Australia, Canada and Ireland have universal healthcare systems, although run on different lines to Britain's NHS. And then there is the USA
As David Cameron makes personal pledges on the future of the NHS, after fierce opposition to the government's NHS reform plans, the coalition would do well to examine other countries' experiences of running a public, universal health service.
European countries, explored in a previous article, tend to use a mix of public and private provision, with safety nets for those who can't afford the latter. Australia and Canada have comprehensive coverage, but it is provided in different ways to Britain's, with use of insurers, public and private. Canada's universal scheme, which used to be similar to the UK NHS, was almost downed in the 1970s by GPs looking at their colleagues' wealth south of the border - possibly showing what a health service with greater input from GPs might look like.
Ireland has its own NHS, but its system seems complex by comparison to Britain's. Meanwhile, it is difficult to see the plus points in the US healthcare model, which President Obama is working steadily to change – though he may be losing the battle.
While British and Irish visitors to Australia get access to the government-run Medicare scheme on a reciprocal basis, the system is quite different to the NHS.
Medicare is controlled by the Australian government's Department for Health and Ageing (DHA). But each state is responsible for public hospitals under the Medicare scheme, which dates from 1984 (the same year Canada's system was implemented). Blood transfusion services are provided by the Red Cross and dentistry, optometry and ambulance services are outside Medicare.
There is a separate government-run pharmaceutical benefits scheme that subsidises prescription medication and allied treatment, but patients are expected to pay the excess at the point of dispensing.
Medicare is financed by a 1.5% income tax levy, plus an additional 1% levy on higher rate taxpayers who do not take out private insurance. The government encourages all citizens to take out private healthcare to top up the Medicare co-payment system - which offers 100% subsidies (in other words, free) treatment for in-patient stays, 85% for specialist services and 75% for GP treatments.
Patients are expected to pay at the point of care for the 'excess' unless they have insurance or exemption. However, there is also a low earners card allowing totally free government-funded healthcare.
Private insurance is complex, with citizens choosing between a mutual or the government-run Medibank service. There are incentives for young working people to sign up for private insurance, with premiums being government subsidised on a mean-tested rebate basis of between 30 and 40%. However, citizens over 30 are premium surcharged on private insurance at the rate of 2% per year, up to a cap of 20%. Private insurance also operates on a community basis, with premiums not wholly based on age or previous medical history.
With its Commonwealth links, Canada has paralleled the UK in developing universal health coverage. In 1944, the province of Saskatchewan introduced universal hospital insurance, four years before Britain introduced the NHS. In 1956, the federal government offered an open-ended 50-50 cost sharing arrangement between itself and the provinces, and within two years all provinces had introduced universal hospital coverage.
In 1962, despite medical strikes against the plan, Saskatchewan introduced full universal medical coverage. By 1965, the federal government had launched a national programme with 50-50 cost sharing, with national implementation in place by 1971.
But the scheme started to fall apart by the late 1970s, with many GPs - reportedly eyeing the wealth of their US colleagues - opting out of the state programme. This resulted in a complete revamp in 1984 to a Medicare scheme, implemented along the lines of the Australian scheme of the same name.
However, unlike Australia virtually all Canadian healthcare is delivered free at the point of care. Most services are provided privately under the Canada Health Act, which lays down strict standards and administrative simplicity. This simplicity involves a GP-centric organisation - a single payer system which bears more than a passing resemblance to the planned GP commissioning model for England - with no billing involvement for the patient.
Most hospitals are publicly-funded, though each unit operates on an independent basis, a factor which is acknowledged as potentially increasing overall healthcare costs.
Each citizen is issued a health card, which acts as their passport to healthcare, in a similar fashion to many European countries including France. Dentistry and optometry are not always covered – it depends on the province – but if not, people are usually insured through employer-funded schemes. Prescription medicines are chargeable, but subject to very strict price controls.
Republic of Ireland and United States of America
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Read the complete post at http://www.guardian.co.uk/healthcare-network/2011/jun/07/healthcare-systems-australia-medicare-canada-saskatchewan
Jun 07 2011, 12:21 PM
Healthcare Network | guardian.co.uk