Download Comparative Health Systems

Comparative Health Systems
What Metrics are important?
• When comparing health systems, what
metrics would you use?
– Be specific.
Gruber: ACA
• http://www.youtube.com/watch?v=qEAyoxhj
7O0
• Or cspan link
• http://www.cspanvideo.org/program/303580-1
• At minute 38 discussion of US v other systems
Categories of Health Systems
1. National Health Insurance (Canada)
government is third party payer
2. National Health Care system (UK)
government provides health care
3. Community sickness funds w/subsidy (FR &
GE)
4. Mixed public and private (US, Japan,
Australia)
0
5
10
15
20
United States
France
Switzerland
Germany
Belgium
Austria
Canada
Denmark
Netherlands
Greece
Iceland
New Zealand
Sweden
Norway
Italy
Spain
United Kingdom
Finland
Slovak Republic
Ireland
Hungary
Czech Republic
Korea
Poland
Mexico
2007 Total Health Expenditure as a % of GDP
Total expendit. on health /capita, $ PPP
$8,000
US
$6,000
$4,000
France
$2,000
Korea
$0
$10,000
$20,000
$30,000
GDP Per Capita $PPP
$40,000
$50,000
Total expendit. on health /capita, $ PPP
$8,000
US
$6,000
$4,000
France
$2,000
Korea
$0
$10,000
$20,000
$30,000
GDP Per Capita $PPP
$40,000
$50,000
0
2
4
6
8
Korea
Ireland
Poland
Norway
Greece
United Kingdom
Spain
Czech Republic
Austria
Mexico
Netherlands
Belgium
United States
New Zealand
France
Japan
Denmark
Canada
Switzerland
Sweden
Finland
Germany
Italy
Iceland
1990-2007 Average annual % change in total health
expenditure per capita, $PPP (OECD)
10
2007 Public and Private Health
Expenditures as percent of GDP
France
Denmark
Germany
Austria
Iceland
Norway
Sweden
United States
New Zealand
Canada
United Kingdom
Italy
Switzerland
Ireland
Finland
Spain
Australia
Czech Republic
Greece
Hungary
Slovak Republic
Poland
Korea
Mexico
Public
Private
-
5.0
10.0
15.0
20.0
2007 Public Health Expenditures as Percent of GDP
France
Denmark
Germany
Austria
Iceland
Norway
Sweden
United States
New Zealand
Canada
United Kingdom
Italy
Switzerland
Ireland
Finland
Spain
Australia
Czech Republic
Greece
Hungary
Slovak Republic
Poland
Korea
Mexico
-
2.0
4.0
6.0
8.0
10.0
Canadian Health System
•
•
•
•
•
Single Payer
Financed out of income tax revenue
No “official” gate keepers
No parallel private insurance allowed
Supplementary insurance subsidized as
employer based in US
Canadian Health System
•
•
•
•
Physicians and Hospitals
Diffusion and Use of technology
Role of Insurance
Divergence between US and Canada
German
•
•
•
•
Sickness Funds
Private Insurance
Reforms of the 1990s
Hospitals Mixed public/private
German
• Physicians and Hospitals
• Technology
• Effects of Financing through Payroll Tax
– With elastic labor supply the decrease in demand
results in lower employment rather than lower
wages
UK
• Structure of NHS
– Rationing by queuing
– Private parallel insurance
• Physicians compensation
– Hospitals (Salary)
– Non-Hospital (Capitation)
Summary
• Canada has best health outcomes
• UK spends the least.
• Germany has the greatest Hospital/Physician
capacity
• US Spends the most, and has the worst
outcomes as measured by life expectancy