Healthcare Policy: Part 1
Cedric Dark, MD and Anand Swaminathan, MD
- Universal Healthcare
- Universal healthcare essentially means that everyone living in a given country has healthcare provided.
- WHO definition
- 90% of people living in a country have some level of healthcare.
- 90% of people have access to skilled child delivery.
- Some type of government system is in place to ensure that people have access to coverage.
- Benefit: Improved health equity among socioeconomic groups.
- Systems for achieving universal healthcare
- Single Payer (national health insurance system)
- These systems are funded through taxes but services by physicians and hospitals are paid through a private delivery system (ie, physicians and hospitals are private).
- Examples: Canada, US Medicare/Medicaid
- Advantages: Costs can be regulated, including pharmaceutical costs, through a controlled formulary and the leverage that this provides in negotiation.
- Downsides: Delays in care, physicians/hospitals have reduced negotiation power.
- National Health System
- Government owns the hospitals and employs the doctors, nurses etc
- Examples: UK (NHS), US Veterans Affairs, US Indian Health Services
- Advantages: Costs can be regulated as with single payer.
- Downsides: Delays in care.
- Compulsory Health Insurance System
- People must purchase insurance through private systems or through a marketplace.
- Hospitals and physicians are private.
- Regulated and subsidized through the government
- Examples: Switzerland, Germany, Singapore, US Healthcare.gov (ie. Obamacare)
- Advantages: More expedient care delivery.
- Downsides: Not all people can afford coverage and if tied to employment, coverage can be lost.
- Voluntary System
- A voluntary system is unlikely to achieve universal healthcare on its own.
- The US system has features of all of the above systems.
tom f. - June 10, 2021 12:59 AM
very interesting , stimulating conversation.
it is interesting how this wasn't a significant part of my medical training or conversations.
Mallory B. - June 14, 2021 5:06 PM
Is it true that in these universal systems that are primarily government lead that "they" can decide on if a treatment is provided. As an example, if an elderly person needs a major surgery "they" can deny them based on age and Comorbidities etc. And are "they" able to determine how long a person can be intubated etc without family input.
Anand S. - June 14, 2021 5:25 PM
Not exactly. Insurance companies in the US can decide not to issue approval for diagnostics, treatments, medications etc. Systems in other counties have similar issues. Definitely a no on the deciding about intubation. There are numerous systems (most in developing countries) where everything is pay for service; if you can't pay for the intervention (ie intubation and mechanical ventilation) it won't happen.
In future segments, we'll be diving more into how individual country's systems work. We'll be chatting with docs who have worked in the US as well as in another system to discuss the differences in practice.
J. B. L. - July 4, 2021 10:26 AM
I moved from the USA to Israel in 1997 ( half way through my career) and feel I could give you some input on the system here. Since I work with many "FMGs ( ie learned medicine outside of Israel) " - we could help you also understand systems in Egypt, West Bank,Jordan,Spain and Germany. Let me know