I have a question for those in countries that have nationalized health care. Are competing health services deemed illegal? If a group of doctors and venture capitalists want to open a state-of-the-art cancer treatment facility with the latest equipment, charging correspondingly high fees to customer willing to pay these fees, does the government shut them down?
We have a National Health Service here in the UK.
We also have a private system, where you pay a lot (or use private health insurance).
Why would the Government shut down a well-run alternative service?
Ditto Israel – system is slightly different from the UK, in that there is already some competition built into the system – there are 4 Health Funds, who **must **insure anyone, and they get paid by the government.
Said funds can also offer additional benefits paid for directly by the beneficiary (although they do it through insurance companies, each offer is effectively ties to a single fund).
Then you have private insurance companies offering yet further coverage above and beyond that…
And you have private hospitals, as well.
In other words – basic coverage is guaranteed. Anything beyond that is free market.
Ditto in Australia. There’s a government-run and financed public health system, and there’s the alternative of private doctors. You pay for the private doctors yourself - or make use of your private health insurance. In fact, private health insurance is heavily subsidised by the government as an incentive for people to buy it and use the private system, thus lessening pressure on the public one.
Mexico has nationalized health care (guaranteed by their constitution), but any coverage worth anything is completely private.
Canada has a mixed public/private system, but I have to imagine (I don’t know) that doctors offering basic services must participate in the government pay scale. Otherwise, why do so many cash-wielding Canadians come to the US for their coverage?
Yeah, sorry – not the most informed of responses :o
As I understand it, the Canadian situation is rather complicated, with about as many answers as provinces (maybe more, given the ongoing legal challenges). In some provinces, your hypothetical high-cost high-tech clinic seems like it would be illegal; private medical providers are not allowed to charge more than the rates within the public system. (I’m not sure how that would cover, say, new diagnostic tests which are not used in the public system.) In others, it’s legal, but there are other disincentives to private practice; for example, patients are not allowed to use their public insurance coverage to cover any of the cost of private health care.
Here’s one summary of the Canadian situation.
I don’t know; it seems odd to me too, but some of the Canadian regulations do seem to be directed toward that end.
One of the problems with private healthcare in the UK is that its used to jump the queue for more routine surgery such as joint replcement, rather than for the much more serious and expensive stuff.
This is annoying in itself, but understandable, but the worst aspect I find is that if anything happens to go wrong then the first thing these private hospitals do is ship their patients off to our Nationalised system, so that they cause the problems whilst trying to make money, and then cost the rest of us to pay for their problems, and in effect they are using our Nationalised system to subsidise their own risks.
Its annoying because the private patient jumps the queue and then pays a smaller amount for their treatment than their risk justifies, when they should be paying more to fully reflect all the costs of their treatment.
Germany effectively has two distinct health systems parallelly. There’s the nationalized system with compulsory health insurance for people below a certain income limit (for some, I presume historic, reasons, self-employed people and government officials are exempted from compulsory membership in this system). There’s a lot of debate about reforming this, but as of today, the majority of the German population is obliged to participate in it. Contributions are a percentage of your income; there’s a certain degree of competition between various insurers, almost exclusively based on the percentage of your income the insurer charges as the scope of benefits covered by these insurances is regulated by the government.
Then there’s the “private” sector of health insurance, where membership is voluntary and which those people who choose not to participate in the government system (and who are allowed to stay away from it) use. These insurers compute the premiums of their customers based on risk factors like age, previous illnesses, etc., usually without regards to income as they do not regard themselves as a part of social welfare. Usually, these insurances cover better and more expensive treatments than tghe government systems, which is why doctors prefer “private” patients. Some doctors do not even accept publicly insured patients.
In Canada, most healthcare is paid for by the provincial government. GPs are usually running their own business, but they submit the bills to the province. Hospitals, on the other hand, are built and run directly by the province.
In Canada, allowing such a private treatment centre would likely violate the Canada Health Act, which provides for Universality of care, among other things. The province in which the treatment centre was located would have to shut it down or risk heavy financial penalties from the Federal government.
For all you European Dopers who wonder why so many Americans are opposed to nationalized health care, Rysto and Omphaloskeptic have the answer. The Powers That Be in Canada do seem to be rather hostile toward the whole concept of private medical care. Which was rather off-putting when certain US politicians tried to force a similar system down our throats a while ago.
Diceman, did you read any of the posts from the people who said a public health service doesn’t prohibit private health care as an alternative?
Maybe my comments weren’t sufficiently clear. Canada’s system, which is the one most familiar to Americans, tends to come across with an attitude like, "How dare you think our public system isn’t good enough for you? :mad: " We’ve had two posters comment on how Canada’s laws would seem to be aimed at putting a squeeze on competition. I was not attempting to say anything about any other country’s health care systems, or the concept in general, just to comment on where America’s hostility toward national systems stems from.
Let’s put this way every dollar spent by the private sector is one saved by the taxpayer, why would the government shut down the private system?
I’m a bit confused about Canada; do they allow private schools or only public? Are you allowed a private car or have to catch a taxi? If people are willing to pay for private treatment why would the taxpayer want to pick up the bill.
When did politicians try to force a Canadian style system down our throats? The only serious advocates of a Canadian style system in the US that I can think of were Paul Wellstone in the 90s and perhaps the Green Party today.
There is also the model being pursued in the UK, where private contractors can bid for public healthcare. The private companies are paid the same money as the NHS (National Health Service) for procedures, and can try to make a profit while achieving the same outcomes. This is used for things like cataracts.
Very controversial, as public money is being used, but it does produce reductions in waiting lists.
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My UK experience is that the same surgeons work for the NHS and privately - on the same premises (ie: they moonlight on NHS premises).
If you have private insurance or are loaded, then they are smarmy and the ‘waiting list’ takes days - if you are on the NHS then they are brusque and the waiting list can be interminable.
The problem is mixing the two systems with the same people on the same premises, it really boils down to little more than bribing doctors for preferential treatment.
Japan has a nationalized health care system, but allows private care. However, if you work for a company with more than 20 employees, you can’t opt out. You have to pay for the national health care costs, but you can pay for private care if you want. For medical care, there isn’t much of a difference, but there is for dental.
That’s not entirely true **Cuncator. ** If a person without private health insurance visits a private doctor, they are reimbursed for the value of the Medicare Scheduled Fee…for example, next week I will be attending a private dermatologist which will cost $140 (AUD) but I will be refunded by Medicare to the value of around $60 for the consultation thereby costing me $80 out of pocket.
This strikes me as the sort of system that would be most popular to the US. Is something like this being bandied about any? I only ever seem to hear about Canada and the UK in discussions of this topic.
(And the real benefit of a system like this, assuming that the government pays more for people who are high risk like the elderly, is that it becomes profitable to raise the average lifespan of the population to the insurance companies.)
Japan: No. There are clinics that don’t accept the national health insurance, and they’re perfectly free to operate. There aren’t very many, though, and the quality isn’t any better than the ones that do take state insurance*. There are also lots of private insurance companies that sell supplementary insurance.
*Regarding the Tokyo Medical and Surgical Clinic, an acquaintance of mine said “They know English, but that’s all they know.” They were the ones who repeatedly misdiagnosed my cancer for a year. It was the National Cancer Center that successfully treated it.