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Smokey
09-15-2013, 08:05 PM
For most western countries, the health care cost seem to be averaging around $4500 per year per capita. For USA, the cost is almost 100% more at $8,500 per person a year.

Ranked accordingly:

Mexico: <richtext><xhtml>In 2000, half of the country had no health insurance, but the country passed a universal health care law a decade ago, creating Seguro Popular, which literally means popular insurance, and has enrolled more than 50 million people.
Per capita spending (in U.S. dollars): $977
Share of GDP spent on health care: 6.2%
Share of health care that is publicly funded: 47.3%

Italy: <richtext><xhtml>All residents are covered for emergency medicine and doctor visits, and the system is primarily funded through taxes. Some services require small copays, and a private system covers services such as dental.
Per capita spending (in U.S. dollars): $3,012
Share of GDP spent on health care: 9.2%
Share of health care that is publicly funded: 77.8%

Spain: <richtext><xhtml>The system offers universal coverage and no out-of-pocket expenses aside from prescription drugs. The system is partially funded through taxes, and services such as dental care are paid out of pocket.
Per capita spending (in U.S. dollars): $3,072
Share of GDP spent on health care: 9.3%
Share of health care that is publicly funded: 73%

Japan: <richtext><xhtml>Health care is covered 70% by the government and 30% by the patient. Those without access to insurance through employers can participate in the national health insurance program through local governments. Hospitals are run as nonprofit organizations.
Per capita spending (in U.S. dollars): $3,213
Share of GDP spent on health care: 9.6%
Share of health care that is publicly funded: 82.1%

United Kingdom: <richtext><xhtml>Universal care is provided to residents, including primary care, mental health and hospitals, with cost-sharing for dental and prescription drugs. Health care is largely funded through taxes.
Per capita spending (in U.S. dollars): $3,405
Share of GDP spent on health care: 9.4%
Share of health care that is publicly funded: 82.8%

Sweden: <richtext><xhtml>The universal public health system is largely funded through taxation. Dental care is included for children under 21, and adult dental care is partially subsidized.
Per capita spending (in U.S. dollars): $3,925
Share of GDP spent on health care: 9.5%
Share of health care that is publicly funded: 81.6%

France: <richtext><xhtml>According the World Health Organization, France provided the best overall health care (publicly funded universal health care) in the world in 2000.
Per capita spending (in U.S. dollars): $4,118
Share of GDP spent on health care: 11.6%
Share of health care that is publicly funded: 76.8%

Germany: <richtext><xhtml>Since 1883, Germany has had some form of social health insurance. Standard insurance is funded by employee contributions, employer contributions and government subsidies. Some pay a tax to opt out of the standard plan, paying for private insurance based on health status.
Per capita spending (in U.S. dollars): $4,495
Share of GDP spent on health care: 11.3%
Share of health care that is publicly funded: 76.5%

Canada: <richtext><xhtml>Universal health care is for the most part publicly funded. Canadians are guaranteed access to hospital and physician services, but each province determines whether to cover benefits such as dental care and drug coverage. Many Canadians purchase supplemental insurance or have an employer-sponsored policy to cover these things.
Per capita spending (in U.S. dollars): $4,522
Share of GDP spent on health care: 11.2%
Share of health care that is publicly funded: 70%

Switzerland: <richtext><xhtml>Basic health insurance is mandatory, and insurers are required to offer insurance to everyone and are not allowed to make a profit from basic insurance (but can profit on supplemental plans for dental or other services). Low-income individuals receive government subsidies to help pay for coverage.
Per capita spending (in U.S. dollars): $5,643
Share of GDP spent on health care: 11%
Share of health care that is publicly funded: 65%

Norway: <richtext><xhtml>A universal public health system is paid for largely through taxation. It does not include dental coverage.
Per capita spending (in U.S. dollars): $5,669
Share of GDP spent on health care: 9.3%
Share of health care that is publicly funded: 85%

United States

<richtext><xhtml>Per capita spending: $8,508
Share of GDP spent on health care: 17.7%
Share of health care that is publicly funded: 47.8%

Global medical costs -- how the US stacks up- MSN Money (http://money.msn.com/health-and-life-insurance/global-medical-costs-how-the-us-stacks-up)
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Feanor
09-16-2013, 08:01 AM
The per capita amounts would, I'd guess, reflect the cost of living and/or wage costs in the various countries, thus Mexico's are understandably lowest while Switzerland, Germany, Norway, as well as the USA's are higher. Sweden is close to Norway however it has notably lower cost per capita and % GDP but a similar level of public funding -- are Swedes healthier or younger than Norwegians? Or is the former's system more efficient?

In any case there is nothing to support the notion that the USA's system is more efficient on account of being largely private vs. largely public. So is the USA's system higher quality? And if higher quality, is that higher quality accessible to all or really just to a minority?

blackraven
09-16-2013, 09:13 AM
Our costs are higher for several reasons. The majority of our health care dollars are spent in the last 6 months of life. We waste more money keeping people with no or poor quality of life alive at all costs. We have a very sue happy society that drives up malpractice and product liability costs. This causes inflated prices and defensive medicine. Our population is larger and we have a very large geriatric population which eats up health care dollars. We have a large uninsured or under insured population that do not pay their health care bills. The emergency dept I used to work in use to collect about 55% of their accounts payable, last year they collected 28% (and we are a non profit hospital but we have to pay our bills and employee's). This causes hospitals to raise their prices to make up the difference. Patients also want and demand the latest and greatest often demanding MRI's, Cat Scans, etc. Other countries
do not have an MRI scanner in every hospital and they practice more sensible, restrained medicine and patients have more realistic expectations. Patients in this country are now regarded as consumers and customers as opposed to patients. Customer service is now the biggest priority to hospital systems as opposed to good practical medicine. I could go on and on about why medical costs are so high.

JohnMichael
09-16-2013, 09:58 AM
I agree that we concentrate too much on the quantity of life over the quality of life. No one gets out of this life alive so people should be educated about final choices. As a caregiver to older adults I am surprised how few really understand how much fun it would be to have someone perform CPR or put them on a vent instead of letting them go quietly into this good night.

Oh and of course we have people who want to sue. Doctors and hospitals having to pay malpractice insurance also raises prices. My funny I am going to sue you story is a gentleman while his wife was at work decided to try one of her toys. If you lube something enough to slide something inside you it can just as easily slip out of your fingers. Needless to say a trip to the ER was needed. The object was removed and the patient kept for observation. He began to get ill and sure enough he had given himself a rectal tear. Once he was told what was wrong he was going to sue. I would love to hear him explain how it got up there in the first place.

We were just implementing HIPAA and everyone was happy that they could not tell the family why he was going back to surgery.

Feanor
09-16-2013, 10:47 AM
Our costs are higher for several reasons. The majority of our health care dollars are spent in the last 6 months of life. We waste more money keeping people with no or poor quality of life alive at all costs. We have a very sue happy society that drives up malpractice and product liability costs. This causes inflated prices and defensive medicine. Our population is larger and we have a very large geriatric population which eats up health care dollars. We have a large uninsured or under insured population that do not pay their health care bills. The emergency dept I used to work in use to collect about 55% of their accounts payable, last year they collected 28% (and we are a non profit hospital but we have to pay our bills and employee's). This causes hospitals to raise their prices to make up the difference. Patients also want and demand the latest and greatest often demanding MRI's, Cat Scans, etc. Other countries
do not have an MRI scanner in every hospital and they practice more sensible, restrained medicine and patients have more realistic expectations. Patients in this country are now regarded as consumers and customers as opposed to patients. Customer service is now the biggest priority to hospital systems as opposed to good practical medicine. I could go on and on about why medical costs are so high.
It strikes me that this is all valid more or less. (I know you're a medical professional.)

A lot of money is burned on Canada too for last year of life care. Contrary to what some people would like you to believe, there are no "death panels" here, but there are standards of care that balance cost vs. effectiveness such that people who are clearly terminal don't get "heroic" measures on the public tab.

I've heard some people quote outrageous fees charge to US Medicare. I wonder if this true, and if it is, whether it's an attempt, as you imply, to recover money from those people or institutions that have money to subsidize the cost of people who don't. This doesn't happen in Canada because coverage is universal.

Coverage here in Canada is definitely not "consumer driven". Procedures are funded or not funded depending on what provincial health authorities deem cost-effective; in practical terms this usually means that treatment A or drug A must be tried before treatment B or drug B is permitted -- assuming the 'B' versions are funded which isn't always the case. Note that insurance companies by law MAY NOT pay for any part of treatment for a condition that the provincial schemes cover; e.g. an insurance company cannot pay for an MIR, (for say, a bad knee), in order for the patient to get quicker treatment. If you want your MIR this week, take a plain, car, or bus to Michigan or your nearest US state and pay for it out of pocket.

Self-interested medical providers are constantly advocating that private payment be permitted for, e.g., the aforementioned MIR. They argue that (a) it would take pressure of the system if the better-off would pay some of their medical bills themselves, (b) competition would increase efficiency & improve service, (c) consumer choice is a human right. Basically this is a "two-tiered" system: IMO, this approach inherently cannot ensure that everyone gets the same quality of essential healthcare: resources will always be flee from the free segment to the paying segment and consequently less well-off people will get increasingly poorer healthcare.

For-profit systems are good at delivering profits, not so much good healthcare for all.

Correct me if I'm wrong, but in the USA it seems that "consumer choice", that is, patient choice, is mostly an illusion for anything but basic, routine costs. Where the rubber hits the road it's the insurance company, HMO, Medicare, or Medicaid is who makes the choice.

blackraven
09-17-2013, 07:42 AM
It strikes me that this is all valid more or less. (I know you're a medical professional.)

Correct me if I'm wrong, but in the USA it seems that "consumer choice", that is, patient choice, is mostly an illusion for anything but basic, routine costs. Where the rubber hits the road it's the insurance company, HMO, Medicare, or Medicaid is who makes the choice.


You are correct.

What ever happens here, people will not be satisfied.

Other issues with the health care system here is that Obama is forcing the private practitioner out of business and forcing him to become an employee of a hospital or health care system. This puts the physician under the thumb of the government and hospital administrators. It really takes a lot of the medical decision making away from the physician. The government cares only about saving money at the expense of quality of care and the health care administrators only care about making money causing them to run hospitals and clinics with lean staffing over working health care providers causing a dangerous environment for patients. You can't cut staffing and expect staff to work harder with less and maintain a safe environment and provide quality care. Under Obama, reimbursements to hospitals will now be tied to certain parameters. Here are a few for emergency medicine (they seem good on paper but are not obtainable) They want door to doctor time at 20 minutes or less, door to injectable pain medicine for long bone fractures in less that 30 minutes (it could take an hour to get all the xrays that you need to determine if there is a fracture, plus, nurses and doctors could be tied up with critical patients.). Door to EKG time in 10 minutes or less- this is a good thing but heart conditions don't always present with chest pain and the typical symptoms. And lastly, length of stay in the ER under 180 minutes. This is ridiculous because it could take 2 hours just to get a cat scan done. All these measures will force your healthcare provider to take short cuts, spend less time with a patient and lower the quality of care.

Sorry about my rant but this is what is coming down the pike here in the states and it is not good. As hospitals get paid less, it will be the patients that ultimately will suffer.