Universal Healthcare Briefing

Topics Covered:

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• Universal Healthcare

• Taxpayer-Funded Universal Healthcare

  • Single-payer System

• Canada

  • Role of the federal government

  • Role of the provincial governments

• Sweden

• United Kingdom

  • The NHS

  • Private Healthcare

• Universal Public Health Insurance

  • Public Health Insurance System

  • France

  • Austria

• Private Universal Healthcare

  • Multi-payer System

  • Germany

  • Netherlands

• Comparative Analysis and Comparison with the United States

  • Cost of Introduction and Impact on Population Health

  • Future Healthcare Challenges

  • Comparison with the US Healthcare System

• Conclusion

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Briefing Intro:

Universal healthcare represents a system of healthcare that provides automatic coverage for every citizen. While this is typically associated with government-run healthcare systems, there are a variety of ways universal healthcare has been implemented around the world. One constant thing is the strong role of government in any universal healthcare system – almost universally, the government provides a way to fund the public healthcare system to varying degrees: from universal coverage through taxation or mandatory government-run health insurance, to mandatory health insurance (public or private) to cover basic and emergency medical care. However, almost every universal healthcare system also includes private health insurance which supplements public health insurance. The share of public healthcare expenditure varies from 65% to 85% of the total healthcare expenditure. This major share of public healthcare expenditure allows the government to achieve significant savings in purchases of medical supplies, equipment, and pharmaceuticals, providing it with an extremely strong bargaining position and giving it the ability to dictate the market conditions and save significantly due to economies of scale.

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The universal healthcare system should not be equated with the existence of a comprehensive public healthcare system. There are countries, like the UK, that runs a comprehensive public healthcare system. However, there are other countries, like Germany, where the healthcare system contains both public and private hospitals and clinics, which offer services to patients with both public and private health insurance. The number of public hospitals in Germany has been declining steadily in the last 20 years due to their privatization.

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In addition, universal healthcare systems typically have other significant advantages:

• reduced administrative load on the doctors and medical staff

• establishes universal standards of service across the entire system

• removes the profit imperative from healthcare

• easier adoption of cost-reducing policies, like preventive healthcare

• reduces healthcare inequality

• allows the government to use other instruments to promote healthier habits in the population

 

The disadvantages of universal healthcare include:

• equal distribution of healthcare costs across the population: healthy pay for the healthcare of the sick

• focus on basic, primary, and emergency care

• rising healthcare costs may impact government budgets having a negative impact on other government-funded services

• governments typically place limitations on high-cost low-success services, like drugs for rare conditions, experimental drugs, and procedures, or end-of-life care

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There are three models for financing universal healthcare:

• Single Payer: healthcare is paid for by tax income; government runs and owns the entire healthcare system; private providers

• Social or National Health Insurance: healthcare is paid for through a mandatory government-run health insurance fund; both government-owned and private service providers can exist in the healthcare system

• Multi Payer: mandatory health insurance is provided by non-profit public and private providers

 

One can see that a feature in most of these models is that government controls the financing of the healthcare system, either by taxation, or some form of government-run insurance. This is essential because it naturally regulates the healthcare system, removing the free-market elements that tend to drive the healthcare costs up. The government is positioned as the sole source of money in the system, allowing it to dictate the market conditions to benefit the end-users – the patients.

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More than 100 countries around the world have some form of universal healthcare. The quality of healthcare varies, mostly depending on the economic development of a particular country. According to the data from WHO, twenty out of twenty world’s best healthcare systems have universal healthcare (Table 1). In fact, out of the top 50 healthcare systems in the world, only the US doesn’t have some form of universal healthcare.

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More to be covered at the briefing.