Variations in health care systems

Supporters of a tax-financed, single-payer health system claim that it would remedy inequities in health outcomes by providing equal access to health care for low-income families, but a new survey by Harvard University's School of Public Health and the Commonwealth Fund found lower-income people have much worse health regardless of financing methods.

The countries run the gamut from the U.K. (physicians are government employees and hospitals are government owned) to the U.S. (voluntary private insurance for most with government programs for the poor and elderly.) Canada, New Zealand and Australia have private-government hybrids, though with a strong government presence.

None of the systems is ideal.

Only 3 percent of Britons say they have had "problems paying medical bills," compared to 7 percent in Canada, 11 percent in Australia, 12 percent in New Zealand and 21 percent in the United States.

Forty-three percent of Britons report no out-of-pocket costs in the previous year, and only 2 percent report having paid more than $1,000; the figures for the United States are 7 percent and 26 percent respectively.

Thirty-nine percent of lower-income Americans did not use prescriptions they received due to the out-of-pocket cost in the past year, compared to 21 percent in Australia, 22 percent in Canada, 20 percent in New Zealand and 7 percent in the U.K.

However, the study finds that only 5 percent of Americans wait four or more months for surgery. The others range from Australia (23 percent) to the U.K. (38 percent) (see figure). http://www.ncpa.org/pub/ba/ba397/ba397fig1.gif

The United Kingdom has the least out-of-pocket costs, but it has the longest waiting times. The United States is just the opposite. The rest fall somewhere in between on both measures.

Source: Greg Scandlen (NCPA senior fellow in health policy), Health Care in Five Nations, Brief Analysis No. 397, June 17, 2002, National Center for Policy Analysis.

For BA text http://www.ncpa.org/pub/ba/ba397/

For Commonwealth study http://www.cmwf.org/programs/international/schoen_fivenation_ib_542.pdf

For International Comparisons of Health Systems http://www.ncpa.org/iss/hea

FMF Policy Bulletin\18 June 2002