Healthcare Around the World
Healthcare systems vary around the world. It is a challenging issue because of the high costs required, aging populations and different cultural, economic, social and political situations. Health care ranges from preventative and lifestyle to catastrophic and long term care. Most wealthy countries have some sort of universal health care system with the exception of the United States. There is no easy answer and no one system is perfect. Following is an overview of health care around the world.
NORTH AMERICA -
Canada's health care system is publicly funded and adheres to guidelines set by the federal government. It is administered on a territorial or provincial basis. Individual citizens are provided preventative care and medical treatment as well as access to hospitals, surgical dentists and other medical care. All Canadian citizens qualify for health coverage no matter their income level or medical history. Approximately 9.5% of Canada's GDP is spent on healthcare. One problem is the shortage of doctors and nurses who feel better compensated elsewhere. Attracting and keeping skilled medical workers is a priority in Canadian politics. Despite all that, Canada boasts one of the highest life expectancies in the world (80 years) and the lowest infant mortality rate in all industrialized nations.
The Mexican healthcare system is a pluralistic one combining private and public programs. Approximately 6.6% of Mexico's GDP is spent on healthcare that serves 40% of the privately employed population. The system consists of three components. The largest is the Social Security organization (IMSS) which is funded by employers, beneficiaries and the Mexican government. Funded by the federal government, the uninsured poor program covers about 40 million citizens. It offers basic but limited healthcare benefits. Lastly there's the private sector where individuals pay out-of-pocket for healthcare. Because it is very affordable there are about 3 million Mexicans who go this route as well as medical tourists. In general, Mexicans enjoy excellent healthcare. One problem is that rural areas are under-served and lack proper facilities. Life expectancy in Mexico is 76.41 years and the last decade has seen a huge improvement in the infant mortality rate.
UNITED STATES -
In the United States, health care is not so much a system as a combination of provisions by many separate legal entities. Most medical facilities are owned and operated by the private sector. Health insurance, on the other hand, is now largely provided by the government with programs such as Medicare, Veteran's Administration, Medicaid and others. Approximately 16% of the GDP is spent on healthcare in the United States. It is one of the only industrialized countries that does not ensure that all its citizens have health care coverage. Physicians in the United States are paid double that of doctors in Europe though wages vary by region. Many regulations are in place to protect consumers from fraudulent and substandard healthcare. Life expectancy in the United States is 78.2 years and there has been a steady decline in death rates in the last several years.
In 2010, President Barrack Obama signed the Affordable Care Act (also known as Obamacare) into law. It is intended to make health insurance more affordable for all citizens. It still faces challenges and is a work in progress.
SOUTH AMERICA -
The Brazilian healthcare system combines government health services, the private sector and non-profit health organizations. Medical facilities are ultra-modern and use state-of-the-art equipment and technology. Sao Paulo was recently recognized as one of the 47 world-class centers for medical technological innovations. All services and treatments are free and there are no charges for non-Brazilians at public hospitals. This attracts medical tourism though many choose private hospitals which offer reasonable costs. Physicians are paid up to three times more to work in the poorest areas of Brazil. Approximately 7.9% of the GDP is spent on healthcare. One problem is that government hospitals are often crowded and waiting times can be long. Life expectancy in Brazil is 72.86 and rising. According to UNICEF, Brazil is among the 25 nations with the best overall improvement in survival rates for children under the age of five.
In Argentina, the public sector's healthcare is managed and funded by Obras Sociales which is an umbrella organization for Argentina'a trade unions. There are over 300 chapters of Obras Sociales in Argentina, each organized by the occupation it represents. There are over 8 million beneficiaries covered by Obras Sociales insurance plans and the top thirty chapters hold 73% of them. Services vary greatly in quality and by organization. Argentina spends approximately 10.1% of the GDP on healthcare. Due to economic problems which began in 2001, more Argentine citizens are being forced to use the public system as unemployment rises. This is a highly decentralized system and is often left to local townships to deal with. American, Swiss and other Latin American health care providers are increasingly opening the market to private insurance. Life expectancy in Argentina is 76.95.
Chile enjoys a very advanced health care system with well-trained doctors, state-of-the-art hospitals and regulation of standards that exceed most international standards. The country maintains a duel health care system where citizens can opt for a private health insurance company or for the public National Health Insurance Fund. The system is funded by a universal income tax deduction which amounts to about 7% of every worker's wages. Chile's private/public partnership is mostly effective and there is a growing emphasis on concentrating on certain chronic diseases where care is guaranteed and cost effectiveness assured. Chile spends approximately 5.4% of its GDP on health care. The country has seen a 50% reduction in child mortality in the last 16 years. Life expectancy in Chile is 78 years.
All citizens of the Netherlands are required to purchase health insurance. The average cost of that insurance is (US)$127 per month. Insurers are either for-profit or non-profit and are regulated by the federal government. They are required to accept every resident within their coverage area no matter what preexisting conditions there may be. Everyone with the same policy pays the same premium. People under the age of 18 are covered at no cost. The government provides tax cuts and other measures to help low-income citizens afford insurance. Long term care is funded by social insurance which is funded by earmarked taxation. The Netherlands spends approximately 9.9% of its GDP on healthcare. Life expectancy is 79.68 years.
The French have access to some of the best health care in the world. All citizens pay mandatory health insurance. An automatic premium is deducted from employees' pay and this is based on income. Taxes on alcohol and gambling are directed toward health care and those receiving social services must also contribute. Recently, the government has required some co-payments for services (approximately 1.45 USD for doctor's visits and 20-25 USD a day for hospital stays and procedures). This helps to offset rising health care costs. On element to the French insurance system is that the more ill the person, the less they pay. Treatment for serious illnesses are reimbursed 100%. Doctors in France pay no tuition for medical school and malpractice insurance is inexpensive. France spends approximately 11.2% of their GDP on health care. Life expectancy is 81. 19 years.
Iceland's health care system is progressive and well-organized. Citizens there are some of the healthiest in the world. No private health sector exists in Iceland. Regardless of status, all citizens receive health care under the state-run service. The central government funds its health care through taxation. Taxes are based on a percentage of an individual's wages. Iceland has health care centers in different districts. These centers are visited regularly by doctors and specialists who are employed by the government. Every citizen must register with a General Practitioner of their choice. Every area has a doctor on call 24 hours a day. Iceland has more doctors per head of population than anywhere else. The country spends approximately 9.1% of its GDP on healthcare. Life Expectancy is 80.67 years.
The health care system in China is badly in need of reform. Medical training is highly variable and hospitals range from first-class facilities to overhauled boarding houses depending on location. Market reforms eliminated the once adequate health commune centers and forced communities to deal with their medical needs on their own. Doctors do not have private practices. Patients must go to hospitals for any treatment. Village doctors migrated to urban areas where people could afford their services in the now for-profit, fees-for-service system. Most hospitals are government owned and doctors are paid poorly some as little as 120 USD a month. If doctors want to increase their income, they dole out prescription drugs and order unnecessary procedures because the government sets the fees and they are usually well beyond what they actually cost. China spends less than 5% of its GDP on health care. Life expectancy is 72 years.
The Japanese people live long healthy lives. Everyone is required to buy health insurance either through their workplace or from community-based insurance companies. The government pays for those who are too poor to afford it. Their system is not considered "socialized medicine" because most of Japan's hospitals are privately owned and doctors offices are private businesses. All citizens are covered and premiums run an average of 280 USD a month per family. Employers pick up half that cost and citizens keep that insurance even if they lose their job. The Japanese Health Ministry controls the price of health care and along with the health industry negotiates a fixed price for procedures and drugs. No citizen can be turned down despite serious illness. Hospital stays are approximately 10 USD a day but may rise to maintain a balanced budget. Japan spends approximately 8% of its GDP on health care. Life expectancy is 82.25 years.
SAUDI ARABIA -
Health care in Saudi Arabia is free to all citizens. A number of government agencies collaborate to provide services though there is increasing participation from the private sector. Health care centers throughout the Kingdom provide preventative, rehabilitative and curative health care for the population. Saudi Arabia's Ministry of Health oversees the health care budget. Hospitals use state-of-the-art technology and doctors are well-trained. The growing population is causing a more congested system therefore efforts are underway to expedite additional private sector involvement. Saudi Arabia's large reliability on foreign labor has created challenges and reforms include compulsory health insurance, better health education and medical education within the Kingdom. Saudi Arabia spends approximately 3.6% of its GDP on health care. Life expectancy is 74.11 years.
In Tunisia, the health care system is divided between government run and funded clinics and hospitals and private for-profit and non-profit ones. The Ministry of Public Health closely monitors both. Health care in Tunisia is generally excellent and their private hospitals attract foreign patients for medical procedures in the fields of urology, cardiology and cosmetic surgery. The medical tourism industry is the second largest employer in the country. Over 85% of the population has access to health care. Unfortunately, there is a lack of medical facilities outside of the major cities often forcing the ill to travel a great distance for treatment. Rapid population growth has increased demand and waiting times for care, particularly in the public sector, are long. The government of Tunisia recognizes that reforms are needed and is considering charging co-payments for prescriptions and hospital stays. Tunisia spends approximately 5.5% of its GDP on health care. Life expectancy is 75.01 years.
Botswana's health care includes both a private and public system each with their own physicians, clinics and hospitals. All citizens of Botswana receive free health care which includes hospitalization, laboratory testing, prescriptions as well as primary care. Every health region is managed by a district medical officer. In more sparsely populated areas, health posts are available for care. Botswana funds its health care system through profits from the diamond industry. The prevalence of the HIV/AIds virus in Botswana has prompted the government to give priority to health care issues and as a result it has managed to make remarkable strides. It is considered a model country in Africa. Botswana spends approximately 7.6% of its GDP on health care. Life expectancy is 58.5 years.
Kenya has experienced a lot of overhaul in health care since their independence from Great Britain in 1963. The Kenyan government oversees about 41% of health centers, the private sector about 44% and NGO's run 15%. While most nursing homes and maternity facilities are operated by the private sector, the government takes care of most hospitals and clinics. Poverty is high in Kenya and health care remains a challenge. The Ministry of Health is forced to work with the budget the Ministry of Finance allocates for health care. This amount often falls far short of the need. Much of the health care in Kenya is financed through donors. Though the United States is the largest bilateral donor, the United Kingdom, Germany, Japan and Denmark contribute as well mostly through the United Nations system. One very real problem is maintaining physicians particularly in the public sector. Trained health care workers tend to migrate to the higher paying private sector or leave Kenya altogether. Kenya spends approximately 4.2% of its GDP on health care. Life expectancy is 59.48 years.
All Australians have access to free or low cost health care. Through the Department of Health and Ageing, the Australian government oversees national health policies and subsidizes state and territory governments in providing health services. Their health care system, called Medicare, is funded through a taxation levy based on the individual's income. Public hospitals are jointly funded by both the state and territory governments and by the Australian government. In the private sector which accounts for about 41% of the population, safety net measures exist to make sure patients who require high-level treatment and medication in a single year do not have significant out-of-pocket expenses. Those citizens who earn over a set amount ($70,000 individuals, $140,000 couples) pay an extra 1% tax levy. Australia spends approximately 9.1 percent of its GDP on health care. Life expectancy is 81.81 years.
NEW ZEALAND -
New Zealand has one of the oldest universal health care systems in the world. Health services in New Zealand are provided by a complex network of various organizations and people. Every year the national government decides the amount of public money that will be spent on health care. They then allocate these funds to the District Health Boards. Broad guidelines are in place on what services the DHBs must provide. The DHBs then purchase health services from public, non-profit and private agencies and organizations. Citizens are responsible for choosing and paying a primary health care provider. A GP's fees range from 13-33 USD. On the other hand, specialty care is covered by the District Health Boards. Low income residents of New Zealand are subsidized for any health cost. New Zealand spends approximately 8.9% of its GDP on health care. Life expectancy is 80.59 years.
PAPUA NEW GUINEA -
Health care in Papua New Guinea is dismal at best. Infrastructure is limited in this developing country and diseases such as malaria, tuberculosis and HIV/AIDS claim many lives. Over 87% of the population lives outside urban areas where poor logistical conditions prevent any type of adequate health care. There is also an overwhelming lack of human resources to serve the need. The government of Papua New Guinea is working closely with WHO and other donor partners to find solutions. Faith-based organizations are also working in conjunction with the government to help facilitate access to health care and medication. The neighboring countries of Australia and Japan support the Department of Health in the planning and coordination of health care activities. Papua New Guinea spends approximately 3.2% of its GDP on health care. Life expectancy is only 45.5 years.
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