From now on when the politicians roll out their next victim saying they could not get health insurance, ask the question.  Ask the politician if they are aware of National Association of State Comprehensive Health Insurance Plans.  Either they are ignorant of the program or they are just deceiving you.

Thirty five States participate in the high risk pooling and guaranteed health insurance.  I would ask the politician why we need a 2,000 page Bill to cover the uninsured when all we need is to get the remaining States to join the pool?

Paying the premium is one thing but the way the politicians make it sound is that the un-insurable can’t get insurance in any State in the Union.  It is just not true.

“Health insurance risk pools are special programs created by state legislatures to provide a safety net for the “medically uninsurable” population. These are people who have been denied health insurance coverage because of a pre-existing health condition, or who can only access private coverage that is restricted or has extremely high rates.

Each of the state risk pool-type programs is different. Generally, the programs operate as a state-created nonprofit Association overseen by a board of directors made up of industry, consumer and state insurance department representatives. The board contracts with an established insurance company to collect premiums and pay claims and administer the program on a day-to-day basis. Insurance benefits vary, but risk pools typically offer benefits that are comparable to basic private market plans — 80/20 major medical and outpatient coverage, a choice of deductible and co-payments. Maximum lifetime benefits vary by state from as low as $350,000 to $2 million.

Generally, there are no exclusions. However, risk pools do have waiting periods for coverage of pre-existing conditions to make sure individuals pay for continual coverage and the program can operate financially sound. Without waiting periods, the concern is that too many people could forego paying for insurance until they had a high cost claim, and the programs could not function financially. However, under the federal portability legislation, people who have had continuous coverage in the group market, not broken by more than 63 days, can access coverage in risk pools without any waiting periods.

Risk pool insurance generally costs more than regular individual insurance, but the premiums are capped by law in each state to protect the individual from exorbitant costs. The caps range from as low as 125 percent of the average for comparable private coverage in some states, up to 200 percent of the average or more in other states. Most states offer coverage at less than 150 percent of the average.

All state risk pools inherently lose money and need to be subsidized. While the individuals in risk pools pay somewhat higher premiums, roughly 50 percent of overall operating costs need to be subsidized. Subsidy mechanisms also vary from state to state — some states assess all insurance carriers, HMO’s and other insurance providers; others provide an appropriation from state general tax revenue; some states share funding of loss subsidies with the insurance industry using an assessment of insurance carriers and providing them a tax credit for the assessment, or other states have a special funding source, such as a tobacco tax, or a hospital or health care provider surcharge.

It is important to note that risk pools are not created expressly to serve the indigent or poor who cannot afford health insurance. Risk pools are designed to serve people who would not otherwise have the right to purchase health insurance protection. The indigent can access coverage through state medical assistance, Medicaid or similar programs. However, some state risk pools do have a subsidy for lower income, medically uninsurable people.”

http://naschip.org/Savannah/savannahconf.htm

http://www.naschip.org/states_pools.htm

On of the keys to the Obama plan is that health insurance will be guaranteed issue.  Currently there are a lot of the “uninsured” that choose to be uninsured.  Some call it irresponsible.  In the Obama plan what will make these people become responsible?

The Obama plan isn’t going to require people to buy insurance.  What is to keep the current irresponsible group to:

1. Not purchase insurance
2. Stay uninsured
3. Wait until an illness such as cancer
4. Go to an insurance company, lay down a $100 premium and say, “now cover me for $70,000 of cancer treatments.

An Obama plan would entice people to be irresponsible.  But isn’t that what many government – give-away take – care – of – you plans always create?  Government is good at creating moral hazards.

I am about to loose my lunch or take up arms.  Not sure which.  There isn’t much to this diary except to let out my frustrations over how fast the Socialists are taking over and with today’s elections Europe is going to opposite way.

Newsweek editor Evan Thomas brought adulation over President Obama

“Friday, declaring on MSNBC: “I mean in a way Obama’s standing above the country, above – above the world, he’s sort of God.”

Thomas replied: “Well, we were the good guys in 1984, it felt that way. It hasn’t felt that way in recent years. So Obama’s had, really, a different task We’re seen too often as the bad guys. And he – he has a very different job from – Reagan was all about America, and you talked about it. Obama is ‘we are above that now.’ We’re not just parochial, we’re not just chauvinistic, we’re not just provincial.”

Today is the last of the series on National Plans of the world………………..

Brazil

http://www.ncbi.nlm.nih.gov/pubmed/10154360?dopt=abstractplus

The private sector is the predominant provider of health care in Brazil, particularly for inpatient services, and financing is a mix of public (through a prospective reimbursement system) and private. Roughly a quarter of the population has private insurance coverage, reflecting rapid growth in the past decade fuelled by the crisis in the public reimbursement system and the perceived deterioration of publicly provided care.

Four major forms of insurance exist:

1. Prepaid group practice
2. Medical cooperatives, physician owned and operated preferred provider organizations
3. Company health plans where employers ensure employee access to services under various types of arrangements from direct provision to purchasing of private services
4. Health indemnity insurance. Each type of plan includes a wide variety of subplans from basic individual/family coverage to comprehensive executive coverage. The paper discusses the characteristics, costs and utilization patterns of all types of privately financed care, as well as the major problems associated with private financing: the limited package of benefits and low payout ceilings, inadequate consumer information and virtually no regulation.

Taiwan

Taiwan’s New National Health Insurance Program: Genesis And Experience So Far – 2003

http://content.healthaffairs.org/cgi/content/full/22/3/61

Taiwan’s NHI is a government-run, single-payer national health insurance scheme, financed through a mix of premiums and taxes, that compensates a mixed public and private delivery system predominantly on a fee-for-service basis.16 NHI enrollment is mandatory, to ensure adequate risk pooling and the broad-based collection of funds to finance the NHI. More than 96 percent of Taiwan’s population is now enrolled

The bulk of Taiwan’s health care facilities—86 percent of hospitals (1999) and 65 percent of all hospital beds (2000)—are privately owned. Most of the privately owned beds are in nonprofit hospitals that nevertheless can earn sizable profits, like their U.S. counterparts. Doctors in Taiwan are either salaried staff physicians in hospitals or self-employed owners of medical practices known as clinics, of which 97 percent are privately owned. As of 2000 about half of Taiwan’s physicians practiced in their own clinics.

Cost sharing by patients. Out-of-pocket spending by households represents services not covered by the NHI, such as orthodontics, prosthodontics, lab tests that are not medically necessary, extra charges for non-NHI beds, special nurses and physicians requested by patients other than those routinely assigned by the hospital, long-term care, and nursing home care. It also includes “user fees” and copayments for NHI-covered ambulatory care, inpatient care, and pharmaceuticals.

The share of the premiums paid by the insured, by employers, and by government varies greatly within the six categories of population subgroups. For employees of public or private enterprises, for example, government pays 10 percent of the premium, the employer 60 percent, and the employee 30 percent (the latter through payroll deduction). The non-poor self-employed pay 100 percent of their income-based premium, without any government subsidy. For military personnel and their dependents, and low-income unemployed people who are unable to pay the premium, the government subsidizes 100 percent of the premium. The premium collected by the NHI for an individual varies based on his or her number of dependents (for whom premiums are levied on a per capita basis), although dependents in excess of three are effectively insured gratis.

Since 1998, however, the NHI’s expenditures have outstripped its revenues. Over the entire period 1995–2001, NHI revenues increased at an average annual rate of 4.26 percent, while expenditures increased at 6.26 percent.58 The large cash reserves accumulated during the first three years were used to cover the deficits for the period 1998–2002. By mid-2002 the cash reserve had dwindled to less than a month’s expenditure, forcing the BNHI to borrow from banks to the tune of NTD$50 billion a month (about one-sixth of total monthly expenditures) to pay claims.59 The NHI has addressed this shortfall in several ways.

Premium increases. For the first seven years of the NHI’s existence, its premium rates remained unchanged. Because the NHI could draw on its cash reserve after 1998 to cover deficits, the public and its political representatives resisted the idea of raising premiums in step with the growth in spending. Furthermore, the KMT government may not have considered it politically wise to raise premium rates shortly before the presidential election year of 2000.

Only in September 2002, with the NHI facing imminent bankruptcy, was the DoH able to push through a premium rate increase of about 7 percent, from 4.25 percent of assessable income to 4.55 percent. For 90 percent of the insured public, this premium increase represents an average of NTD$40 (US$1.14) per month.

Even before the September 2002 premium increase, the BNHI raised copayments in July 2001 for certain types of visits, drugs, and inpatient care, although critics have decried this strategy as regressive. Copayments rose again in September 2002, and the BNHI started to charge copayments for lab tests and examinations at that time.

http://www.annals.org/cgi/content/full/148/4/258

A 10-Year Experience with Universal Health Insurance in Taiwan: Measuring Changes in Health and Health Disparity – February, 19, 2008

Universal national health insurance, financed jointly by payroll taxes, subsidies, and individual premiums, commenced in Taiwan in 1995. Coverage expanded from 57% of the population (before the introduction of national health insurance) to 98%.

Copayments are required: roughly 10% for inpatient and 20% for outpatient

With an average income of $15,170 in 2004, the average Taiwanese person spent $926 on health care, an increase from $548 the year before the introduction of national health insurance.

Overall, while Taiwan’s population grew 5.2 percent between 1994 and 2000, the volume of services delivered greatly increased. Between 1994 and 2000 total hospital outpatient visits increased by 16.6 percent, emergency room visits by 42.2 percent, outpatient surgery by 56.4 percent, inpatient surgery by 19.7 percent, kidney dialysis by 80.4 percent, and inpatient hospitalization by 18 percent.

With the exception of certain costly high-tech treatments (for example, heart, lung, liver, and bone marrow transplants, or gamma radiation) for which prior BNHI authorization is needed, there are effectively no ceilings on utilization in the NHI. This has resulted in high health care use rates, especially outpatient care. Outpatient visits averaged 14.4 per capita in 2001, compared with 5.8 for the United States (1996), 6.4 in Canada (1998), 6.5 in Germany (1996), and 16 in Japan (1996). In Taiwan there were 129 hospital admissions per 1,000 population in 2001, which is roughly comparable with the acute care hospital admission rate of 118 per 1,000 population in the United States and 99 in Canada.

Payment of providers

Taiwan’s health care providers obtain their revenues from three sources:

(1) payments by the NHI

(2) patient user fees and copayments, and

(3) proceeds from the sale of products and services not covered by the NHI

Experts in Taiwan appear to believe that the absolute level of fees paid by the NHI is too low and that many fees are considered to be below cost. In the absence of effective volume controls, providers’ simplest response to low fees is to expand the volume of services they provide while reducing the resources going into each unit of service (for example, shortened visit length). The BNHI’s chief executive officer, Hong-Jen Chang, remarked that “Taiwan’s doctors are well paid. But they work very, very hard to use volume to make up for the low fees.”

Ta-Fu Huang, chairman of the DoH’s Quality Commission, has written extensively about Taiwan’s medical culture of the “three-minute patient visit“ with physicians that is typical of doctors in Taiwan. That fee-driven practice style may lead to misdiagnosis, improper treatment, or delays in proper treatment.

Rewards for revenue generation

With rare exceptions, hospitals in Taiwan now reward their staff physicians individually for bringing in revenue. Traditionally, hospital-based physicians in Taiwan had been paid fixed salaries. In recent years more and more hospitals have shifted partially (mainly large public hospitals) or wholly (all private hospitals and some public hospitals) to the “professional fee” (PF) system. That system compensates doctors mainly on the basis of their revenue productivity: the number of patients seen, procedures performed, lab tests ordered.  Although seniority counts as well, the higher the service volume a doctor or a hospital delivers, the greater will be the hospital’s revenue and the doctor’s pay.

It is to be expected that such a reward system can trigger physician-induced care that may not always be clinically indicated. The BNHI’s Chang estimates that overuse and misuse of health care may well constitute up to a third of the BNHI’s current expenditure, a view that is widely shared.

Others decry the “commercialization of medicine” in Taiwan and the “profit-driven motives” of Taiwan’s providers. Finally, providers in Taiwan can and do respond to low fees for some services by profiting from the sale of products and services not covered by the NHI or by emphasizing the sale of NHI-covered products on which the NHI allows large profits. Prominent among these are prescription drugs. Drugs constituted 22 percent of total national health spending in 2000 and 23.8 percent in 2001.

Coupled with the PF system of rewarding hospital-based doctors, permitting hospitals to profit from the sale of drugs leads to a serious conflicts of interest, as it invites the overmedication of patients, including a perilous overmedication with antibiotics. According to a December 2002 study report by the DoH, close to half of the doctors in Taiwan prescribe four to five drugs per visit for upper respiratory infections, and 10 percent prescribe more than eight drugs.

Care can be Deadly Care

According to the previously cited chairman of the DoH Quality Commission, “When patients in Taiwan are faced with life-threatening illnesses, although their economic burden is reduced [by the NHI], the probability of their losing their lives is several times greater than it is in the U.S.

For example:

1. Survival for all cancers in Taiwan is half the rate in the U.S.
2. Deaths from anesthesia is eight times that of the U.S.
3. Deaths from tuberculosis is ten times that of the U.S.
4. Antibiotic resistance in streptococci [sic] pneumonia is the highest in the world.

In its April 2002 global budget report, Taiwan’s DoH concurred that “the policy of low cost insurance with prices frozen, which resulted in ‘fast-food health care,’ has seriously negatively impacted on both the quality of care and the medical environment.“

A major lesson to emerge from Taiwan’s experience is that social insurance programs can easily fall victim to the Tragedy of the Commons, in which commonly owned properties face the risk of depletion from overuse by individuals seeking to maximize their own well-being without regard for the common good. The challenge health policymakers face is to educate the public to the fact that a social health insurance system, too, faces this type of threat.

United Kingdom

Britain’s public provider of health care is known as the National Health Services (NHS). Services provided by the NHS include hospitals, family doctors, specialists, dentists, chemists, opticians and the ambulance service.

Not all services provided by the NHS are free of charge. Unless exempt, patients pay

1. (subsidised) fixed costs for prescriptions
2. Sight tests
3. NHS glasses
4. Dental treatment.

Hospital treatment, the ambulance service and medical consultations remain free.

The UK’s NHS was the first state organisation in the world to provide free universal healthcare. Today, it is an organisation with some severe structural problems, which means that waiting lists for treatments even for urgent operations have grown and the standard of treatment in some hospitals has deteriorated. Many Britons in the higher income bracket purchase private health insurance and there is a growing number of employers providing private cover as standard to their employees.[1]

Private Health Care

Private medical treatment in Britain is amongst the best in the world, with London having some of world’s most skilled specialists. Within the country, most people go private to avoid NHS waiting lists for non-emergency specialist appointments and non-urgent treatment. Around a quarter of all operations are performed privately.

There is almost always no difference in quality between private and NHS doctors. Indeed, you will often end up seeing the same specialist privately as you would have seen through the NHS. The difference will be  when you get the appointment and how quickly you are treated, i.e. a heart bypass operation may be diagnosed for and completed in a couple of weeks with private treatment, but through the NHS this could take two or three months. Many employers also provide their workers with private health insurance, which is definitely worth finding out about if interviewing for different positions or negotiating a package.[2]

NHS to allow ‘private’ drugs for cancer

Patients may soon be allowed to pay for “top up” drugs on top of their NHS care under a major reform to Britain’s healthcare system expected next month.

Approval of top-up payments for cancer and certain other treatments is being widely anticipated from the review being conducted by Professor Mike Richards, the Government’s national cancer adviser, despite fears that it could introduce a two-tier NHS.

Medical organisations have accepted that the change is inevitable in a health service that champions patient choice and is increasingly driven by consumer demand. But there is little enthusiasm for the move, which is seen as difficult to implement and would pose a long-term threat to a comprehensive NHS.

The review was ordered by Alan Johnson, the Health Secretary, in June after protests from NHS cancer patients who were told they could not pay privately for cancer drugs that had been rejected, or not yet assessed, by the National Institute for Clinical Excellence.[3]

Life prolonging cancer drugs to be banned because they cost too much

Thousands of patients with terminal cancer were dealt a blow last night after a decision was made to deny them life prolonging drugs. The Government’s rationing body said two drugs for advanced breast cancer and a rare form of stomach cancer were too expensive for the NHS.

The National Institute for Health and Clinical Excellence is expected to confirm guidance in the next few weeks that will effectively ban their use. The move comes despite a pledge by Nice to be more flexible in giving life-extending drugs to terminally-ill cancer patients after a public outcry last year over ‘death sentence’ decisions. Leading campaigners last night said Nice had failed the ‘acid test’ of whether it really intended to give new priority to people with just a few months to live. [4]

Cost Containment has created problems in the NHS

FILTHY hospitals in Kent have led to the death of 90 patients – and now you can find out if your local hospital has been affected too.

Appalling hygiene at Kent and Sussex Hospital, Pembury Hospital and Maidstone Hospital saw the killer Clostridium difficile bug C.diff directly linked to 90 deaths.

Almost every hospital in England has suffered C.diff outbreaks and MRSA scares.[5]

Find out how your hospital has been affected by using our interactive map. Just click on the link below.[6]

Hard-up hospital orders staff: Don’t wash sheets – turn them over

Cleaners at an NHS hospital with a poor record on superbugs have been told to turn over dirty sheets instead of using fresh ones between patients to save money. Housekeeping staff at Good Hope Hospital in Sutton Coldfield, have been asked to re-use sheets and pillowcases wherever possible to cut a £500,000 laundry bill.

Posters in the hospital’s linen cupboards and on doors into the A&E department remind workers that each item costs 0.275 pence to wash. Good Hope reported a deficit of £6million last year and was subject to a report by the Audit Commission because of its poor financial standing.

It recorded 36 cases of MRSA from April last year to January, while cases of clostridium difficile have more than doubled in less than a year to 327. A Government hit squad was drafted in to solve the infection problems last year but the trust is still failing to hit MRSA targets.

Tony Field, chairman of Birmingham-based MRSA Support, said: ‘Is that all the safety of a patient’s life is worth? 0.275 pence? ‘It is utterly disgraceful and tantamount to murder because hygiene like changing sheets is essential to protect patients.

“It proves beyond all doubt that cost- cutting is directly contributing to hospital acquired infections.” The scheme is one of many ways that cash- strapped trusts are trying to save money.

Staff at West Hertfordshire NHS Trust were amazed to receive a memo urging them to save £2.50 a day by:

1. Prescribing cheaper medicines
2. Reducing the number of sterile packs used
3. Cutting hospital tests
4. Asking patients to bring drugs in from home
5. Epsom and St Helier Trust in South London has removed every third light bulb from corridors.[7]

The NHS cost containment can be deadly

Dying woman refused chemotherapy by the NHS Tuesday 3^rd June 2008

A widower has demanded a change in the law after his wife was denied chemotherapy for bowel cancer on the NHS because she paid privately for life-extending drugs.

Linda O’Boyle, 64, and husband Brian, 74, both retired NHS workers, decided to pay for drug cetuximab in addition to NHS treatment after her consultant said it might prolong her life.

The decision meant she was considered a private patient and had to pay for her NHS treatment as well, because the Government has banned patients mixing public and private care. Mrs O’Boyle died on March 26 this year. Mr. O’Boyle, who was a health manager for 30 years before his retirement, blames the Government and South West Essex Primary Care trust for the system which saw them paying out £11,000 for private treatment, including cetuximab and chemotherapy.

Mr O’Boyle said he and Linda, who was an assistant occupational therapist, were angry at the decision.

He blames Health Secretary Alan Johnson, who last year issued guidance to NHS trusts telling them not to permit patients to pay or additional medicines. Mr. Johnson claims co-payment would create a two-tier NHS, with preferential treatment for patients who buy extra drugs.

“Linda told me they just did not think she was worth helping and had put her on the dump and sent her to die. “That was her initial reaction. It was a huge shock.”

He added: “I still think it extended her life by three months, so don’t regret doing it, but the system needs to be changed.”

Comments on the page:

Mrs. K., Southend on Sea says…
8:36am Tue 3 Jun 08

In 1997 when it was discovered that my Dad had lung cancer, he wasn’t offered any sort of chemotherapy or radiotherapy at all.
Maybe it was because it was too far gone to do anything, or maybe it was because he was 80 years old, although he only looked about 65 and was still full of life. He died six months later.

Tony Winchester, Wos says…
1:15pm Tue 3 Jun 08

Atragic decission from the PCT but then again they wont even give school kids the TB vaccine (not British ones anyway)so therefore this case don’t surprise me unfortunately. My heartfelt wishes go out to her family.[8]

Cost Containment – waiting times

Friday 8 June 2007 – One in eight NHS hospital patients still has to wait more than a year for treatment, the government acknowledged yesterday in its first attempt to tell the full truth about health service queues in England.

A Department of Health analysis of 208,000 people admitted to hospital in March showed 48% were wheeled into the operating theatre within 18 weeks of a GP sending them for hospital diagnosis. But 30% waited more than 30 weeks and 12.4% more than a year.

The inpatient clock started when the consultant decided hospital treatment was needed and stopped when the patient was treated. The maximum inpatient delay is six months. Until now, the NHS did not measure the time patients waited after the first outpatient appointment before going on the inpatient list. This “hidden” delay could last months.

Some primary care trusts ordered hospitals to go slow in March to avoid overspending. The analysis measured the waits of people who were treated during the month without estimating the extra waiting experienced by those still in the queue.

Norman Lamb, the Liberal Democrat health spokesman, said: “Behind the statistics, thousands of sick people are still waiting more than a year for hospital treatment. This is a daily tragedy.”[9]

Operations cancelled as NHS runs out of money – January 4, 2007

Patients are being denied basic operations, including treatments for varicose veins, wisdom teeth and bad backs, as hospitals try frantically to balance the books by the end of the financial year.

NHS trusts throughout the country are making sweeping cuts to services and delaying appointments in an attempt to address their debts before the end of March. Family doctors have been told to send fewer patients to hospital, A&E departments have been instructed to turn people away, and a wide range of routine procedures has been suspended.

In one example of the cash-saving strategies, seen by The Times, a primary care trust in Yorkshire has told hospitals that they will not be paid for some non-essential operations, while patients will not be given a hospital appointment in under eight weeks. Similar tactics have emerged at hospitals in Norfolk and Surrey, while dozens of trusts have resorted to closing beds and offering voluntary redundancy in recent months. Devon Primary Care Trust has offered voluntary redundancy to all 5,000 staff.

The cuts are widespread, although there are no central records to provide definitive figures. Among the most comprehensive plans are those from North Yorkshire and York Primary Care Trust, which faces a deficit of £24 million this year.

A letter from its chief executive, Janet Soo-Chung, says that all non-urgent admissions must be approved by an assessment team or they will not be paid for. A&E departments in Harrogate, Scarborough, South Tees and York have been told that they will not be paid for treating patients with minor ailments who could go elsewhere.

No patients will be given a hospital appointment in less than eight weeks, and none admitted for elective surgery unless they have waited a minimum of 12 to 16 weeks. Those treated quicker will not be paid for.

The trust also announced the immediate suspension of treatments for varicose veins, wisdom teeth, X-rays of the back, operations for carpal tunnel syndrome, bunions, arthroscopy of the knee, and grommets for the ear, among others. “We fully appreciate the difficulties that the introduction of these measures entail,” Dr Soo-Chung’s letter says. “However, the financial position of the PCT is such that there is absolutely no alternative to this programme if we are to avoid even more difficult decisions in the near future.”

Norfolk PCT has issued similar instructions, telling hospitals not to treat patients who have waited less than 17 weeks — expected to rise to 18 weeks by February. Hilary Daniels, the interim chief executive, told hospitals to work out how many patients could be deferred until next financial year, and said that the trust would not pay for elective operations on smokers until they had attended smoking clinics.

In a report published this week, the think-tank Reform said that NHS deficits were deepening. It called for a one-off repayment of debt followed by a more rigorous financial regime and immediate administration for failing trusts. But the idea was rejected by the Department of Health.

Last year the NHS returned a net deficit of £512 million, a fraction of the total budget. But the scale of the problems was concealed by strategic health authorities saving large amounts of money largely by cutting education and training budgets.[10]

Netherlands and Sweden

In both countries, the majority of the population buys supplemental policies, often purchased from the insurer providing basic coverage. Insurers providing supplemental coverage are subject to fewer (Netherlands) or no (Switzerland) risk-rating restrictions. This has had complex effects on competition and mobility of the insured in the supplemental insurance market.

Tight regulation of basic health insurance markets, with requirements for open enrollment and community rating. Both countries require that insurers accept all applicants and prohibit variations in premiums by health status—community rating, with guaranteed offer and renewal. The two countries differ markedly, however, regarding insurance market oversight, the way premiums are set, and the extent of risk equalization efforts across competing plans.

An additional 1.5 percent is insured but behind on premium payments—a policy concern in both countries. Both countries subsidize premiums for low-income households, with about 40 percent receiving such premium assistance.[1]

Netherlands

• Compulsory social insurance for people earning an income below a certain income level
• Private insurance available for people earning above a certain income level
• Becasue of the Matching Act legislation – Illegal Aliens can only receive limited care.  Example – illegal aliens would receive no care for a costly medical claim such as AIDs.
  

Sweden

Sweden attaches high priority to the provision of health services to the entire population paid for through

• National taxes
• Regional taxes.[2]

Netherlands – The Health Insurance Act of 2006

The Health Insurance Act of 2006 was the culmination of several years of Dutch legislation and policy aimed at achieving universal health care coverage. It requires all people who legally live or work in the Netherlands to buy health insurance from a private insurance company. Insurers are required to accept each applicant at a community-rated premium regardless of preexisting conditions.

As discussed, insurance companies are required to accept each applicant for basic insurance coverage. Individuals can choose from among 14 private insurance companies and several related subsidiaries. The Dutch government has set up a Web site where consumers can compare all insurers with respect to price, services, consumer satisfaction, and supplemental insurance, and compare hospitals on different sets of performance indicators.

The plan is financed with individuals’ annual income-based contributions to the tax collector. Employers are required to compensate their employees for these contributions.

• In addition, all adults are required to pay premiums directly to the selected insurer, which sets its own community-rated premium. It is estimated that 1.5% are uninsured[3]

In the Netherlands, the government is not in charge of the day-to-day management of the healthcare system.

1. Private health suppliers are responsible for the provision of services in this area
2. The government is responsible for the accessibility and quality of the health care

Since January 1^st 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.

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). [4]

In the Netherlands, for example, people must buy supplementary insurance for health care such as cosmetic surgery, non-rehabilitative physiotherapy, or more comprehensive dentistry. Costs have been cut, quality driven up, and fees are far from prohibitive; in fact 93% of the population have bought some form of supplementary insurance.[5]

“Have you recently moved to the Netherlands? “Remember to take out health insurance. Obligatory health insurance Health insurance covers the costs of medical care. Residents in the Netherlands are obliged by law to take out health insurance, for themselves and for their partners and children. Even if you already have a health insurance policy, you are still obliged to take out a new policy in the Netherlands.[6]

The Netherlands operates a national insurance market for its 16 million residents. Plans may operate on a for-profit or nonprofit basis.

Plans typically offer coverage in all areas of the country and include all providers, although selective contracting is allowed. Children are covered in full through public funds. Premiums charged for adults represent 50 percent of the expected annual costs. Netherlands has notably low cost-sharing, with additional protections for the chronically ill. [7]

Switzerland

The Swiss health care system has gained a reputation of being one of the best in the world. There is an extensive network of hospitals and doctors, waiting lists for treatment are rare and medical facilities have the latest technology. However, as with most things in Switzerland, there is a price tag attached to this quality!

Hospitals ( Krankenhaus, Spital/hôpital) can be recognized by a white “H” on a blue background and are listed in the yellow pages under Spitäler or hôpitaux. Except for emergencies, you usually have to be referred to a hospital by a doctor. You normally have to visit a hospital in the canton where you are residing, although there are exceptions to this.

Depending on your insurance scheme, you will either be put in a general ward with two to four beds (standard cover), a two-bed room (half private) or a single room (private). Note that standard cover does not give you the right to choose your doctor, this may be important as not all doctors may speak your language.

Hospitals in Switzerland aren’t cheap! All hospital fees have to be paid for either by you or your insurance company. There is no such thing as ‘free treatment’ in Switzerland (even in the case of emergencies). If the decision is up to you whether or not to go into the hospital, you should first talk to your insurance company.

After visiting a hospital or doctor, you will receive a bill which you should pay within the specified period (usually around 30 days). You then send a copy to your insurance company, which will reimburse the percentage covered by your insurance scheme. If you are not resident in Switzerland and don’t have any sufficient health insurance, hospitals can require a deposit upon your admittance, which may range from CHF 2000 to 10,000.

Health insurance – Public and private health insurance in Switzerland

According to the Health Insurance Act ( Krankenversicherungsgesetz – KVG) every person living in Switzerland is obliged to take out a basic health insurance policy ( Grundversicherung). Note that in Switzerland, sickness insurance will normally not be arranged by your employer. You have the responsibility of contacting providers and arranging the insurance yourself. Only if your employer has an agreement with a specific insurer and pays part of your premiums (which rarely happens), will you be forced to choose a specific provider.

Health insurance premiums in Switzerland are not dependent on income, but are calculated based on your personal risk profile. However, the Swiss Confederation subsidizes premiums for low-income individuals/families. In 2004, the basic insurance premium was around CHF 250/month.

Swiss insurance schemes only cover individuals, not families as in some other European social security schemes. You will therefore have to insure each household member, including children.

If you only have a compulsory basic insurance scheme, you are obliged to make a contribution towards your total annual medical cost, up to a certain limit per year. This ‘franchise’ is calculated as a percentage of your total annual medical costs and capped at a yearly limit.

About 40% of the Swiss population chose to top-up their insurance cover. This is commonly in order to have more comfortable accommodation during a hospital stay or wider choice of treatments.[8]

The Swiss have operated with a mandate since 1996. Uninsured rates are low (estimated at below 1 percent in Switzerland). An additional 1.5 percent is insured but behind on premium payments.

Switzerland imposes much higher cost-sharing, including deductibles and coinsurance than the Netherlands.

The Swiss insurance system (7.5 million people) is highly decentralized, with plans operating and setting premiums at the canton level (26 divisions). In Switzerland, only nonprofit insurers may participate. The 10 largest of some 85 carriers insure 80 percent of the population. Swiss insurance risk equalization efforts adjust only for age and sex factors at the moment. Currently, Swiss premiums vary widely by health risks of insured pools across the country and within regions.

Switzerland, 12 percent of the population is enrolled in HMOs or other managed care plans. However, savings have been limited because most of these enrollees are in the least integrated plans, and plans have no ability to negotiate prices with providers. Outside such plans, Swiss patients have open access to physicians and can self-refer to specialists. Swiss provider fees are generally set by negotiations between provider associations and insurance associations.

Hospitals are mostly paid per diem rates, although a large fraction has already changed to prospective reimbursement.

A nationwide diagnosis-related group (DRG) system (SwissDRG) will be introduced in 2012. Cantons finance more than 50 percent of hospital costs either directly or through DRGs.  People may be familiar with USA Medicare DRG. [9]

Been out of town on business and haven’t kept up with my health care series. I’ll pick up where I left off.

Japan

According to the Organisation for Economic Co-operation and Development (OECD) statistics, Japanese per capita health expenditure is lower than Germany by 15 percent and by about a half compared to that of the United States.

Because of economic incentives involved as well as tradition, the percentage of pharmaceutical-related expenses in total health expenditures is exceptionally high in Japan. The figure was reportedly 29.5 percent (including both inpatient and outpatient care) in Japan in 1993, compared with 17.1 percent in Germany and 11.3 percent in the United States (table 3).

Because of legal caps, patient cost-sharing has been low historically (about 15 percent on average for the nonelderly and 5 percent for the elderly); therefore this has not been a major problem in Japan so far.

1. Patient cost-sharing has increased and
2. Patient charges on pharmaceutical costs for outpatient services has been in use for the first time since September 1997, which was reported to have a major impact on patients’ behavior.

Inefficiency exists in areas such as: long hospital stays and outpatient care waiting times

Public Health Insurance in Japan – Tetsuo Fukawa

1. Amenities in hospitals are far inferior to those in other developed countries.

2. A significant but uncounted number of services are not reimbursed by sickness funds

3. Uncounted services may not be included in national health expenditure calculations.

4. Families often help with nursing in hospitals.

5. There are also some under-the-table payments to physicians for favors such as special attention and treatment, and quick admission.

6. The health plan pays relatively little attention to preventive care.

Once benefits provided by health insurance reach a certain level, moral hazard comes into play inevitably—for patients as well as physicians. In this vein, we now turn to negative lessons from Japanese experiences.

Despite vigorous price control measures in the 1980s and 1990s, health expenditures increased by 1 trillion yens annually in recent years. As a general rule, if the persons receiving fees (such as physicians ) also control the volume of services, they will normally respond to a reduction in fees by raising the volume of services to restore their income; Japan is no exception.

The effects of patient cost-sharing on distributional aspects and on effective use of health services are not fully investigated. Moreover, we cannot continue to increase patient cost-sharing. The next step might be the introduction of selective benefit. In this scenario, insurance coverage would be classified into two categories: basic benefit and selective benefit. A higher contribution would be required to receive the selective benefit.

Japan enjoys the lowest infant mortality rate and the longest life expectancy in the world. Furthermore, the country’s public health expenditure is only 5 or 6 percent of its GDP, and the health care system appears to be functioning quite well. However, we should be careful in drawing any conclusions from these, because infant mortality rate and life expectancy at birth are no longer proper indicators for evaluating a health care
system. [1]

Preventative care and maternity

• Large employers may provide some preventive care
• Health insurance covers little preventive care
• It provides only cash payment for normal pregnancy because
• Pregnancy is not considered an illness in Japan.

Cost Containment All patients except the elderly face higher cost-sharing.

Cost sharing

1. Employer-based health insurance
2. Employees pay 10% coinsurance for their care
3. Dependents pay 20 percent for inpatient care
4. Dependents pay 30 percent for outpatient care[2]

National Health Insurance

1. Regular patients pay 30 percent coinsurance
2. Retired employees within the National Health Insurance scheme pay 20 percent
3. Dependents pay 20 percent for inpatient care and 30 percent for outpatient care

The McKinsey Quarterly, May 2008

At first glance, Japan’s health care system, like its people, seems to be in remarkably good shape. The country’s National Health Insurance plan provides generous universal coverage. The Japanese suffer relatively low rates of disease and have among the highest life expectancy in the world. Moreover, spending on health care is lower than in most Organisation of Economic Co-operation and Development (OECD) countries, thanks to strictly controlled reimbursement levels.

But Japan, like many other economically advanced countries, faces mounting health care expenses that will be difficult to support using current methods. MGI research suggests health care spending in Japan could double as a proportion of GDP within 30 years, with advances in medical technology, growing wealth, and demographic changes driving the increase. The financing gap is so large that policies on which Japan has relied in the past, such as increasing co-payments, will not be sufficient to close it.”

There is often an important potential conflict between efficiency and equity, but in Japan this is less of a problem because people are accustomed to their egalitarian system generating minor inconveniences in terms of accessibility (Mooney 1996).

Consumption of pharmaceuticals is high in Japan. Because of economic incentives involved as well as tradition pharmaceutical-related expenses in total health expenditures is exceptionally high in Japan.

Japanese doctors not only prescribe drugs but also dispense them. There is a certain gap between the discount price at which doctors buy drugs and the official price by which doctors are reimbursed by the Insurance system for the drugs they prescribe. [3]

The  first  negative  feature  is  the  distorting  effect  on patient  volume.  Since  fees  are  controlled,  providers  seek  to  maximize their  revenue  by  seeing  more  patients.  This  dilutes  the  services  provided.  In  outpatient  care,  a  clinic  physician  sees an  average  of forty-nine  patients per day;  13  percent see more than a hundred. While  patients have ready access  to  care,  consultation  times  are  short,  and  patients  end  up  paying repeat  visits  to  the  clinics.  In  inpatient  care,  the  total  number  of  staff  peroccupied  bed  is  still  only  0.77,  about  one-quarter  the  U.S.  level.

A  second  negative  feature is  the-distorting  effect  on  the  type  of  services provided.  Services  for  which  the  fee  schedule’s  price  is  higher  than  the market  price  (for  example,  drugs  and  laboratory  tests)  tend  to  be  provided excessively, despite  a  recent  lowering  of  their  scheduled  prices.  In the case of drugs, the result of lowered  fees has been heavy promotion of new drugs whose  patents  protect  them  from  fierce  price  competition.  One  consequence  is  that  third-generation  antibiotics  are  used  more  extensively  in Japan  than  anywhere  else.

In  the  case  of  laboratory  tests,  free-standing laboratories  have  cut  their  prices  to  the  point  that  their  efficacy  is questioned.  On  the  other  hand,  cognitive  procedures  and  home  care  are under-provided  because  of  the  implicit  rationing  process  that  keeps  their fees  at  a  very  low  level,  if  fees  are  established  at  all.  Also,  experimentation with  new  financing  mechanisms  has  proved  difficult  because  of  the monolithic  structure  of  the  nationally  enforced  procedure-based  fee-for-service system.

The  third,  and  perhaps  most  serious,  negative  feature  has  to  do  with quality  of  care.  Because  Japan’s  fee  schedule  guarantees  uniform  payment to  all  providers,  on  the  assumption  that  their  quality  is  uniform,  no  real incentives  exist  to  maintain  quality.  No  formal  quality  assurance  programs  exist,  and  specialty  boards  do  not  contribute  much  to  quality assurance.  Under  these  circumstances,  the  increasingly  quality-conscious public  has  turned  to  the  large  public  and-teaching  hospitals,  perceiving that  their  quality  is  higher.  This  has  resulted  in  long  queues  in  their outpatient  departments  (appointments  are  not  the  general  rule,  even  in these  hospitals)  and  waiting  lists in  their  inpatient  departments.

A  black  market  exists  for  those  who  can  afford  it. Using  the channel  of  a  monetary  gift  in  the  range  of  one  to  three  thousand  dollars to  the attending  physician  in  a  Tokyo  university  hospital,  which  is  socially prescribed,  a  patient  choosing  a  private  room  can  be  admitted  sooner  and can  be  treated  by  a  senior  specialist.  Notwithstanding  the  inequities implicit  in  such  an  arrangement,  it  also  means  that  quality  assessment  is difficult,  if  not  impossible.[4]

Germany

“German Health System Not Quite in Intensive Care ” – Going by media reports and public opinion in Germany, one might think the country’s health care system is sclerotic and near collapse. But international comparisons and health-care experts paint a different picture.

But ask Germans about their own system and they are usually quick to judge it wanting. One survey conducted by the Commonwealth Fund, an American health care foundation, found that 55 percent of Germans thought the system needed fundamental reform.

Americans on the other hand, rate the system better. More than 50 percent of Americans rate the US35 percent of Germans would give their own system health-care system as “excellent” only such high marks.

Health-care reforms enacted over the past several years, which introduced a nominal co-pay for doctor’s office visits and made some changes to drugs covered by public health plans, have unleashed widespread anger among the populace and only deepened public dissatisfaction

Right now, the system is supported for by contributions from workers, who generally pay around 14 percent of their wages for health care. But Germany’s stubbornly high unemployment rates have meant less money is going into the system.

Uninsured in Germany has risen above the 200,000 mark, with some suggesting that number could reach as high as 250,000.

Germany will be applying higher co-payments and more services will not be covered by insurance plans in the future.[1]

Most agree that Germany’s creaking health care system needs reform. Cries have gotten louder that the system of public and private insurance providers has created two classes of health care.

Privately Insured and preferential treatment

When Peter Stegman calls to set up a doctor’s appointment, he usually gets what he wants. The 37-year-old Berlin resident who works in the mobile phone industry is insured privately, and if he wants an appointment on the next day, he almost always gets it. “You just get treated better when you have private insurance than if you have the public kind,” he said. “The service is better and you have more choice.”

Before coming to Germany from Finland two years ago, he investigated the country’s insurance system and was told that if he could afford it, private insurance was the best option, since people on the public plans get lower priority with many doctors. “They have problems getting appointments quickly; it takes a lot more time,” he said.

Anecdotal evidence abounds about difference in service between those insured under private health care plans in Germany and those with the state system. The newspaper Bild conducted a test of 100 doctor’s offices around Germany, calling each to set up appointments.

In each case, one caller would claim to have private insurance, another to be insured under the public system. In the majority of cases, the privately insured individual got appointments much sooner than did publicly insured pretend patients, if they got appointments at all.

“Private patients are preferred, publicly insured patients are brazenly turned away, just gotten rid of,” Heinz Windisch, president of VKVD, an interest group for both privately and publicly insured individuals, told the newspaper.

People who earn less than 46,800 euros ($54,850) per year are obligated to enroll in one of Germany’s public health plans. Their contributions are determined by their income and range from 12.7 to 15.5 percent, half of which their employer pays.

In addition, patients must pay a 10 euro quarterly office fee, five to 10 euros for medicines, pay for shared rooms in hospitals and generally cover 50 percent of the cost of dental prostheses.

Private Patients on the other hand, generally have much more choice regarding doctors, have long lists of services covered, are not required to pay a quarterly office fee, and can receive medicines or eyeglasses without additional charges. “Those who pay more in Germany get better service,” said Kai A. Konrad, a professor specializing in health system economics at the Institute of Public Finance and Social Policy at Berlin’s Free University. “They are like two different products.”[2]

German hospitals are coming under increasing pressure to cut costs, and are seeking concessions from their medical staff. Doctors working in hospitals are paid roughly the same salary as an elementary school teacher, despite having to endure work weeks that often amount to more than 60 hours.[3]

Striking German Doctors Shed Light on System Ills

Some 20,000 doctors at German state-run hospitals lay down their stethoscopes this week demanding better pay and work conditions. Can the country afford to pay its doctors more—and can it afford not to?

Indeed, a 2004 study by UK economic research group NERA showed German hospital physicians at the rock bottom of a list of 11 western countries in terms of compensation, earning between 35,000 and 65,000 euros ($41,000 to $77,000) per year. A similar OECD study showed German physicians earning 15 percent less than their counterparts in the UK, and 40 percent less than US doctors. The problem with physicians’ pay is not recent. “It has been a political problem for the past 20 years, but it’s been ignored,” Henke said.[4]

You may opt for private health insurance

(Private Krankenversicherung or PKV) instead of joining the government health plan if you can show that your gross annual salary is presently more than 48,150 Euros and has been more than 47,700 Euros per year for each of the past three years. For those seeking to upgrade their medical coverage, for instance the right to consult a private doctor, to homeopathic remedies, a private room in hospital and higher dental reimbursements, supplemental insurance coverage is available which can top up the government system benefits.

Generally, private health plans cover a wide choice of medical and dental treatment and provide broad geographical coverage. Private patients generate higher earnings for medical professionals and will usually be treated by senior doctors. A private patient can also request and will often get, doctors who speak their native language. Germany has an extensive network of pharmacies.

· National health prescription plan: Reimbursement for generic drugs, with a copayment

Prescription drugs for children have no co-payments.

· Private health prescriptions: brand-name medication will be covered.[5]

Health Insurance Options in Germany – 2008

Germany has a reputation for having one of the best health care systems in the world, providing its residents with comprehensive health insurance coverage. Approximately 85% of the population are mandatory or voluntary members of the public health scheme while the others usually have private health insurance. The health insurance reform of 2007 now requires everyone living in Germany to be insured for at least hospital and out-patient medical treatment. The costs of the German health care system are immense and rising due to demographics as well as long-term unemployment rates.

Recent government reforms have attempted to make hospitals more competitive and thereby reduce costs for the state health insurance providers (Gesetzliche Krankenversicherung or GKV).

1. Reduced benefits for dental work.

2. Increased out-of-pocket payments.

3. Additional 0.9% insurance premium above and beyond regular income tax.

Efforts to cut the social security cost for employers and reduce the monthly cost for state health insurance members were controversial and after a very long and drawn out political battle, a further health reform compromise was reached which went into effect in 2007.

The cost of government health insurance is currently approx. 15 % (the rates depend on the provider “Krankenkasse” you choose) of your eligible gross salary to a maximum monthly income of 3,600 Euros. If you earn more than this you do not pay a higher insurance premium. Assuming you pay a monthly premium of 530 Euros as an employee earning at or above the threshold and are therefore a voluntary member, your contribution is approx. 280 Euros and your employer pays approx. 250 Euros.

The public plan benefits include

1. In-patient (hospital) care as a ward patient with doctor on duty at your nearest hospital,

2. Out-patient care with registered doctors (Kassenärzte) and basic dental care.

3. Generally no coverage for private doctors or surgeons, a private room in hospital, alternative/homeopathic medical care, dental implants, vision products for adults or benefits outside of Europe.

4. Your non-working dependents living at your address in Germany are presently insured at no additional cost and are simply to be registered with the “Krankenkasse“.[6]

France

“In the movie Sicko, Moore lumps France in with the socialized systems of Britain, Canada, and Cuba.

I have not seen the movie.  I wonder if Sicko showed:

1. The problems inherent in the French system
2. 85% buy supplementary private insurance
3. People pay first and are reimbursed
4. Considering HMO type cost containment’s are in the plan (some already exist)
5. France has run away health care inflation

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 (HMO) tactics to rein in costs. [1]

Subscription to the general French social security system (except in some specific cases) gives rights only to the basic health insurance coverage which reimburses usually only part of medical expenses. [2]

Regardless on whether you are insured in France or in your home country, you are generally required to pay medical expenses as they occur, e.g. when visiting a doctor, buying prescribed medicines and for medical tests. Then you can ask to be reimbursed by your health insurer.

A general doctor may charge from €20-25 for a consultation, a specialist €25-30. Fees will be higher at night or the weekend – a home visit will also cost more.

Types of payment vary: doctors usually prefer payment by check and some organisations might not accept cash. Only in some cases – such as some hospitalisations or if you are covered by specific heath coverage – you may be exempt from advance payment.

If you are subscribed to the French social security, you need to send a completed form (feuille de soins) to your CPAM (Caisse Primaire d’Assurance Maladie). Reimbursement takes usually 2-3 weeks and you can check on-line on www.ameli.fr (you should receive access information in the documentation provided by CPAM).

If you have a Carte Vital and the doctor (or a healthcare organization) is linked to the social security system, it is possible you may only pay the non-reimbursable part instead of having to claim it back afterwards.

For some medical costs (e.g. dental or orthopaedic prostheses), you must get prior approval from your CPAM to ensure subsequent reimbursement. This is why most people – nearly 85% of the population in France – choose to take a complementary private insurance (mutuelle, assurance complémentaire). This additional coverage covers partly or completely the percentage of medical costs not paid for by the general social security system. Some employers pay for some or all of an employee’s supplementary coverage. In our directory, you find a list of some mutual heath insurance organizations. [3]

France must make big changes to its health system in order to cut waste and increase efficiency, a government-commissioned report is warning

‘Badly regulated’

The report was written by the High Council for the Future of Health Insurance, an advisory body set up by the government.

1. Average French GP prescribes drugs worth 260,000 euros a year
2. The French use three times as many antibiotics as Germans
3. They use twice as many anti-cholestorol drugs as Britons
4. A fifth of health spending goes on pharmaceuticals

The council said even a structural shake-up of the system would not necessarily rule out the need to raise further revenues.

• Health spending nearing 9% of GDP
• Projected healthcare deficit this year – 10.9 billion euros
• Deficit in 2010 if nothing is done – 29 billion euros
• Healthcare deficit to account for 20% of total public deficit this year

The report says citizens must pay more and doctors must alter their behavior.

The council said even a structural shake-up of the system would not necessarily rule out the need to raise further revenues..[4]

The council also highlights the CSG welfare levy – a charge paid by workers, the unemployed and pensioners – as an area for possible reform. “The High Council is unanimous in its refusal to turn to massive indebtedness to cover the growth in health insurance expenditure,” the report said. Problems in the French health system were exposed last year, when a heat wave killed around 15,000 mostly elderly people. There was also a bed shortage in hospitals in December, when a nationwide flu and bronchitis epidemic broke out. [5]

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.

[ I always wonder about health cost statistics given from governments.  Because paying for medical school and paying two-thirds of the doctor's tax, make the system run, it should be included in the cost of health care.  Without such payment schemes the system would not work so therefore, it is part of the cost of health care. The USA Medicare administration hides costs, and I have the feeling France doesn't include the costs in their "cost of health care"]

Many French doctors, in fact, earn more by:

1. Increasing their patient load, or
2. Prescribing more diagnostic tests and procedures

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.

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.[6]

French doctors go on strike to demand reintroduction of compulsory out of hours work

Emergency services at public and university hospitals in France last week began a “general and unlimited” strike, organised by the French Association of Hospital Emergency Doctors. Joined by nurses, administrators, and ambulance drivers, the striking doctors are asking not only for more staff, better working conditions, more beds, and more money but a revamp of France’s entire emergency and out-of-hours care system.

They are also complaining that doctors with private practices do not carry out enough out-of-hours work during evenings, weekends, and holidays, forcing patients to use hospitals instead. They want to see a system introduced whereby most general practitioners with private practice are obliged to do out-of-hours work. Doctors complain that on-call work adds to an already burdensome 55 to 58 hours of work a week, according to the Private Doctors Union. [7]

The public health insurance system covers about 75% of total health expenditures

Half of the outstanding amount is covered by:

• Patients’ out-of-pocket payments
• Other half is paid by private health insurance companies

These supplementary health insurance policies can be taken out by individuals or groups.

For example, patients must pay 30% of Social security’s tariff for a physician’s visit and roughly 40% of specialists and 15% of GPs are allowed to charge more than the tariff. Copayments are also high for dental prostheses and eye-ware. This tended to deter the poorest citizens (few of whom had supplementary insurance) from seeking care.

Once varying depending on the fund, disparate reimbursement rates were replaced by uniform rates. The funds are financed by employer and employee contributions, as well as personal income taxes. The latter’s share of the financing has been ever-increasing in order to:

• compensate for the relative decrease of wage income,
• limit price distortions on the labor market,
• and more fairly distribute the system’s financing among citizens.

Most health insurance funds are private entities which are jointly managed by employers’ federations and union federations, under the State’s supervision. The joint labor/management handling has always sown discord within the funds’ boards, as well as between the boards and the State. [8]

Canada

Spending on health care to reach $5,170 per Canadian in 2008

November 13, 2008—Canada’s health care spending is expected to reach $171.9 billion in 2008, or $5,170 per person, according to new figures released today by the Canadian Institute for Health Information (CIHI). This represents an increase of $10.3 billion over estimated expenditures for 2007, or a growth of 6.4%. These figures are featured in National Health Expenditure Trends, 1975 to 2008, Canada’s most comprehensive source of information tracking how dollars are spent on health care in this country.

When looking at health care spending as a proportion of Canada’s overall economy, health expenditure is expected to reach 10.7% of the gross domestic product (GDP), the highest share ever recorded. This rate has climbed gradually, from 10.0% in 2002, to an estimated 10.6% last year.

Since 1997, the public and private sector shares of total health expenditure have remained relatively stable, with governments accounting for 70% of total spending and the private sector (including privately insured and out-of-pocket expenses) for 30%. In 2008, public-sector health care spending is expected to reach $120.3 billion (70.0% of total spending), compared to $51.6 billion spent by the private sector (30.0% of total spending).

Spending on health varies from province to province

Examples:

1. Alberta and Manitoba, at $5,730 and $5,555, respectively

2. Quebec ($4,653)

3. British Columbia ($5,093) [1]

Seismic shift in cancer drug funding to private payers

The Cancer Advocacy Coalition of Canada reveals steady shifting of cancer drug costs from public to private insurers, leaving employers and individuals to shoulder the increasing burden of cost.

“Expenditures for oral, take-at-home therapies now represent approximately half of the total for all cancer drugs,” says Dr. Kong Khoo, a B.C. medical oncologist and lead author of the study. “Employers and insurers should be made aware of the magnitude and pace of these shifts.”

Private insurance plays a critically important role in assuring access to medically necessary prescription drugs. The CAC says the bigger issue is that a reasonable 20% co-pay on a $60 average drug becomes unaffordable when the drug costs $25,000 or more and suggests that pooling high cost drug claims — often catastrophic to patients and their families — is an idea whose time is long overdue.[2]

Private Health Insurers’ Roles To Expand As National Healthcare Costs Soar, Projects PricewaterhouseCoopers

31 October 2006 – Governments around the world are looking to expand the role of private insurers as a source of funding the delivery of healthcare, according to a new report issued today by PricewaterhouseCoopers. The report entitled “Healthy Choices: The Changing Role of the Health Insurer,” forecasts that the threat to governments’ fiscal objectives from rising public sector health expenditures will drive the expansion of private sector contributions, and this trend will reshape the health insurance business model globally. Risk sharing will grow as consumers pay more of the cost of their care and efforts to control health costs focus on the reduction of frivolous healthcare claims and over-usage.[3]

Critical Illness Private Insurance in Canada

TORONTO, March 4 2009 – 61 per cent of Canadians admit they have no plan ready in the event they are diagnosed with a critical illness, reveals a recent survey of more than 1,600 Canadians by Ottawa-based polling firm, Redfern Research. Many are concerned about the time it takes to see a specialist, and then get the necessary tests done. And a growing number see the need for critical illness insurance to cover costs the healthcare system doesn’t cover. Bottom line, Canadians believe their healthcare system will be there for them if they do become critically ill – but many feel under protected. [4]

Private sector health care spending continues to increase while access to non-emergency surgery has improved in recent years, according to the Canadian Institute for Health Information’s Health Care in Canada 2008 report. Total private-sector health care spending – which includes payments by health insurance providers as well as individual Canadians’ out-of-pocket expenses – was an estimated $47 billion in 2007, up 5.7% from $45 billion in 2006. [5]

While health care spending is on the rise, it appears that wait times for elective surgery are down slightly. In 2007, 32% of Canadians reported waiting less than a month for elective surgery, compared with 15% in 2005, according to a Commonwealth Fund international survey cited in the CIHI report. [6]

Small drop in median wait times for surgery

The median wait time for Canadians seeking surgical or other therapeutic treatment dropped to 17.3 weeks in 2008 from 18.3 weeks in 2007, according to new research recently published by The Fraser Institute.

This year’s report shows the main decrease in wait times occurred in the time between a referral from a general practitioner and consultation with a specialist, which decreased to 8.5 weeks from 9.2 weeks. [7]

This nationwide improvement in access reflects waiting-time decreases in 7 provinces, while concealing increases in waiting times in Saskatchewan, Nova Scotia, and Newfoundland & Labrador.

Waiting for diagnostic and therapeutic technology

The waits to see a specialist and to receive treatment were not the only delays facing patients in 2008. Patients also experienced significant waiting times for various diagnostic technologies across Canada: computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound scans. The median wait for a CT scan across Canada rose slightly to 4.9 weeks from 4.8 weeks in 2007. Alberta and Ontario had the shortest wait for computed tomography (4.0 weeks), while the longest wait occurred in Prince Edward Island (19.0 weeks). The median wait for an MRI across Canada fell to 9.7 weeks from 10.1 weeks in 2007.

In 2000-01, Statistics Canada data showed that an estimated 4.3 million Canadians had difficulties obtaining routine care, health information or advice, immediate care for minor health issues, and other first contact services, and approximately 1.4 million Canadians had difficulties gaining access to specialist visits, non-emergency surgery, and selected diagnostic tests (Sanmartin et al., 2002).

Twenty percent of those who waited for the latter three specialized services indicated that the wait affected their lives; most of these people experienced “worry, stress, and anxiety, pain, or diminished health as a result of waiting” (Sanmartin et al., 2002).

Over 20 percent of the 1.4 million also indicated that their waiting time was unacceptable (Sanmartin et al., 2002). Polls regularly show that Canadians are concerned about wait times and the general state of the health care system.[8]

We’re finally getting an MRI scanner, but it’s only a base unit Upgrades are essential

It’s about time!” says Chief of Neurosurgery Dr. Brian Hunt. “Lions Gate Hospital has been performing neurosurgery since the 1960s, yet unbelievably we are one of the only neurosurgical units in North
America that doesn’t have an MRI scanner.” [9]

Interactive webpage map for health care costs of each Province:

http://www.cbc.ca/news/interactives/map-healthspending/

The provinces and territories also provide some groups with supplementary health benefits not covered by the Act, such as prescription drug coverage. The level and scope of coverage for supplementary benefits varies between jurisdictions.[10]

Access to Insurance Coverage for Prescription Medicines

Under the Canada Health Act, all necessary drug therapy administered within a Canadian hospital setting is insured and publicly funded. Outside of the hospital setting, provincial and territorial governments are responsible for the administration of their own publicly-funded prescription drug benefit programs.

Most Canadians have access to insurance coverage for prescription medicines through public and/or private insurance plans. The federal, provincial and territorial governments offer varying levels of coverage, with different eligibility requirements, premiums and deductibles.

The publicly-funded drug programs generally provide insurance coverage for those most in need, based on age, income, and medical condition.[11]