Curing Our Medical System – a Look at how Other Countries Operate

Assuming we have finally admitted our healthcare system has been failing, how do we fix it? The best place to start is to look at systems that are working better than ours. Good places to look first are France and Italy, countries that are consistently rated 1 & 2 in the world for medical services, general health, and reasonable cost by the World Health Organization (WHO). These countries also enjoin a similar lifestyle, cost of living, and expect the same creature comforts and services that we do. The United States is ranked 37th in the world by WHO yet the cost of our health care is the most at 15.2% of the GDP (Gross Domestic Product - total economic productivity). By contrast, France pays only 11.2% and Italy 8.9% of their GDP. These are shocking numbers. Not only is the health care delivery to our population significantly inferior to 36 other countries, we are paying 40-50% more for it – you should be outraged!

All countries in Europe have universal health care including Austria, Belgium, Bosnia and Herzegovina, Bulgaria, Croatia, the Czech Republic, Denmark, Estonia, Finland, France, Georgia, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, the Netherlands, Norway, Poland, Portugal, Romania, Russia, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland, Ukraine, and the United Kingdom. In the Americas, Argentina, Brazil, Canada, Chile, Costa Rica, Cuba, Panama, Peru, Uruguay, and Venezuela all have public universal health care. The United States is the only wealthy industrialized country in the world without universal healthcare. Universal health care covers medical, dental, and mental health care. These programs vary in their structure and funding mechanisms. Typically, most costs are met via a single-payer health care system or compulsory health insurance.

France’s system is consistently rated 1 or 2 in the world. It has coverage of everyone, reasonable monthly fees, excellent care, and very few complaints by the population. Everyone is required to pay into the basic system as a percentage of their salary, except those in the bottom 1% of the population. Employers pay 12.8% of the salary and employees pay 0.75%, although most employees (85%) pay an additional voluntary 2.5% of their salary to a mutual insurer for supplementary insurance. The French have their choice of any GP or specialist and do not have to go through a GP gatekeeper to see a specialist. They pay the doctor fee up front and then typically claim back 75-80%. The French national insurance makes no distinction between public and private hospitals and patients are free to choose. Public hospitals make up 65% of beds.

The French government tries to control costs by deliberately encouraging responsible consumer demand by requiring modest consumer payments. It also has a built-in safety valve of supplementary insurance in case the wishes of the French government are out of sync with the French people. The result is a nice blend of consumer choice, professional autonomy, central regulation, and government-backed guarantee for the poor which provides universal benefits within a competitive market.

Up until 2002, France’s malpractice claims system was similar to our, except the injured party was rarely able to get a jury trial, which were the ones likely to award the large amounts. In response to rising malpractice premiums, France has moved to a Scandinavian compensation system.  Under the French implementation of the Scandinavian system, wronged patients bring claims before their regions' government-appointed review board which is responsible for determining if compensation is in order and, if so, how much. For a patient to get paid, the board does not have to find the doctor at fault, or that medical negligence caused whatever pain and suffering the patient is experiencing. Money for patient relief comes from a national compensation fund. The closest analogy to this sort of system in the United States would be workers' compensation funds that many states run. The goal of such systems is not to find fault or establish causation as much as it is to provide a bit of compensation to workers who are injured on the job.

The above healthcare & malpractice systems would be workable and acceptable in our own society as well. Many of the requirements and infrastructure are already in place. The biggest objectors are likely to be the private insurers and malpractice lawyers who been reaping huge profits and fees respectively over the past few decades. A successful transition will require reasonable control of malpractice claims, as this has also driven up costs dramatically in this country due the need to order an excessive number of tests and consults due to the fear factor among doctors. A successful transition will require very strong leadership from our elected officials, who will need our backing as well. Let us hope that president-elect Barack Obama and the new Health & Human Services director have the strength and courage. Please write to them and your congressmen to let them know your concerns and your opinions. Feel free to use or quote from parts of my article. A good vehicle to reach the proper elected officials is through the AMA at http://www.patientsactionnetwork.org/content_adcenter.aspx

More info on single payor systems: http://www.pnhp.org/single_payer_resources/proposal_of_the_physicians_working_group_for_singlepayer_national_health_insurance.php

Timothy McClain, MD

Laurel, MD

Sources: World Health Organization; Civitas, The Institute for the Study of Civil Society