To do this, government agencies must collect and analyze data and use their purchasing power to influence health care providers. The United Kingdom developed the single-payer system. Other countries include Spain, New Zealand, and Cuba. The United States offers it to veterans and military personnel with the Department of Veterans Affairs and the armed forces. Countries often combine universal health coverage with other systems to introduce competition. These options can lower costs, expand choice, or improve care.
In some cases, citizens can opt for better services with supplemental private insurance. Countries that use a social health insurance model require everyone to buy insurance , usually through their employers.
Employers deduct taxes from employee payroll to cover the costs, and the taxes go into a government-run health insurance fund that covers everyone. Private doctors and hospitals provide services. The government controls health insurance prices. It also has a lot of clout to control the private providers' prices. Germany developed this system, which is also known as the Bismarck model.
France, Belgium, the Netherlands, Japan, and Switzerland also use it. Obamacare system also requires insurance, but there are many exemptions , and this rule is no longer enforced by penalties. It is also similar in that it provides subsidies to health insurance companies for low-income enrollees. The national health insurance model uses public insurance to pay for private-practice care. Every citizen pays into the national insurance plan.
Administrative costs are lower because there is one insurance company. The government also has a lot of leverage to force medical costs down. Canada, Taiwan, and South Korea use this model. Here is a look at the UHC systems in some of the world's developed nations. Australia has a mixed health plan. The government provides public health insurance, called Medicare, and runs public hospitals. Everyone receives coverage.
People must pay deductibles before government payments kick in. Many residents are willing to pay for additional private health insurance to receive a higher quality of care. Government regulations protect seniors, the poor, children, and rural residents. In , health care cost 9. Wait times for elective surgeries ranged from 17 days for a coronary bypass to for knee replacement.
Australia also has one of the best infant mortality rates of the compared countries at 3. Canada has a national health insurance system. The government pays for services provided by a private delivery system. Private supplemental insurance pays for vision, dental care, and prescription drugs. Hospitals are publicly funded. They provide free care to all residents regardless of their ability to pay. The government keeps hospitals on a fixed budget to control costs, but it reimburses doctors at a fee-for-service rate.
In , health care cost I came across this quote from Princeton economist Uwe Reinhardt while I was starting to report this project, and it stuck with me throughout.
From his most recent book Priced Out , which was published after he died in Canada and virtually all European and Asian developed nations have reached, decades ago, a political consensus to treat health care as a social good. By contrast, we in the United States have never reached a politically dominant consensus on the issue. When I told people in Taiwan or the Netherlands that millions of Americans were uninsured and people could be charged thousands of dollars for medical care, it was unfathomable to them.
Their countries had agreed that such things should never be allowed to happen. I saw all kinds of health systems in action: true single-payer in Taiwan, a mix of public and private insurance in Australia, private coverage for everybody in the Netherlands. Each of them surpassed the United States in two critical ways: Everybody had insurance, and costs to patients were much lower.
Specialty care in the rural parts of the country is lacking. On the whole, the medical field seems to be ambivalent about the national health insurance. But raising taxes to more adequately fund the system or bumping up cost sharing to encourage more discretion in health care use is almost as big of a political challenge there as it would be here.
Nobody wants to pay more for health care next year than they did the year before. Australia has layered a private health care system on top of its universal public insurance program, and that gives both doctors and patients more choice about medical care.
But once you have different tiers in your health care system, disparities are going to emerge. And because the Australian government is spending billions of dollars supporting a struggling private insurance industry for middle-class and wealthier patients, it has fewer resources to devote to disadvantaged populations, like indigenous Australians or patients living in rural areas who have less access to medical care.
Public patients in public facilities face longer wait times. The Netherlands, meanwhile, has handed over the responsibility for providing coverage to private health insurers, and that has come with costs too. The Dutch have had to impose strict regulations on health insurance, including harsh penalties for people who fail to sign up for insurance on their own. Doctors in the Netherlands are more likely than those in more socialized systems to say their patients struggle to afford medical care.
They are also more likely to say the administrative work they have to do is a drain on their time. Health care spending in the Netherlands has also been rising at a faster clip since the move to the mandatory private insurance system. So the question becomes what kind of trade-off is more palatable.
There is no way to avoid it: If you want universal coverage, the government is going to play a huge role. In Taiwan and Australia, that means the government runs a universal insurance program that covers everybody for most medical services. But even in the Netherlands, which relies on private health insurers, the government oversees everything.
It sets rules about what benefits have to be covered, what prices can be charged, and what cost sharing is required. It collects contributions from employers to pay the cost of covering everybody and spreads it among the insurers based on the health status of their customers.
All told, about 75 percent of the funding for health insurance in the Netherlands is still running through the national government, even if the actual insurance benefits are being administered by private companies. Under all of these insurance schemes, the governments use much more force to keep health care prices down compared to the US. In Taiwan, that means global budgets — an annual amount set aside every year for various sectors of the health industry hospitals, drugs, traditional Chinese medicine, etc.
In the Netherlands, even with private insurers, the government sets limits on how much health spending can accrue in a given year and has the authority to impose budget cuts if spending exceeds that limit.
Kerr , 1 Justin B. Moore , 2 and Lee Stoner 1. Find articles by Gabriel Zieff. Zachary Y. Find articles by Zachary Y. Justin B. Find articles by Lee Stoner. Author information Article notes Copyright and License information Disclaimer. Received Sep 6; Accepted Oct Abstract This commentary offers discussion on the pros and cons of universal healthcare in the United States.
Keywords: chronic disease, health insurance, socio—economic status, obesity, diabetes, hypertension, health promotion, universal healthcare. Introduction Healthcare is one of the most significant socio—political topics in the United States U.
Argument for Universal Healthcare Universal healthcare in the U. Preventive Initiatives within A Universal Healthcare Model Beyond providing insurance coverage for a substantial, uninsured, and largely unhealthy segment of society—and thereby reducing disparities and unequal access to care among all segments of the population—there is great potential for universal healthcare models to embrace value-based care [ 4 , 20 , 34 ].
Conclusions Non-inclusive, inequitable systems limit quality healthcare access to those who can afford it or have employer-sponsored insurance.
Author Contributions Conceptualization, G. Funding This research received no external funding. Conflicts of Interest The authors declare no conflict of interest.
References 1. Study Light D. Universal health care: Lessons from the British experience. Public Health. Chernichovsky D. Integrating public health and personal care in a reformed US health care system. Unger J. Health Serv. Economic Freedom of the World Cato Institute. Disparities Healthy People Fuchs V.
JAMA J. Blahous C. Daniels M. Sessions S. A road map for universal coverage: Finding a pass through the financial mountains. Health Polit. Policy Law. Sanders B. Options to Finance Medicare for All. Thorpe K. Skocpol T. Podemska-Mikluch M. I always thought if we built accessible health services for rural areas it would be an easy sell for people. Unfortunately, that was incomprehensibly incorrect.
If you have never had quality healthcare before, then the process of using it can be a foreign concept. A huge amount of effort must be made to unpick these complex cultural norms.
As unfortunate as it is, corruption is often our first stumbling block. Government officials have asked us for thousands of dollars as a precondition before allowing us help their low-income constituents access affordable healthcare.
Unfortunately, this means we sometimes walk away from many in-need communities as a result. Corruption also occurs in more systemic ways. While many multinational pharma companies are increasingly committed to access initiatives, the social impact of these schemes can be muted by predatory middlemen or even government officials with commercial conflicts of interest.
Stronger enforcement must be taken to stamp out these behaviours. Like many other countries, e-prescriptions were banned in the Philippines until recently, with temporary allowances only allowed as part of the COVID response. Diagnosis still cannot be made without a physical in-person consultation. Given the lack of human health resources in rural areas these policies necessitate rule-breaking and a complete disregard for regulations for example, most pharmacies in the Philippines will not ask for a prescription.
More pressure must be put on governments to rethink the rulebook to create flexible, realistic regulations for remote communities. Technology can enable the solution, coupled with multilateral and donor policies encouraging flexible regulations for different parts of a country with different health access issues.
Too much funding is put towards rebuilding the provider-led, unintegrated health systems of yesterday, rather than reinventing health systems for tomorrow.
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