U.S. system stacks up worldwide

Over the last few months, I’ve looked at health care systems worldwide to see what we might learn from others. What I found was not what I expected.

In the past year, we’ve heard the term “universal health care” a great deal. Universal health care means that all people in a country are provided with health care. How that’s done varies tremendously.

In countries such as the UK, Ireland, Canada, Australia, New Zealand, Spain, Portugal and in Scandanavia, the government is the primary payer for health care.

The UK system is run through health-care trusts, funded by the government, that operate on a local level. Policy decisions are made by a public administrator, doctors and patients. Wait times are very low, with primary care visits available same or next day. Two-thirds of elective hospital admissions have no wait list. The costs of health care represent half of what we spend. Perfect? Not quite.

In the UK, decisions about what services will be covered are made by functionaries, based solely on cost. Many procedures we take for granted are not easily available, especially to the elderly. Use brighter light bulbs and don’t go out at night. No big deal for the cataract sufferer.

Use a cane. You’re old. Why do you need a new hip?

Those who have the money get what they need from a growing number of private doctors, the “Harley Street physicians.”

Health care in Norway has been ranked the best in the world. It is funded by the government. All Norwegians receive the same generous benefits and doctors can not charge more than the set fees.

But Norway has a huge problem with wait lists. For recommended (non-emergency) hospital admissions, a three-month wait is the norm. Norwegians often opt out of the system and travel abroad for their care.

Other countries have universal coverage through private insurers rather than single payers, who must cover everyone at the same premium. Physician reimbursements are mostly tightly regulated. The Netherlands and Switzerland have private systems that seem to be able to provide universal health care to its citizens in a relatively smooth fashion without long waits for services.

The rest of the developed nations all have a system that is a mix of private and public funding. Costs are far less than in the U.S.

What about quality? The World Health Organization ranked us 37. But let’s look at how this dismal ranking was obtained.

The WHO places a lot of weight on “fairness.” Those who have the most should pay higher burden than others. In the U.S., we mostly pay for the actual level of coverage, independent of our means.

The WHO looks at “distribution” of services. If 75 percent of the public receives excellent care, and 25 percent good care, the distribution is worse than if all were good. They want everyone to have exactly the same available care.

Life expectancy and infant death are important in their rankings, but these are largely social issues.

Take out deaths from homicide, auto accidents, alcohol and drug use, obesity (highest rate by far in the world) and smoking, our life expectancy is not worse.

Infant deaths are influenced by unmarried teenage pregnancies (we have the highest rate in the developed world). Pre-natal services for pregnant women are generally available through an assortment of public and private organizations. The real problem is compliance with recommended care and the continuance of dangerous lifestyles in pregnancy, not a medical issue.

The WHO is part of the United Nations with a mission largely socio-economic.

In summary, our problems are not really due to our system. Other than not having a universal health care provision, our system is not that different from many countries.

Our root problem is cost, mostly from fraud and abuse, which prevents us from being able to cover the entire population.

The European Healthcare Fraud and Corruption Network several weeks ago published an exhaustive report on fraud in Europe. They concluded, based on hard data, that 40 percent of this could be eliminated with proper data and analysis.

Based on this number, we potentially could save $800 billion over the next 10 years. Compare this to a known cost of at least $1 trillion, with the so-called reform bills that still don’t provide for universal coverage,

Next, I will offer some suggestions as to how government policy could achieve this level of savings.

Charles Barta retired to Green Valley after 10 years as a medical director for several health care insurers. Before that, he was physician-in-charge of Kaiser Permanente of Colorado and a private internist in Las Cruces, N.M. He had previously held a management position in the Medical Systems Division of Pfizer. His column is published Sundays. He can be reached at Cbar52@aol.com.