European Healthcare
Most European countries have achieved universal coverage for their citizens; but how exactly are they doing it?
We hear people talk about the Canadian model of single-payer financing to create universal coverage, but this is not the typical way it is done in most European countries.
Only Canada uses the pure Canadian model where there is a single payer, no private insurance plans and all health insurance coverage is paid solely from the general tax revenue of the country. It is also worth noting that per capita healthcare costs in Canada are now the fifth highest in the world, exceeded only by Luxembourg, Norway, Switzerland and the U.S.
Canada, Cuba and North Korea hold the distinction of being the only three countries in the world where it is currently illegal for an individual patient to buy healthcare services directly from a doctor or hospital in the country.
Austria, Belgium, Germany, Switzerland and the Netherlands all use mixed public-private models that involve individual mandate laws where citizens are required to buy coverage. In addition, there are public and private health plans competing to sell health coverage to their customers, there is a "guaranteed issue" requirement that necessitates private health plans to sell a basic level of coverage to all people regardless of their health status, and there is a very strong government subsidy to help low-income people buy their health insurance.
Britain uses a mixed model with the National Health Service, or NHS, providing basic care for everyone. Primary-care physicians are paid by the government based on the number of patients in each doctor’s “panel. A number of competing private health plans sell private market insurance coverage to British citizens who don’t want to wait in queues for certain types and categories of hospital care or NHS-funded specialty care.
In Germany, the health plans are called “sickness funds”. They have been in place since Chancellor Otto von Bismarck ruled the country more than a century ago and there are nearly 300 competing plans.
There are roughly 30 competing health plans in the Netherlands and everyone gets his or her care through one of those plans.
In France, the government provides a basic Medicare-like insurance plan for all citizens, and then 90% of the citizens buy supplemental coverage from several dozen competing “mutualisms” (mutual aid societies) and private insurers. Those plans look a lot like the private Medicare supplemental plans in the U.S.
A number of countries, including Belgium, England, France and the Netherlands, also offer private insurance plans that provide coverage for care not paid by the basic government plan.
European countries fund universal coverage primarily through payroll taxes. In most European countries, there is a mandatory payroll deduction or income-linked contribution required of each worker and it averages in the 3% to 9% range. The employer is also required to make a matching contribution in the same general range in several of the countries.
In the Netherlands, employees pay 6.5% of their pretax income, plus a nominal annual fee, toward health insurance. Employers reimburse the income-based contribution.
In the U.S., typical employer costs run from 8% to 11% of total worker payrolls and employee healthcare costs run in the 5% to 10% range.
Many American workers actually spend a lower percentage of their pay for health insurance and direct costs than many European workers.
So what we Americans presume to know about European healthcare is probably inaccurate. Rather than comparing ourselves to what we think the European countries have, we need to decide on what our needs are and figure out how best to meet them.
There does not appear to be a simple solution or a single program that will work for everyone. We will need to use a combination of individual mandates, subsidized coverage and a mixed public-private models to create universal coverage that meets our needs and we will need to place individual responsibility as a high priority.
We hear people talk about the Canadian model of single-payer financing to create universal coverage, but this is not the typical way it is done in most European countries.
Only Canada uses the pure Canadian model where there is a single payer, no private insurance plans and all health insurance coverage is paid solely from the general tax revenue of the country. It is also worth noting that per capita healthcare costs in Canada are now the fifth highest in the world, exceeded only by Luxembourg, Norway, Switzerland and the U.S.
Canada, Cuba and North Korea hold the distinction of being the only three countries in the world where it is currently illegal for an individual patient to buy healthcare services directly from a doctor or hospital in the country.
Austria, Belgium, Germany, Switzerland and the Netherlands all use mixed public-private models that involve individual mandate laws where citizens are required to buy coverage. In addition, there are public and private health plans competing to sell health coverage to their customers, there is a "guaranteed issue" requirement that necessitates private health plans to sell a basic level of coverage to all people regardless of their health status, and there is a very strong government subsidy to help low-income people buy their health insurance.
Britain uses a mixed model with the National Health Service, or NHS, providing basic care for everyone. Primary-care physicians are paid by the government based on the number of patients in each doctor’s “panel. A number of competing private health plans sell private market insurance coverage to British citizens who don’t want to wait in queues for certain types and categories of hospital care or NHS-funded specialty care.
In Germany, the health plans are called “sickness funds”. They have been in place since Chancellor Otto von Bismarck ruled the country more than a century ago and there are nearly 300 competing plans.
There are roughly 30 competing health plans in the Netherlands and everyone gets his or her care through one of those plans.
In France, the government provides a basic Medicare-like insurance plan for all citizens, and then 90% of the citizens buy supplemental coverage from several dozen competing “mutualisms” (mutual aid societies) and private insurers. Those plans look a lot like the private Medicare supplemental plans in the U.S.
A number of countries, including Belgium, England, France and the Netherlands, also offer private insurance plans that provide coverage for care not paid by the basic government plan.
European countries fund universal coverage primarily through payroll taxes. In most European countries, there is a mandatory payroll deduction or income-linked contribution required of each worker and it averages in the 3% to 9% range. The employer is also required to make a matching contribution in the same general range in several of the countries.
In the Netherlands, employees pay 6.5% of their pretax income, plus a nominal annual fee, toward health insurance. Employers reimburse the income-based contribution.
In the U.S., typical employer costs run from 8% to 11% of total worker payrolls and employee healthcare costs run in the 5% to 10% range.
Many American workers actually spend a lower percentage of their pay for health insurance and direct costs than many European workers.
So what we Americans presume to know about European healthcare is probably inaccurate. Rather than comparing ourselves to what we think the European countries have, we need to decide on what our needs are and figure out how best to meet them.
There does not appear to be a simple solution or a single program that will work for everyone. We will need to use a combination of individual mandates, subsidized coverage and a mixed public-private models to create universal coverage that meets our needs and we will need to place individual responsibility as a high priority.
Labels: European, healthcare, universal
posted by Anonymous at 6:00 AM
13 Comments:
A basic coverage should be universal, a la Medicare, for every citizen in this country from birth to death. I truly do not feel that if this where a government plan it would be the boogie man that some say it would. To reward those who work to get ahead in life, give them the option of purchasing a supplemental plan to give a greater range of care. Those who don't work harder or can't can simply rely on the more basic plan which would cover basic needs. I feel this would satisy our capitalistic mindset and also be sympathetic to the reality that not all can achieve what some do.
Easy to say, watcher, except what happens when someone needs a procedure to save their life that isn't covered in their "basic" plan?
Obviously, people who are much smarter than I will have life saving procedures included in the basic package.
Then what wouldn't be included in the basic package.
In my opinion, trying to reform just the payor and insurance side of our health system will not fix the problem. We need to address the cost side of it also.
Providers blame everything on the payors and even claim that if the provider remimbursements were higher, the costs would go down???
In short, as almost any healthcare professional will confide to you, every day there are many medical procedures being performed primarily to increase revenue and whose costs exceed their medical benefit.
Things that may not be included may be coverage for pimple meds or anything that may not be as important as saving a life. Some of things that we are used to having at our disposal for nothing may have to cost something. Thus the need for a supplemental plan as well as the incentive to work for it.
Do you really think eliminating things like acne treatment will significantly reduce costs?
The heavy costs are in hospitalization, surgical procedures and treating degenerative diseases like diabetes and cancer which require life-long treatment often with no real "cure".
Ironically for these degenerative conditions the better the disease is managed the longer the patient lives, thereby further increasing the costs.
Yo 1:45 PM. Pimple meds was a generic example.
Yo 2:10 PM Generic or not, your point is still a good example. Medically unnecessary procedures are already largely excluded from healthplans.
Not necessarily endorsing this idea but adding to the discussion.
Perhaps the coverage should be the other way around. Universal major medical coverage with less coverage for the basics. I know, what is major and what is basic?
This general idea would cover the most expensive procedures that most people could never pay for even if they attempted to plan for it. It would also add some personal accountability on the basic end. If you want a plan that has low co-pays for doctor's visits for your "acne" you will pay more in premiums or you will just pay more to the doctor. Something that most people could work into their budget if they had too and considered it a priority.
I am pretty much a believer in high deductibles. It is my responsibility to save and plan for a certain amount of expenses and the insurance is to cover the "big" stuff.
Maybe we can see this as somewhat similar to public education. As a society, we make 12 years of education available to all children in our country. It is possible to opt out for private education or to pay for special programs beyond the general subjects offered but everyone gets a shot at being educated (and everyone pays taxes to support public schools). It won't be cheap, but we should figure out how to provide NECESSARY medical care to all citizens. You would be on your own for a facelift, but not for care that any of us with group insurance coverage would consider routine.
amen.
Can you imagine the hand wringing some providers will be doing while waiting to see if their service is deemed a necessity?
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