November-December 1992 Home   Newsletters

January 1993

February 1993

President's Message (Arlene Ellis)
Certificate Honoring and Commending the LWV-Hawaii
Viewpoint
Health Care Consensus
Health Care - Position Statement of the LWVUS
Health Care: Phase 2 Consensus Questions
People's Water Conference Focus
Vote Counts
Year in Planning, Zoning and Transit (Astrid Monson)
Membership
Health Care - Summary of Proposed Reforms
Comparison of International Health Care Systems

Comparison of International Health Care Systems

United States     Canada     United Kingdom     Germany     Japan    

United States

Health Expenditures as % of GNP (1989): 11.8%

Annual Per Capita Expenditure: $2,354

What Is It?

Multiple-payer. Coverage for services is based on ability to pay or eligibility for public programs for the poor, elderly and the disabled. Covered services vary depending on the specific health insurance. Covered individuals seek care from the provider of their choice.

How is it financed?

Public and private sector financing of health care. The public sector, at both the federal and state level, finances programs to care for the poor, the elderly and the disabled. Private insurance and individual out-of-pocket payments finance care for people not eligible for public programs.

How is it administered?

The various public and private payers generally reimburse providers on a fee-for-service basis, i.e., the payer reimburses the provider for his/her charges. Other methods of administration include managed care arrangements wherein a flat rate is paid in advance for all services rendered by the provider. There is no coordination of activities between the different payers.

Mechanisms for cost control?

'there are no comprehensive cost control mechanisms. Payers attempt to control their individual costs with a variety of mechanisms, including prospective and retrospective review of services.

Universal? No.

Supplemental insurance available? Not applicable.

Canada

Health Expenditures as % of GNP (1989): 8.7%

Annual Per Capita Expenditure: $1,683

What Is It?

National Health Insurance. Each of Canada's 10 provinces offers its citizens portable (i.e., recognizable in all other provinces) coverage for a mandated range of comprehensive health care services including hospital care, long-term care, physician services, X-rays and lab tests. In addition, other services are mandated for specific populations, e.g., prescription drugs for the elderly and welfare recipients, and dental care for children and welfare recipients. Citizens seek care from a public or private provider of their choice who is reimbursed on a fee-for-service basis from the provincial health agency.

How is it financed?

The federal government guarantees to cover approximately 40 percent of the costs of providing care in each province. The provinces finance the remaining amount. At both the federal and provincial level, funding comes from general revenues - taxes.

How is it administered?

Each province has a public agency responsible for providing coverage and reimbursing providers. This agency is accountable to the provincial legislature. The provincial governments negotiate annually with providers to determine physician fees and total operating budgets for hospitals.

Mechanisms for cost control?

"Global budgets" for health care expenditures; fixed hospital budgets; low administrative costs; and negotiated fees for providers.

Universal? Yes.

Supplemental insurance available?

Yes. Private insurance is available for things not covered by the national health insurance, such as a private room.

United Kingdom

Health Expenditures as % of GNP (1989): 5.8%

Annual Per Capita Expenditure: $836

What is it?

National Health Service. The government finances and delivers a comprehensive set of health care benefits to its citizens, including: prescription drugs, hospital care, long-term care, preventive care and some dental care. Every citizen is registered with a general practitioner (GI') in her/his community who acts as a "gatekeeper" for the health services the patient receives. The government operates and owns most of the hospitals and has put most of the country's doctors on salary. Roughly 9.3 percent of the population has private insurance (to cover elective surgery and avoid long waiting periods for such services) and there is a small system of private practitioners.

How is it financed?

General revenues - taxes. A small amount of health care is financed by the private sector in the form of private insurance.

How is it administered?

The national government allocates the health care budget among the regional health authorities which, in turn, plan the health services for the districts within their region and set hospital operating budgets. GPs are paid on a capitated basis - one fee for all services - that, is negotiated with the government, with additional allowances for special preventive services. Doctors working within hospitals are salaried.

Mechanisms for cost. control.?

National budget for health care expenditures; government ownership and control of the delivery system; regulated provider fees; fixed hospital budgets; and low administrative costs.

Universal? Yes.

Supplemental insurance available?

Yes. A private insurance system is in place to permit people to avoid the long waits for elective surgery.

Germany (pre-unification)

Health Expenditures as % of GNP (1989): 8.29%

Annual Per Capita Expenditure: $1,232

What Is It?

Compulsory Social Insurance. All workers earning less than $33,000 are required to enroll in a "sickness fund" for themselves and their dependents that finances a comprehensive set of medical benefits, including: hospital care, preventive care, long-term care and dental care. People earning more than $33,000 have the option of enrolling in a sickness fund or purchasing private insurance with similar benefits. The unemployed receive federal and state subsidized coverage for membership in sickness funds. Retired persons also receive coverage from sickness funds. Citizens seek care from the provider of their choice.

How is it financed?

Workers and their employers are both legally required to contribute amounts set by the sickness funds. Workers earning more than $33,000 finance their care either by purchasing private insurance or enrolling in a sickness fund. The state and federal governments finance their obligations through general revenues.

How is it administered?

The bulk of sickness fund premiums is given over to regional associations of physicians. The sickness funds negotiate a fee schedule with regional associations for doctors operating outside of the hospital setting. Providers receive reimbursement from their regional association on a quarterly basis. Hospitals negotiate per diem rates with the sickness funds and pay their doctors on a salaried basis.

Mechanisms for cost containment?

Negotiated fee schedules for providers; fixed budgets for hospitals; state limits on hospital investments; and national caps on health expenditures.

Universal? Yes.

Supplemental insurance available?

Yes. Even those who are mandated to be covered by sickness funds can purchase private insurance for supplemental benefits. Japan

Health Expenditures as % of GNP (1989): 6.7%

Annual Per Capita Expenditure: $1,035

What Is It?

Multiple-Payer Social Insurance. Citizens are required to belong to one of three types of social insurance plans providing a comprehensive set of medical benefits, including: prescription drugs, long term care, dental care and some preventive care. Consumers choose their provider, and the provider seeks reimbursement from the insurance plans. The three types of plans are: employer-based plans that cover 63 percent of the population; insurance plans for the self-employed and their dependents that include a national insurance plan for the poor with the government acting as the insurer; and a separate system that is a pool of funds to pay for the health care costs of the elderly.

How is it financed?

Employer-based plans are financed by premiums divided equally between the employer and the employee. Plans for the self-employed and their dependents are financed by premiums based on income, the number of people in the household and assets. The national health insurance plan is financed by the central government. The pool for elderly health care costs is financed by equal contributions from all of the plans.

How is it administered?

Each plan is responsible for the administration of health care services and reimbursement of providers. Reimbursement rates are based on a nationally set fee schedule negotiated by the government. The government also sets the scope of services that can be provided by the plans.

Mechanisms for cost control?

Government control of services and fees; retrospective review of claims submitted by providers for payment; low administrative costs.

Universal? Yes.

Supplemental insurance available?

Yes. Citizens may purchase insurance for supplemental benefits, such as a private room during a hospital stay and other incidental expenses.

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