Question

How might one compare the organizational forms of health care systems or Switzerland, Germany, and the United States?

Answer 1

Ans) Variations exist in terms of financing, provider payment mechanisms, and the role of government, including the degree of centralization.

- The United States stands out as the country with the highest expenditures on health care. It would appear that systems that ration their care by government provision or government insurance incur lower per – capita costs. On the other hand, in the largely private system in the United States, waiting times tend to be shorter than in rationed systems, a conclusion that follows simply from theory as well as from observation.

- Americans have been more dissatisfied with their health system than Canadians or Germans have been with theirs. Many characterize the main gap in the American system as the problem of the uninsured – more than 40 million people. While this does not mean that they go entirely without care, the uninsured consume only half as much health care on average as the insured.

- Among three countries, the United States is by far the biggest spender in absolute per capita terms. It is also the biggest spender as a share of GDP. Germany manages to provide a health system that delivers universal health insurance while avoiding queues that often trouble government systems. However, costs per capita have been increasing faster than the incomes per capita, a problem leading to strenuous reforms in the 1990s.

- Many Americans feel that Canada has successfully developed a comprehensive and universal national health insurance program that is both cost effective and popular.

- Compared to the US system, the Canadian system has lower costs, more services, universal access to health care without financial barriers, and superior health status. Canadians and Germans have longer life expectancies and lower infant mortality rates than do US residents.

- Part of the gap between US and Canadian health care costs may be explained by a failure to account for Canadian hospital’ capital costs, larger proportion of elderly in the United States and higher level of spending on research and development in the US.

- One should mention that data from different countries may not be directly comparable for several reasons and therefore, should be accepted with some skepticism.

- For instance, no standard taxonomy exists across countries. Also in practice it is often very difficult to draw a line separating medical services such as acute and long-term care services. In addition, monetary values for health care expenditures and gross domestic product must be converted to a common denominator such as US dollars, before meaningful comparison can be made. Any conversion factor, such as purchasing power parities or currency exchange rates is not without measurement error (Santerre and Neun 561).

- Finally, most Canadians and Germans think that their health care systems need minor to moderate changes, while in the United States a substantial portion of the population thinks that large and fundamental changes are needed. Each health care system analyzed above is experiencing a continuous process of changes and improvements and all three systems fight the never-ending battle of cost containment, provision of quality services and maintaining and expanding access to health care. This goal is one that they can only hope to attain or come close to. Large portions of the economic pie are consumed by the health care systems in these three countries and the importance of health care is likely to have an even greater significance in the years to come. Consequently, it will be fascinating to observe the future developments and improvements in the health care systems of Canada, Germany and the United States.