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.