Posted 15 June 2012 - 12:42 PM
The full article goes longer, but you have to sign up for the website in order to get the full article. I'll highlight a couple things that I found interesting.
A country's ability to provide for its population's health care needs is influenced by financial abilities, priorities of the government, and the political environment. Throughout history, various organizational research has demonstrated improved outcomes of health care variables such as infant mortality, fertility rates, and morbidity and mortality rates related to a combination of improved socio-economic conditions and public health measures (Guyer, Freedman, Strobino & Sondik, 2000). In response to these findings, many countries have improved health care, education and allocated financial support to programs aimed at continued improvement of socioeconomic conditions and public health.
These improvements are critical as the financial health of a country is important to its success in other areas. The supply of adequate health care, health care demands of citizens and the presence of funds available for health care are important factors in the health of a country. For individual citizens, the presence of an effective, efficient, high quality low-cost health care system is important for health and wellness. Without government-provided, or employersponsored, health care, few individuals can afford the ever rising costs of doctor visits, surgeries, or medications.
The purpose of this paper is to analyze data from North American and European countries and contrast multiple health care and health status variables along with economic and social variables within each selected country to determine the link between expenditures and improvements in such health measures. The specific countries were chosen for study as they all published data from the 1990-2000 decade regarding health expenditures, fertility and mortality rates, population ratios, and per capita Gross Domestic Product (GDP). The United States (US), Canada, and Mexico represent North America while Germany, France, and the United Kingdom (UK) represent Europe. This information is useful in comparing nations based on growth or decline and how this change relates to a country's expenditure on health care. The findings are also important to determine how health care expenditures impact key measures of health.
REVIEW OF LITERATURE
Since the pioneering paper on international health comparison is by Newhouse in 1977, there has been much research on health expenditure determinants. This interest in understanding health care expenditure has led to the creation of theories as well as the analysis of health care expenditures (Gerdtham and Jonsson 2000). There is an ongoing debate in the U.S. about possible universal coverage as a way to decrease the costs of care for the poor and the elderly. Recent statistics show much variation in spending among countries with no correlation between expenditure and performance goals (www.oecd.org).
While France is often touted as a model of health care efficiency for study, all do not agree. Heath, Dhalla, and Thomson (2008) agree it is misleading to state that "the World Health Organization anointed the French health care system as the best in the world" and that it "ranked Canada 30th in the same survey." France only ranks first in efficiency and this was calculated by relating a country's overall health achievement to its health system expenditures. Lopes (2007) supports the Organization for Economic Co-operation and Development's view of France's total expenditure on health as a percentage of gross domestic product which was 10.5% in 2006 and began to match and then surpass Canada's at 9.5%. Reforms in 1996 through 1998 also sought to widen the financial base of the French social security system. The French national insurance system has maintained constant deficits since 1985; the deficit now tops $14.77 billion.
Rodwin (2003) agrees the French health system combines universal coverage with a public-private mix of hospital and ambulatory care and a higher volume of service provision than in the United States. Although the system is far from perfect, its indicators of health status and consumer satisfaction are high; its expenditures, as a share of gross domestic product, are far lower than in the United States; and patients have an extraordinary degree of choice among providers.
Kjellstran, Kovithavongs, and Szabo (1998) found the U.S. had the most inefficient outcomes in relation to money spent on health care and that one third of the retail price of prescription medications was spent on administrative costs and investors. However, the advent of "managed care" in the United States is having a favorable influence on the value of health care provided through private health insurance. Gains have been made by increasing the level of preventive care spending and reducing unnecessary care. However, overbearing managed care systems can cause a backlash by consumers and are subject to governmental intervention ("Private Health Insurance," 2004).
Frenk (2006) supports the need for Mexican health care reform because its health system has not kept pace with the pressures of disease, malnutrition, common infections, and reproductive health problems along with non-communicable disease and injury. Despite the fact that life expectancy at birth in Mexico has improved from 42 years in 1940 to 73 years in 2000, major inequalities persist in health and access to health care (Barraza-Llorens, Bertozzi, Gonzalez-Pier, and Gutierrez, 2002.
Tanne (2008) agrees the cost of common medical, surgical, and dental procedures varies widely across nine countries of the European Union, based on HealthBASKET (Health Benefits and Service Costs in Europe) studies but found the total cost of care for each procedure was lower than the average due in part to lower wage levels.
Sox (2008) agrees that reforming health care will not be easy, but argues that it's not impossible. Other countries have done it, and they have lower costs and better overall systematic performance than the U.S. Garber, Goldman, and Jena (2007) go so far as to suggest that spending could be reduced by as much as 30 percent without adversely affecting American's health. According Garber, et. al. (2007), the RAND Health Insurance Experiment (HIE) showed that U.S. spending on health care could be reduced by 30 percent if we improve the efficiency of the health care and if we delivered it in an efficient manner. The National Center for Policy Analysis (at www.ncpa.org) argues that the US devotes a significant amount of its health care expenditures to advanced cases and the elderly that use proportionately more resources, effecting the overall quality of health care.
Health Care Expenditures
Total health care expenditure continues to grow in United States at a fairly substantial rate although recent growth rate has shown some signs of moderating. Significant trends within the last few years are toward increased spending for medications that now comprise over 16% of all health care related expenses. However, capital spending is the area seeing the most significant level of growth. Investment in new technology has more than doubled in the last seven years ("Health spending", 2003). Technological investment in molecular biology, computer and medical science, electrical, mechanical, genetics and biomedical engineering (including cell, molecule and tissue), instrumentation, and advances in early detection that have allowed successful treatment of conditions that were previously untreatable. Ironically, this can serve to add even more cost to the health care system, as a larger segment of the population will live longer and utilize greater amount of health care services in the future (Holtz-Eakin, 2004).