Chapter 19

1. Chapter 19 American Health Care in International Perspective Joe White

2. Comparing Possibilities • Range of comparison • Offers insight on just what is possible in the field of health care • This is particularly useful when America, or any other country, contemplates health care reform

3. Comparing Cause-and-Effect • Pooling experiences in health care worldwide • Shows how certain actions lead to predictable (or unpredictable) reactions

4. Comparing Cause-and-Effect • For instance: • Successful adoption of national health insurance appears linked to making insurance compulsory for a broad sector of society (based on income)

5. Comparing Cause-and-Effect • For instance: • Aging does not raise health care spending per se • Far more important is how much a society pays in health care costs

6. Comparing Preferences • Preferences often dependent on one’s position in a society • Especially one’s professional affiliation

7. Comparing Preferences • Many health care positions and popular conceptions • Actually arise from the opinions of established groups • Cost-savings arising from preventive care are, for instance, often stressed by public health workers

8. Comparing Preferences • Shape of a particular national health care system • Often contingent on just which views, and therefore interests, are valued over others

9. “International Standard” of Health Care • Just about every major industrialized country offers health coverage to nearly all citizens • U.S. stands out (negatively) in this regard • 40 + million lacking coverage today

10. “International Standard” of Health Care • Most other countries cover all “medically necessary” procedures • With the definition thereof differing between systems

11. “International Standard” of Health Care • While many in other countries receive “decent” care • Some others more • Many in the U.S. also receive decent care, with some receiving far more • But with many others receiving minimal or no care

12. “International Standard”of Health Care • In other countries: • Insurance is not purchased, but financed by the State through any number of mechanisms • In American context: • ACCESS TO CARE is often determined by the ability to pay • Infirm often pay more than others, as do larger families

13. “International Standard”’of Health Care • Cost control is handled differently in other countries • Number of payers strictly circumscribed, and savings coming from the pooling of buyers • Plethora of buyers exist on the American market • Few effective cost control measures

14. Limits of Comparison • Nations and peoples are unique in some ways • Therefore comparisons aren’t always foolproof

15. Limits of Comparison • International comparison does little to reveal alternatives in health delivery systems • As there is such diversity within the U.S. on this count

16. Chapter 19 Summary • Efficacy of international comparisons in health care arises from their capacity to offer insights on possibilities • Cause-and-effect relationships, and preferences • United States diverges considerably from the “international standard” in health care

17. Chapter 19 Summary • Far higher health spending: • Does not seem to translate to significantly better health outcomes in U.S. • When compared to those in other nations

18. Chapter 19 Summary • Those in similar (professional) positions worldwide • Tend to have similar preferences • But different systems can shape broader political positions • Just which interests have the upper hand in policy debates