Global Health Care Systems

Hey guys! We are a group of nursing students sharing our opinions on today's healthcare systems around the world. Feel free to comment and tell us what you think!

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Health Care in Norway

Photo Credit: https://www.tripsavvy.com/guide-to-scandinavian-flags-4123574

Access to affordable healthcare has always been a challenge in the United States. It is no secret that many Americans do not have access to basic quality care due to a host of reasons. More often than not, these kinds of conversations often to lead to comparisons with other countries where there is universal healthcare for every individual and not having to worry about crippling medical bills is a reality. Let’s take a closer look at one particular country that’s always been mentioned when it comes to Universal healthcare: Norway

THE BASICS

The Norwegian Healthcare system is primarily funded by tax revenues. On a per head basis, Norwegian expenditure on healthcare is the highest in the world.To gain a better understanding of the basic structure of their healthcare, let’s take a look at the chart below: 

credit: https://international.commonwealthfund.org/countries/norway/

Government is responsible for providing health care to the population, in accordance with the stated goal of equal access to health care regardless of age, race, gender, income, or area of residence. Primary health and social care is the responsibility of the municipalities, with Norway’s ministry of health playing an indirect role through legislation and funding mechanisms. In specialist care, the ministry also plays a direct role through its ownership of hospitals and its provision of directives to the boards of regional health care authorities (RHAs). 

 Credit: https://international.commonwealthfund.org/countries/norway/

credit: https://www.slideshare.net/soder145/single-payer-health-care-systems-final

credit: https://helsenorge.no/foreigners-in-norway/eea-citizens-seeking-to-receive-healthcare-in-norway

Who’s eligible?

If you are a resident of Norway, an asylum seeker or NATO personnel you are entitled to a fastlege, which is the Norwegian equivalent of a GP / general practitioner. Provided the doctor of your choice has vacancies, you can register with them free of charge, and you change your registration up to twice per year. Each fastlege manages their own appointments system.

Credit: https://www.lifeinnorway.net/healthcare/

Key Features:

Expenditure CAP - Contrary to Popular belief, Healthcare in Norway is not free. Residents (with the exception of pregnant women and people under 16 years of age) are expected to pay for every doctor’s visit and consult. The biggest benefit is that once a person reaches an annual limit of expenditure (currently just over 2,000kr or roughly $200 ), they receive an exemption card which entitles them to free treatment for the remainder of the year. This system ensures that everyone pays a little, but the sick are not burdened with the stress of huge medical bills.

Free Hospitalizations -  Hospital admissions and inpatient treatment are free in Norway

Mental Health Services - There is an extensive network of GP’s and Specialized care facilities around the country that primarily aims to provide free and quality inpatient and outpatient care for people who need it. Hospitalizations are free of charge in Norway.

Affordable Long term Care -  Cost-sharing for institutionalized care is income-based and set at 75 percent to 85 percent of patients’ income. The levels of care at home or in a nursing home are determined by the municipality.  People under 67 with permanently reduced functioning who live at home have a right to a personal assistant who will aid them according to their preferences. Very few patients pay individually for full-time private nursing home care. End-of-life care for terminal patients is often provided in specific wards within dedicated nursing homes. There is a system in place for informal caregivers to apply for financial support from the municipalities.

EXEMPTIONS & LOW-INCOME PROTECTION - Exemptions for children <16 years somatic, <18 years psychiatric, pregnant women, for some communicable diseases (including STDs), those with work-related injuries; low-income groups receive free essential drugs and nursing care  

 Credit: https://international.commonwealthfund.org/countries/norway/

Challenges

Long wait times for Primary Care appointments

Higher Taxation relative to other developed countries

Tight Budgets for Hospital Equipment and dependence of available government funding

Credit: https://international.commonwealthfund.org/countries/norway/

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Health Care In Canada

Healthcare in Canada

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=2ahUKEwiB3-W-

Don't you love it when you go somewhere, and you get things for free? Like to your local Starbucks that you go to almost every day and that one barista gives you a drink for free! Or when you go to your favorite restaurant with your best friend or significant other, and they say, "don't worry about it today, it on me!" Well, for the most part, that is how the Canadian healthcare system works. Canada's healthcare system, called the Universal Health Care System (UHCS), is a single-payer system. Coverage is publicly funded, which means that the money comes from federal and provincial taxes.

But there are limits to this free health care system. 

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=2ahUKEwirtcONhIfmAhXDxV

One restriction is that this form of healthcare in Canada is only available to Canadian residents. This means that it's not given out to anyone that is not documented legally in Canada. But those undocumented immigrants, temporary visitors are still eligible for limited benefits in Canada. Another Limit is that this form of health care does not cover all of your medical costs. 

I know shocking right!? You are probably thinking, "But it's free, so shouldn't it cover everything!?!" Well, we all wish that was the case, but unfortunately, it's not. You may have gotten a free coffee from the barista, but it's not like (s)he is going to keep on doing this every day. Besides, your best friend (or significant other) is not going to buy food or other things for you every day. In the end, that barista and your best friend can only give you so much for free.

In Canada, things that are covered by the UHCS is things such as regular visits to primary care doctors, hospitals, and even diagnostic services. But for other services such as ambulances, dental care, vision care, and long-term care facilities, you will have to pay partially out of pocket for that. Which does cause a problem for people who have more significant out of pocket medical expenses than others? However, the Canadian government still does provide a tax credit to ease this problem.

Also, to cover those expense gaps, Canadians are still able to purchase private coverage from an individual health insurance company.

Loop Hole?

https://www.google.com/imgres?imgurl=http%3A%2F%2Fwww.macmillandictionaryblog.com%2Fwp-

As you can see, the Canadian universal care doesn't necessarily cover everything. But there is a loophole! Even though the Canadian Health Association dictates that medically-necessary services are included at no cost. There is no real definition of what "medically necessary" really means, specifically, leaving each province or state and territory to decide. For example, you might be able to get free Xrays in one area of Canada while under UCHC, but in another area, you may be forced to pay a fee of a 100$ or more.  Therefore in Canada, most visits to primary care doctors, hospitals, and even diagnostic services are covered by Provincial Health Insurance, which has different guidelines depending on the province you are located in Canada. 

So if you need to get an Xray done but you cannot afford it then it's possible for you to travel to other provinces in Canada that can fit your medical needs and cover your expenses.

Here comes the bad news..

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=2ahUKEwj86pzfhIfmAhWlq1k

Now while this "free" Health care is excellent, especially since you can go see your doctor whenever you please without worrying about the cost! The wait times to see these doctors are horrendous. It is so bad that there is about one health care physician for every 1000 people. Therefore, some people are forced to wait for hours or even days to see a general practitioner. While people with urgent needs are guaranteed reasonable wait times, they can still expect to wait much longer since they are under the free health care system rather than private ones.  

Is it similar?

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=2ahUKEwiA8taFhYfmAhWF1

In addition, just in case you were wondering what the similarities between the US HCS and Canadian HCS are. You will conclude that the Canadian system pretty similar to the US Medicare system. Since both are free to those eligible and have a limit to what they can cover. (Please read a previous blog post on the American Health care system for more information)

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Health Care in Argentina

Credit: https://stock.adobe.com/be_en/images/argentina-medical-healthcare-infographic-template-with-map-and-multiple-charts-and-graphs/164058328

           Argentina has a population of 44.3 million. Poverty in Argentina effects 30.3% of its population and is rising every year. Though this may be the case, insurance is offered to all foreign and local people. Argentina has 3 forms of insurance, Public, Obras Sociales (Social Security), and private insurance. About 50% of the population uses Public insurance, 45% use Obras Sociales and only 5% use private insurance. Healthcare services in Argentina are considered the best in South America. In the big cities of Argentina like Buenos Aires, Cordoba or Mendoza, hospitals and medical staff are advanced and very competent. However, in poorer regions in Argentina, medical facilities are understaffed and underequipped and Health care is not always available to all. This shows that although everyone is offered insurance, poverty effects ones access directly to quality care.

Credit: https://www.expatassure.com/argentina/

Health Care Coverage Systems

Credit: https://nationaleczema.org/resources/eczema-and-your-health-care/

Public Health Care

Credit: https://internationalliving.com/countries/argentina/health-care-in-argentina/

           Public Health insurance provides free or highly subsidized insurance. This form of insurance is offered to 50% of the Argentinian population as well as to tourist and foreigners. This form of insurance usually covers fully patients medical, hospital, dental and palliative care as well as rehabilitation, prosthetics and medical transport costs. One backside to this insurance is that there is a large waiting time for receiving care. Another backside to this insurance is it only covers 30% of medication for chronic conditions and 60% of regular medications. This hinders the ability of people in a lower economic standing being able to afford medications necessary for chronic disorders. Due to this and long waiting lists for medical care, if patients can afford it, they prefer other insurances.

Credit: https://www.expatassure.com/argentina/

Obras Sociales (Social Security)

Credit: https://www.opticamultivision.com/obras-sociales/

This form of insurance is the second largest in the country. It is one of the biggest scams in the country. It is provided by employers by health insurances allowing employees to pay a fixed fee monthly in exchange for coverage. This insurance is run by trade unions which are the most common insurance companies in the country. They scheme those under their coverage by offering the lowest coverage possible in preventative, diagnostic, medical, dental, and maternity care. This forces the patient to pay the difference between their minimal coverage and the cost of treatment. On top of this, this insurance does not cover treatment for pre-existing conditions. This forces those under this plan to pay large sums of money for treatment and to go into debt for paying for medical expenses.

Credit: https://www.expatassure.com/argentina/

Private Health Care

Credit: https://www.expatriates.co.uk/healthcare/argentina.html

           Private insurance in Argentina is only used by 5% of the population due to most of the population not being able to afford it. Private insurance covers preventative, diagnostic, medical, dental, and maternity care. Private insurance unlike public insurance guarantees rapid treatment. This is because hospitals in Argentina prioritize patients with this type of insurance. Therefore, private insurance is more preferred to those who can afford it. Argentinian private insurance is very localized per city so insurance from one area do not work anywhere else in the country.

Credit: https://www.expatassure.com/argentina/

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Healthcare In Poland

Source: 

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=2ahUKEwjsjN_tmdLlAhWsmuAKHTHEAU8QjB16BAgBEAM&url=https%3A%2F%2Flibertyflagandbanner.com%2Fproduct%2Fpoland-flag-eagle%2F&psig=AOvVaw3GtO9M0UUNWIaEXv7sQZp7&ust=1573013289527138

If you’re just moving to Poland or are just planning to visit, you must know what your options are in terms of the countries healthcare system.

Poland has a population of around 38 million. With a female life expectancy of about 80 in the male life expectancy is around 70. This country has a healthcare system that focuses on an all-inclusive insurance policy, with the government giving subsidized healthcare to all the Polish citizens who are currently covered by general health insurance. Nowadays, there’s an extensive range of private hospitals throughout the country that anyone can go to seek medical attention just in case you don’t want to be treated or taken care of in public state-run facilities.

Source: 

https://www.independent.ie/regionals/droghedaindependent/lifestyle/together-everyone-can-achieve-more-36517803.html

Healthcare During Communism

Source: https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=2ahUKEwj_za3Gm9LlAhXlQd8KHWM7BbgQjB16BAgBEAM&url=https%3A%2F%2Fwww.johndclare.net%2Fcold_war6.htm&psig=AOvVaw2cqidId2EyNv9oTLmlF_E8&ust=1573013887259927

Unfortuantly though Poland, wasn’t always like this. Before 1989 Poland was under communist rule for 44 years. Due to the communist government, although there were still many facilities that you could go to see critical attention, they were all public unless you were a person of high power or we’re just very wealthy. If you were a government official, military, or a police officer, then you and your family had their own private hospital what you were allowed to use whenever you pleased. Ordinary people were not allowed in these hospitals, they were forced to use public facilities that were not as well equipped for medical emergencies as the private ones were.

Source:https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=2ahUKEwjUlKHSnNLlAhVGiOAKHQ5BDF0QjRx6BAgBEAQ&url=https%3A%2F%2Fwww.123rf.com%2Fphoto_44717447_vip-only-red-stamp-text-on-white.html&psig=AOvVaw01NJ6idhp9o9OZpDAOqW9D&ust=1573014176448233

Looking on the bright side, though, at least healthcare is free, right?

Well, although healthcare was technically free in Poland during communism, the way just to see one doctor could be up to 3 to 4 hours or even longer if it was the flu season or winter, especially in public facilities. Many people had to resort to bribery at the time to see a doctor sooner, so if you were both poor and an everyday person, you had to wait those long hours’ notice to see a medical professional. Also, most of the public hospitals only had general doctors who could only provide necessary healthcare procedures. If a typical person were to be diagnosed with a specific disease, they would be forced to go to a new hospital with particular doctors who specialize in that field in which your disease was classified. But government officials, military and police officers had access to all of this for free with little to no wait times.

Source: Boguslaw Kolakowski (Eyewitness who grew up during this time in Poland as a son of a police officer) Bogumila Kolakowska (Eyewitness who grew up during this time in Poland as a daughter of a typical person)

Image Source: https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=2ahUKEwiy5reTnNLlAhWRVN8KHVMODmkQjRx6BAgBEAQ&url=https%3A%2F%2Fwww.agefotostock.com%2Fage%2Fen%2FStock-Images%2FRights-Managed%2FIKO-10870009&psig=AOvVaw2rMWTg40w_jazj1qKwWePr&ust=1573014024686883

Poland’s Healthcare System Today

Today Poland’s healthcare system is still free. Still, now in Poland, hospitals and any clinics answer to the Polish Ministry of Health who are responsible for the everyday administration of the healthcare system and its standards of patient care and hygiene. Also, the ministry scrutinizes all the medical practice that occurs in the country to continually improve Poland’s health care. Unlike during the times of communism nowadays, most people do not have to wait for 3 to 4 hours to see a medical professional it would take an hour or two at most, which is a vast improvement. Also, it is much more challenging to bribe medical personnel to see the doctor sooner.    Although in Poland, even those medical care has made significant improvements and is more easily accessible to all the citizens, healthcare is still just not as advanced as when compared to its western neighbors. And any specialized medical centers can only be found in major cities such as Warsaw and Krakow. But those are just some minor setbacks right now. At the moment, Poland is in the middle of an extreme transformation of its health care system, as most of the hospitals are being prepared for significant renovations. So people can have better quality healthcare on par with its western neighbors and better access to it.

   Even though it’s taking some time, at the rate, Poland is currently going it, maybe most of his western neighbors in healthcare quality and management.

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Healthcare in Pakistan

From: https://www.lonelyplanet.com/maps/asia/pakistan/

Pakistan, officially the Islamic Republic of Pakistan, is a country in South Asia. It is the world’s sixth-most populous country with a population exceeding 212.7 million people. In the area, it is the 33rd-largest country, spanning 881,913 square kilometers. The healthcare sector is very important for any country which directly affects the economy of the country. The healthcare system of Pakistan consists of the private and public sectors. The private sector serves nearly 70% of the population and 30% by the public sector. Pakistan is a low-income country and according to the Human Poverty Index (HPI), it ranks 65th among 102 developing countries. Only 27% of the population benefited from full healthcare coverage which includes mostly government employees and members of armed forces and the remaining 73% depend on out of pocket installments.

From: http://www.ijarp.org/published-research-papers/oct2017/Healthcare-System-Of-Pakistan.pdf

Healthcare Delivery System

From: http://hospital-medical-management.imedpub.com/comparison-and-analysis-of-health-care-delivery-systems-pakistan-versus-bangladesh.php?aid=18097

The health care delivery system of Pakistan is complicated because it includes healthcare subsystems by federal governments and provincial governments competing with formal and informal private sector healthcare systems. Healthcare is delivered mainly through different institutions such as provincial and district health departments, Non-governmental organizations (NGOs), private sector and others.

From: https://en.wikipedia.org/wiki/Healthcare_in_Pakistan

Health Programs

From: https://www.streetbuzz.pk/poor-healthcare-in-pakistan/

Pakistan is a struggling economy with inadequate health statistics in the region. However, there are some programs and interventions that ensure preventive and medicinal services to the public. National Program for Family Planning & Primary Healthcare was launched in 1994. This provides Primary Healthcare Services to about 80 million people, most of whom reside in rural areas and are impoverished. Extended program on immunization (EPI) started in Pakistan in 1978 whose objective is to reduce death and disease by offering immunization services. National TB Control Program stands out as one of the Public Health Programs whose objective is to reduce the prevalence of MDR-TB among the patients who have never received any tuberculosis treatment. National AIDS Control Program (NACP) helped focused on the quality of HIV treatment and services. Malaria Control Programs are on the ground since the 1950s. Drug Abuse Control Program by Ministry of Narcotics Control in 2010-14, a program whose objective was to make a drug-free country. There are numerous other programs at the national level such as; Cancer Treatment Programs, Tobacco Control Cell, National Nutrition Program and National Maternal, Newborn and Child Health Program, and etc.

From: http://www.ijarp.org/published-research-papers/oct2017/Healthcare-System-Of-Pakistan.pdf

Health Financing

From: https://slideplayer.com/slide/5719420/

Currently, Pakistan is spending 0.4% of its GDPs on health and this amount is about 50 billion Pakistani Rupees (PKR). The funding is dominated by out of pocket payments, government revenues, private insurances, NGOs and world funding. Though no official figure exists for health expenses, it is believed that most of that amount is through out-of-pocket payments. Several organizations and agencies have made significant contributions to improve health outcomes in Pakistan over the last few decades. Foreign aid as a percentage of total health sector distribution is about 2% only. The main internal NGOs and agencies contributing to the health system are HANDS, Shifa Foundation, and Aga Khan Health Services Pakistan (AKHSP). In addition, the external funding agencies in Pakistan are USAID, and the Department for International Development, UK. Currently, some programs are being governed by donor agencies as well such as the National Tuberculosis Control Program, EPI programs, diagnostic kits for the HIV/AIDS program, and Hepatitis program.

From: http://hospital-medical-management.imedpub.com/comparison-and-analysis-of-health-care-delivery-systems-pakistan-versus-bangladesh.php?aid=18097

Health Insurance

From: https://www.investopedia.com/terms/h/healthinsurance.asp

Health insurance in the past few years has transformed into a developing and fast-growing market that is generally divided into three components: life insurance, general insurance, and health insurance. The Government of Pakistan established the Department of Insurance in April 1948 as a department of the Ministry of Commerce; the aim of this department is to take care of affairs related to the insurance industry. The cost of international health insurance in Pakistan will vary based on factors such as age, current health status, and coverage requirements, but according to the Cost of International Health Insurance - 2018 report, the average cost of international health insurance for all plans and demographics in Pakistan is USD $7,234. 

From: https://en.wikipedia.org/wiki/Insurance_in_Pakistan

https://www.pacificprime.com/country/middle-east/pakistan-health-insurance-pacific-prime-international/

Challenges

From: https://blogs.jpmsonline.com/2014/04/29/health-sector-of-pakistan-redefining-roles-and-overcoming-challenges/

Despite the increase in public health facilities, Pakistan's population growth is in crucial need of quality healthcare. Public healthcare institutions that address critical health issues are often only located in major towns and cities. Due to the absence of these hospitals and the cost associated with transportation, poor people living in remote areas tend to consult private doctors. Very few systems exist to regulate the quality, standards, ethics, and prices within the private health sector, which results in disparities in health services. The health care is now a provincial function and the four provincial governments can set their own priorities in their respective provinces. Considering the current economic situation in Pakistan, it is unlikely that the government will be able to enhance provisions to the health sector without expanding the tax base and improving tax collection. It is also essential to set up a health system that offers efficient comprehensive care. Medical practice in the country is alarmingly unregulated. Moreover, it is costly at the point of service. Providers need to be regulated for standardized, quality care. The country’s health sector is also marked by urban-rural disparities in healthcare delivery and an imbalance in the health workforce, with insufficient healthcare providers such as nurses, paramedics, and physicians. Moreover, Health Policies mainly focus on an increasing number of health facilities, laboratories, ambulances, and modern equipment’s without assessment of how health professionals will use them, who are not trained for modern technology.

From: http://www.pakistaneconomist.com/2017/02/27/public-hospitals-and-healthcare-facilities-in-poor-quality/

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Health Care in Russia

Photo credit: https://www.optilingo.com/blog/russian/health-care-system/

In the beginning:

Russia is the largest country in the world by size and has a population of 145 million people. Being the 9th largest country by population means the government has a big job to make sure their citizens are well taken care off. Unfortunately most Russian citizens might have a hard time receiving the care they need. Russia has had a long history of health care that spans across the Tsarists Era, the Soviet Era and till present times. Russia is considered a super power in the world but their health care system does not reflect that title. Economic and government issues that started in the 1980’s have lead to a health crisis today.

 With communism came one of the first promises of free healthcare to all citizens. The promise was fulfilled with a program called the Semashko system. This system was created in the 1920’s and it included government funded health care for every citizen, in this system all medical employees were employed by the state. The Semashko system saw great success with better overall health across the country. At one point healthcare and health standards in Russia equated those of the United States and some European countries.

 Credit: http://ghandra.cat/index_htm_files/indextutor_htm_files/09.-%20Essay_russia.pdf

The Down fall:

Unfortunately as time went by economic strife hit the country and it took a toll on the health care system. Under investment into health care caused serious issues that the country still feels today. Even though the Soviet Union had four times the amount of doctors and hospital beds than other developed countries the lack of funding caused the quality of health care to decrease. There were shortages in medicine, diagnostic equipment, and most common technologies that were present in that area. Even the medical staff was under trained. Food and bedding offered were of poor quality or sometimes not existing. Some hospitals did exist for the elite of the Soviet Union which was equipped with better doctors and equipment, but even those were considered low by global standards. The decline of heath care continued into the fall of the Soviet Union in 1991 and went even passed that into the 2000’s. At this point the life expectancy of a Soviet Citizen was 10% less those citizens in the united Sates.

Credit: https://www.sochealth.co.uk/2017/05/26/health-reform-revolutionary-russia/

 Life expectancy in Russia and the US, 1960-2015.Data source: World Bank - World Development Indicators

Reforms after the fall of the Soviet Union:

After 1991 and the fall of the Soviet Union, the new Russian government took it upon themselves to fix their health care crisis. Reforms were put into place that promised a citizen’s right to obtain free health care and assistance.  Some changes were put into effect to uphold that promise. A new mixed model of health care was put into place. Alongside regular state funded health care, citizens would be required to obtain their own private insurance as well. The private insurance was funded through OMS, a type compulsory medical insurance that was funded by the people through taxes and employers. OMS gave insurance to all people, working or non working. OMS funded over 300 private insurances. Also after the fall of the Soviet Union, doctors were now allowed to work in the private sector. Having their own insurance and private doctors allowed citizens of Russia to be able to choose which doctor they would like to see instead of going where ever the government sends you.

The downside is that these reforms didn’t do much to help the people; private doctors didn’t become popular as people still went to state funded hospitals which had low health care standards. And most of the private insurance companies that were being funded by the OMS system were for profit and were using it to make their own money without care for the people. And on top of the new failed system, some old issues were still around, most regions on Russia still had no access to healthcare and doctors and some regions still only had mediocre care. For the people that lived in urban areas, they were somewhat better off because most doctors were practicing in those locations.

Credit:1) http://www.oecd.org/officialdocuments/publicdisplaydocumentpdf/?doclanguage=en&cote=eco/wkp(2006)66                    

2)http://siteresources.worldbank.org/INTRUSSIANFEDERATION/Resources/PublicSpendingInRussiaforHealthCare.pdf

3)https://www.rand.org/pubs/conf_proceedings/CF124/CF124.chap5.html

Photo Credit: https://assets.bwbx.io/images/users/iqjWHBFdfxIU/i6WdF4h6_bz8/v3/800x-1.jpg

Present times:    

After the past failed attempts to fix the healthcare system, president Putin decided to start spending more on healthcare. He added $10 Billion to fund heath care and increased the amount of money employers put into OMS to 5.1%. Also to increase the quality of health care given the salary of doctors was to be increased. With more funding going into health care the quality of medical training increased, but only in some areas. State operated clinics still had mediocre care, and this allowed private insurance companies to become more popular because having private insurance allowed you to see doctors outside state run clinics. These private clinics had better doctors, training and equipment. The problem with this is that all of these changes only benefited large cities. The only way to get top tier mandatory insurance through OMS is if you had a high paying job/employer to fund it. In smaller towns the lower salary are not enough to support top or even mid level tiers for private insurance, so the people still have to go to state run clinics which have mediocre care. And besides the low quality of care, some places in rural towns don’t even have physical access to clinics to seek the care they need, and if they do have access the doctors are under trained and needed equipment is either outdated or not even present. This model of health care favors the people in large cities like Moscow while ignoring the rest of the country.

 Aside from insurance through OMS or the government, citizens can also purchase their own insurance, this insurance usually got you the best care around but only if you can afford it. So the only way to get good care in Russia is to have a good paying job at a good employer, or be rich enough to afford your own insurance.

Credit: 1)web.archive.org/web/20160920033739/http://www.jamestown.org/single/?tx_ttnews%5Btt_news%5D=42927&no_cache=1

2) http://russialist.org/in-putins-russia-universal-health-care-is-for-all-who-pay/

Photo credit: https://www.bizarro.com/cartoons

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Health Care In Uruguay

Credit: http://powderlyspanish160.blogspot.com/2015/01/

Uruguay is a country in South America located between Argentina and Brazil. Its population is about 3.46 million people. Currently, 8.2 percent of the population experience poverty. Although this may be the case, public health care is available to all Uruguayans despite their financial standing. Uruguay gets its funding for public health care through property taxes, corporate taxes and export taxes. Currently there is no income tax in Uruguay. This allows Uruguayans to spend their funds on other forms of health care such as private insurance and private-hospital membership plans called “mutualista”, as well as other daily necessities.

Credit: https://www.worldbank.org/en/country/uruguay/overview

Health Care Coverage Systems

Credit: http://www.asse.com.uy/categoria/Region-Este-516?pagina=1

Public Healthcare System

           The public health care system of Uruguay is called La Administración de los Servicios de Salud del Estado or ASSE for short. This health care system provides care for all those with need, who don’t have a coverage plan already. In order to gain this health care plan, one must go to their website, describe the need the patient needs for this coverage and apply. Depending on the persons financial standing, the health care plan may be accepted or declined. This public health care system does not cover frequent health care visits as well as full medical procedures.

Credit: http://www.asse.com.uy/categoria/Region-Este-516?pagina=1

Credit: https://www.bcbsu.com.uy/bcbsu/archivos/Carta_factura_electronica.pdf

Private Insurance

The main private health insurance company Uruguay has is the Blue Cross Blue Shield de Uruguay. This company offers corporate and individual health care insurance plans. They include no limit to clinical office visits as well as no out of pocket copay fees. Under these plans all exams and medications are fully covered. This medical plan also covers around $35,000 USD in treatment in foreign countries.

Credit: https://www.bcbsu.com.uy/bcbsu/SiteBCBSU

Credit: http://www.ciu.com.uy/innovaportal/v/263/1/innova.front/cosem---mutualista-semm.html

Private Hospital Membership Plans

           The last form of health care coverage plans is Private Hospital Membership Plans. These are called Mutualista and usually cost around $100 USD a month. When entering in one of these plans, a patient personally makes a contract with a hospital which they will be primarily attending for future care. These plans can be made to individual hospital as well as big chain hospitals. Patients in these plans have discounts on medication and treatment as well as smaller copays. These plans usually don’t cover psychiatric health.

Credit: https://internationalliving.com/countries/uruguay/health-care/

Credit: http://serenelifehospital.org/psychiatric-disorders

Challenges

           The one issue with Uruguayan health care coverage is that only the more expensive private health insurance covers all aspects of health care. Public and hospital membership plans don’t cover psychiatric treatment and stay in hospitals while Private health insurance covers 12 psychiatric visits a year as well as a 30 day stay in a psychiatric unit of a hospital yearly. This shows that still certain aspects of health care are unavailable to the full population. of people.

Credit: https://www.bcbsu.com.uy/bcbsu/SiteBCBSU/Archivos/Planes/plan_sm350.pdf

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Healthcare in the Philippines

Photo: https://medicalobserverph.com/tag/philippine-healthcare/

The Philippines is an archipelago in Southeast Asia. Known for its diverse history and amazing natural scenery, it is home to approximately 105 million people. With a poverty rate of 21%, access to healthcare is a challenge to many Filipinos. In 1995, the Philippine government created the Philippine Health Insurance Corporation (PhilHealth) with a goal of providing sustainable national health insurance for all. 

Credit: https://web.archive.org/web/20110904135731/http://www.philhealth.gov.ph/about_us/others/ra7875.pdf

Photo: https://businessmirror.com.ph/2019/06/09/philhealth-chief-insists-no-mafia-in-agency-probe-of-anti-fraud-cases-continuing/

Philhealth

Philhealth is a tax-exempt, government-owned and controlled corporation (GOCC) of the Philippines, and is attached to the Philippine Department of Health. It’s goal is to provide sustainable quality  healthcare to all Filipinos. 

Credit: https://en.wikipedia.org/wiki/Philippine_Health_Insurance_Corporation#cite_note-1

Membership

There six membership categories:

(1) "Formal" sector are workers employed by public and private companies and other institutions. 

(2) "Indigents" also called "Philhealth sa Masa" are subsidized by National Government the National Household Targeting System for Poverty Reduction. 

(3) "Sponsored Members" are subsidized by their respective Local Governments (LGU). 

(4) "Lifetime" (non-paying members) are retirees and pensioners and have already paid premiums for 120 months of membership and are 60 or older. 

(5) "Senior Citizen" under RA 10645 that all citizen ages 60 years old above are eligible to have free philhealth coverage. 

(6) The "Informal Economy" is composed of Informal Sectors, Self-Earning Individuals, Organized Group, Filipino with Dual Citizenship, Natural-Born Citizen. Although treated separately, the Overseas Filipino Workers (OFW) program or Migrant Workers is as part of the Informal Economy. Migrant Worker is sub-categorized as whether Land Based or Sea Based (for Sea Fearers).

Credit: https://www.philhealth.gov.ph/members/

Photo: https://www.who.int/features/2015/ncd-philippines/en/

Coverage

Recent Reforms have allowed Philhealth to shift from Fee-for-service to Case Rate payment scheme. Coverage is essentially the same across categories with additional outpatient benefits to indigents and OFW’s. Deduction rates largely depends on the medical diagnosis of each patient. Each diagnosis contains a full service package that includes physician fees, diagnostic fees, medication lists, and outpatient services.  This deduction list will be subtracted from patient’s final bill. Indigent and sponsored members, lifetime members, senior citizen members and household members are entitled to avail the free hospitalization under the no-balance billing scheme (NBB) when they are admitted in a non-private room of public or government hospitals. 

Credit: http://www.mb.com.ph/articles/280037/extending-health-care-all-filipinos

Service Delivery

61% of the network's providers are private and 39% are public. In order to achieve accreditation, all in-network hospitals and day-surgery centers must be licensed by the Department of Health.

Photo: http://www.access2hc.com/our-philippines-team.html

No Healthcare system is free from flaws and Philhealth is far from it. Since its creation, it has dealt with corruption, enrollments,  over inflation of healthcare claims from providers and facilities as well as push back from pharmaceutical companies and private insurance providers. Despite these serious limitations and challenges, the Philippine Government is heading in the right direction when it comes to addressing the healthcare needs of its people. It is worth considering that if a tiny island nation in the pacific can attempt to provide universal coverage for majority of it’s citizens, maybe this country at least have a decent bipartisan debate on affordable healthcare for all Americans.

http://www.newsbreak.ph/2011/05/25/bogus-claims-haunt-philhealth/

Photo: https://www.dreamstime.com/doctor-holding-fruits-vegetables-hands-philippines-flag-background-national-healthcare-concept-medical-theme-image154611084

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Health care in Japan

As we have discussed healthcare in the United States, let’s talk about the healthcare on the other side of the world, Japan. Japan is known for their technology, traditional tea houses, pet cafes and more, but do we know what their health care system is like? 

Japan’s government has long boasted about their healthcare system and it may just be as good as it sounds. Japan’s healthcare system guarantees that 100% of their citizens have healthcare, well at least the people who can pay for it. Japan covers a range of healthcare services from screening services to prenatal care to disease control. Their government is willing to cover 70% of patient’s medical costs, with the patient paying either 30%, 20% or even 10%! The percentage the patient is paying obviously varies depending on family income, to make everything affordable for the low-income families. Monthly payments are made to the insurance companies for coverage. Seems like Japan really lives up to its boasts and claims and got everything under control.

credit: https://www.japantimes.co.jp/news/2017/02/19/national/japans-buckling-health-care-system-crossroads/

Photo credit: https://konnnichiwa.com/healthcare-system-in-japan/

Most working personnel are given healthcare insurance by their employers but for the employees that do not get insurance from their employer, no need to fret because the government has just the thing. People who are not given insurance by their insurance can participate in a national health insurance program that allow patients to choose their own health facilities and physicians and won’t be denied coverage. How great is that!

credit: https://en.wikipedia.org/wiki/Health_care_system_in_Japan

Photo credit: https://konnnichiwa.com/healthcare-system-in-japan/

Japan has boasted that Japanese health care is first class and has reached new levels with low mortality rates and high life expectancy. With all this insurance coverage, Japanese people can see their physicians twice as often compared to Americans. Japan has the world’s longest life expectancy and second lowest infant mortality. Japan indeed has one of the best healthcare systems. Despite this great health care system, there is another side of this story. Japan’s technological advances as a first world country has made so much improvements in the medical field. They have helped many people with the arrival of new drugs and procedures. But with the rise of new drugs to manufacture, costs can get very high. This can make the sustainability of this healthcare system waver. Japan is trying to get their system under control though, they are trying to do their best to help people in need. 

Credit: https://www.snopes.com/fact-check/healthcare-in-japan/

Photo credit: https://medium.com/emi-foundation/healthcare-in-japan-d1a105693de6

One example to show how benevolent Japan is, is when the drug Opdivo was being used in Japan. This is a biotechnology driven drug that can treat lung cancer, melanoma, metastatic and more. Japan’s government has made it official to halve the price of Opdivo for patients, to make it more easily attainable. This drug costs ¥35 million yen per year per patient which is $325,080 in USD per year per patient. That is a lot of money. The Japanese government still decided to cut the price in halve to help adjust to the ones with lower incomes. Look how great Japan’s healthcare system is! People with any kind of job can have access to drugs needed. If only America had a healthcare system like that instead of making patients wait longer to see a physician and using our tax money for their own selfish purposes.

credit: https://www.japantimes.co.jp/news/2017/02/19/national/japans-buckling-health-care-system-crossroads/

Photo credit: https://imgbin.com/png/2NGukZ7s/japan-job-organization-person-illustration-png

There is no government regulation in the United States healthcare system unlike Japan. This can cause so many health problems in the rural and poor areas of the U.S. which results in low life expectancy rates and high rates in obesity and heart disease. People are not getting the help they need from the government and yet the U.S. government expects the citizens of the country to support their every move while collecting taxes at high rate?  We really need to learn from the Japanese government to adopt their ideals, the way they treat their citizens and most importantly adopt Japan’s healthcare system. 

credit: https://www.snopes.com/fact-check/healthcare-in-japan/

Photo credit: https://www.pinterest.co.uk/pin/696298792362273943/

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Healthcare in the United States

credit: https://henrykotula.files.wordpress.com/2015/11/cartoon-us-healthcare-policy.jpg

As the leader in the global economy, you could reasonably expect that the United States would also rank high in terms of health care, but it instead sits somewhat uncomfortably at number 37 on the World Health Organization’s list of global healthcare systems. Some of those countries that beat us on that list are perhaps predictable like France (#1), Italy (#2), Spain (#7), others for whatever reason were a little less obvious to me, like Saudi Arabia (#26) and the United Arab Emerats (27) and a few of the countries that outrank us I’m not embarrassed to admit I’ve never even heard of. San Marino anyone? Number #3. Am I the only one who’s never heard of the great country of Andorra? They’re number 4 on the list. 

To complicate matters, the United States is  #1 in terms of healthcare spending per capita according to the Organization for Economic Cooperation and Development, in fact spending over twice as much per person as its competitors. Yet a 2014 study by the Commonwealth Fund found this country to rank last in a group of 11 industrialized countries in terms of health measures like life expectancy, mortality from preventable conditions and infant mortality. And, we sit at #30 on a list of life expectancy by the Center for Disease Control, with Americans on average living to 78.6 years old, a number which has been on a decline for the past four years- largely attributed to suicide and drug overdose, likely from the opioid epidemic. 

How is it that the richest country in the world that spends the most per capita on healthcare ranks so low in terms of quality and life expectancy? If not towards the health of the populace… where is the money going? 

credit: https://iroon.com/irtn/cartoon/2855/us-health-care-system/

Although our current president apparently did not know that healthcare could be so complicated- we, as a group of nursing students, have a fairly reasonable grasp on the notion and are not attempting to exhaustively report on the state of healthcare systems around the globe. Instead, we want to explore who pays for what in different countries, how public versus private systems work and are organized, and how these different setups benefit citizens in terms of relative measures of health like life expectancy, infant mortality, relative availability of medical care. 

How Healthcare in the United States is Organized 

In the United States there is a decentralized system of health insurance, meaning that no single entity finances medical expenditures. Instead, financing of things like regular doctor visits for preventive care, hospital stays, and prescription medication comes from a mixture of governmental sources on the federal, state and local levels, privatized insurance companies and individuals. Most people rely on their employers to pay for their health insurance, and public assistance like Medicare provides for citizens over 65 years old and the disabled, and Medicaid which covers people with low income. According to the Census Bureau, private insurance policies covered over half of Americans (56%), followed by Medicaid, Medicare, direct purchase policies covered, and then military benefits- leaving 25.6 million Americans without health insurance in 2017- a number that jumped to 27.5 million in 2018 and is expected to rise in 2019. 

Delivery of healthcare services is also decentralized, lacking any kind of regulation in terms of dispersal of medical facilities. Physicians are authorized to practice individually and the trend in the past has been to set up solo practices, although multi-physician facilities are also found. And hospital services are provided by a mix of government funding, private for profit and not for profit organizations. Both doctors offices and hospitals are established at the discretion of their organizations, and being for profit endeavors, naturally gravitate towards more populated, more able to pay geographies which can cause problems for those in rural and inner city areas. 

How Healthcare Dollars in the United States are Spent 

These two charts detail the money trail in the US, who’s paying for what kinds of services in the healthcare industry. 

credit: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/PieChartSourcesExpenditures.pdf 

credit: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/PieChartSourcesExpenditures.pdf 

Now that we have an idea of where the money is coming from and how it is spent, let’s look at the value of those dollars and circle back to that question: How is it that the richest country in the world that spends the most per capita on healthcare rank so low globally in terms of quality of healthcare provided? 

A lot of people think Americans are just wasteful. They blame the huge amount of GDP spent on healthcare on too many people getting a frivolous amount of medical services, and a huge network of specialists driving a huge amount of medical appointments in lieu of preventive care type actions. But, a major study of the US compared to ten other industrialized countries shows that in terms of utilization, proportion of specialists, and medical services spending compared to spending on other social services/preventative care, we actually come out in the middle of the pack. 

  The problem instead seems to be that everything in this country just COSTS more. Medical school is expensive and therefore our doctors are expensive, the pharmaceutical industry is unregulated and therefore prescription drugs are more expensive. Not to mention the fact that pharmaceutical advertising is legal in this country, and advertising is expensive- the costs of which get passed down to the consumer. And moreover, the privatized insurance industry adds layers of cost simply by nature of being for-profit- they too spend consumer dollars on marketing and advertising, and have margins built into their costs for… well, profit. 

Our system is also incredibly inefficient and complex. For example, I didn’t realize that we have separate healthcare systems for “seniors, veterans, military personnel, Native Americans, end stage renal care, under 16 in a poor family, over 16 in a poor family, and working for the federal government”- according to T.D. Reid who wrote a book about this topic. And, because the system is so complicated, there’s a whole industry of people called “compilers” who aggregate medical bills and shuttle them through the complicated payment and reimbursement process. 

Also, the fact that there is no governmental regulation on the healthcare industry means that for profit physicians, hospitals, pharmaceutical manufacturers, etc. can charge essentially unlimited amounts for services. And they’re free to compete in the free market for real estate in profitable areas without any mandate to provide necessary services to people in low income or rural areas- causing a huge gap in care that can probably explain why our average life expectancy is so low and rates of obesity and heart disease are so high. 

credit: https://www.cartoonstock.com/cartoonview.asp?catref=hscn3887

I fell through the cracks of our healthcare system personally in years right after college when I was freelancing and made too much money to qualify for Medicare or any governmental health benefits but not enough money to pay for health insurance out of pocket because it’s outrageously expensive. Even when Obamacare passed in 2010 I knew plenty of people who still couldn’t afford the premiums, and then were fined for failing to secure healthcare coverage later. I think the move towards a Medicare for All single-payer government regulated healthcare system is necessary to fill in the kinds of gaps we’ve talked about here- helping to insure that Americans in all parts of the country have access to a high standard of healthcare, that nobody is lacking in local emergency services, and that people can afford their prescription medications, and that people are free from being at the mercy of for profit insurance and medical corporations for essential life saving services. I’m really interested to see what other healthcare systems are like in countries around the world, and curious if there are other privatized systems that better serve its citizens or if government regulated healthcare is the best way to go. 

credit: https://thecomicnews.com/edtoons/2012/0711/health/04.php