Fifteen
International Chapter Health Care and Pharmaceutical Services
International Vs. US Health Care Sys
US is the only industrialized country that does not have a national health insurance;
US spends the more money on it's health care than any other industrialized country;
US population is the least satisfied with its health care systems and the least healthy of all the industrialized nation;
Healthy care systems of the following countries will be covered in this chapter:
1. Canada 2. United Kingdom 3. Germany 4. Japan 5. China 6. Cuba
1. Canada's Health Care System
has a national (public funded) health insurance called Medicare; covers hospital and physician services for every citizen;
financed by income tax;
has 12 different health care plans - one for each 10 provinces & the 2 territories;
all plans have 5 similar principles: portability, comprehensiveness, universality, accessibility, and public administration;
Canadian hospitals are: 90% nonprofit, community hospitals & teaching hospitals; 5% private; 5% federal government (military);
50% of physicians are general practitioners or family practice physicians;
all patients have a PCP as the gatekeeper; very little or no managed care;
all hospital and physician fees are fixed by government since most services are paid by Medicare;
private health insurance available for services not covered by Medicare dental, plastic surgery, outpatient prescription; long waiting period for non-emergency procedures - anywhere from 3-6 months; most Canadians are happy with the national health care systems;
2. United Kingdom's Health Care System
has a national (public funded) health insurance called National Health Service that is consistent throughout the country; covers hospital, community services, physician & dental services for every citizen; financed by income tax (mandatory 9% deduction from salary);
all hospital care requires referral by primary care physicians; all patients are registered with a PCP;
physicians work in hospitals or in office practice but not both; and most physicians are paid mostly by capitation; most British citizens are satisfied with the National Health Service; long waiting period for many services due to lack of facilities and staffing;
3. Germany's Health Care System
90% of the population is covered by a statutory health insurance system called, Krankenkasse or "sickness fund"; 8% (the rich) has private insurance and 2% (police, armed forces, welfare recipients) get free medical services; Krankenkasse is funded by payroll tax from employees and employers, and managed by private organizations;
majority of the hospitals are owned by the government or by nonprofit organizations;
doctors are either hospital-based or officebased (private practice); most office-based physicians are gatekeepers/PCP;
patients require authorization by PCP for hospitalization; then medical responsibilities transferred to hospitalbased physicians;
hospital based physicians are salaried and office-based physicians are paid by FFS;
all fees for medical procedures are fixed and negotiated by labor unions, physician associations, hospitals, etc.
little or no co-payment by patients, most health care services are free;
high utilization of physician services and Rx drugs, but low hospitalization;
one of the best health care systems in Europe and successful in keeping its population healthy;
4. Japan's Health Care System
all Japanese citizens covered by either the Employee Health Insurance or the National Health Insurance;
the Employee Health Insurance covers 55% population who are employed in private and public sectors while the Health National Insurance covers selfemployed persons and retirees;
both insurance programs are financed by payroll taxes or the government; health care delivery is dominated by private hospitals and clinics; most physicians are salaried employees of the hospitals or clinics; very little officebased practice; specialist and GP get same salary rate; salary depends on years of experience;
hospitals and clinics are reimbursed by insurance on a fix rate for each service provided; patients get a summary of all services used at the end of each year;
Japan has one of the healthiest population in the world with lowest infant mortality rate and highest life expectancy;
success has been attributed to high per capita income, excellent medical care, healthy diet, high literacy rate, and low rate of violence; due to aging population, Japan may have some budgetary problems in the future;
5. China's Health Care System
90% of the rural/agricultural pop. covered by the cooperative medical services; but privatization of the agricultural industry in the late 70s left only 5% of the rural pop. covered; the other 95% of rural pop. do not have any health insurance at all;
50% of the urban pop. covered by the government insurance system (public agencies & university employees) or the labor insurance system (state & company employees); financed by payroll contributions/ premiums;
currently, only 39% of Chinese population have health insurance; the rest are on FFS (no insurance, no gov't assistance);
ownership of hospital is determined at the bed level; some beds are owned by the government and some beds are owned by private companies - all within the same hospital building; western-trained and traditional Chinese physicians practiced side by side in most hospitals;
traditional Chinese medicine still used to a large extend;
despite a large percentage of population who are without access to health care, the health status of the population has not declined in the last few decades;
in fact, life expectancy and infant mortality rate has improved slightly; the Chinese health care system is in crisis due to high number of uninsured population and unequal distribution of and access to health care;
6. Cuba's Health Care System
Cuba has two main health care delivery systems called: a. The Family Physician Program; b. The Medicine in the Community Program;
The Family Physician Program has "family physician and nurse" teams that provide preventive, curative, and environmental health to a community of 600 - 800 persons;
the teams are also provided with housing and offices in the community - office based practice;
family physicians hold office hours during the day and perform hospital rounds or visits during the afternoons;family physicians are also responsible for inspecting community facilities, like food stores, pharmacies, and day care centers;
The Medicine in the Community Program provides polyclinics and hospitals that perform/offer laboratory and emergency room services, specialty physician consultations, and physician residency training; all health care services and education are financed by the government; the quality of health care and the health of the population in Cuba are as good as those in Canada and the US;
Cuba lost financial and political support after the fall of the Soviet Union and it has also lost 85% of it's international trade from the US economic embargo;
biggest health problem is lack of food for the people but the health of the population is better than ever due to the government's stress on education and health care; Cuban population is satisfied with the health care system in the country;