Healthcare: Comparing different systems

  • Healthcare systems
Published on 2017-07-28 at 12:18
Healthcare is an important consideration if you are thinking about moving abroad, and it is nice to know there is a good system in place, should anything untoward occur. The Commonwealth Fund has assessed the healthcare systems of eleven developed nations in order to compare the top ten with last place US.

Top three healthcare systems

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The UK and its universal healthcare system came out on top overall, despite the NHS budget being constantly squeezed by the current UK government. However, it notably feels short on health outcomes, coming in just ahead of the US and a fair way behind the rest of the pack. This suggests that long term treatment is perhaps not as effective as it should be. This is reflected in its rate of mortality amenable to healthcare, which was the highest in 2004 and, despite a fair drop in numbers, remained the third highest in 2014.

In the second place, with a system similar to the US Medicare plan, is Australia. This is a hybrid public-private system, with healthcare via public insurance being funded by taxpayers and care being provided by the private sector, which individuals can supplement with additional health insurance. Australia scored highly across the board, though it did come in seventh for equity, leaving room for improvement regarding accessibility across different economic backgrounds.

The Netherlands featured in third place overall, though it came in first for access (looking at affordability and timeliness of services). Bearing some similarities to the US system, the Dutch healthcare is administered through private insurers financed by premiums and taxes, which are allocated according to the risk overview of the insurer's customers. Undoubtedly playing a key role in the Netherlands' first place for access is that there are subsidies for those on lower incomes, ensuring that basic coverage is not out of reach.

The bottom three healthcare systems

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Canada is often held in high regard for its system of universal healthcare, however, it came in ninth place, just two above the US. In spite of this, healtchare in Canada performed poorly when it came to access, equity and outcomes. The Canadian healthcare system has a limited remit, with many choosing private healthcare to cover aspects such as dental care, which are not covered under the universal healthcare system.

Another country that is often mentioned for the high quality of its healthcare is France, however, it came in just above the US in tenth. The French healthcare system involves public insurance with financing being controlled by the government, with residents obliged to pay for insurance. It has a broader remit than Canada, for example, with a large part of dentist fee's being reimbursed in addition to doctors. France fared best in healthcare outcomes, where it came fifth, indicating that despite its low position, treatment of illnesses is moderately effective.

The US: Lessons to be learned

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At the bottom end of the table, the US has been in the news recently due to Republican efforts to repeal the 'Obamacare' policies. However, there has been a notable struggle to find a replacement that would both turn over key parts of the legislation and continue to provide the same amount of healthcare coverage across the US, given the cost of private health insurance. America came in fifth when it came to the care process, highlighting the positives of the system; namely interaction between patients and health professionals during treatment, as well as preventative care. However, it came in last on almost all the measures (for administrative efficiency it came in tenth), despite having the highest level of spending on healthcare, by far.

In addition, the US had, by far, the highest rate of mortality amenable to healthcare, along with the lowest reduction over ten years. It had over twice as many mortalities as Switzerland (which had the least, overall). The low level of decline in deaths amenable to healthcare (16%) lags far behind the rest of the group, with levels of reduction between 26% and 37%.

When looking at whether recipients had issues regarding cost when trying to access healthcare, the US had the highest level of reported cases, at 33%, 10% more than tenth place Switzerland. It also had the lowest levels indicating a regular doctor or place of care, again, just below Switzerland.

Mortality rates aside, the overall level of health also appears to be at a lower level when compared with the other high-income countries assessed. With the highest rate of infant mortality and the lowest life expectancy at aged 60 than the other ten countries, it seems the US has more to do on the preventative side of care as well. Healthcare is certainly not the only contributing factor to these issues, but given that it has the highest percentage of adults between 18 and 64 with at least two out of five common chronic conditions, an efficient healthcare system is imperative.

Given the current question marks over the US healthcare system, it is clear that there is room for change and an appetite for it, however, the direction is the subject of much debate. The US can definitely stand to take some inspiration from other countries with more effective healthcare systems.

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