Taking The Measure Of Health Care In America

Compare Medical Bills

The United States spends on average $6,402 per person annually on medical care. France spends about half that — while providing better maternity benefits and complete coverage for people with conditions such as diabetes and cancer. Compare the systems.

Health Care For All

In a month-long series, NPR examines five countries in Western Europe that provide health care coverage for all of their citizens.

Series At A Glance

Germany

Germans are quite satisfied with their care, Richard Knox finds. But doctors have some major gripes about how they are paid.

Every doctor gets a quarterly budget related to the number of patients he or she sees. Once the budget is used up, doctors are essentially working for free.

Meghan Sullivan reports on how Germany handles the few people who lack health insurance only 0.2 percent of the population is uninsured, compared with 18 percent in the United States.

France

France's fabled maternal care system and the country's new approach to treating cancer are the focus of Joseph Shapiro's stories.

"People feel secure that they'll get the care they need," he says, "even the most expensive, experimental drugs. And they know they won't have to fight constant battles with insurers to get coverage or manage their care."

The Netherlands

The Netherlands' recently reformed health care system is essentially a giant national HMO, using for-profit and not-for-profit companies.

Patti Neighmond reports that several leading American experts see the Netherlands as a leading model for the United States.

Great Britain

In her interviews, Joanne Silberner finds strong support for rationing health care in the United Kingdom.

"The folks I talked to were unanimous in saying that it was better for everyone to have access to a broad base of care than for some people to have access to the latest high-tech medicine and others to have access to nothing," she says.

Switzerland

Switzerland's private health care system has been cited by some Republicans as a potential model for a future U.S. health care system.

"The Swiss value health care highly and are willing to pay a lot for it," Julie Rovner reports. "But like Americans, they don't want to give up free choice in the name of cost containment and are being hammered by ever-rising costs."

No doubt you've heard that the United States is the only developed nation without a universal health care system that provides care for all.

The result is that 47 million people in the United States lack health coverage. It's one reason the U.S. ranks 29th in the world in terms of life expectancy and at or near the bottom of most international health care comparisons.

What you might not know is that many of the universal health care systems in Europe provide high-quality health care to all residents, at a much lower cost than what people in the United States spend on health care.

Waiting times for care aren't all that different from the United States, and Europeans use the same high-tech medicine, only more sparingly.

Indeed, the countries of Western Europe rank higher on most measures of good health.

The cost to achieve better overall health in those countries is far less than you'd expect. Spending per person is about half what's spent in America, which in 2007 was around $7,000 a year.

High costs and the lack of access to health care are likely to be big issues in the U.S. presidential election this fall. A key part of the discussion will be whether the country should establish universal health care or go in a different direction.

To provide context for these upcoming debates, NPR is presenting a special monthlong series, Health Care for All, which examines five countries that have the most successful health care systems in the world: Germany, France, the Netherlands, the United Kingdom and Switzerland.

Radio and online reports will look at major aspects of health delivery in these five countries. Things like how quickly patients get needed care. How much they have to pay in taxes and copayments (not as much you might think). And the problems they face as their populations get older.

Each Friday, you can hear a podcast of that week's radio stories. Just download NPR: On Health to your computer or your MP3 player.

SERIES ISSUES

Health Insurance Mandatory

Each of the five countries has a different structure for financing and delivering health care. But all have one thing in common: Health insurance is mandatory for all residents.

Our reporters and producers said nearly every person they talked to was astonished to learn that in the United States, health care isn't automatic — or required — and that medical bills are the most common reason for bankruptcy.

"We have in Britain, as in most of Europe actually, health care systems that are based on the principle of social solidarity," Sir Michael Rawlins told NPR. He runs the National Institute for Health and Clinical Excellence, which determines which drugs and treatments will be paid for by the government.

"We look after each other when we're sick, and that's very precious to us in Britain and other parts of Europe, too," he said. "And that's what we find so difficult to understand about your system — you don't have that."

Solidarity is often equated with socialism, though only the U.K. has nationalized health care. The others have built their systems around privately owned insurance companies, doctors in private practice and hospitals that are in large part owned by religious or other private institutions.

You can compare the differences by looking at the set of interactive charts on this Web site and decide for yourself whether universal care is where our country should be headed.

One thing that emerges from our reporting is that Americans are paying more for health care than Europeans, and getting less overall.

Costs Rising Everywhere

Our reporting team found that rising health care costs are a major issue in each country they visited and that each takes a different approach to keeping costs down. The United Kingdom, for example, explicitly rations expensive care — an idea that doesn't have much support in the United States.

But in the other countries, governments play a lesser, though important, role. The private sector is still crucial.

The most laissez-faire country is Switzerland, and that's one reason its health care system is finding favor among Republicans. The country covers everyone through private insurance, which is not linked to people's jobs. The Swiss choose from a broad array of health plans. In general, they can choose any doctor or any hospital they want.

That freedom comes at a price. The Swiss system is the second most expensive system in the world after the U.S. system. American conservatives say that maintaining free choice is worth the cost.

Economists point to profits and administrative costs as the main drivers of health care costs in the United States. Overall, health care is not nearly as lucrative in Europe as it is here, because of more intensive regulation of the various health care sectors in Europe.

Another difference behind the lower costs is that care is less intensive in other countries. A headache doesn't always necessitate a CT scan in Europe, as it seems to in America.

Differing Expectations

The five countries examined have fewer MRIs, fewer expensive heart procedures — less of the high-tech medicine that keeps costs so high in America. And with fewer machines comes less of a financial incentive to keep them running at a profit.

"People [in the U.S.] routinely expect to become millionaires in health care. That is much less common in Germany," Princeton economist Uwe Reinhardt says. "Everything in Germany is more modest in scale, more modest in expectations."

And it's that difference in expectations that is one of the most distinguishing features of European health care.

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