Health care reform

Health care reform

: "This article is about political movements affecting the delivery of health care and health care systems. For more information about movements to improve health, see Health reform."

Health care reform is a general rubric used for discussing major policy creation or changes—for the most part, governmental policy that affects healthcare delivery in a given place. Health care reform typically attempts to:
* Broaden the population covered by private or public health insurance
* Expand the array of health care providers consumers may choose among
* Improve the access to health care specialists
* Improve the quality of health care
* Decrease the cost of health care

The Netherlands

The Netherlands has introduced a new system of health care insurance based on risk equalization through a risk equalization pool. In this way, a compulsory insurance package is available to all citizens at affordable cost without the need for the insured to be assessed for risk by the insurance company. Indeed health insurers are now willing to take on high risk individuals because they receive compensation for the higher risks.

A video which explains how the new Dutch health care system works is available at (Warning: The video has a soundtrack in both English and Dutch. Be prepared to click the T symbol in the playback control to see substitles in English).

A 2008 article in the journal Health Affairs suggested that the Dutch health system, which combines mandatory universal coverage with competing private health plans, could serve as a model for reform in the US. [Wynand P.M.M. van de Ven and Frederik T. Schut, [ "UniversalMandatory Health Insurance In The Netherlands: AModel For The United States?,"] Health Affairs, Volume 27, Number 3, May/June 2008] [Helen Garey and Deborah Lorber [ "Universal Mandatory Health Insurance in The Netherlands: A Model for the United States?,"] In the Literature, the Commonwealth Fund, May 13, 2008]


Taiwan is reported to have changed its health care system in 1995 to a system basically equivalent to the US Medicare system. As a result, the percentage of uninsured has dropped from over 40% to virtually nil. It is said to deliver universal coverage with free choice of doctors and hospitals and no waiting lists. Polls in 2005 are reported to have shown that 72.5% of Taiwanese are happy with the system, and when they are unhappy, it's with the cost of premiums (equivalent to less than US$20 a month).

National Health Insuruance or NHI premiums is similar to that of social security contributions in the US. Employers and the self-employed are legally bound to pay them. Unlike the US social security fund, the NHI is a genuine pay-as-you-go system. The aim is for the premium income to pay costs, but there is also a tobacco tax surcharge that goes to the NHI, and contributions from the national lottery.

Main source [ Guardian Unlimited article October 7 2007]

United Kingdom

Health care was reformed in 1948 with the creation of the National Health Service or NHS. It was originally established as part of a wider reform of social services and funded by a system of National Insurance, though receipt of health care was never contingent upon making contributions towards the National Insurance Fund. Private health care was not abolished but had to compete with the NHS. About 15% of all spending on health in the UK is still privately funded but this includes the patient contributions towards NHS provided prescription drugs, so private sector health care in the UK is quite small. As part of a wider reform of social provision it was originally thought that the focus would be as much about the prevention of ill-health than it was about curing disease. The NHS for example would distribute baby formula milk fortified with vitamins and minerals in an effort to improve the health of children born in the post war years as well as other supplements such as cod liver oil and malt. Many of the common childhood diseases such as measels, mumps, chicken pox were mostly eradicated with a national program of vaccinations.

The NHS has been through several reforms since 1948 although it is probably fairer to say that the system has been through phases of evolutionary change. The Conservative Thatcher administrations attempted to bring competition into the NHS by developing a supplier/buyer role between hospitals as suppliers and health authorities as buyers. This necessitated the detailed costing of activities, something which the NHS had never had to do in such detail, and some felt was unnecessary. The Labour Party generally opposed these reforms, although after the party became New Labour, the Blair government retained elements of competition and even extended it, allowing private health care providers to bid for NHS work. Some treatment and diagnostic centres are now run by private enterprise and funded under contract. However, the extent of this privatisation of NHS work is still very very small, though remains controversial. The adminsitration committed more money to the NHS raising it to almost the same level of funding as the European average and as a result, there has been a large expansion and mordernisation programme and waiting times are now much more acceptable than they once were.

The government of Gordon Brown has [ announced several new reforms] for care in England. One is to take the NHS back more towards health prevention by tackling issues that are known to cause long term ill health. The biggest of these is obesity and related diseases such as diabetes and cardio-vascular disease. The second reform is to make the NHS a more personal service, and it is negotiating with doctors to provide more services at times more convenient to the patient, such as in the evenings and at weekends. This personal service idea would introduce regular health check-ups so that the population is screened more regularly. Doctors will give more advice on ill-health prevention (for example encouraging and assisting patients to control their weight, diet, exercise more, cease smoking etc.) and so tackle problems before they become more serious. Waiting times, which have already fallen considerably under Blair (median wait time is about 6 weeks for elective non-urgent surgery) are also in focus. The NHS will from December 2008, ensure that no person waits longer than 18 weeks from the date that a patient is referred to the hospital to the time of the operation or treatment. This 18 week period thus includes the time to arrange a first appointment, the time for any investigations or tests to determine the cause of the problem and how it should be treated.

United States

The debate over health care reform in the United States centers around questions of access, efficiency, quality, and sustainability. The mixed public-private health care system in the US is the most expensive in the world, with the US spending more on health care, both as a proportion of gross domestic product (GDP) and on a per capita basis, than any other nation. [ [ World Health Organization: Core Health Indicators] ] Current estimates put U.S. health care spending at approximately 16% of GDP. [ "National Health Expenditure Data: NHE Fact Sheet,"] Centers for Medicare and Medicaid Services, referenced February 26, 2008] [ [ "The World Health Report 2006 - Working together for health."] ] In 2007, the U.S. spent a projected $2.26 trillion on health care, or $7,439 per person. [ [ "National Health Expenditures, Forecast summary and selected tables"] , Office of the Actuary in the Centers for Medicare & Medicaid Services, 2008. Accessed March 20, 2008.] Health care costs are rising faster than wages or inflation, and the health share of GDP is expected to continue its historical upward trend, reaching 19.5 percent of GDP by 2017.

The U.S. is the only wealthy, industrialized nation that does not have a universal health care system, according to the Institute of Medicine of the National Academy of Sciences. [ Insuring America's Health: Principles and Recommendations] , Institute of Medicine at the National Academies of Science, 2004-01-14, accessed 2007-10-22] Americans without health insurance coverage at some time during 2006 totaled about 16% of the population, or 47 million people. [ "Income, Poverty, and Health Insurance Coverage in the United States: 2006."] U.S. Census Bureau. Issued August 2007.]

International comparisons that could lead to conclusions about the quality of the health care received by Americans are inconclusive and subject to debate. The US lags other wealthy nations in such measures as infant mortality and life expectancy, but some argue that these differences have little to do with the structure of its health care system. Other comparisons indicate that the US system performs better on some measures, such as responsiveness and higher cure rates for serious illnesses such as cancer.Fact|date=March 2008

Whether a government-mandated system of universal health care should be implemented in the U.S. remains a hotly debated political topic, with Americans divided along party lines in their views of the US health system and what should be done to improve it. Reform proposals include restructuring the private health insurance market, employer "pay or play" requirements, premium subsidies to help individuals purchase health insurance, increased use of health information technology, research and incentives to improve medical decision making, reduced tobacco use and obesity, reforming the payment of providers to encourage efficiency, limiting the tax federal exemption for health insurance premiums, and reforming several market changes such as resetting the benchmark rates for Medicare Advantage plans and allowing the Department of Health and Human Services to negotiate drug prices.

A fundamental problem in evaluating reform proposals is the difficulty estimating their cost and potential impact. Because proposals often differ in many important details, it is difficult to provide meaningful side-by-side cost comparisons. The empirical data and theory underlying cost estimates in this area are limited and subject to debate, increasing the variation between estimates and limiting their accuracy. [Sherry Glied, Dahlia K. Remler and Joshua Graff Zivin, [,%20Remler%20&%20Zivin,%2080-4.pdf "Inside the Sausage Factory: Improving Estimates of the Effects of Health Insurance Expansion Proposals,"] The Milbank Quarterly, Vol. 80, No. 4, 2002]


As evidenced by the large variety of different health care systems seen across the world, there are several different pathways that a country could take when thinking about reform. Germany for instance, makes use of sickness funds, which citizens are obliged to join but are able to opt out if they have a very high income (Belien 87). The Netherlands uses a similar system but the financial threshold for opting out is lower (Belien 89). The Swiss, on the other hand use more of a privately based health insurance system where citizens are risk-rated by age and sex, among other factors (Belien 90). The United States government provides health care to just over 25% of its citizens through various agencies, but otherwise does not employ a system. The free market provides the balance of health care services, generally centered around modestly regulated private insurance methods.

ee also

*California Speaks
*Health policy analysis
*Healthcare system reform in the People's Republic of China
*Journal of Health Care for the Poor and Underserved
*Kaiser Family Foundation
*Massachusetts health care reform
*Medicare Rights Center
*National health insurance
*National Physicians Alliance
*Puerto Rico Health Reform
*United States National Health Insurance Act
*Universal health care


*Belien, Paul. " [;jsessionid=GWNc25ThKfnhTKsgNnD2Jp8q0bnyN8LC61ZM1qKBHQRtQ9GQyBGf!675572714!181195628!8091!-1 Healthcare Systems - A New European Model?] " PharmacoEconomics. Vol 18, supplement 1, (2000). 85-93. [Subscription only]

External links

* [ 2008 Presidential Candidate Health Plan Report Card] issued by the National Physicians Alliance

* [ 2008 Presidential Candidates' Health Reform Proposals] from The Commonwealth Fund

* [ 2008 U.S. Presidential Candidates' Health Care Plans Update: A Side-by-Side Comparison]

* [ A Health Care Reading List from the Cato Institute]

* [ A Model For Health Care Reform Board In Developed Countries With Canadian Focus]

* [ California's Health Care Reform Discussion: A Non-Partisan, Unbiased Review]

* [ Doctors support universal health care: survey] , Reuters, March 31, 2008 (first reported in Annals of Internal Medicine).

* [ Health in transition countries - a dossier]

* [ Sick Around the World: Can the U.S. learn anything from the rest of the world about how to run a health care system?] from Frontline, PBS.

* [ States Moving Towards Comprehensive Health Care Reform in the U.S.] , The Henry J. Kaiser Family Foundation

* [ Video: Universal Health Care Coverage in the United States] , October 3, 2007, Woodrow Wilson Center event featuring Robin Cook (novelist), James Morone, Michael Cannon, and Paul Seltman.

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