According to Economis “THE private provision of health care comes in several forms across Europe. In Germany and the Netherlands it provides coverage for those not on government schemes; in Britain and Ireland it duplicates state-run systems; and in France it tops up cover from official programmes.
But do private health schemes lead to better care overall? A study by the Boston Consulting Group concludes that countries relying mainly on insurance—such as France, Germany and the Netherlands—provide better care than those, like Britain, Italy and Spain, that are chiefly funded by taxes and which spend less on health care as a proportion of GDP.”
Universal health care
Universal health care is health care coverage for all eligible residents of a political region and often covers medical, dental and mental health care. Typically, costs are borne in the majority by publicly-funded programs.
Universal health care is implemented in all industrialized countries, with the exception of the United States. It is also provided in many developing countries.
Universal health care in Europe
Virtually all of Europe has publicly sponsored and regulated universal health care. The public plans in some countries provide basic or “sick” coverage only; their citizens can purchase supplemental insurance for additional coverage. Countries with universal health care include Austria, Andorra, Belgium, Bosnia and Herzegovina, Bulgaria, Croatia, the Czech Republic, Denmark, Estonia, Finland, France, Georgia, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Monaco the Netherlands, Norway, Poland, Portugal, Romania, Russia, San Marino, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland, Ukraine and the United Kingdom.
Denmark has a universal public health system paid largely from taxation with local municipalities delivering health care services in the same way as other scandinavian countries. Primary care is provided by a general practitioner service run by private doctors contracting with the local municipalities with payment on a mixed per capita and fee for service basis. Most hospitals are run by the municipalities (only 1% of hospital beds are in the private sector).
In Finland, public medical services at clinics and hospitals are run by the municipalities (local government) and are funded 76% by taxation, 20% by patients through access charges, and 4% by others. Private provision is mainly in the primary care sector. There are a few private hospitals . The main hospitals are either municipally owned (funded from local taxes) or run by the medical teaching universities (funded jointly by the municipalities and the national government). According to a survey published by the European Commission in 2000, Finland’s is in the top 4 of EU countries in terms of satisfaction with their hospital care system: 88% of Finnish respondents were satisfied compared with the EU average of 41.3%.
Finnish health care expenditures are below the European average. The private medical sector accounts for about 14 percent of total health care spending. Only 8% of doctors choose to work in private practice, and some of these also choose to do some work in the public sector.
Taxation funding is partly local and partly nationally based. The national social insurance institution KELA reimburses part of patients prescription costs and makes a contribution towards private medical costs (including dentistry) if they choose to be treated in the private sector rather than the public sector. Patient access charges are subject to annual caps. For example GP visits cost €11 per visit with annual €33 cap; hospital outpatient treatment €22 per visit; a hospital stay, including food, medical care and medicines €26 per 24 hours, or €12 if in a psychiatric hospital. After a patient has spent €590 per year on public medical services (including prescription drugs), all treatment and medications thereafter in that year are free.
Germany has the world’s oldest universal health care system, with origins dating back to Otto von Bismarck’s Health Insurance Act of 1883. As mandatory health insurance, it originally applied only to low-income workers and certain government employees, but has gradually expanded to cover the great majority of the population. The system is decentralized with private practice physicians providing ambulatory care, and independent, mostly non-profit hospitals providing the majority of inpatient care. Approximately 92% of the population is covered by a ‘Statutory Health Insurance’ plan, which provides a standardized level of coverage through any one of approximately 1100 public or private sickness funds. Standard insurance is funded by a combination of employee contributions, employer contributions and government subsidies on a scale determined by income level.
Higher income workers sometimes choose to pay a tax and opt out of the standard plan, in favor of ‘private’ insurance. The latter’s premiums are not linked to income level but instead to health status.
Historically, the level of provider reimbursement for specific services is determined through negotiations between regional physician’s associations and sickness funds. Since 1976 the government has convened an annual commission, composed of representatives of business, labor, physicians, hospitals, and insurance and pharmaceutical industries. The commission takes into account government policies and makes recommendations to regional associations with respect to overall expenditure targets. In 1986 expenditure caps were implemented and were tied to the age of the local population as well as the overall wage increases.
Although reimbursement of providers is on a fee-for-service basis the amount to be reimbursed for each service is determined retrospectively to ensure that spending targets are not exceeded. Capitated care, such as that provided by U.S. health maintenance organizations, has been considered as a cost containment mechanism but would require consent of regional medical associations, and has not materialized.Copayments were introduced in the 1980s in an attempt to prevent overutilization and control costs. The average length of hospital stay in Germany has decreased in recent years from 14 days to 9 days, still considerably longer than average stays in the U.S. (5 to 6 days). The difference is partly driven by the fact that hospital reimbursement is chiefly a function of the number of hospital days as opposed to procedures or the patient’s diagnosis. Drug costs have increased substantially, rising nearly 60% from 1991 through 2005. Despite attempts to contain costs, overall health care expenditures rose to 10.7% of GDP in 2005, comparable to other western European nations, but substantially less than that spent in the U.S. (nearly 16% of GDP).
The public health care system of the Republic of Ireland is governed by the Health Act 2004, which established a new body to be responsible for providing health and personal social services to everyone living in Ireland – the Health Service Executive. The new national health service came into being officially on 1 January 2005; however the new structures are currently in the process of being established as the reform programe continues. In addition to the public-sector, there is also a large private health care market.
Italy has a public health care service for all residents called “Servizio Sanitario Nazionale” or SSN (National Health Service) which is modelled on the UK National Health Service. It is publicly run and funded mostly from taxation with small co-pays. Like the UK, there is a parallel private health care system.
The Netherlands has a dual-level system. All primary and curative care (i.e. the family doctor service and hospitals and clinics) is financed from private compulsory insurance. Long term care for the elderly, the dying, the long term mentally ill etc. is covered by social insurance funded from taxation. According to the WHO, the health care system in the Netherlands was 62% government funded and 38% privately funded as of 2004.
Insurance companies must offer a core universal insurance package for the universal primary, curative care which includes the cost of all prescription medicines. They must do this at a fixed price for all. The same premium is paid whether young or old, healthy or sick. It is illegal in The Netherlands for insurers to refuse an application for health insurance, to impose special conditions (e.g. exclusions, deductibles, co-pays etc or refuse to fund treatments which a doctor has determined to be medically necessary). The system is 50% financed from payroll taxes paid by employers to a fund controlled by the Health regulator. The government contributes an additional 5% to the regulator’s fund. The remaining 45% is collected as premiums paid by the insured directly to the insurance company. Some employers negotiate bulk deals with health insurers and some even pay the employees’ premiums as an employment benefit).
All insurance companies receive additional funding from the regulator’s fund. The regulator has sight of the claims made by policyholders and therefore can redistribute the funds its holds on the basis of relative claims made by policy holders. Thus insurers with high payouts will receive more from the regulator than those with low payouts. Thus insurance companies have no incentive to deter high cost individuals from taking insurance and are compensated if they have to pay out more than might be expected.
Insurance companies compete with each other on price for the 45% direct premium part of the funding and try to negotiate deals with hospitals to keep costs low and quality high. The competition regulator is charged with checking for abuse of dominant market positions and the creation of cartels that act against the consumer interests. An insurance regulator ensures that all basic policies have identical coverage rules so that no person is medically disadvantaged by his or her choice of insurer.
Hospitals in the Netherlands are also regulated and inspected but are mostly privately run and for profit, as are many of the insurance companies. Patients can choose where they want to be treated and have access to information on the internet about the performance and waiting times at each hospital. Patients dissatisfied with their insurer and choice of hospital can cancel at any time but must make a new agreement with another insurer.
Insurance companies can offer additional services at extra cost over and above the universal system laid down by the regulator, e.g. for dental care. The standard monthly premium for health care paid by individual adults is about €100 per month. Persons on low incomes can get assistance from the government if they cannot afford these payments. Children under 18 are insured by the system at no additional cost to them or their families because the insurance company receives the cost of this from the regulator’s fund. There is a fixed yearly treshold of €165 for each person, excluding some health categories (like diagnosis and acute care), as incentive against excessive claims.
United Kingdom Healthcare
Each of the Countries of the United Kingdom has a National Health Service that provides public healthcare to all UK permanent residents that is free at the point of need and paid for from general taxation. However, since Health is a devolved matter, considerable differences are developing between the systems in each of the countries.
The National Health Service (NHS), created by the National Health Service Act 1946 has provided the majority of healthcare in England since its launch on 5 July 1948.
The NHS Constitution for England documents at high level, the objectives of the NHS, the legal rights and responsibilities of the various parties (patients, staff, NHS trust boards) and the guiding principles which govern the service. The NHS constitution makes it clear that it provides a comprehensive service, available to all irrespective of age, gender, disability, race, sexual orientation, religion or belief; that access to NHS services is based on clinical need and not an individual’s ability to pay; and that care is never refused on unreasonable grounds. Patient choice in terms of doctor, care, treatments and place of treatment is an important aspect of the NHS’s ambition, and in some cases patients can elect for treatment in other European countries at the NHS’s expense. Wait times are low, with most people able to see their primary care doctor on the same day or the following day and only 36.1% of hospital admissions are from a waiting list, with the remainder being either emergencies admitted immediately or else pre-booked admissions or similar (e.g. child birth).
No patient should experience a delay of more than 18 weeks from initial hospital referral to final treatment. This includes the time for all investigative tests and consultations, and two thirds of patients are currently treated in under 12 weeks.
Although centrally funded there is no large central bureaucracy to manage it. Responsibility is highly devolved to geographical areas through Strategic Health Authorities and even more locally through NHS primary care trusts , NHS hospital trusts and increasingly to NHS foundation trusts which are providing even more decentralized services within the NHS framework, with more decision making taken by local people, patients and staff. The central government office, the Department of Health, is not involved in day to day decision making in either the Strategic Health Authorities or the individual local trusts (primarily health, hospital or ambulance) or the national specialist trusts such as NHS Blood and Transplant, but it does lay down general guidelines for them to follow.
Local trusts are accountable to their local populations, whilst government ministers are accountable to Parliament for the service overall.
The NHS provides, among other things, primary care, in-patient care, long-term healthcare, psychiatric care and treatments ophthalmology and dentistry. All treatment is free with the exception of certain charges for prescriptions, dentistry and ophthalmology (which themselves are free to children, the elderly, the unemployed and those on low incomes). Eighty-nine percent of NHS prescriptions are obtained free of charge, mosly children, pensioners and pregnant women. Others pay a flat rate of £7.20, and others may cap their annual charges. Private health care has continued parallel to the NHS, paid for largely by private insurance. Private insurance accounts for only 4 percent of health expenditure and covers little more than a tenth of the population.
Private insurers in the UK only cover acute care from specialists. They do not cover generalist consultations, pre-existing conditions, medical emergencies, organ transplants, chronic conditions such as diabetes or conditions such as pregnancy or HIV.  Most NHS general practitioners are private doctors who contract to provide NHS services but most hospitals are publicly owned and run through NHS Trusts. A few NHS medical services such as “surgicentres”) are sub-contracted to private providers  as are some non-medical services (such as catering). Some capital projects such as new hospitals have been funded through the Private Finance Initiative, enabling investment without (in the short term) increasing the public sector borrowing requirement, due to the fact that long-term contractually-obligated PFI spending commitments are not counted as government liabilities.
Northern Ireland Healthcare
Health and Social Care in Northern Ireland is the designation of the national public health service in Northern Ireland.
NHS Scotland, created by the National Health Service (Scotland) Act 1947, was also launched on 5 July 1948 though it has always been a separate organization. Since devolution, NHS Scotland follows the policies and priorities of the Scottish Government, including the phasing out of all prescription charges by 2011.
NHS Wales was originally formed as part of the same NHS structure created by the National Health Service Act 1946 but powers over the NHS in Wales came under the Secretary of State for Wales in 1969, in turn being transferred under devolution to what is now the Welsh Assembly Government.
Source Wikipedia & European Newspapers. Edited By Jamal Panhwar