Where is the best health care system in the world?

Certainly not in the United States, as many attendees concluded after listening to T.R. Reid’s presentation in Plenary Session IV. The Washington Post reporter and National Public Radio commentator introduced us to facts about the United States health care system, then went on to present the pros and cons of other systems.

A common feature in other advanced, high-tech democracies is that the same health care system applies to every citizen. In the US, the richest country in the world, 49.4 millions Americans don’t have health insurance, and Reid called this a “lethal condition”, as 22,000 die each year of treatable diseases. Even if they survive a life-threatening condition, 800,000 Americans face bankruptcy every year, while at the same time the finest care is reserved for congressmen. Reid stated that “Americans need to change their rotten, unfair and unequitable health system”.

Why doesn’t the United States choose to provide health care for everyone? Reid went on a trip around the world to find out how other countries achieve this. None of the systems is perfect, and horror stories happen everywhere; many socialized medicine systems integrate private care; and every country is struggling with increasing health care costs. The four basic models of health care systems are:

  1. Beveridge model (Great Britain, Spain, Cuba, Scandinavia): In this public model, the government owns hospitals and labs, and employs specialists. Physicians are private, but bill the government and give house calls. There are no premiums, no co-pay, and no doctor bills. The service is efficient, and overall health statistics are similar to those in the US.
  2. Bismarck model (Germany, Switzerland, France, Japan): At the opposite end of the spectrum, everything in this model is private: doctors, hospitals and insurance. Health care is, in effect, a regulated  private enterprise.
  3. Douglas model (Canada, Australia): This model is a blend of the two previous models. It features private doctors and private hospitals, but public payment, as all citizens pay a fee on their paycheck. A disadvantage of this system is waiting lists.
  4. Out of-pocket model (about 150 countries): For most of the rest of the world, health care is a luxury. If you don’t have money, you pay with what you’ve got, for example a 10-pound bag of potatoes.

All these models coexist in the United States. Nineteen millions veterans and Native Americans are on the Beveridge model; 47 millions seniors are on Medicare, based on the Douglas model; 150 millions Americans use the Bismarck model of private health care; which leaves 49.9 million US citizens on the out-of-pocket model. By contrast, all other countries treat everyone the same, and advantages of having a single model include:

  • Much simpler to administrate and therefore cheaper.
  • There is an economic incentive to promote public health.
  • There is a moral imperative to do so. It’s fair, decent and ethical to include everybody in the system.

Reid concluded that designing a medical system involves decisions, but the fundamental question is: do we want to include everyone? “If Americans could find the political will to provide healthcare to all, other countries could show them the way.”

About Natalie Clairoux

I graduated from Université de Montréal's LIS program in 2008, and started working at the Health Library of the same institution right after. My duties include reference services, information literacy workshops and Web site coordination. In a previous life, I worked as a research assistant in various academic laboratories specializing in molecular microbiology. I detain B.Sc. (McGill 1990) and M.Sc. (Laval 1992) diplomas in Microbiology and Immunology. I blog in French about LIS meetings I attend on Bloguer, c'est la santé.
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2 Responses to Where is the best health care system in the world?

  1. Goulnik says:

    I’d be interested to know your reference for listing France under the ‘Bismarck’ model. In actual fact, the French system is very similar to what you have in Canada, as a hybrid between the first two.

    • Natalie Clairoux says:

      I am not very familiar with these models. You may wish to contact Mr Reid directly, or read how France’s health system is depicted in his book: “The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care”.