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Comparative Health Systems
What Metrics are important?
• When comparing health systems, what metrics would you use?– Be specific.
Gruber: ACA
• http://www.youtube.com/watch?v=qEAyoxhj7O0
• Or cspan link• http://www.c-spanvideo.org/program/303580
-1
• At minute 38 discussion of US v other systems
Categories of Health Systems
1. National Health Insurance (Canada)government is third party payer
2. National Health Care system (UK)government provides health care
3. Community sickness funds w/subsidy (FR & GE)
4. Mixed public and private (US, Japan, Australia)
United StatesFrance
SwitzerlandGermanyBelgiumAustriaCanada
DenmarkNetherlands
GreeceIceland
New ZealandSwedenNorway
ItalySpainUnited
KingdomFinlandSlovak RepublicIrelandHungaryCzech RepublicKorea
PolandMexico
0 2 4 6 8 10 12 14 16 18
2007 Total Health Expenditure as a % of GDP
$10,000 $20,000 $30,000 $40,000 $50,000$0
$2,000
$4,000
$6,000
$8,000
GDP Per Capita $PPP
To
tal
exp
en
dit
. o
n h
ea
lth
/ca
pit
a,
$
PPP France
US
Korea
$10,000 $20,000 $30,000 $40,000 $50,000$0
$2,000
$4,000
$6,000
$8,000
GDP Per Capita $PPP
To
tal
exp
en
dit
. o
n h
ea
lth
/ca
pit
a,
$
PPP France
US
Korea
KoreaIrelandPoland
NorwayGreece
United KingdomSpain
Czech RepublicAustriaMexico
NetherlandsBelgium
United StatesNew Zealand
FranceJapan
DenmarkCanada
SwitzerlandSwedenFinland
GermanyItaly
Iceland
0 1 2 3 4 5 6 7 8 9 10
1990-2007 Average annual % change in total health expenditure per capita, $PPP (OECD)
MexicoKorea
PolandSlovak Republic
HungaryGreece
Czech RepublicAustralia
SpainFinlandIreland
SwitzerlandItaly
United KingdomCanada
New ZealandUnited States
SwedenNorwayIcelandAustria
GermanyDenmark
France
- 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0
2007 Public and Private Health Expenditures as percent of GDP
Public Private
MexicoKorea
PolandSlovak Republic
HungaryGreece
Czech RepublicAustralia
SpainFinlandIreland
SwitzerlandItaly
United KingdomCanada
New ZealandUnited States
SwedenNorwayIcelandAustria
GermanyDenmark
France
- 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 10.0
2007 Public Health Expenditures as Percent of GDP
Canadian Health System
• Single Payer• Financed out of income tax revenue• No “official” gate keepers• No parallel private insurance allowed• Supplementary insurance subsidized as
employer based in US
Canadian Health System
• Physicians and Hospitals• Diffusion and Use of technology• Role of Insurance• Divergence between US and Canada
German
• Sickness Funds• Private Insurance • Reforms of the 1990s• Hospitals Mixed public/private
German
• Physicians and Hospitals• Technology• Effects of Financing through Payroll Tax– With elastic labor supply the decrease in demand
results in lower employment rather than lower wages
UK
• Structure of NHS– Rationing by queuing – Private parallel insurance
• Physicians compensation– Hospitals (Salary)– Non-Hospital (Capitation)
Summary
• Canada has best health outcomes• UK spends the least.• Germany has the greatest Hospital/Physician
capacity• US Spends the most, and has the worst
outcomes as measured by life expectancy
