The Efficiency of the Healthcare Systems in Canada, France and Germany - Essay Example

Introduction Which country delivers the best health care? This is a politically- and culturally-charged question which can draw heated debate amongstthose of different countries. The question is especially relevant today, as the populations of most developed nations is aging rapidly, and their needs for healthcare services, pharmaceuticals and devices is rising. This paper compares the efficiency of healthcare systems in three countries: Canada, France and Germany. It will attempt to answer the efficiency and productivity questions first, then delve into the differences between the healthcare systems. Some of these differences can be accounted for by differences in cultural outlook, and others by spending differences. Who is Best and Why? Of these three countries, the best health is enjoyed by the French and the Canadians in a tie. The following table compares life spans for the three countries surveyed: 12Country Life Expectancy Men Life Expectancy Women Average Life Expectancy France 77.1 84.1 80.6 Germany 76.5 82.1 79.3 Canada 78.3 82.9 80.6 One could argue that a strict life expectancy comparison skews the data, and that other factors, such as genetics, poverty, public health and other practices can make a significant difference. Although each country has plusses and minuses in such measures as childhood mortality, one can conclude that all three countries have a relatively high standard of health care. So which country is the most efficient? If one assumes that the ultimate quality of care, as measured by life spans, is nearly equal in all three countries, the amount spent may be an indicator: Country % of GDP spent on healthcare Per-capita spending on health care 3France 10.5% $3,549 Germany 10.6% $3,726 Canada 9.8% $3,379 Thus in this three-country survey, Canada is the “efficiency champ,” with a slightly lower per-capita spending for essentially the same life span. Critics with a statistical bent would argue that this is unfair, as the average age of Canadians is lower than the other two countries, and that health care spending goes up as people age. Almost any conclusion is difficult to defend, except one: all are champs when compared to the US, which has a similar lifespan but per-capita spending that is much higher at $6,412, or nearly double these three fairly developed countries. With this perspective, it seems clear that all three countries are relatively efficient at delivering fairly high-quality health care. All three have had a major increase in the percentage of GDP that they spend on health care; although Germany and France have had a modest increase over the past decade, Canada’s increase has been more precipitous. The latter’s climb may be attributable to the perceived need to reduce waiting times and increase service levels in Canada’s single-payer system. How the Countries Practice Health Care Germany has more private insurance than the other two countries, although all three have a universal health care plan. In Germany’s case, 40% of the population is covered at least partially by some form of private insurance, while 60% are covered through the OAK (allgemeine ortliche Krankenversicherung) (Emerson) (ESS-Europe). The primary benefits offered by German private insurers are ‘supplemental’ health benefits, such as better private hospitals, single rooms, and some additional care for elders. Germany, like other European nations, has faced a significant squeeze on its healthcare budget as its population is rapidly aging. As a “pay as you go” system, the German Nebenkosten (benefits costs) are at a high 42% of wages (Ganssmann); the government wants to limit benefits expenses, because they limit new employment. As a result, Germany’s various health ministers over the years have tried to ‘jawbone’ prices for pharmaceuticals. They have moved between trying to control the number of procedures, such as surgeries, with DRG (diagnostic-related group) controls, then price negotiations with medical equipment and pharmaceutical providers. Despite these efforts, the amount spent by the average German for these products is significantly higher than in France and Canada. Germans are justly proud of their health care system, but they have been rocked by scandals in recent years. In particular, most Germans do not trust their cardiologists. They are pictured as money-grubbers since a “Herzklappe,” or heart valve, scandal in the early 1990’s. In this scandal, several heart valve manufacturers were caught paying doctors to refer patients to use their very expensive valves. This “Herzklappenskandal” led to additional investigations in Germany for other areas where it was felt that physicians’ groups were bilking the public (Bock). Those who were involved in laboratory medicine were also particularly vilified, as there were only about 250 such physicians in a country with 82 million residents, the average one earning over $1 million per year. Unlike France and Canada, Germany’s physicians are more like guild members; those that work in exclusive areas such as heart surgery or laboratory medicine were able to exact near-monopoly premiums from the healthcare system. Now that the public has taken a more active interest, this occurs less often. The French system has several of the elements of the German system. Relatively fewer Frenchmen and –women avail themselves of private insurance, and have a generally egalitarian healthcare system with less differentiation than in Germany (Buchmueller). In addition to standard public and private hospitals, France has a network of AP, or “Assistance Publique” hospitals in Bordeaux, Paris and Lyon. These hospitals are generally very large, and focused on the poorest in the community. They are most similar to large city hospitals in US and Canadian towns. The French pride themselves on community medicine. They require a yearly visit to a ‘community doctor’ by all employees. These doctors travel in motor homes to worksites, where they interview and inspect every subject one-on-one, and follow up on any treatments which are recommended. Similarly, France has a fairly well-developed preventative health program for prenatal care. France has an exception in its healthcare system: Alsace (dabord!). This border region, which consists of two ‘departements,’ lower and upper Alsace, has its own healthcare insurance scheme. This system is more similar to the German system—a tradition borne at the time that Alsace was in German hands (from 1871 to 1918). Canada has a single-payer system with very little private payer participation. Like France and Germany, Canada has universal health coverage. The key advantage of this arrangement is that hospitals and health care providers know that they will be paid by a reliable body for the care that they deliver—there is no ‘patient shifting,’ as in American hospitals, where some patients are either denied care, or shifted as soon as possible to another institution. Canada is more similar to Germany than France in that there is relatively little preventative care, although some communities do have a well thought-out prenatal care routine. Canada is a single-payer country, more similar to France than Germany (Robinson). As in France, the Canadian government negotiates in a fairly strict fashion with pharmaceutical and medical device suppliers, which insures that the costs in Canada are significantly lower than in the United States for similar drugs and procedures. The concern of some pharmaceutical companies of cross-border sales has caused those suppliers to tighten up their supply networks; to a degree, Canadian health officials are complicit, in that they do not want to endanger Canada’s advantageous pricing position vis-à-vis the United States. Like France, Canada has an ‘exceptional’ region, Quebec. This province has a healthcare insurance scheme much more similar to France than the rest of Canada. Medical practice is very different in each country. Even the diagnoses are different. In France, the diagnosis of “crise de foie,” or liver crisis, is one of the most common in the physician’s lexicon (MacIntyre). This diagnosis does not exist in Germany or Canada. In Germany, “Herzinsufficienz,” or “Heart Insufficiency” is the most common diagnosis (Silverman). Although the English language has roughly similar terms, such as “CHF—Congestive Heart Failure,” there is no comparable diagnosis in Canadian or American medicine. The rates of surgery for various ailments differ significantly from country to country as well. This is due to the training and cultural beliefs of each country’s practicing physicians (Romito). The practice of medicine in each country can seem very strange to those in other countries. If a patient arrives with vague digestive symptoms, but the physician believes that there are no organic disease signs, an American specialist may think of a food allergy. A British physician may interpret it as a virus infection, a French doctor as a “crise de foie,” and a German doctor might call it heart insufficiency. French physicians are more comfortable with the notion of “terrain,” or the general notion of the human body in coexistence with bacteria and other microbes, whereas German physicians may think of microbes as something to be prevented as much as possible. French (and Quebecois) doctors are much more attuned to bacterial infection—perhaps due to the influence of Louis Pasteur—and tend to have an infectious disease physician specialist on every hospital staff. The same is not true for Germany or Canada (save Quebec). The above differences do not argue that one system is better or worse than another—just different. The fact that all three countries have equally-long lifespans and similar spending argues that all three are equally efficient, or equally inefficient. Certainly in comparison with the US, all three are extremely efficient at delivering health care to their citizens. Works Cited Bock, R-W. "Drittmittelfinanzierung und Industriesponsoring - Zulässigkeit und strafrechtliche Grenzen." Zentralbli Gynekol (2003): 435-440. Buchmueller, TC and Couffinhal, A. Private Health Insurance in France. Working Paper. Brussels: Directorate for Employment, Labour and Social Affairs, 2004. dabord!, Alsace. "Assurance maladie en Alsace: le remboursement a 90% est menace." 2007. Alsace dabord. 3 December 2007 . Economist. 2008 World Almanac. London: Economist, 2007. Emerson, C. "How To Germany: Insurance." 2007. How To Germany. 3 December 2007 . ESS-Europe. "The health insurance system of Germany." 2007. ESS-Europe. 3 December 2007 . Ganssmann, H. "Germany: Capital Flees." Le Monde Diplomatique February 2004: n.p. MacIntyre, S. "National notions of ill health / Review of Medicine Culture: Notions of Health and Sickness in Britain, the US, France and West Germany by Lynn Payer." New Scientist (1989): n.p. Robinson, B. "Canadas Single Payer Health Care System--Its Worth a Look." 2007. BCN. 3 December 2007 . Romito, P. "Medicine & Culture. Notions of Health and Sickness in Britain, the US, France and West Germany." Sociology of Health & Illness (1990): 228-229. Silverman, M. E., Upshaw, C. B. and Lange, H. W. "Woldemar Mobitz and His 1924 Classification of Second-Degree Atrioventricular Block." Circulation (2004): 1162-1167. Read More