I have posted my summaries of OECD summaries of healthcare systems of the UK, The Netherlands, France, Germany, Denmark, and Sweden.
This link brings them all up in one window.
Otherwise, click on the links for the individual countries on the right.
Cheers,
Showing posts with label OECD Summaries. Show all posts
Showing posts with label OECD Summaries. Show all posts
Monday, November 10, 2008
OECD Summaries Link
UK - OECD Summary
Summaries of summaries of healthcare systems based on the Commonwealth Fund reports.
Author(s) of the originals are:
Karsten Vrangbaek, Isabelle Durand-Zaleski, Reinhard Busse, Niek Klazinga, Sean Boyle, and Anders Anell
UK/NHS
• The UK, along with Sweden, is a prototypical socialized system.
• Essentially everyone is covered and all the funding takes place through a federal government taxes.
• General taxes account for 76% of the funding and then there are national insurance contributions to account for 19% of the funding. (I do not understand what the national insurance contributions are or where this money comes from.)
• User charges also account for a further 5% of the funding.
• Cost-sharing amounts to small drug co-pays of $14 but this is only for about 12% of all prescriptions written so it is therefore relatively small amount. In other words 80% of prescriptions require no co-pay.
• Dental requires up to $400 per year out of pocket before reimbursement occurs (I think).
• Out-of-pocket expenses account for 12% of the total health care expenditure.
• Primary care physicians are paid directly by the primary care trusts through capitation, salary, and fee-for-service arrangements.
• Hospitals are run by national health service trusts.
• Consultants and specialists are salaried.
• The private system in Britain covers approximately 12% of the population. It is a mix of profit and not-for-profit providers as well as supplementary insurance.
Sweden - OECD Summary
Summaries of summaries of healthcare systems based on the Commonwealth Fund reports.
Author(s) of the originals are:
Karsten Vrangbaek, Isabelle Durand-Zaleski, Reinhard Busse, Niek Klazinga, Sean Boyle, and Anders Anell
Sweden
• The Swedish system sounds very much like the truly socialized systems that we have come to expect from right-wing fear mongers. Everyone is covered, everything is covered, and virtually everything is funded by the government through taxes.
• There are some co-pays and the deductibles and routine dental care for those over 18 is not generally covered.
• Co-pays for visits amount to about $20 for a general practitioner and $40 for a specialist. There is an approximately $12 per day co-pay for hospitalization and there is a deductible of about $140 annually for prescriptions. Once you go over this amount then there is a scaled re-payment or reimbursement (the higher the expenditure, the higher percentage the state pays.)
• Out-of-pocket expenses account for approximately 14% of total health expenditure.
• Funding is through federal and local taxes.
• The federal government is mostly responsible for prescription drug costs.
• County governments are responsible largely for hospitals, mental-health care, provider reimbursement etc.
• Municipalities are responsible for skilled nursing facilities and the like, as well as home care and some other things.
• Private insurance covers approximately 25% of the population and accounts for less than 1% of total health expenditures.
• Physicians are paid largely through capitation with some fee-for-service. Half of primary care physicians are private and half are employed or salaried.
• Hospitals are mostly county owned and the hospital-based physicians are generally salaried.
The Netherlands - OECD Summary
Summaries of summaries of healthcare systems based on the Commonwealth Fund reports.
Author(s) of the originals are:
Karsten Vrangbaek, Isabelle Durand-Zaleski, Reinhard Busse, Niek Klazinga, Sean Boyle, and Anders Anell
Netherlands
• The Netherlands will be experiencing major changes that began in 2006 due to dissatisfaction with the prior dual system of competing public and private health care.
• All residents are required to buy health insurance.
• Health insurance is "statutory" but provided by private health insurers and regulated under "private law".(?)
• Financing: statutory health insurance, or SHI or public insurance is funded by a 6.5% tax on taxable income up to €30,000. This 6.5% apparently must be reimbursed by the employer however.
• The self-employed pay a 4.4% rate of tax for their insurance on their income.
• The average annual premium as of 2006 was €1050
• The government completely covers children up to age 18.
• "Substitutive" private health insurance was abolished in 2006.
• The statutory health insurance fund distributes risk-adjusted funds to the insurers. These insurers also provide, for a fee, complementary/supplementary insurance. The premiums for these complementary policies are not yet regulated.
• Private insurers may be for-profit but must accept everyone in their geographic area. They are compensated for this by risk adjustment reimbursement by the government.
• 78% of total health care expenditure is public.
• The statutory health insurance covers usual healthcare and includes drugs but does not include routine dental care. The annual deductible is €150 per year.
• Out-of-pocket expenditures account for 8% of the total health expenditure of the Netherlands
• Physicians contract directly or indirectly with insurers. General practitioners income is a combination of capitation and fee-for-service and pay-for-performance is being tried. Specialists are two thirds self-employed even if hospital-based and one third are salaried.
• Hospitals are mostly private but not for profit.
• Cost controls: it sounds like they are working on a version of managed competition though I am not clear on that.
Germany - OECD Summary
Summaries of summaries of healthcare systems based on the Commonwealth Fund reports.
Author(s) of the originals are:
Karsten Vrangbaek, Isabelle Durand-Zaleski, Reinhard Busse, Niek Klazinga, Sean Boyle, and Anders Anell
Germany
• Germany's system is based on public or social health insurance (SHI)
• SHI is mandatory for those with income less than €48,000 (this is about 75 to 80% of the population)
• The top quintile of income earners can opt in or out of SHI; 75% of these high earners opt in. (This matches up interestingly with the quintiles in the US, with the top 5% in Germany opting out of SHI it sounds like.)
• Also civil servants and the self-employed are excluded from SHI and make up the bulk of the 10% of privately insured individuals. (I don't understand the rationale of excluding the self-employed or, for that matter, civil servants except that I presume they just get these benefits paid for by the government anyway.)
• SHI covers the usual healthcare plus dental and drugs and more.
• Cost-sharing occurs through co-pays for outpatient visits, drugs and dental care. Apparently this is new since 2004. Cost-sharing max-out is 2% of income. Out-of-pocket expenses account for 13.8% of total health expenditure.
• SHI is operated by over 200 competing health insurers and these are called "Sickness Funds".
• The Sickness Funds are all autonomous and nonprofit but regulated.
• Funding comes from the employer at 8% of gross up to €43,000 and from the employee at 7% of gross.
• For those not in SHI, the sickness funds set rates but in 2009 the government will collect and regulate this as well. After 2009 the government will distribute to sickness funds based upon risk adjustment mix of their clients.
• Interestingly, private health insurance rates cannot change once you have been accepted into the plan.
• Private health insurance accounts for less than 10% of the total health expenditure of Germany.
• Physicians receive fee for service plus "fees per time period" (the latter sounds like capitation). Just a note here to refer to the NPR story about the fee-for-service money running out towards the end of every quarter
• Hospital-based physicians are salaried.
• Hospitals are split up into about 1/2 public, 1/3 private nonprofit and 1/6 private for-profit. The latter for-profit segment is apparently growing at this time.
• Hospital reimbursement is now a DRG based.
France - OECD Summary
Summaries of summaries of healthcare systems based on the Commonwealth Fund reports.
Author(s) of the originals are:
Karsten Vrangbaek, Isabelle Durand-Zaleski, Reinhard Busse, Niek Klazinga, Sean Boyle, and Anders Anell
France
• 79% of all care is publicly financed
• Employer and employee payroll taxes account for 43% of the funding. The employer pays 12.5% of payroll and the employee pays 0.75% of payroll.
• Part of the national income tax goes to funding health care and accounts for 33% of the funding.
• Tobacco and alcohol taxes supply another 8% and state subsidies and other social security taxes provide another 10%
• Coverage includes everything except dental and eye.
• Cost-sharing occurs through coinsurance and co-pays and extra/balance billing
• Out-of-pocket expenditures account for 7.4% of the total health expenditure
• Private health insurance accounts for 12.8% of the total health expenditure
• The public funding goes to public health insurance funds with membership based upon occupation
• Benefits/prices/cost-sharing levels are determined, since 2004, by the national Union of health insurance funds (UNCAM)
• Low income persons also get free complementary-supplementary coverage including dental and eye and they qualify for no balance billing
• Private insurance is like our supplemental policies. It reimburses for the cost-sharing elements of the national plan. This is usually provided by employment-based insurers called "mutuelles" . 90% of the population gets this. So far there is only a minimum competition in this market.
• Physicians, non-hospital-based, are self-employed and fee-for-service. Hospital-based physicians are salaried.
• Two thirds of hospital beds are either government-owned or nonprofit.
• One third hospital beds are private located in for-profit clinics and, I believe, in hospitals as well.
• Hospital reimbursement is moving to a DRG style system. Hospitals do get subsidies for research and teaching and emergency care.
• There are some cost controls in place. Controlling formularies a big issue at the present time according to my interview with Dr. C'alloch in Paris.
OECD Denmark summary
Summaries of summaries of healthcare systems based on the Commonwealth Fund reports.
Author(s) of the originals are:
Karsten Vrangbaek, Isabelle Durand-Zaleski, Reinhard Busse, Niek Klazinga, Sean Boyle, and Anders Anell
Denmark
• The health-care system of Denmark covers all regular healthcare
• Insurance is universal and compulsory
• Cost-sharing occurs in dental and corrective eye care and drugs
• Out-of-pocket costs account for 14% of the total health expenditure
• There is a safety net for the poor and the chronically ill to limit their expenses
• The system is publicly financed
• Federal tax of approximately 8% of taxable income goes into the fund; this accounts for 82% of total health expenditure
• Private or complementary insurance is available. 30% of the population buys this through not-for-profit Danish Health Reimbursement Scheme plus some others. This is often a fringe benefit for employees.
• The system is organized into five regions. Each region owns and runs hospitals skilled nursing facilities etc.
• The various regions finance the practitioners dentists and "pharmaceuticals" (? Pharmacists)
• It was not clear to me whether practitioners get fee-for-service or rates or if they are able to negotiate.
• Some professionals, I'm not sure which, our salaried-perhaps hospital and clinic-based.
• Hospital-based physicians are salaried.
• Other physicians have a capitation arrangement which accounts for approximately 30% of their income plus fee-for-service for the rest.
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