Lessons for Health Care Policy in the United States: Comparing Health Care Systems CHRISTIAN ASPALTER
Professor of Social Policy, Former Head Social Work and Social Administration Program Beijing Normal University-Hong Kong Baptist University United International College, Zhuhai, China Note: A shorter version of this paper has been published in C. Aspalter, Y. Uchida and R. Gauld (eds.) (2011) “Health Care Systems in Europe and Asia” (Routledge Studies in Social Welfare in Asia), Routledge: London.
Health care systems are one of the most complex and comprehensive administrative and policy systems that there are. They are not to be comprehended by looking at any single data or perspective. They are constantly developing. They are elusive and often misunderstood, i.e. they may be mistaken for something they are not, or certain aspects may be overestimated or underestimated. Health care systems are needed, loved and detested. There are, as a matter of fact, a great deal of misperceptions and misunderstandings when it comes to health care. The recent debate in the United States, to name just one illustrative example, has clouded the issue of health care policy and health care reform in greater mystery than it helped to unravel and reveal new insights to the actual facts. In the comparative study below, we will see that for instance the United States would be among the top three world health care systems in terms of “socialism,” or, in other words, absolute public spending per capita for health care. Only in Luxembourg and Norway, does the government spend more on health care per person that in the United States (5,212, 4,006 and 3,315 PPP/US$ respectively). The often cited case of the United Kingdom, in the American debate, would not qualify to be only a moderate “socialist” health care system after all, as the UK government only spends 2,444 PPP/US$ per capita on health care, compared to 3,315 PPP/US$ spent by the American government. So, the health care system in the United States, as it is, is actually about 35 percent more “socialist” than that of the United Kingdom. In terms of percentage of GDP, the US leads the world in terms of total health spending, making it not the best health care system, but the most expensive health care system—both in relative terms (% of GDP) and in absolute terms (per capita expenditure, PPP/US$).
Electronic copy available at: http://ssrn.com/abstract=1960821
Measuring and Comparing Health Care Systems The best health care systems are the ones that need less money and, at the same time, cure more patients and prevent more illness and suffering. Health care outcomes are not too difficult to find and to measure, life expectancy and healthy life expectancy rates are easily available and comparable, and so are neonatal, infant, below-5, maternity and adult mortality rates. The service delivery itself can also be measured satisfactorily in comparative terms, i.e. by looking at the ratios of doctors, nurses and midwifery personnel, hospital beds, acute hospital beds, MRIs and CT scans to the population, as well as GP visits per person per year, average stay in hospital per person, etc. Effectiveness is output. Efficiency is the ratio of output to input. Input is relatively easily measured as well, through absolute health care spending per capita in PPP/US$. Though, there are problems, when doing so. For example, the costs of buildings and administration are in actual fact not supporting directly the health of patients, and there is a lot of room for redundancy and wasteful investment in these areas. Also, PPP/US$ favors Western countries, since PPP is based on e.g. hamburgers, a food item which is expensive in e.g. Asia, but comparatively very cheap in Western countries, e.g. what may be a luxury item in the East, is a food for the poor in the West, and vice versa. Hence, misrepresentations between different continents are always possible (and actually certain). In China, people do not eat...
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