How is the system funded: The Netherlands' all-private market requires everyone to purchase private health insurance.
The government also collects contributions from employers to fund the cost of care for children and the country's private insurance system. Revenue generated from the health care system is spread among insurers based on the health status of their patients. Under the health system, most insurers and hospitals operate as nonprofits, Scott reports.
The system uses a global budget, under which insurers establish caps on payments for medical services, to keep costs down. The government also can implement cuts if spending exceeds the predetermined limit.
Coverage costs: Patients in the Netherlands shoulder higher costs than in other health care systems with universal coverage—and doctors note their patients cannot always the cover their out-of-pocket costs.
The system is designed to encourage patients to use health care services appropriately, Vox reports. Patients do not have to pay out of pocket for primary care visits, but they do pay a fee, which goes toward their deductible, for a hospital visit. The government provides financial assistance to individuals with lower incomes. Quality of care: To keep non-emergent patients out of the ED, the Netherlands relies on general practitioner co-ops, in which doctors share the duty of providing round-the-clock care, seven days a week.
The concept was devised by general practitioners themselves. As co-op members, providers could be tasked with conducting home visits, staffing in-person clinics, or taking queries from patients on a hotline number.
According to Scott, Dutch patients were wary of the system at first because it meant receiving care from someone who may be less familiar with their medical history.
The country's health system has its challenges, Vox reports. Doctors, particularly primary care doctors who serve as the backbone of the system, have said they feel strained. In , nearly every physician in the Netherlands went on strike because they felt they did not have enough support to provide after-hour care.
Some physicians complain about being underpaid, too. In the s, Taiwan transitioned to a government-run, single-payer health care system. Under the Taiwanese health care system, Taiwanese residents carry a national health insurance card, which allows providers to access a patient's medical records on a computer using a chip reader.
How is the system funded: The Taiwanese health care system is funded through income taxes; payroll-based premiums, which include contributions from employers and employees; and tobacco and lottery levies. Experts have credited Taiwan's advanced IT infrastructure for keeping administrative costs low.
To control costs, Taiwan in the early s adopted a global budget to pay for the country's health care. The global budget requires government officials and private providers to negotiate payment rates for services and establish annual caps on total payments to hospitals and physicians. Nobody wants to pay more for health care next year than they did the year before. Australia has layered a private health care system on top of its universal public insurance program, and that gives both doctors and patients more choice about medical care.
But once you have different tiers in your health care system, disparities are going to emerge. And because the Australian government is spending billions of dollars supporting a struggling private insurance industry for middle-class and wealthier patients, it has fewer resources to devote to disadvantaged populations, like indigenous Australians or patients living in rural areas who have less access to medical care.
Public patients in public facilities face longer wait times. The Netherlands, meanwhile, has handed over the responsibility for providing coverage to private health insurers, and that has come with costs too. The Dutch have had to impose strict regulations on health insurance, including harsh penalties for people who fail to sign up for insurance on their own. Doctors in the Netherlands are more likely than those in more socialized systems to say their patients struggle to afford medical care.
They are also more likely to say the administrative work they have to do is a drain on their time. Health care spending in the Netherlands has also been rising at a faster clip since the move to the mandatory private insurance system. So the question becomes what kind of trade-off is more palatable. There is no way to avoid it: If you want universal coverage, the government is going to play a huge role. In Taiwan and Australia, that means the government runs a universal insurance program that covers everybody for most medical services.
But even in the Netherlands, which relies on private health insurers, the government oversees everything. It sets rules about what benefits have to be covered, what prices can be charged, and what cost sharing is required. It collects contributions from employers to pay the cost of covering everybody and spreads it among the insurers based on the health status of their customers.
All told, about 75 percent of the funding for health insurance in the Netherlands is still running through the national government, even if the actual insurance benefits are being administered by private companies. Under all of these insurance schemes, the governments use much more force to keep health care prices down compared to the US.
In Taiwan, that means global budgets — an annual amount set aside every year for various sectors of the health industry hospitals, drugs, traditional Chinese medicine, etc. In the Netherlands, even with private insurers, the government sets limits on how much health spending can accrue in a given year and has the authority to impose budget cuts if spending exceeds that limit. Prices are also set for particular services, like after-hours primary care. Insurers do have some limited flexibility in which providers they contract with, but the government sets their health care budget for them.
We have experimented with that kind of system in the US, as Tara Golshan covered in this series in her story on Maryland. She documented how the state has tried to use a model like this, global budgets, to improve care for patients by encouraging hospitals to focus on the health of their patients instead of whether they have enough people in their beds. But Maryland remains an exception. And as the research shows, the US spends dramatically more for many common medical services compared to other developed countries:.
For most developed economies, their aging populations will present a serious challenge of both cost and care delivery. The chart below shows what countries were already paying notice the US lags significantly both overall and in public investment and then projects what they will be paying in Yi Li Jie, a spinal atrophy patient I met, has to pay out of pocket for her caregivers; she also has to pay a substantial share of her transportation costs to get to medical appointments.
On the other end of the spectrum, the Netherlands has a universal public program to cover long-term care, even though it has private medical insurance. Of course, the needs for these populations extend beyond the basic provision of medical care. A universal health insurance proposal trains the spotlight also on how care is delivered economically. One potential downside of the Sanders program is that it would remove the need for experimentation with different health care models, said Field.
He pointed to experiments underway with bundled payments, accountable care organizations and others at the Center for Medicare Innovation. A single-payer system would doubtless be disruptive to the private health insurance industry, but opinions were mixed on how serious that could be.
Pauly noted that private companies would continue to play a significant role in claims processing, administrative services, adjudicating disputes and other such functions. The U. Investors who espouse environmental, social and governance ESG principles will achieve little by selling their shares in so-called "dirty" companies, according to new research co-authored by Wharton's Jules H.
Another All health care service providers, except for the VA, are private. Many democratic candidates promote universal health care under the title "Medicare for All. Despite this cost, the quality of care in other areas is worse than in comparable developed countries. The infant mortality rate was 5.
The third leading cause of death in the U. Sources for table. World Health Organization. New York State. Annals of Internal Medicine. Princeton University. Physicians for a National Health Program. See if You'll Owe a Fee. Physician Practices vs. Population Health Management. Centers for Disease Control and Prevention.
Academic Medicine. Medical Expenditure Panel Survey. Accessed June 27, Partnership for America's Health Care Future. American Medical Association. The University of British Columbia. American Journal of Hospice and Palliative Care.
Australian Government Department of Health. OECD Stat. Government of Canada. New York University. National Center for Biotechnology Information. The Commonwealth Fund.
The BMJ. Actively scan device characteristics for identification. Use precise geolocation data. Select personalised content. Create a personalised content profile. Measure ad performance. Select basic ads. Create a personalised ads profile. Select personalised ads.
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