Canadian Doctors for MedicareProponents of private pay health care often claim that countries with multi-payer health care systems (aka private pay + public pay) out-perform Canada 🇨🇦, but keep costs low and still cover everybody equitably. Sounds amazing. Is it true? Not quite. A #BetterMedicare 🧵/1
Like health care systems everywhere right now, Canada’s is struggling. No country is emerging from the pandemic unscathed - whether they have single- or multi- payer health care systems. /2
But we need to be cautious about drawing conclusions from health care systems in other countries. Each country must take into account the legacy of its history, its culture, its politics, and the values of its people. What works in one country may not work in another. /3
This video from @[email protected] talks specifically about three countries: the Netherlands 🇳🇱, Japan 🇯🇵, and the UK 🇬🇧, so let’s look at each. https://www.youtube.com/watch?time_continue=215&v=lYb2ws4FC4E&feature=emb_title /4
Canada's health-care system is a laggard. Here's how the top-ranked countries do it
In 🇳🇱, everyone must buy insurance from private insurers, with only 45% of funding coming from taxes. Another 45% comes from mandatory individual insurance premiums. A mandatory deductible further increases costs and financial risk to patients. https://www.commonwealthfund.org/international-health-policy-center/countries/netherlands /5
Netherlands
By Joost Wammes, Niek Stadhouders, and Gert Westert, Radboud University Medical Center The Netherlands’ universal social health insurance approach merges public and private insurance. All residents are required to purchase statutory health insurance from private insurers, which are required to accept all applicants. Financing is primarily public, through premiums, tax revenues, and government grants. The national government is responsible for setting health care priorities and monitoring access, quality, and costs. Standard benefits include hospital, physician, home nursing, and mental health care, as well as prescription drugs. Adults pay premiums, annual deductibles, and coinsurance or copayments on select services and drugs. The government pays for children’s coverage up to age 18.
Even with private insurance competing to drive down costs, 🇳🇱still spends ~10.5% of its GDP on health care, only 1% less than 🇨🇦 (~11.5%). Competing private insurers in the 🇳🇱 pushed up administrative costs. /6
In Japan 🇯🇵, total spending on health care consumes 11% of GDP, only slightly lower than 🇨🇦 (~11.5%) yet 84% of 🇯🇵’s health care is publicly-funded compared to just ~70% in 🇨🇦. /7
Extra public spending in 🇯🇵means that mental health, #pharmacare, #dentalcare, physical therapy, and certain home care services are also covered by the public purse. https://www.commonwealthfund.org/international-health-policy-center/countries/japan /8
Japan
By Ryozo Matsuda, College of Social Sciences, Ritsumeikan University Japan’s statutory health insurance system provides universal coverage. It is funded primarily by taxes and individual contributions. Enrollment in either an employment-based or a residence-based health insurance plan is required. Benefits include hospital, primary, specialty, and mental health care, as well as prescription drugs. In addition to premiums, citizens pay 30 percent coinsurance for most services, and some copayments. Young children and low-income older adults have lower coinsurance rates, and there is an annual household out-of-pocket maximum for health care and long-term services based on age and income. There are also monthly out-of-pocket maximums. The national government sets the fee schedule. Japan’s prefectures develop regional delivery systems. Most residents have private health insurance, but it is used primarily as a supplement to life insurance, providing additional income in case of illness.
Private insurance in Japan plays only a supplementary role to pay for limited services, like orthodontics. /9
The UK 🇬🇧spends only ~ 9.8% of its GDP on health care, considerably less than 🇨🇦 (~11.5%). This relatively low public spending means costs have been shifted to individuals and private insurers. https://www.commonwealthfund.org/international-health-policy-center/countries/england /10
England
By Ruth Thorlby, Assistant Director, Policy, The Health Foundation All English residents are automatically entitled to free public health care through the National Health Service, including hospital, physician, and mental health care. The National Health Service budget is funded primarily through general taxation. A government agency, NHS England, oversees and allocates funds to 191 Clinical Commissioning Groups, which govern and pay for care delivery at the local level. Approximately 10.5 percent of the United Kingdom’s population carries voluntary supplemental insurance to gain more rapid access to elective care.1
In the 🇬🇧, those who can afford to pay get rapid access to care & choice of specialists, which has increased inequity in access to care. The mismatch between funding, demand & the cost of providing services has also led to an underlying deficit of ~4.3 bn GBP (7.2bn CDN). /11
In the English NHS, outsourcing care to for-profit providers significantly increased rates of treatable mortality. It harmed patients.
https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(22)00133-5/fulltext
https://pubmed.ncbi.nlm.nih.gov/12054406/ /12
https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(22)00133-5/fulltext
https://pubmed.ncbi.nlm.nih.gov/12054406/ /12
What can we learn from other countries? 1) Multi-payer systems waste money paying private insurance administrators; single-payer plans like Canada’s are more efficient. 2) Countries that spend more money on health care can cover more services, so Canada should do the same. /13
Bottom line: Canada’s single-payer system keeps costs low and ensures equitable access to care. We need to strengthen our health care system & urgently improve access to care, but we can do that through better coordination in how we deliver care & increased public funding. /14
The solution is not to waste money on private insurance that duplicates what’s already covered in our public plans, nor is it forcing patients to pay out-of-pocket. #BetterMedicare /end