Doctors and the administrative costs

My understanding from the videos is that why don't we consider Japan's health care system more seriously? Just like the U.S, both the payer and the provider are private entities, and they have an aging population. Surprisingly, they do have the healthiest nation in the world.

There are problems that come to my mind, and I as well have read in the T.R Reid's book. First, is that the doctors are making much more money here in the United States than other industrialized countries. But my understanding is that if we change the rules a little bit, then some doctors wouldn't be able to abuse the system and over-use the medicine. There are doctors who try to make more money by buying another imaging machine, or by making insider deals with the home health care providers. But they do have a choice. There are doctors who use the money to hire another nurse to check on the diabetic and obese patients to see if they are taking their medication or if they are doing they physical activity. They might even hire office workers who remind patients about their mammograms or pap smears. I read in an article that Dr.'s pen is the most expensive piece of medical equipment out there.

Next thing is the administrative costs. I read that the private insurance companies are spending 25% for administrative costs. They actually think that every cent they pay for patients is a "loss", because they are for-profit. U.S is the only industrialized country that has general coverage covered by for-profit insurance company. They actually run health insurance just like car or home insurances. So their loss is in patients getting well!

Those are the two problems that come to my mind when comparing U.S system's with other countries.

The vote is in!

Unanimous!! From the remarks posted by my classmates, it seems we unanimously agree the US health care system is in need of reform.

How, though, do we reform the fragmented system we already have in place? As it stands today, the US health care system has bits and pieces of each one of the health care systems spoken of in the Frontline videos. Much like Switzerland we think we are “the exception” and do not want to be found following anyone else’s lead. Our country was founded much on this principle in our break from the British rule. We have social medicine, for war veterans, as is practiced in Taiwan in that the government pays the medical bill, the wait lines are nil and they are open on the weekends. The US health care fragments again and resembles the Japanese system in that both operate in a capitalist society. We have welfare which pays for poor and pregnant women to birth their babies without paying the medical bill, this resembles the health care system in Germany. The United States also encapsulates the British medical system in its “price regulation” for medical services (in a small way) administered to the elderly receiving Medicare. All in all, the US health care system seems confused on what it wants to be and do.

The three points made near the end of the film I thought were great conclusions and a good platform on which to push toward reform for our own country. The United States would need to decide they want to offer health care to the nations’ citizens as a benefit for to citizenship, namely for the enrichment of society as a whole. Continuing from here, it seems wise to set some limits, perhaps we could call them “standards” for medical pricing. We, as American’s do not like to be limited in what we do, so this will be difficult for many. In imposing limits, the reform would need to revolutionize the way insurance companies operate on a for-profit basis, control the exuberant, sky-high prices of medical care. It is arguable that these high prices are ““justifiable” as one student poignantly stated in their blog. There reason for medical doctors to demanding such high wages is due to costly, time-invested medical training and high malpractice insurance costs.

Our current medical conundrum needs some resolution. The “foreign health care” is not really so foreign, we have all of these ideas on a small scale, it seems to me we need a way to choose a method system and reform in that direction. How long would such a reform really take? Would we see it in our lifetime?

Gatekeepers?!!?!?

Hey everyone!
I really liked the Taiwanese video because I liked they mentioned that they looked to the world's health care systems to create one of thier own. This already shows that they are open to new ideas and willing to learn from other countries and methods. This is already going in the right direction, I think. I also liked the idea that there are no "gatekeepers" which here are Gp's...in order to refer them to a specialist. I agree with Taiwan in that the people are more important and the problem (for example, a neck problem) should be taken care of right away.

The Switzerland video..was interesting as well. I think that if they could have a similar health care system before...and now they have changed!...WHY cant WE??? I think the world laughs at our country...because we do not have our priorities straight. :/

Dan Shaer

The successful systems of other countries are quite impressive. Japan's government has health care under control with universal coverage at low costs. Besides crunching numbers, percentages, premiums and rates, an interesting factor that may go under the radar is the healthy (healthier) lifestyle of the Japanese, unlike the United States. This means a lower number of people get ill in a way that needs serious medical attention, because a healthy lifestyle reduces risks of countless diseases and disorders.

In addition, it's apparent that the American system is a business transaction, a market-oriented system aimed for profit rather than public health and well-being. As long as profiting and making money is at the top of the list, a successful reform will be quite impossible. The high cost for health care is almost always being blamed on the claims of overpaid physicians and high doctors' income. The reality lies somewhere along the lines of high costs of medical supplies, malpractice, rent, nurses, etc. The example given was that an MRI scan in Japan costs $98, whereas in the US it costs $1200. The reason is because the MRI scanner costs exponentially more than it does in Japan. A simple example of one step that has been taken to help remedy this problem is the use of generic drugs in hospitals rather than the brand-name drugs that cost twice as much. As Uwe Reinhardt states, "this doctor bashing, I think, is barking up the wrong tree." Overall I believe we should look at the roots of what makes the costs so high in the United States. The fact that we spend significantly more on health care per capita than the other, more successfully reformed and "healthy" countries, and we still are short in care coverage shows that we have unaccounted deficits, weaknesses, or flaws somewhere in the system.



Here is a link to an interesting article posted very recently about the public health reform in my home country Lebanon. What do you think of this system?
http://www.dailystar.com.lb/article.asp?article_ID=105650&categ_ID=1&edition_id=1

Can we become the "following cart"

I was particularly inspired by the quote mentioned in Taiwan’s video, “The track of the previous cart is the teacher of the following cart.” Taiwan, once a poor country, is now a rich and industrialize country with a good health care system because they learned from the mistakes of other countries. They manage to come from half its citizen with no coverage to universal health care. They used current systems, like Japan and Germany, to their advantage. Even though Taiwan must borrow from banks to pay their providers, at least they are making a huge step to better health care. No medical system is perfect.

Switzerland’s health care system, once similar to the US, has reformed itself to have universal health care with high quality. This just says... US can reform to the better too. I believe if US used Taiwan’s method of learning from other countries, 16% of GDP will actually be used efficiently for health care.

I found it shocking that US is the world’s most expensive medical system, yet ranks 37^th in quality. This raises many questions. What is limiting the US to reform the health care system? If other countries can make people join and pay, why can’t US? I think US’s most favorite word is profit. The ending of the videos brings up questions to possible solutions that may be dreadful for insurance companies and providers. Can US make insurance companies except everyone, can US force everyone to purchase insurance, and will doctors and hospitals accept standards costs? If doctors and insurance companies aren’t so concerned with profit, patients won’t be so concerned with bills leading them to bankruptcy. If other countries can spend a lot less on their medical system, I think US can use the money spent on their health care system to gather methods from all countries and make changes according to American culture to provide health care for all, or at least not to become bankrupt from medical bills.

Real Cost of Health Care

One fundamental problem illustrated in the video was succinctly summed up by Anderson: "the relationship between the financial resources that individuals pay to the providers of health care and the real resources these providers contribute to the process of health care may not be nearly as tight as some observers have proposed." Health care does generate profit by creating jobs, in the provision of resources, medical research, etc but there is a discrepancy between the "real" costs and the final price tag. This discrepancy is much larger in the US. Why does an MRI cost so much more in the United States? Obviously, it can be done for a fraction of the price in the Japan. Higher fees seem to fuel larger profit margins. Yet, I have to wonder if the inability of so many to pay their bills leads to a viscous cycle of price mark-ups? When patients cannot pay, the system must absorb the cost and raise prices ever higher to maintain a profit.

Thank you for posting early!

I'm really impressed by all of the relatively early responses this week.  Keep it up!

Let'sPick And Choose

I agree with what most people have been saying.  

1) We need to follow the idea of picking what works and what doesn't work, and try to adapt those ideas to our system.

2) We need to get everyone insured.

3) We can't let insurance companies choose who they are going to insure.

Some of the other ideas are a little more controversial.  I personally agree with the idea that insurance companies need to be not-for profit.  The German model seems to support that this is an option,  though I'm not sure I understand how it can be called non-profit if the more clients you have the higher salaries you distribute, unless there is some sort of government subsidy.  

The issue that seemed to continue to come up is that when the hospitals and doctors are paid less (for fixed prices) they aren't able to cover their expenses.  In our system, physicians are paid more ostensibly because they have very high loans, and are starting repayment relatively late in life (as compared to say a stock broker who starts earning right out of business school).  Not even mentioning malpractice insurance and overhead costs.  I don't see how fixing prices at 10$ a nite for a hospital bed can even approach paying for bedding and nurses and IVs and food and supplies, when 10$ won't even get you a decent bed in a hostel.  The answer seems to be to try to keep prices low, but maybe not as low as Japan and Taiwan are trying to be. 

Another issue that I feel should be addressed is drugs/innovation.  What hasn't been said, and may or may not be true, is that the cost control mechanisms are negotiated by the companies, which is to say that low drug prices are being subsidized by the people who are paying more; eg, the US.  Are the MRI machines that are so cheap for Japan, cheap there because we are paying Toshiba a boatload here?  Or is it like car production, where in the UK, the cars already get 50-60 mpg, but in the US we're struggling to get 40mpg with hybrids only because we have always tolerated the low efficiency?  I used to defend the drug companies, because only 3 of every 10 drugs tested makes it to market, and only 1 of every 10 ever makes a profit.  Then I looked at some of the budget sheets, 30% of the operating budget goes to R&D, while 35% goes to marketing!  I think ultimately I agree with the Swiss interview, the companies will find a way around it.  God forbid I don't get my drug pen.

I am not sure about fixed prices, I think it'll get a lot of opposition from physicians, drug companies and insurance companies.  There would have to be some sort of mechanism in place to prevent physicians from just taking care of the easy patients.  For instance, will surgeons who get  paid a fixed amount for taking out an appendix need an incentive to take out the ones in people with heart disease and diabetes and prior surgeries, when its going to be a much more difficult, time consuming and risky surgery, whats to stop them from saying, no I won't operate on you, when I can operate on 3 healthy patients in the same time.  Of course this is a problem we have  now, and why the county hospital is full of medicaid patients that are too "complicated" for their own doctors.  

In summary:

We need to stop tolerating our inefficient system.  We need a universal, part-social insurance plan, and we need to cut costs.  Schooling and malpractice are not separate issues and need to be addressed.  All doctors should be on salary, with bonuses for keeping patients healthy and with some check on quality/quantity of care.

What can we learn?

I agree with Stephanie. Why can't we learn from Taiwan or any of these other countries?

Our system is so focused on profit. Doctors make money, drug companies make money, insurance companies make money.... everyone makes money. EXCEPT the patient. It blew my mind in the videos that every person interviewed in the other countries seemed puzzled by the idea that healthcare could completely drain their savings while in the US it is a fact of life for so many people. The US system has become an uphill race for the medical system to try to make as much money as possible while the patients slide down the hill hoping and praying that they are not trampled by the system or crushed by the others who are falling. So few people can afford to play in this game anymore. I believe the huge rate of uninsured, the lower rate of infant mortality and shorter life expectancy speaks to this issue.

I am ready for the change, but these videos have given me a different perspective. I really think we should consider these other systems. In our program we talk about how an intervention can't be successful unless it is tailored to the population it is supposed to serve. We should create a healthcare system the same way.

I wonder how much the US took into account these other systems when the healthcare overhaul began. Did we even take this into account? I know there is no such thing as perfection, but I would think that like the scientific method we would learn from experiments done by other countries that are so similar to our own. Couldn't we create a system that covered everyone, was affordable, provided excellent care, and still allowed America to live their capitalist lifestyle? Maybe I am seeking perfection.

The example of what not to become

The Frontline videos show that the world’s health care systems promote health while the US health care system promotes profits. Other countries health care systems spend less money while giving better coverage to their citizens. We have become the example of what not to become; the world scoffs at us.

What struck me was the fact that patients in other countries never go bankrupt because of medical bills. Since the numbers are so high in the states (700,000 people/year) I thought that this must happen in other countries as well. But, every time the reporter asked about the bankruptcy issue in their country, the interviewees would respond as if they were asked if they had ever seen a unicorn.

From the last Frontline video the class concluded that for reform to happen in America there will have to be cuts made in the health care budget. But, who will take the cuts? From looking at other countries systems, it seems as though doctors, hospitals, and pharmaceutical companies are the ones receiving the cuts. Hospitals going broke? Standard prices for doctor and hospital visits? These ideas are unheard of here in the states. Although the service providers are the ones getting the short end of the stick, the ones receiving the services seem to be mostly happy. But, will this work in our profit-driven economy?

public goods vs individual goods

All Americans want an affordable, accessible and quality health care system like other nations. All five nations had something in common; health care systems operated and funded predominately by their government while no one files bankruptcy for medical bills. It was really shocking that doctors even get bonus for keeping their patients healthy and MRI costs $98 in Japan while it costs $1200 in U.S.

Many people might think that it is not a proper role of government to provide social health services to citizens and also concern about the impossibility of fairness between private and public health plans. They also believe pharmaceutical and technology industries may be hindered by government’s operation due to underfunding.

Each nation’s health care system is built based on their national values and cultures. In Britain, Germany and Switzerland, they emphasize on the public goods and social solidarity which resulted that everyone gets health coverage (universal health coverage). However, we, American, more emphasize on individual good rather than social/ common goods which resulted in highly complex fragmented health care system in the earth.

Japan also has a very multi-payer system like U.S but has still managed to do well despite of the fact that 80% of the hospitals are privately managed. Japanese citizens have free choice of doctors and hospitals and few waiting lists. In every other year, Japanese government sets fixed prices for medical services of both patients and doctors. Surprisingly, most of the Japanese hospitals do not compete for their profits but for quality of service while private insurance and pharmaceutical companies in U.S. compete for their own profits.

Germany has adopted Bismark model that every German citizen is eligible to be enrolled in the social health insurance network (sickness funds) that rich pays for poor. Despite the fact that they are privately owned, they are publicly accountable and administer a public benefit.

We have seen how foreign countries implement the health care system in their countries and we can pinpoint that there is no such thing as perfect health care system. Even though the health care system seem to delivered effectively to most of the citizens, all five countries currently struggle with maintaining/ creating a balance between cost of each patients pay for service and reimbursement to doctors/ hospitals so they don’t go broke.

It would be an ideal thing if we are able to create universal health coverage for all people while we provide comprehensive benefits (focus more on primary care), high levels of technology at low cost of services like in Japan and Germany. In conclusion, we need to focus more on public goods than individual goods in the health care system delivery. With the amount of money spent in health care, we need to develop health system more efficiently so that no one including patients, providers, and government can go broke.

What a striking difference!

These videos highlighted the sharp contrast between America's health care system and those of other countries. It was clear that all these countries seem to have a system that is working better than that of the United States. One of the videos said that America ranks 37th in the world in terms of health care quality and fairness. It scares me though that the U.S, historically and culturally speaking, is founded upon beliefs and principles that may hinder us from emulating these systems that seem to work so well. For instance the U.S seems to be centered around individuality, privatization, laissez-faire, and having as little government involvement in the private sector as possible.

It was so interesting to learn more about the system in Japan. It is encouraging to hear that Japan has found a way to provide all 130 million inhabitants with health insurance and how health care costs are so incredibly low. I was shocked to hear that it costs only $10 to stay in a 4 person room at a hospital overnight, and $90 to stay in a private room. This sounds almost impossible. However, because Japan's health ministry is regulating costs and making them standardized across the entire country, it is possible. As a result of these low prices though, 50% of hospitals are in deficit. Clearly, the Japanese system has its flaws, but they are doing something incredibly right considering that they are spending half as much as the U.S. per capita and have the longest healthy life expectancy and the lowest infant mortality rate. My questions about the system in Japan are: 1) How could they keep their costs low and affordable, and yet keep their hospitals out of deficit? 2) If an individual does not need to make an appointment to see a doctor, how can it be that there is no wait time?

I also found it interesting that the U.K is marked as the world leader in preventative medicine. My question is: 1) Why is this? 2) And how could we as the U.S learn from this? I just think that preventative medicine is so fundamental. With more preventative medicine our uninsured citizens could avoid having to go to the E.R. and being charged preposterous fees.

Lets Follow Taiwan

It has been so enlightening to learn about how other major nations manage what the U.S. views as an impossible feat: health care. It is still a wonder to me how our country is so behind compared to the other developed countries in providing a basic necessity to our citizens. I say we follow Taiwan and take the best parts of other health care models while reducing the problems.

There are glaring problems with the U.S. system, namely large GDP spending, high administrative costs, and discriminatory coverage. If I were able to simply pick traits from other health care systems, I would use Britain's single payor system to begin with. I would take Japan's idea of fixed costs for procedures, but use less extreme prices to avoid putting hospitals in debt. I like Germany's idea of covering for unconventional treatments such as spas or dance class. I think that Switzerland's $750 monthly premium is reasonably, seeing that they are the only country that is not in major debt from premiums that are far too low. I absolutely love Taiwan's up to date "smart card" that not only assists in the payment of services but actually flags over-users. In general, the idea of not having to use a gatekeeper or referral system seems to appease more citizens while significantly reducing wait time for patients.

The more videos that I watch pertaining to health care reform, the more I wonder why so many in the U.S. are completely opposed to making the health care market anything but a free market. America does not profit off of libraries, police stations, Medicare, and other social offerings...so why health coverage? Universal health care would be a far stretch from socialism in the same regard, it would be be basic human right. After watching the videos and seeing how Switzerland, once like the U.S., changed, I believe that we can too. Maybe private insurance companies and pharmaceutical companies have too much of a stronghold on our legislators and the greed needs to stop like it did in Switzerland. I certainly took the message away from Frontline's video that reform IS possible as evidenced by all other developed countries embracing a non-profit health care system.

Five Capitalist Democracies - Lea Salvatore

The key to these pieces that really can not be stressed enough is that the highlighted countries are all capitalist democracies. These rich, developed, free market countries all have similar economic structures and they all are very similar to the United States.

I focused mostly on the U.K. and Japan. These interested me because they are very similar to the US but vastly different as far as healthcare is concerned. Both countries have fairly different systems but they seem to work efficiently and cheaper than the US system. They both have high levels of satisfaction among citizens, lower infant mortality rates, and higher life expectancies than the US.

The U.K. has a socialized system funded by tax revenue. This means that there are NO premiums, NO co- pays, NO fees, NO bills, and most importantly NO medical bankruptcy. Hospitals are government owned, doctors are salaried employees, and citizens can choose which facility they would like to go to. According to Nigel Hawkes, a writer for The Times, the primary care and emergency care in the U.K. is very good. Similar to American HMO plans, when a patient wishes to see a physician they must first have an appointment with a general practitioner "gatekeeper" who can then refer them elsewhere. These people have salaries based on the number of patients they are repsonsible for and their bonuses are based on the level of health these patients maintain, giving physicians incentives to keep patients healthy. The downfalls of this program are the waiting lists for surgeries deemed elective such as, a hip replacement. Also, it is believed that patients see their doctors more than necessary because they can.

In Japan they have universal health coverage with no gatekeepers, meaning that all their citizens are covered. All citizens pay in to a social plan. Somewhere around 80% of their hospitals are private and all their doctors have private practices. Patients do not need to make appointments and generally go to the doctor twice as much as Americans. What I found most interesting was that because Japanese patients seem to like and trust medical technology there is a Health Ministry in charge of tightly regulating technology and testing fees. This is also in place to prevent doctors from making unneccessary profits. Every two years the ministry meets, looks at frequency of certain technologies and testing, and accordingly gives a fixed price list.

I think that being able to look at these programs that work well for countries with similar structures to the United States gives us good ideas that we can pick and choose from when creating our new healthcare system.

Dude, I want universal healthcare

Dude, after watching these videos, I want universal healthcare (not that I didn't before..but I think now more than ever).

The thing that struck me most with these five countries is that even though their healthcare spending per GDP is a lot less than the US, their citizens seem to be getting more benefits. These countries seem invested in healthcare as a right, and providers (whether public or private) are okay with accepting that it may not lead to lots of profits (although there may be profits to be made such as in supplemental services in Switzerland).

In the UK, government providers compete against each other "to survive."

In Japan, the insurance companies are barred from making profit, as the government health ministry controls prices.

In Germany, hospitals cannot raise prices and the hospitals and the doctors are not paid enough (as evidenced by the doctor strikes in March 2006).

In Taiwan, the government is now borrowing from private banks to pay providers.

In Switzerland, there is extreme competition between private providers and the only way profits can be made is through supplemental coverage.

The fact that healthcare is such a profit-rich arena in the US serves to point out an inherent difference between these countries and our very own. Furthermore, a lot of our healthcare spending is dedicated to administrative costs compared to countries like Taiwan who have a "Smart Card" that minimizes the need for such expensive administrative costs (costing them less than 2% of their GDP).

Bankruptcy in these countries due to healthcare spending is almost unheard of, which leaves a lot to be desired in the US. I couldn't help but wonder why such a developed country like ours can be in the forefront of so many issues, yet be so behind. We need to first change the social and cultural values that we place on healthcare. Is it a right to us or a privilege for the few? If it is a right, then we need to start really investing into this idea that it seems like all countries but us have adopted--universal healthcare. I'm glad that healthcare is now making headlines in the Obama administration.

-Alex Nguyen

Obsession with Laissez Faire (Kelly Leech)

United States was established on the notion of complete freedom and individualism so as to never be under the control of a monarchy again. No wonder Americans are almost obsessed with the idea of no government intervention in society and the laissez faire market. Centuries have passed and immigrants compose a majority of the population probably because of the numerous freedoms. Throughout history, what actually composes human rights has changed – civil rights, women’s rights, gay and lesbian rights, educational rights, employee rights, legal rights, etc. Many Americans opposed the legalization of some of these rights at first, but now these rights are generally accepted in American society.

From the videos, it sounds like this happened in Switzerland – a similarly capitalistic society. Health care wasn’t viewed as a right, but with a vote by a small margin, health care law was passed making it a human right (i.e. universal health care). This is what is happening in the United States right now. Health care, not viewed by the majority as a human right, is trying to legally become one and will be accepted in years to come as history and other countries have shown.

While analyzing the different countries, there was often a mention of how this or that wouldn’t work in the United States. For instance, in Great Britain the presence of government is too much and in Taiwan intervening to notify a patient they’re going to much the doctor is too “Big Brother” for the United States. However, the conclusions were great at the end basically laying out what could work in the United States doing what Taiwan did – choosing the best and most adaptable ideas:

•Insurance companies must accept everyone and there is no profit.
•Everyone is mandated to buy health insurance and the government covers the poor.
•Insurance, providers and pharmaceuticals negotiate on a set of standard price.

I especially like how he also provided a wake-up call that we are already using these “foreign” health care ideas in the United States:

•Veterans = Britain
•Medicare = Taiwan
•Employees insurance = Germany
•Uninsured = poor country

(My favorite is the last category of course ;)

I can see one complaint of a universal health care system in the United States being that health care providers and practitioners would have to accept a lower salary when they work overtime and have medical school debt to pay off. It’s almost like a viscous cycle in which doctors are caught. In Germany, for instance, doctors get paid less, but they went to medical school for free and have lower malpractice premiums so it almost makes up for receiving a lower salary. So if American doctors could go to medical school for free, then it would be more acceptable to receive lower salaries. It’s called thinking upstream!!

We’re caught in a “sick” health care system and desperately need to “cure” it before things get worse. United States needs to put aside its obsession with laissez faire and realize, health care is not functional in an open market, but is a human right and needs to be recognized as so like all other human rights have with some systematic change and societal adjustment.

Regulation = The Cure

After watching these videos, specifically the Japanese and Taiwanese ones, I believe the problems of the U.S. health care system can be summarized in one word: abuse. Every moment of every day, there are people around the country who are not only trying to game the system but are also succeeding. We’ve all heard of the patients who are looking for their next fix of morphine or a warm bed and meal and the hospitals and physicians who consistently overbill their patients. Unfortunately, we haven’t heard about any means to fix these problems, which result in high health care costs for everyone.

Japan has managed or at least limit the problem of overbilling by establishing a set price for all tests and treatments in a price guide. They limit further overcharging with the threat of lowering the price even farther on overused tests or treatments. In contrast, Taiwan limits hospital visits with the threat of a government official visiting and talking to offenders.

These techniques do limit the rising healthcare costs but I believe the final aspect of abuse that was not covered in the film is the greatest problem, malpractice insurance. To me, this seemed like the slippery slope of the problem for health care cost. Physicians are forced to pay anywhere from $10,000 to $200,000 annually for insurance depending on the amount of invasiveness of their treatment. In addition, they run an abundance of tests even for the most routine procedures. The end result is the cost is passed down to the patient thus raising costs.

In the end, the message from the videos is pretty clear. Americans are paying more and getting much less in return. It seems the means to fix the health care problem is to do what the Taiwanese did, examine other systems and what they did correctly while cutting out the poorly functioning aspects. In other words, the proper system for the U.S. might be a combination of socialist and totalitarian (i.e. government owned and overly controlled and regulated). The question becomes would America follow her democratic ideals or her checkbook?

Free market of health care system???

The government of these five countries in the video set some restricts for the health care system and everyone is under coverage by the health insurance. There are no countries’ health insurance exclude the coverage of pre-existing conditions, the medical bill bankruptcy seems doesn’t exit in these countries. If you lose your job, you wouldn’t be kick out of the health insurance you already have. Actually, most people of these five countries are quite satisfied with the health care systems they have.

I don’t think the other countries physicians make not enough money; I think the basic problem is maybe the U.S. physicians are making too much money, and so are the hospitals and drug companies. Germany has the market-based health insurance just like U.S., and everyone in Germany can get the health care they need. The Sickness Funds of Germany is the health insurance plans base on people’s income, and people pay for little co-payment when they go to the clinics. United Kingdom is the only country has the government run National Health Service, and it’s pretty effective to their people. No one in U.K. has to pay for the medical bills. Japan and Taiwan have very low GDP expenditure
in health care; the medical care providers and the hospitals provide highly efficient medical care. Switzerland performed the success health care reform in 1994, and people don’t have to worry about their medical bills. The law ”Sickness” in Switzerland provides the compulsive health insurance, and the state government pays for the poor; everyone gets the comprehensive package of health care coverage. Their insurance companies compete with each other by provide faster service, lower price and the supplemental coverage. The video mentioned there are three general concepts these five countries have in common, the first is the insurance companies must cover everyone, and can’t make a profit on basic care, the second is everyone has to buy insurance, and government will pay for the poor, the third is there are standard price for each medical care treatment, procedures and drugs.

The Health care systems in these five countries seem doing pretty good job but there are no perfect system in the world. I think the biggest problem of these countries might be the hospitals, clinics, insurance and drug companies, even the government couldn’t afford the medical cost of taking care the people through the whole nations. I believe even these countries are still looking for the right solutions to their own health care system problems.

Po-tay-to, po-tah-to

I've seen these videos quite a few times before, but it never fails to strike me just how many ways there are to accomplish the same thing. The thing is, there's no exact right or wrong answer to how to achieve a good health care system. For example, the UK utilizes gatekeepers, but Japan does not. But in both cases, their systems work out well enough for their people.


A health care system, in essence, should be specifically tailored. I think Taiwan's method of overhauling their system had the right idea: they looked abroad (we are, after all, living in a highly globalized culture now) to other systems that were working well, but didn't completely copy them. Instead, they picked and chose certain aspects that would fit best with their country and their demographic, and implemented them in a culturally appropriate manner.


Like Mr. Reid summarized in the videos, there are many similarities between the better health care systems around the world which the US should probably keep in mind. Keep administrative costs low...in Taiwan, for example, they rely heavily on electronic records for every little thing. Aggressively promote prevention and preventive services, like in the UK. Don't spend too much on health care, but at the same time, don't spend too little.


As a side note, I was quite amused to see the Brits protesting privatization...in distinct contrast to Americans protesting socialization.

Frontline videos

Click on the title of this post to get to the frontline videos about the U.K., Japan, Germany, Taiwan, and Switzerland.