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