Transcript Health Economics & Policy 3rd Edition James W. Henderson Chapter 16 Medical Care Systems Worldwide.

Health Economics & Policy
3rd Edition
James W. Henderson
Chapter 16
Medical Care Systems Worldwide
International Comparisons
Who’s got the best system
 Key statistics
 Health care spending
 Medical outcomes

WHO Health Care System
Performance, 1997
Health
Canada
France
Germany
Japan
United
Kingdom
United States
Responsiveness
Level
12
3
22
1
14
Distribution
18
12
20
3
2
Level
T7
T16
5
6
T26
Distribution
T3
T3
T3
T3
T3
Financial
Fairness
T17
T26
T6
T8
T8
24
32
1
T3
T54
Goal
Attainment
7
6
14
1
9
Overall
Performance
30
1
25
10
18
15
37
Key Statistics
United
United
2001
Canada
France
Germany
Japan
Kingdom
States
Population (millions)
31.1
59.2
82.4
127.1
58.8
284.8
GDP per capita1
28,811
26,879
26,199
26,652
26,315
35,182
Health Expenditures
Health care spending
2,792
2,561
2,808
1,9843
1,992
4,887
per capita
Health care spending
9.7
9.5
10.7
7.63
7.6
13.9
(percent of GDP)
Medical Services
Number of physicians
2.1
3.3
3.3
1.93
2.03
2.74
(per 1,000)
Number of hospital
3.23
6.73
6.3
16.55
3.9
2.9
beds (per 1,000)
Average length of
7.23
8.53
9.3
40.85
7.0
5.8
stay (days)
Medical Technology2
CT Scanners
9.5
9.63
17.16
84.44
6.24
13.13
MRI Units
3.5
2.63
6.26
23.24
4.64
8.13
3
6
7
Lithotripters
0.4
1.0
1.7
4.0
2.93
4
3
3
4
Patients undergoing
45.7
64.0
162.4
27.0
86.54
dialysis
Source: OECD Health Data 2003, OECD, Paris, 2003.
1. In U.S. purchasing power parity (PPP) dollars—the exchange rate where different currencies buy the
same bundle of goods.
2. Per 1 million population.
3. 2000
4. 1999
5. 1998
6. 1997
7. 1993
Health Care Spending
Annual Compound Growth Rates
Component
Canada
1980s
1990s
9.64
3.89
8.47
2.89
France
1980s
1990s
9.64
3.82
9.06
3.48
Nominal health care spending
Nominal per capita health care
spending
Real health care spending1
3.76
2.23
4.61
2.38
Real per capita health care
2.65
1.25
4.08
2.04
spending1
Real health care spending2
4.68
2.55
3.59
2.31
Real per capita health care
3.57
1.57
2.72
1.97
spending2
Note: Measurements based on changes denominated in national currencies.
Source: OECD Health Data 2003, OECD, Paris, 2003.
1. Spending adjusted by the 1995 medical expenditures deflator.
2. Spending adjusted by the 1995 GDP price deflator.
3. 1990-1996.
Germany
1980s
1990s
4.19
6.87
4.11
4.12
Japan
1980s
1990s
4.73
3.83
4.19
3.57
United Kingdom
1980s
1990s
8.91
6.80
8.78
6.58
United States
1980s
1990s
9.78
5.76
8.90
4.59
1.24
1.16
6.213
2.103
2.53
2.01
3.203
2.943
2.04
1.89
2.613
2.423
2.82
2.00
2.38
1.24
1.63
1.54
4.95
2.24
2.94
2.42
3.52
3.26
3.13
2.97
3.82
3.61
5.69
4.84
3.76
2.61
Health Outcomes, 2000
Life Expectancy at Birth1
Life Expectancy at Age 801
Infant
Mortality
Rate2
5.3
4.6
4.4
3.2
5.6
Country
Males
Females
Males
Females
Canada
76.7
82.0
7.8
9.7
France
75.2
83.0
7.4
9.3
3
3
3
Germany
74.7
80.7
6.8
8.33
Japan
77.7
84.6
8.0
10.6
United
75.4
80.2
6.9
8.6
Kingdom
United States
74.1
79.5
7.6
9.1
6.9
Source: OECD Health Data 2003, Paris: Organization for Economic Cooperation and Development, 2003.
1. In years.
2. Perinatal deaths per 1,000 live births.
3. 1999.
Total HCE/GDP, 1970 - 2000
Australia
Austria
Belgium
Canada
Czech
Republic
Denmark
Finland
France
Germany
Greece
Hungary
Iceland
Ireland
Italy
Japan
Korea
Luxembourg
Mexico
Netherlands
New
Zealand
Norway
Poland
Portugal
Slovak
Republic
Spain
Sweden
Switzerland
Turkey
United
Kingdom
United
States
Total
OECDe
OECD 19
Country
Averagef
1970a)
5.6
5.3
4.0
7.0
..
1980
7.0
7.6
6.4
7.1
..
1990b)
7.8
7.1
7.4
9.0
5.0
2000c)
8.3
8.0
8.7
9.1
7.2
1970-80
1.4
2.3
2.4
0.1
..
1980-90
0.8
-0.5
1.0
1.9
..
1990-00
0.5
0.9
1.3
0.1
2.2
8.0
5.6
..
6.3
6.1
..
4.9
5.1
..
4.5
..
3.6
..
6.9
5.1
9.1
6.4
..
8.8
6.6
..
6.1
8.4
..
6.4
..
5.9
..
7.5
5.9
8.5
7.9
8.6
8.7
7.5
7.1
7.9
6.6
8.0
5.9
4.8
6.1
4.4
8.0
6.9
8.3
6.6
9.5
10.6
8.3
6.8
8.9
6.7
8.1
7.8
5.9
6.0
5.4
8.1
8.0
1.1
0.8
..
2.5
0.5
..
1.2
3.3
..
1.9
..
2.3
..
0.6
0.8
-0.6
1.5
..
-0.1
0.9
..
1.8
-1.8
..
-0.5
..
0.2
..
0.5
1.0
-0.2
-1.3
0.9
0.7
0.8
-0.3
1.0
0.1
0.1
1.9
1.1
-0.1
1.0
0.1
1.1
4.4
..
2.6
..
7.0
..
5.6
..
7.8
5.3
6.2
..
7.8
6.2
8.2
5.9
2.6
..
3.0
..
0.8
..
0.6
..
0.0
0.9
2.0
3.6
6.9
5.6
2.4
4.5
5.4
9.1
7.6
3.3
5.6
6.6
8.5
8.6
3.6
6.0
7.7
7.9
10.7
4.8
7.3
1.8
2.2
2.0
0.9
1.1
1.2
-0.6
1.0
0.3
0.4
1.1
-0.6
2.1
1.2
1.3
6.9
8.7
11.9
13.0
1.8
3.2
1.1
7.2
7.9
7.7
8.4
1.7
0.6
0.6
5.4
7.1.
Mortality Ratios - Cancer
Type of Cancer
Country
Canada
France
Germany
Japan
United Kingdom
United States
All Developed
Countries
Colon/Rectal
40.3
46.0
48.2
40.9
53.0
39.1
46.6
Breast
27.8
25.7
32.2
24.6
35.8
23.2
29.4
Cervical
33.6
34.4
36.6
26.6
41.9
41.8
35.9
Prostate
20.4
34.1
34.4
47.6
46.0
17.2
29.4
All Sites
Except
Skin
49.6
58.8
56.5
57.9
65.7
44.8
57.8
Source: J. Ferlay et al., GLOBOCAN 2000: Cancer Incidence, Mortality, and Prevalence Worldwide,
Version 1.0, IARC Cancer Base No. 5, Lyon: IARC Press, 2001.
Canada
Evolution of the Canadian system
 Single-payer concept
 Cost-control measures

– Binding fee schedules
– Global budgets for hospitals
– Regionalization of high-tech services

Canada’s safety valve—private travel
health insurance
Germany



Evolution of the German system
Sickness fund concept
Cost-control measures
–
–
–
–

Institutional framework
Linking health care spending to income
Binding fee schedules
System-wide global budgets
Germany’s safety valve—private health
insurance for upper income population
Japan
Evolution of the Japanese system
 National health insurance
 Cost-control measures

– Uniform fee schedules
– Service distortions

Japan’s safety valve—”gifts of
appreciation” to secure treatment
France


Evolution of the French system
System-wide goals
– Spirit of egalitarianism—solidarity
– Respect for individual freedom—liberty
– Minimal state intervention—laissez faire

Cost-control measures
– Binding fee schedules
– Global budgeting restricting adoption of high-tech
services

France’s safety valve—supplementary private
insurance
United Kingdom



Evolution of the National Health Service
Single-payer concept in a socialized system
Cost-control measures
– Binding fee schedules
– Hospital trusts
– PCG budgetholders

British safety valve—private health insurance
for wait-listed patients
Promoting Equality
Price
Price
MCR
D2
D1
P1
S
A
P1
B
MCS
DE
0
Q1
Q2
Units of
Medical Care
0 ER
ES
ET
Units of
Equality
Lessons From Europe

Germany
– System of comprehensive, universal coverage is
expensive
– Cost control that includes binding fee schedules
must also control utilization

France
– Promoting system-wide goals requires tradeoffs
– Strict budget controls leads to lower investment

United Kingdom
– Strong primary care covers all sorts of ills
– Strict cost controls can lead to long waiting lists
The Economics of a Safety
Valve
Price
Price
S
A
MC
P1
P0
PC
PC
B
D0
0
QS
QD
Primary Market
D1
0
Q1 Q2
Safety Valve
Summary and Conclusions





National health insurance does not guarantee
public satisfaction
Health care provided at zero cost offers no
incentive to limit demand
Eliminating financial barriers to care does not
insure equal access to care or eliminate health
differences across subgroups
If prices are not used to allocate scarce
resources, something else must do so. In
health care it is often waiting lists and limited
access to technology
Safety valves are critical
Public Opinion Polls
Country
Minor
Changes
Needed
19
20
41
41
29
9
25
Australia2
Canada2
France1
Germany1
Japan1
New Zealand2
United
Kingdom2
United States2
17
Source:
1. Blendon, et al. (1990)
2. Donelon et al. (1999).
Fundamental
Changes
Needed
49
56
42
35
47
57
58
Completely
Rebuild
System
30
23
10
13
6
32
14
46
33