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NATIONAL HEALTH CARE – READ ABOUT NATIONS THAT HAVE IT.
By fred | July 23, 2009
Dear Friends, Family & my BLOGer family –
Enough is enough – just because I am a huge advocate of a National Health Care plan in the United States for every man, woman and tiny child – I have been sent some truly vicious letters. I have been called a socialist, a communist, a radical, and far worse. Many of the e-mails received are from such macho bastards that they will not even put their name to it.
Actually in my opinion I did not mind being called a socialist, most of the Scandinavian countries are socialist countries, I still have distant relations in Denmark and I have to say – they are happy campers.
Below you will read about Canada, United Kingdom, Italy, Germany, Holland, Norway, Sweden and Spain. If you want to know more – go to the internet and do your own research.
If you agree that this is of interest – that folks should read how other nations regard their health plans or about how they work, please send this to ALL OF YOUR MAILING LIST. Let’s get some sanity back into this subject. The drug companies and insurance companies that make a ton of money on our health care system will be and are pouring millions into trying to convince our people that this is a bad idea.
They do not care that millions of folks have no health care, they do not care that we are 24th in the nations of the world in the death of our citizens with an even worse rate for children under four years of age. They are extremely happy that we pay over three times what any other nation in the world pays for health care, they are happy as can be. Who cares how many Americans die early, they want the big bucks.
I would also like to remind you of the main reason that our auto makers went bankrupt – is that each American car had hundred of dollars in it for the employee’s health care. Cars made in other nations did not have this expense, as each citizen does not have to rely on a company to provide it, it is provided as a national plan. We must have a National Health Plan if our manufactures are to compete with other nations in the highly competitive world markets.
If you think as I do that it would be best for our citizens to have a National Health Care Program send this all of your list of friends and family – ask them to also forward it – it may help.
You’re Uncle Fred
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NATIONAL HEALTH CARE – COMMENTS FROM AROUND THE WORLD
FROM WRITERS IN THOSE COUNTRIES – THAT HAVE A NATIONAL HEALTH CARE.
FROM THE UNITED KINGDOM (BRITIAN)
National healthcare debate?
I really, really, really don’t understand this debate. The main argument seems to be ‘national healthcare will be ****’. But, why can’t you have both state, and private health care? Meaning, no one has to die because they can’t afford/get insurance, and those who want a premium service can pay for insurance.
This is the system we have in the uk, and it’s excellent. I’ve never had any problems with the nhs; I can phone my doctor at any time, and get a house call if the symptoms warrant it. I can get an appointment the same day if I phone up in the morning, no matter the symptoms. And, I can get full treatment, and drugs whenever I need them, and very quickly.
Basically, I don;t understand the ‘national health service would be slow and ****, and not as good as private…’ argument for two reasons:
1. It wouldn’t be, if it was anything like the uk’s. And, the uk’s lags far behind many others.
2. Private health care would still exist for those that wanted it.
What’s the problem with national healthcare? If it’s taxes, why can’t you route them from your military budget?
• 4 weeks ago
NEXT – MORE UNITED KINGDOM
There are all kinds of healthcare plans in the private sector, but the problem is they are not affordable for the lower paid sector and that is what Obama in the USA is trying to address in this debate about public healthcare.
Something like 60% of all Americans do not have any healthcare insurance. That’s a lot of people, when you consider the UK pop is now (I think) 300-million.
From my perspective here in UK – we have a Welfare State put in place by the Labour Government of 1945-1950 which includes the NHS (National Health Service).
How is the Welfare State including the NHS paid for?
Every single citizen pays NI-Contributions (National Insurance Contributions) which is deduced from their salary weekly or monthly.
Once a citzen (women 60 men 65) reaches retirement age, they no longer pay NI-Contribs.
What does the citzen get in return for these NI-Contributions – free healthcare, a whole raft of benefits including child benefit, unemployment benefit etc. And at the end of their working life (age 60 for women and 65 for men) every citizen gets a UK State Pension.
In addition to the above -every citzen is encouraged to save for their retirement and old age. People here in UK can buy private medical insurance if they wish.
There is NO opt out from the National Insurance Scheme – everyone pays, like it or not.
Right across Europe all EU countries have their own independent state operated healthcare and welfare etc.
You can find out more about the UK NHS as the link below.
History of the NHS – UK
http://www.nhs.uk/Tools/Pages/NHSTimelin…
The problem for Americans is that in order to have a US-Wide State healthcare system, it means accepting a degree of Socialism – exactly what Americans received with open arms from Gordon Brown who invented a way of savings the banks from a fate worse than death. You simply buy the banks with the people’s money.
You could do the same with the healthcare system and buy it all up and then it will be owned by the people, for the people and of the people.
FROM CANADA – COMMENTS ETC
by: Daniel De Groot
Tue Jul 21, 2009 at 21:30
Digby writes about this McClatchy article, highlighting an online poll of Canadians about their (our) health care system.
While the results are generally positive for the Canadian system in comparison to the American one (though McClatchy characterizes it as a “split verdict”), my inner social scientist is always nervous about trusting opt-in online polls too much, and I know this topic actually comes up fairly regularly in Canada so here’s a broader overview on the subject of comparative polling. It turns out we do have polling firms here that do real phone polling so there’s no need to worry about the possibly libertarian bent of online poll respondents.
First up, this Harris-Decima scientific poll from July 5th gives an even brighter picture than McClatchy’s effort, which as it relates to comparisons gives us this:
By an overwhelming margin, Canadians prefer the Canadian health care system to the American one. Overall, 82% said they preferred the Canadian system, fully ten times the number who said the American system is superior (8%).
Daniel De Groot :: Canadians Love Their Health Care and Want it to be Even More Socialized
Now granted one might expect this poll is skewed a bit by patriotism and the natural inkling to prefer the safe and familiar to that other horrid system over the border. For contrast, Harvard asked Americans some similar questions in spring 2008, and got this:
March 20 (Bloomberg) — The majority of Americans say U.S. private health care may not be better than national systems in Canada, France and the U.K., according to a poll by the Harvard School of Public Health.
The survey, co-sponsored with Harris Interactive Inc., a Rochester, New York, research and polling company, found that 45 percent of Americans thought the U.S. medical system generally was the best. The remaining 54 percent either didn’t know or thought other countries’ systems were better.
Now I freely admit Canadians spend too much time comparing ourselves to Americans, and are probably a bit prouder of our health care system than it really deserves given its mediocre placement when compared on objective criteria to some other UHC systems, but no one has ever accused Americans of lacking in patriotism either. As an observer of your politicians, seeing them assert America’s this or that is the best in the world without any factual basis cited is pretty common, and never fails to get applause so I take this poll as a pretty tepid endorsement of the US health care system.
Adding in ideology and party affiliation reinforces the significance of the Canadian result. Harris-Decima provides breakdowns by party, where only 12% of Conservatives preferred the American system and 76% preferred Canada’s. Even among our right wing (who as a rule tend to be very pro-American), you don’t find a lot of support for the American model.
MORE FROM CANADA
National disgrace: Free health care handed out to Americans last year in an animal pen.
Another American blowhard
Just who is this jerk, Rick Scott of propaganda-mongering Conservatives for Patients’ Rights? He and his group are fabricating negatives about Canada’s health care system and I resent this. I am an American who has lived in Canada for more than 35 years. I can vouch that the system is more than adequate and is not run by civil servants but by doctors who are able to treat everyone, rich or poor.
Mr. Scott, and other conservatives (code for rich) are against universal health care without any justification whatsoever. Their criticisms are in accurate and should not be broadcast.
Where are the ethics in network broadcasting? I saw one of Scott’s ads on CNN recently and wondered why the same curation of content was not imposed on CNN advertising messages as is upheld editorially. If CNN is unwilling to vet content, then where is the FCC?
The real story
Here are the facts as to why Canada’s medical system, far from perfect, is dramatically better than America’s:
1. It is cheaper even though it takes care of the entire population, or 10% of GDP compared with 15% in the U.S.
2. Canada’s health care system which fully looks after 32 million people costs roughly what the private-sector health insurance companies make in profits in the United States looking after less than half the population for excessive premiums.
FROM FRANCE
The French Lesson In Health Care
The nation’s system isn’t quite as superb as Sicko maintains, but it’s pretty good
Michael Moore’s documentary Sicko trumpets France as one of the most effective providers of universal health care. His conclusions and fist-in-your-gut approach may drive some Americans up the wall. But whatever you think of Moore, the French system—a complex mix of private and public financing—offers valuable lessons for would-be health-care reformers in the U.S.
In Sicko, Moore lumps France in with the socialized systems of Britain, Canada, and Cuba. In fact, the French system is similar enough to the U.S. model that reforms based on France’s experience might work in America. The French can choose their doctors and see any specialist they want. Doctors in France, many of whom are self- employed, are free to prescribe any care they deem medically necessary. “The French approach suggests it is possible to solve the problem of financing universal coverage…[without] reorganizing the entire system,” says Victor G. Rodwin, professor of health policy and management at New York University.
France also demonstrates that you can deliver stellar results with this mix of public and private financing. In a recent World Health Organization health-care ranking, France came in first, while the U.S. scored 37th, slightly better than Cuba and one notch above Slovenia. France’s infant death rate is 3.9 per 1,000 live births, compared with 7 in the U.S., and average life expectancy is 79.4 years, two years more than in the U.S. The country has far more hospital beds and doctors per capita than America, and far lower rates of death from diabetes and heart disease. The difference in deaths from respiratory disease, an often preventable form of mortality, is particularly striking: 31.2 per 100,000 people in France, vs. 61.5 per 100,000 in the U.S.
That’s not to say the French have solved all health-care riddles. Like every other nation, France is wrestling with runaway health-care inflation. That has led to some hefty tax hikes, and France is now considering U.S.-style health-maintenance organization tactics to rein in costs. Still, some 65% of French citizens express satisfaction with their system, compared with 40% of U.S. residents. And France spends just 10.7% of its gross domestic product on health care, while the U.S. lays out 16%, more than any other nation.
To grasp how the French system works, think about Medicare for the elderly in the U.S., then expand that to encompass the entire population. French medicine is based on a widely held value that the healthy should pay for care of the sick. Everyone has access to the same basic coverage through national insurance funds, to which every employer and employee contributes. The government picks up the tab for the unemployed who cannot gain coverage through a family member.
SAFETY NET
But the french system is much more generous to its entire population than the U.S. is to its seniors. Unlike with Medicare, there are no deductibles, just modest co- payments that are dismissed for the chronically ill. Additionally, almost all French buy supplemental insurance, similar to Medigap, which reduces their out-of-pocket costs and covers extra expenses such as private hospital rooms, eyeglasses, and dental care.
In France, the sicker you get, the less you pay. Chronic diseases, such as diabetes, and critical surgeries, such as a coronary bypass, are reimbursed at 100%. Cancer patients are treated free of charge. Patients suffering from colon cancer, for instance, can receive Genentech Inc.’s (DNA ) Avastin without charge. In the U.S., a patient may pay $48,000 a year.
France particularly excels in prenatal and early childhood care. Since 1945 the country has built a widespread network of thousands of health-care facilities, called Protection Maternelle et Infantile (PMI), to ensure that every mother and child in the country receives basic preventive care. Children are evaluated by a team of private-practice pediatricians, nurses, midwives, psychologists, and social workers. When parents fail to bring their children in for regular checkups, social workers are dispatched to the family home. Mothers even receive a financial incentive for attending their pre- and post-natal visits.
A typical PMI can be found in Goutte d’Or, a poor neighborhood at the foot of Montmartre that has been home for the past 20 years to a swelling population of immigrants from Africa and Southeast Asia. On Rue Cavé, a tidy modern building is given over entirely to caring for expecting mothers, infants, and young children. The place usually is bustling with kids scrambling over toys, while mothers, often immigrants in colorful headdresses and with babies strapped to their backs, talk to their doctors as part of twice-monthly evaluations.
PMI and other such programs are starting to get attention in U.S. health-care circles. “If we really want to ensure that no child is left behind, then the PMI system is a good way to do it,” says Daniel J. Pedersen, president of the Buffett Early Childhood Fund. “It’s based on the practical idea that high-quality investments made at the start of a child’s life will pay huge dividends to both the child and society in the future.”
To make all this affordable, France reimburses its doctors at a far lower rate than U.S. physicians would accept. However, French doctors don’t have to pay back their crushing student loans because medical school is paid for by the state, and malpractice insurance premiums are a tiny fraction of the $55,000 a year and up that many U.S. doctors pay. That $55,000 equals the average yearly net income for French doctors, a third of what their American counterparts earn. Then again, the French government pays two-thirds of the social security tax for most French physicians—a tax that’s typically 40% of income.
Specialists who have spent at least four years practicing in a hospital are free to charge what they want, and some charge upwards of $675 for a single consultation. But American-style compensation is rare. “There is an unspoken and undefined limit to what you can charge,” says Dr. Paul Benfredj, a gastroenterologist in Paris.
Many French doctors, in fact, earn more by increasing their patient load, or by prescribing more diagnostic tests and procedures—a technique, also popular in the U.S., that inflates health-care costs. So far France has been able to hold down the burden on patients through a combination of price controls and increased government spending, but the latter effort has led to higher taxes for both employers and workers. In 1990, 7% of health-care expenditures were financed out of general revenue taxes, and the rest came from mandatory payroll taxes. By 2003, the general revenue figure had grown to 40%, and it’s still not enough. The French national insurance system has been running constant deficits since 1985 and has ballooned to $13.5 billion.
That’s why France is gearing up to make changes. It already requires patients to register with a general practitioner before visiting a specialist, or else agree to a lesser reimbursement, much like many U.S. insurance plans. But France isn’t likely to make major changes to a system most citizens say they like. Why would they? Says Shanny Peer, policy director at the independent French-American Foundation: “France gets better results for less money and everyone is covered.”
By Kerry Capell
FROM A U. S. RESEARCH REPORT / ARTICLE
Is National Health Care Hazardous to Your Health? Check the Facts
by LaVonne Neff 07-22-2009
Various Web sites and e-mails are reporting that cancer survival rates are much higher in the U.S. than in various European countries. Some quote Mark Tapscott in the Washington Examiner, who quotes Jim Hoft in the American Issue Project, who quotes Michael D. Tanner of the Cato Institute, who quotes … well, quite a group of conservative pundits and politicians are involved. They appear to be using the same set of statistics to argue that national health care results in dramatically increased mortality rates from breast, prostate, and other cancers.
To check the facts, I went to the World Health Organization and made myself a chart. Using the most recent statistics available, I compared the health outcomes of six Western nations. No nation’s health-care program is totally private, and no program is totally nationalized. Government funds pay for a percentage of health-care expenses in all six countries: the United States (45.8 percent), Germany (76.6 percent), Italy (77.1 percent), France (79.7 percent), the Netherlands (81.8 percent), and the United Kingdom (87.4 percent).
Do mortality rates increase with a higher percentage of government funding? Here’s what I found:
• The United States ties with Italy for the lowest cancer mortality rate of all six countries. Interestingly, the U.S. and Italy also have the lowest smoking rates. The Netherlands and the U.K. have the highest smoking rates and also the highest death rates from cancer. The cancer mortality rate in the Netherlands is 15 percent higher than that of the United States and Italy.
• However, cancer accounts for fewer than a quarter of all deaths in the United States. Heart disease is an even bigger killer, and statistics on cardiovascular mortality are not so good in America. Of the six countries, the U.S. has the second highest mortality rate, with 59 percent more heart-related deaths than France.
• The U.S. also has the second highest death rate from injuries. American mortality in this category is more than 100 percent higher than that of the Netherlands.
• In the largest category, non-communicable diseases, the United States has the highest mortality rate of all six countries, with 25% more deaths than France.
• The adult mortality rate — that is, the probability of dying between the ages of 15 and 60 — is highest in the United States. The next runner-up, France, is 20 percent lower, and Italy is 70 percent lower.
Personally, I don’t want to die from cancer. I don’t want to die from heart disease or other non-communicable diseases either, and I’d rather not be smashed to death in an accident. In fact, I’d just as soon stay healthy as long as possible, so I’d be very happy if the United States had the best health care in the world. Alas, we have a long way to go.
Of the six countries I compared, the United States is at the bottom in terms of healthy life expectancy: 69 years here compared to 71 in the Netherlands and the U.K., 72 in France and Germany, and 73 in Italy.
The U.S. is also at the bottom in terms of total life expectancy: 78 years here compared to 79 in the U.K., 80 in Germany and the Netherlands, and 81 in France and Italy.
Please, when you get an e-mail or see a Web page giving statistics to argue that the United States already has excellent health care and doesn’t need to revamp the system, stop and ponder. We currently spend roughly twice as much per capita on health care (counting both public and private sources) as these European countries.
What lots of Americans don’t realize is this: The U.S. government already spends more per capita on health care than do the governments of these other countries — over 50 percent more than the Italian government spends, for example. And yet the Italians manage cancer just as well as we do, and their health-care outcomes are better than ours in every other category.
HEALTH CARE IN GERMANY
Health Care in Germany
David G. Green, Ben Irvine and Ben Cackett (2005)
With the exception of about 2 million permanent civil servants, and the self-employed, Germans who earn below Euro 3,862 gross salary per month in 2004 must join one of the 300 statutory sickness funds. Those above the mandatory insurance threshold may opt out of the state system and buy private insurance instead but many opt to remain in the state system – 10 per cent of the population are voluntarily insured.
German sickness funds are required to be financially self-sufficient and premiums are set as a percentage of income. This percentage varies from fund to fund, with an average of 14 per cent, to fall to 13 per cent under Schroeder reforms. The premiums are deducted from pay packets with employer and employee paying half each.
Since the early 1990s German governments have been trying to increase competition. Insurers can easily be compared on the Internet, and for those without web-access, there are magazines and rankings by independent consumer organisations. The result has been a large-scale shift away from the traditionally dominant funds, although competition is muted compared with America.
People who have seen a large chunk of their pay packet disappear each month make demanding patients and expect both immediacy of treatment and value for money. They ’shop around’, go for second opinions, and change doctors frequently. No money changes hands at the point of service. Instead, physicians are reimbursed by sickness funds via their regional physician associations. People who have opted for private insurance, however, generally pay by invoice for treatment received.
The real contrast is not between public and private, but monopoly and competition. Some workplaces make it hard for even well-motivated employees to give of their best, and some make it easy. Can anyone honestly say that the NHS brings out the best in people? Morale is low, recruitment is now reliant on people from overseas, and retention of experienced staff increasingly difficult. We need to learn from other European countries where public sector workers do not have the same ideological hang-ups.
In Germany, hospitals are under diverse ownership, which further encourages competition and constant efforts to raise standards. In 2002 around 54% of hospital beds were in the public sector, about 38% were run by private, non-profit organisations and some 8% were private, for-profit institutions.
If you walk along a typical British high street in search of healthcare professionals you might see an optician, probably a pharmacy, and maybe a dentist, but to see a heart specialist, a dermatologist, an ear, nose and throat specialist, or a paediatrician, not to mention a smattering of GPs, nestled in between Macdonald’s, Dixon’s and W.H. Smith’s would be unusual unless you shop in Harley Street.
Not so in Germany, where queueing up in a hospital outpatient department to see a specialist is largely unknown. First, Germans are free to visit any doctor they like. They may either walk in off the street, or ring for an appointment that will invariably be booked for the same morning or afternoon. Consumers can and do penalise bad service. Our recent study of German consumers commonly produced reactions like this: ‘I saw a long queue, so hopped on the tube and went to a different practice’; ’she was rather ill-tempered so I never went back’; ‘the facilities were drab, so I went to a different one next to my office’; ‘I felt rushed at his practice so didn’t go back’.
Second, Germans do not have to see a GP before visiting a private specialist. GPs do act as gatekeepers to German hospitals, but about half of all specialists practice outside the hospitals. German hospitals provide few out-patient services. Instead, there are a large number of independent clinics, invariably with the most sophisticated diagnostic equipment. Most Germans have a favourite GP, although many maintain a relationship with more than one – just in case – but if they need to see a specialist they would not waste time seeing a GP first.
Third, there are plenty of specialists. Germany has 2.3 practising specialists for every 1,000 people, compared with only 1.5 in the UK.
What about the unemployed?
A distinction is made between those who have previously been in work and those who have not. The majority who have previously worked are included in the national insurance system, but instead of the employers paying, the benefits agency pays. For unemployed people who have never worked (about one-third of the unemployed in Germany) provision is made through a social fund (the Sozialamt) which arranges cover directly with doctors or through one of the AOKs (Allgemeine Ortskrankenkasse) the local funds of last resort which cover about one-third of the population.
What problems are there in Germany? The German media is not excited by the subject. There are no patients lying on trolleys in A&E. Germany suffers no real rationing. Yes, problems occur from time to time. Just at the moment, there is a shortage of nurses, and many Germans feel that care is expensive, but serious complaints are few. Nevertheless, reform is in the air. Since January 2004 members of the statutory insurance plan have had to pay 10 euros per quarter to see a GP. The reforms also saw the introduction of charges for non-prescription drugs, and an end to free treatments such as health farm visits and to free taxi rides to hospital. This is expected to allow for a reduction in premiums from an average of 14 to 13 per cent of annual gross wages.
German satisfaction rates in 1996, the latest Eurobarometer survey, showed that the German are far more satisfied with their system than we are with the NHS. About 11 per cent of Germans said they were ‘very or fairly dissatisfied’, compared with 41% per cent here. And when asked whether their system needed ‘fundamental changes’ or a ‘complete rebuild’ 19 per cent of Germans said ‘yes’, compared with 56 per cent of Britons.
Does the German healthcare system deliver an acceptable standard of care for serious illness to all members of society? Do the poorest in society benefit from a higher standard of healthcare provision than those in the UK? The answer to both of these questions is an emphatic, ‘yes’.
What can we learn? In Germany insurance provides a connection between the people who go out to work and earn their keep and the resources available to healthcare providers. Our reliance on taxation makes it impossible for us to judge whether or not we are receiving value for money. The majority of the population who pay their national insurance contributions accept that they must also pay for the poor, but there is no expectation that in order to ensure access for all there must also be public sector monopoly. On the contrary, the Germans have successfully combined consumer choice and access for everyone. It is true that the rich can always buy a premium service. They can and do in the UK. But German policy makers do not waste their time trying to stop some people from ever getting more than anyone else. They focus on ensuring that the standard of care available to the poorest people is acceptably high.
The lessons are that responsible consumer choice means that there must be both consumer payment and competition between providers. Most other countries have long recognised these realities.
NORWAY HEALTH CARE
Health Care Around the World: Norway
April 18, 2008 in Health Care Around the World, International Health Care Systems
All Norwegians are insured by the National Insurance Scheme. This is a universal, tax-funded, single-payer health system. Compared to France, Italy, Spain and Japan, Norway has the most centralized system.
Percent Insured. 100%. All Norwegian citizens and residents are covered.
Funding. The National Insurance Scheme is funded by general tax revenues. There is no earmarked tax for health care. The Norwegian tax burden is 45% of GDP. The government sets a global budget limiting overall health expenditures and capital investment.
Private Insurance. Norwegians can opt out of the the government system and pay out-of-pocket. Many pay out-of-pocket and travel to a foreign country for medical care when waiting lists are long.
Physician Compensation. Hospital and nonhospital physicians generally are paid on a salaried basis. Some specialists can receive an annual grant and fee-for-service payments. Reimbursement rates, however, are set by the government and, unlike in France, the physician can not charge higher rates than the centrally-set reimbursement rate.
Physician Choice. Patients choose general practitioners (GPs) from a government list. These GPs then act as gatekeepers for specialist services. Patients can only switch GPs twice per year and only if there is no waiting list for the requested GP.
Copayment/Deductibles. There are no copayments for hospitals stays or drugs. There are small copayments for outpatient treatment.
Waiting Times. There are significant waiting times for many procedures. Many Norwegians often go abroad for medical treatments. The average weight for a hip replacement is more than 4 months. “Approximately 23 percent of all patients referred for hospital admission have to wait longer than three months for admission.” Also, care can be denied if it is not deemed to be cost-effective.
Benefits. Very generous. The program also provides sick pay. “As Michael Moore has noted, the Norwegian system will even pay for ’spa treatments’ in some cases.”
SWEDISH HEALTH CARE
Swedish health care
Sweden’s entire population has equal access to health care services. The Swedish health care system is government-funded and heavily decentralized. Compared with other countries at a similar development level, the system performs well, with good medical success in relation to investments and despite cost restrictions.
The life expectancy of the Swedish population continues to rise. In 2005 the life expectancy was 78 years for men and 82.8 years for women. This can be attributed to falling mortality risks for both heart attacks and strokes. A little more than 5 percent of the population is 80 years or older, which means that Sweden has proportionally Europe’s largest elder population.
Chronic diseases that require monitoring and treatment – and usually a lifetime of medication – place high demands on the system. One positive development is that fewer people smoke; almost 85 percent of the population are non-smokers. However, the increasing number of overweight and obese children and teenagers is a problem that the health care system is examining more closely.
Swedes tend to live long in comparison with people in many other countries and the country now has proportionally the largest elderly population in Europe. Photo: Hans Bjurling/www.imagebank.sweden.se
Management
In Sweden the responsibility for providing health care is decentralized to the county councils and, in some cases, the municipalities. A county council is a political body whose representatives are elected by the public every four years on the same day as the national general election. According to the Swedish health and medical care policy, every county council must provide residents with good-quality health services and medical care and work toward promoting good health in the entire population.
Sweden is divided into 20 county councils. One municipality, the island of Gotland, carries the same responsibilities as the county councils for health care. Around 90 percent of the Swedish county councils’ work involves health care but they are also involved in other areas, such as culture and infrastructure.
The population in these 21 areas ranges from 60,000 to 1,900,000. The county councils have considerable leeway in deciding how care should be planned and delivered. This explains the wide regional variations.
Similarly, Sweden’s 290 municipalities are responsible for care for elderly people in the home or in specially adapted housing. This includes people with physical or psychological disabilities. Services provided by doctors are not included in the care for which municipalities are responsible.
The role of central government is to establish principles and guidelines for care and to set the political agenda for health and medical care. This is achieved by means of laws and ordinances or by reaching agreements with the Swedish Association of Local Authorities and Regions (Sveriges Kommuner och Landsting, SKL), which represents the county councils and municipalities.
At national level there are a number of authorities within the area of health care. The National Board of Health and Welfare (Socialstyrelsen) plays a fundamental role as the central government’s expert and supervisory authority. The others are The Medical Responsibility Board (Hälso- och sjukvårdens ansvarsnämnd, HAS), The Swedish Council on Technology Assessment in Health Care (Statens beredning för medicinsk utvärdering, SBU), The Pharmaceutical Benefits Board (Läkemedelsförmånsnämnden, LFN), The Medical Products Agency (Läkemedelsverket) and state-owned Apoteket AB, a national chain of pharmacies.
HEALTH CARE IN SPAIN
Spain is a western European country that consists of the Peninsular Spain, located between the Atlantic Ocean and the Mediterranean Sea. It also has two archipelagos and two separate autonomous cities in Northern Africa.
The Spanish territories also include the Balearic Islands in the Mediterranean and the Canary Islands on the African Coast.
The Spanish healthcare system
The National Health Service of Spain has a wide network of hospitals and health centres located throughout the country. The health centres provide primary healthcare services that include family and GP services, nursing and paediatrics, social workers and physiotherapists. The healthcare centres are, in theory, located within fifteen minutes of a person’s place of residence. Additionally, if circumstances require, it is possible for the medical professionals to go to the patient’s residence.
Medical treatment in Spain
The healthcare system in Spain is considered to be very good. Spanish hospitals are modern and well-equipped. The doctors are also excellent. Although there are some differences in the policies of the Spanish and British health systems, generally speaking, they are quite similar. The biggest difference between the two is the role of the nurse. Spanish nurses are efficient and well-trained but they do not perform the way British nurses do; feeding and personal care in Spain are normally taken care of by the family of the patient.
If you plan on living in Spain, keep in mind that most of the medical staff do not speak English. However, you can always seek a voluntary translation service when you set an appointment with your doctor. It is advisable to make sure that this service is available in the area of Spain that you intend to live.
Medical care in Spain
If you are an expatriate or a visitor coming from another European Member state, you are generally free from hospital and medical care expenses. Having presented your European Health Card (EHC), you will be attended to by a general practitioner at your local centre. If you are not able to make it to your local health centre, the general practitioner will pay you a visit. If the situation requires you to see a specialist or be admitted to a hospital, the general practitioner will give you a referral or a medical certificate. Most hospitals in Spain also have Accident and Emergency departments.
What does the EHC do?
With your EHC, you can receive similar healthcare to that of a Spanish citizen. Expiration dates are indicated on the EHC and they are not valid in Liechtenstein, Iceland, Norway, and Switzerland. Private hospitals and some general practitioners in Spain will not honour an EHC. The EHC is available from relevant healthcare organizations in your country of origin.
What Health forms are necessary?
During your stay in Spain, if there is a need for a specific treatment, e.g. haemodialysis, you are required to fill out an E-112 form. You will also need authorization from an appropriate institution from your home country. Dental treatment is not generally covered in Spain, with the exception of emergency extractions.
If you happen to forget your EHC card, it is your responsibility to pay for you pharmaceutical, medical and hospital bills in advance. By providing your receipts, you can seek a reimbursement from the appropriate healthcare organization in your own country.
Bear in mind that your EHC is not applicable if you travel to Spain for the sole purpose of seeking medical treatments. This also applies to other EU participating countries.
Non European Union citizens
Spain has some form of a bilateral agreement with counties such as Peru, Paraguay, Ecuador, Chile, Brazil and Andorra, and these citizens can also avail of free hospitalization and medical care in cases of medical emergencies or accidents. You simply have to present the corresponding health certificate from your country of origin. In the event that you do not have the certificate with you, simply pay for the doctors, the hospitalization, and the medicines upfront. Ask your healthcare service or insurance provider to fully refund your expenses. Just be sure to present the necessary receipts.
HEALTH CARE IN THE NETHERLANDS (HOLLAND)
In the Netherlands, the government is not in charge of the day-to-day management of the healthcare system. Private health suppliers are responsible for the provision of services in this area. The government is responsible for the accessibility and quality of the healthcare.
Since January 1st 2006 there is a new healthcare insurance system in the Netherlands and you should be aware of the requirements before you leave for the Netherlands.
If you are living in the Netherlands or you are paying income-tax in the Netherlands you are required to purchase a health insurance at a Dutch insurance company. In the past there was a difference between public and private healthcare in the Netherlands. This however has been changed and everybody is now required to purchase basic health insurance.
The basic package
The government has put together a basic package that covers about the same as the previous system. Health insurance companies are legally obliged to offer at least this basic package and can not reject anybody who is applying for it. With the basic package you are covered for the following:
• Medical care, including services by GP’s, hospitals, medical specialists and obstetricians
• Hospital stay
• Dental care (up until the age of 18 years, when 18 years or older you are only covered for specialist dental care and false teeth)
• Various medical appliances
• Various medicines
• Prenatal care
• Patient transport (e.g. ambulance)
• Paramedical care
You can decide to purchase additional insurance for circumstances not included in the basic package. However, in this case insurance companies can reject your application and they have the right to determine the price.
If you are working for a company in the Netherlands, consider purchasing a collective health insurance policy, this can be a good option as it is often cheaper. However, you are not obliged to buy such a policy when it is offered to you and your employer is not obliged to make you an offer. Ask your employer about the possibilities.
Fees of the basic package
The fees for the basic health insurance package are annually determined by the health insurance companies and are normally approximately €95 per month. Although the Ministry of Health ( Ministerie van Volksgezondheid, Welzijn en Sport) determines a standard premium, the insurance companies determine the additions fee you will have to pay in the end by charging a certain rate and a no-claim charge. It is with these additional fees that the insurance companies compete with each other. There are various health insurance companies and a new law will make it easier to change between health insurance companies.
If you are required to purchase health insurance and are earning a salary, you will also pay a supplementary contribution from your income (rated 6.5% up to the first €30,000 of earnings; 4.4% for self-employed individuals).
The fees of health insurance companies can differ so it is advisable to compare the various prices. To help you with this choice, you can go to: www.kiesbeter.nl.
For some, healthcare in the Netherlands has become more expensive as a result of the changes. The Dutch government compensates these cases by offering a care grant ( zorgtoeslag). The Tax Administration ( belastingdienst) determines if you are eligible by examining your income. Foreigners are also entitled to this grant if they qualify.
Children under the age of 18 years do not have to pay any health insurance and are insured for free for the basic package of health care.
Basic health insurance for foreigners
The length of your stay is important in determining whether or not you are required to purchase health insurance in the Netherlands. People staying temporarily in the Netherlands are not required to purchase health insurance.
If you use Dutch medical services during your stay, make sure that you always keep all the bills, prescriptions and receipts. This can save a lot of trouble on your return to your home country. If you are an EU citizen, you should apply for a European Health Insurance Card (EHIC) through your home national health insurance agency or company. This card makes it easier to access health care in European countries and means you either do not have to pay for emergency treatment or you get healthcare charges refunding more quickly.
Foreigners becoming long-term residents in the Netherlands and/ those earning a salary in the Netherlands are required to purchase a basic insurance from a Dutch health care insurance company. Keep in mind that if you do not purchase a health insurance you may be fined.
Foreigners who settle in the Netherlands and remain receiving an income abroad are not always required to purchase a Dutch health insurance. This is determined by the length of your stay. When your stay is temporary you are not required to purchase a health insurance.
When you stay in the Netherlands is not temporary, you are required to purchase a health insurance. However, rules and regulations about the durability of your stay remain unclear. Generally you can use the following rule of thumb:
• A person who stays in the Netherlands for a period of less than one year is assumed to be on a temporary stay;
• A person who stays in the Netherlands for a period between one and three years is assumed to be on a long-term stay, but this will be accepted as temporary when the person can prove otherwise;
• A person who stays in the Netherlands for a period for more than three years is assumed to be on a long-term stay.
In all cases it will be examined whether the center of your civil and social life is in the Netherlands. This depends on your legal (e.g. residency permit), financial (income, tax duty, etc.) and social (membership of a club, family, etc.) situation.
If it is still unclear whether or not you are required to purchase basic health insurance you should contact the following institutions:
• De Belastingdienst (Tax Authorities): www.belastingdienst.nl
• Ministerie van Volksgezondheid, Welzijn en Sport (Ministry of Health): www.minvws.nl
• Sociale Verzekeringsbank (Social Insurance Bank): www.svb.nl
For more information about the health care system, go to: www.denieuwezorgverzekering.nl.
HEALTH CARE DENMARK
The Danish health care service seen in an international perspective
The Danish health care service is characterised both by being publicly financed through taxes and, for most of the services by being run directly by the public authorities.
In a number of Western European countries there is a much larger private element in the health care service, a large number of the hospitals being run by private organisations. The financing is, on the other hand, mainly public, although this is mainly in the form of compulsory insurance schemes rather than in the form of general taxes.
The different ways of organising and financing health care services have different advantages and disadvantages, and the choice of model is largely dependent on different priorities in the different countries.
In Denmark priority has been given to free access to most health services for all regardless of their economic situation.
Even though financing is public, it does not necessarily follow that the institutions which provide the services are public as well. However, in Denmark the majority of the health sector, including the hospital services, is run as publicly owned institutions. The financing and running of the services are thereby integrated.
In the publicly integrated model those providing health services are civil servants receiving a fixed salary. The integrated model with budgetary restrictions and fixed salaries gives budget security, but in itself it does not give the staff any intrinsic incentive towards efficiency. Efficiency must be ensured through other mechanisms such as professional ethics and good management.
2. The financing of health care services
In Denmark the vast majority of health services are free of charge for the users.
Of the total expenditure on health care in Denmark in 2000, public expenditure constituted 81% and private expenditure approx. 19%. Private health care expenditure mainly covers user payments for medicinal products, dentistry and physiotherapy. The total public and private health care expenditure corresponds to roughly 6% of the gross national product (GNP).
Topics: NATIONAL HEALTH CARE FOR ALL | 1 Comment »
July 23rd, 2009 at 8:49 pm
As usual,I agree with Uncle Fred.We have friends from France and Great Britain who have kids and tell us their system is awesome.You receive first class care, you do not wait and wait-that is untrue propaganda.We already do pay for all those who can’t.They go to the ER and can’t be turned away-so the hospital passes on those costs to the folks who do pay.We now have excellent insurance.We used to have **itty insurance,we paid a fortune in premiums and still got stuck with 12,000 dollars in out of pocket costs the year my little boy got really sick.We could pay it,some families would lose their house and destroy their credit.Insurance companies want to take your premiums and then find some way to wriggle out of paying.I bet with National care,your paycheck deduction would be less than the premiums we pay now,and your medical bills would actually be paid.Mark.