sept. 2, 2009) http://www.guardian.co.uk/world/2007/sep/12/film.health
  • Cohn, Jonathan. "Healthy Examples." Boston Globe. July 5, 2009. (Sept. 2, 2009)http://www.boston.com/bostonglobe/ideas/articles/2009/07/05/healthy_examples_plenty_of_countries_get_healthcare_right/
  • Danilova, Maria. "Despite oil wealth, Russia faces huge health care problems." New York Times. June 28, 2007. (Sept. 2, 2009)http://www.nytimes.com/2007/06/28/business/worldbusiness/28iht-russhealth.4.6394606.html
  • DePalma, Anthony. "'Sicko,' Castro and the '120 Years Club.'" New York Times. May 27, 2007. (Sept. 2, 2009)http://www.nytimes.com/2007/05/27/weekinreview/27depalma.html
  • Fan, Maureen. "Health Care Tops List of Concerns in China." Washington Post. Jan. 10, 2008. (Sept. 2, 2009)http://www.washingtonpost.com/wp-dyn/content/article/2008/01/09/AR2008010903222.html
  • Fawthrop, Tom. "Cuba sells its medical expertise." BBC News. Nov. 21, 2003. (Sept. 2, 2009)http://news.bbc.co.uk/go/pr/fr/-/2/hi/business/3284995.stm
  • "Five Capitalist Democracies & How They Do It." PBS. (Sept. 2, 2009)http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/
  • French, Howard W. "Wealth Grows, but Health Care Withers in China." New York Times. Jan. 14, 2006. (Sept. 2, 2009) http://www.nytimes.com/2006/01/14/international/asia/14health.html
  • Gomez, Eduardo. "Brazil's Public Option." Foreign Policy. Sept. 2, 2009. (Sept. 2, 2009)http://www.foreignpolicy.com/articles/2009/09/02/brazils_public_option
  • Haines, Andy. "Health care in Brazil." BMJ. Feb. 20, 1993. (Sept. 2, 2009)http://www.bmj.com/cgi/content/abstract/306/6876/503
  • Harrell, Eben. "Health Lessons from Europe." Time. May 20, 2009. (Sept. 2, 2009)http://www.time.com/time/magazine/article/0,9171,1899873,00.html
  • Harrell, Eben. "Is Britain's Health-Care System Really That Bad?" Time. Aug. 18, 2009. (Sept. 2, 2009) http://www.time.com/time/health/article/0,8599,1916570,00.html
  • Harris, John. "Keeping Cuba Healthy." BBC News. (Sept. 2, 2009)http://news.bbc.co.uk/2/hi/programmes/newsnight/5232628.stm
  • Harvard School of Public Health. "Most Republicans Think the U.S. Health Care System is the Best in the World. Democrats Disagree." March 20, 2008. (Aug. 21, 2009)http://www.hsph.harvard.edu/news/press-releases/2008-releases/republicans-democrats-disagree-us-health-care-system.html
  • Knox, Richard. "History of Tinkering Helps German System Endure." NPR. July 3, 2008. (Sept. 2, 2009)http://www.npr.org/templates/story/story.php?storyId=92189596
  • Knox, Richard. "Most Patients Happy with German Health Care." NPR. July 3, 2008. (Sept. 2, 2009)http://www.npr.org/templates/story/story.php?storyId=91971406
  • Krauss, Clifford. "As Canada's Slow-Motion Public Health System Falters, Private Medical Care is Surging." New York Times. Feb. 26, 2008. (Sept. 2, 2009)http://www.nytimes.com/2006/02/26/international/americas/26canada.html
  • Lowrey, Annie. "The List: The World's Worst Healthcare Reforms." Foreign Policy. July 22, 2009. (Sept. 2, 2009)http://www.foreignpolicy.com/articles/2009/07/22/the_list_the_world_s_worst_healthcare_reforms?page=full
  • Neel, Joe. "Taking the Measure of Health Care in America." NPR. (Aug. 21, 2009)http://www.npr.org/templates/story/story.php?storyId=92136549
  • Reid, T.R. "5 Myths About Health Care Around the World." Washington Post. Aug. 23, 2009. (Sept. 2, 2009)http://www.washingtonpost.com/wp-dyn/content/article/2009/08/21/AR2009082101778.html
  • Reid, T.R. "Taiwan Takes Fast Track to Universal Health Care." NPR. April 15, 2008. (Sept. 2, 2009)http://www.npr.org/templates/story/story.php?storyId=89651916
  • Rein, Shaun. "Health-Care Reform, China Style." Business Week. Aug. 21, 2009. (Sept. 2, 2009)http://www.businessweek.com/globalbiz/content/aug2009/gb20090821_005732.htm
  • Rodriguez, Alex. "Russian health-care system badly ailing." Chicago Tribune. Feb. 26, 2008. (Sept. 2, 2009)http://archives.chicagotribune.com/2008/feb/26/news/chi-russia_side_tuesdayfeb26
  • Rovner, Julie. "In Switzerland, a Health Care Model for America?" NPR. July 31, 2008. (Sept. 2, 2009)http://www.npr.org/templates/story/story.php?storyId=92106731
  • Scott, Melissa. "Healthy in Cuba, Sick in America?" ABC News. Sept. 7, 2007. (Sept. 2, 2009)http://abcnews.go.com/Exclusiva/story?id=3568278
  • Shapiro, Joseph. "France at Forefront of Free, Innovative Cancer Care." NPR. July 9, 2009. (Sept. 2, 2009)http://www.npr.org/templates/story/story.php?storyId=92362918
  • Shapiro, Joseph. "Health Care Lessons From France." NPR. July 11, 2008. (Sept. 2, 2009)http://www.npr.org/templates/story/story.php?storyId=92419273
  • Thompson, Drew. "China's Health-Care Challenge." Wall Street Journal. April 16, 2009. (Sept. 2, 2009)http://online.wsj.com/article/SB123982492165322167.html
  • Varney, Sarah. "Does Canada's Health Care System Need Fixing?" NPR. Aug. 10, 2009. (Sept. 2, 2009)http://www.npr.org/templates/story/story.php?storyId=111721651
  • "Will patients be rewarded?" The Economist. April 16, 2009. (Sept. 2, 2009)http://www.economist.com/world/asia/displaystory.cfm?story_id=13496687
  • "World Health Organization Assesses the World's Health Systems." World Health Organization. June 21, 2009. (Sept. 2, 2009)http://www.who.int/whr/2000/media_centre/press_release/en/