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LIR 55409/16/08
HealthcareUSA/UK
Dawn Roberts, Jamie Miller, Rebecca Seymour, Cory Anderson
Presentation Overview
• Models of healthcare • Description of US & UK systems• Mechanics of US & UK systems• Strengths and Weaknesses
Models of
Healthcare
Dawn Roberts
Models of Healthcare
1. Beveridge Model• Provided by: Medical providers whose salaries
are paid by Government• Financed by: Federal Government, from income
taxes• Admin. by: Federal Government• Examples: England, Spain, Scandinavia,
Cuba, New Zealand, Hong Kong
Models of Healthcare
2. Bismarck Model• Provided by: Private medical providers• Financed by: Nonprofit insurance companies,
Premiums paid by employees, employers, government
• Admin. by: Government (closely regulated)• Examples: Germany, France, Switzerland,
Belgium, Japan, Latin America
Models of Healthcare
3. National Health Insurance• Provided by: Private medical providers• Financed by: Federal Government-run insurance
program, from taxes of all citizens• Admin. by: Federal Government• Examples: Canada, Taiwan, South Korea
Models of Healthcare
4. Out-of-Pocket Model• Provided by: Private medical providers• Financed by: Patients, directly• Admin. by: No one; Each provider collects• Examples: Rural parts of Africa, India, China,
South America
Models of Healthcare
US uses all of these:1. Beveridge (VA, Military)2. Bismarck (Employer-supported
insurance)3. National Health Insurance (Medicare,
Medicaid)4. Out-of-Pocket (Everyone else)
Description of Systems
Jamie Miller
Description of Systems
US System is notable because:1. Numerous plans; Not universal2. Costly3. For-profit providers, financiers,
and administrators
Description of Systems
Costs covered by many separate legal entities:Private Insurance Private out-of-pocket Federal government State/local governments Other private funds
Description of Systems
• More dollars spent per capita than any nation
• 15.2% of GDP, with projection of 19.5% by 2017
• $2.26 trillion → $7,439 per person, in 2007
Description of Systems
Description of Systems
UK
National Health Service (NHS)
Description of Systems
UK System is notable because:1. Universal 2. Providers receive salary from
Federal Government3. Government decides on care
Description of Systems
Dramatic differences in health care provision
Are these reflected in actual health differences?
Description of Systems
Life Expectancy
United States: 78
United Kingdom: 78.7
Mortality Rate
United States: 6.4United Kingdom: 5
Mechanics of Systems
Rebecca Seymour
Mechanics of Systems
US: Multiple Ways to Finance Care• Employer-Supported Insurance• Privately-Purchased Insurance• Government-Sponsored Insurance• The Uninsured
Private9%
Govt28%
0
Employer59%
Uninsured 15%
Mechanics of Systems
Mechanics of Systems–
Employer Supported Healthcare • Health Maintenance Organization (HMO) • Preferred Provider Organization (PPO)• Point of Service (POS)• Health Savings Account (HSA)
Mechanics of Systems–
Employer-Supported Healthcare = 59%
0%
20%
40%
60%
80%
100%
HMO PPO POS H SA
Employment Supported Healthcare 2007
Mechanics of Systems–
Privately Purchased Insurance = 9%• Self-employed or Work for companies not
offering health benefits • Premiums based on individual health
history, age, weight, smoking status and deductible chosen
Mechanics of Systems–
Government Sponsored = 28%• Medicaid • Medicare• VA Health Insurance
Mechanics of Systems
UK: One Way to Finance Care• National Health Service• World’s largest health service and fourth
largest employer• Publicly funded by the taxation of the
general public• Separate administration in UK colonies, but
reciprocity
Mechanics of Systems
UK: One Way?• All citizens, Expats with work permits, Students
there > 6 months• Most services free• How does it work?
• GPs inform hospital of a patient's condition. • Hospital judges urgency, against other patients’ conditions. • Urgent need is met almost immediately.• Others receive appointments. (Median wait time ~ 3 weeks)
Mechanics of Systems
UK: Private Insurance• Currently, 12% of persons• 2/3 employer-provided; 1/3 individually-
purchased• Privately insured go to NHS hospital or one
of five private hospital groups. • Average individual premium = $260/month
Strengths and Weaknesses
Cory Anderson
Strengths and Weaknesses
US Strengths• World-Class facilities and physicians• Relatively short wait-time for treatment • Government directly covers 27.8% of the population
through health care programs for the elderly, disabled, military service families and veterans, children, and some of the poor
*Information obtained from the National Institute of Health www.nih.gov/
Strengths and Weaknesses
US Weaknesses• ~47 million people without health insurance• High administrative cost• Financial problems for the under- or un-insured• Private plans have exclusions or “carve outs”• Disparities in access to health treatments
*Information obtained from the National Institute of Health www.nih.gov/
Strengths and Weaknesses
UK Strengths• Universal coverage • Guaranteed treatment regardless of income level• Health care paid through taxes• Little paper work or bureaucracy
*National Health Service http://www.nhs.uk/Pages/homepage.aspx
Strengths and Weaknesses
UK Weaknesses• Higher tax rate • Underfunding • Long waits for specialists and elective procedures • Lower quality facilities• Exclusions for new or experimental treatment
*National Health Service http://www.nhs.uk/Pages/homepage.aspx
Companies with Best Healthcare Coverage
*Forbes 100 Best Companies to Work For 100% Healthcare Coverage for employees
FOR MORE INFORMATION:
Descriptions of 5 capitalist countries’ systems:
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/
With links to more resources:
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/etc/links.html
Very cool interactive comparison by country
http://www.npr.org/news/specials/healthcare/healthcare_profiles.html
World Health Organization—International health
www.who.int/en/
UK System
www.nhs.uk
US System—Resources & Links
http://www.pbs.org/pov/pov2008/criticalcondition/resources.html
