Sadly it appears that the appetite for changing our broken health care system is becoming mired in our leadership’s favorite past time – politics. The challenge is that while the debate and rhetoric have slowed, the problems still continue to grow. One of the cornerstones of the debate was government run healthcare with Canada and the UK cited as where we would end up, in some cases it was portrayed these were the only options. Alas there are many more. While I do not profess to have the answers to this, I want to take the time to layout some alternatives. First though a little foundation work – a couple of key concepts and one societal conundrum.

So the concepts –

• Universal access as the name implies is access to affordable health care for all Many times, incorrectly, this term is used as a synonym for socialized/government run medicine with Canada and the UK being the poster children.
• Universal insurance is the requirement of all individuals to have health insurance – the result is universal access, but can be approached from a private sector perspective.

The societal conundrum

• Is access to high quality, affordable health care a right or privilege? In most countries it is considered a right (including all those reviewed in this document), in the United States – that is open for debate. This is a key question since once this is answered, the components necessary to manifest health care change have much more clarity (not easier to affect, just clearer)

So with this as a foundation or maybe even a healthcare travel guide, lets venture around the world and quickly do a 50,000’ fly by glance at the health care systems of:

• UK/Great Britain
• Switzerland
• Germany
• Japan
• Australia

First fly by, the UK – a socialized medicine country. The National Health Service (NHS) was created on July 5, 1948 and is the primary source of healthcare in the UK. The NHS is funded by 76% taxation, 19% national insurance contributions, and 5% co-payments by the patient and provides low-cost/no-cost medical care to all the residents of the United Kingdom. The NHS covers preventative care, inpatient and outpatient hospital care, general practitioner services, some medications, basic dental care, mental health care, learning disability care, and rehabilitation. The system is based on the use of general practitioners that act as gatekeepers. The gatekeepers are the initial contact for treatments, advice prescriptions and referrals to specialists.

We’ll wing our way to Switzerland. Switzerland provides an intriguing model that could provide a solid foundation for the United States. The Swiss have a long history of paying for care delivery through privately and publicly provided health insurance. In fact, health insurance started in Switzerland in the 19^th century. The Swiss wanted 100% coverage that drove the passage of a program in the late 1990's called LAMal. LAMal makes health insurance compulsory within Switzerland for anyone living in Switzerland more than 90 days. The coverage is provided by private and public insurance companies and if an individual does not obtain insurance within the designated time frames, the government will assign that individual to an insurance company and “back bill” that individual for the delinquency period – an interesting concept.

Next, Germany - the German health service is highly decentralized. Each of the 16 states that comprise Germany, share responsibility with the central government for the building and maintaining hospitals, while the state-regulated health insurance providers exert some control over running it (sound somewhat familiar?). Germany has the world's oldest universal healthcare system and arguably one of the most successful and like most insured Americans, many Germans get their health coverage, provided by 240 private insurers or sickness funds, through their employers with premiums based on income. Wealthier Germans have an option to obtain private insurance, but only 10% of the population exercises this option. German workers must pay approximately 8% of their gross income to a sickness fund and their employers must match this payment. Sickness funds cannot deny coverage based on preexisting conditions; they compete with each other for members, negotiate fee payment schedules and fund managers are paid based on the size of their enrollments.

So now the final two on this whirlwind tour of care delivery systems - Japan and Australia.

Japan is a collectivist society where group needs and wants are placed above those of the individual and Japanese people tend to be other-directed. Japanese culture sets an expectation that each person will conform to societal ways and norms. Good health is viewed as good for society and therefore tremendously important.  Japan provides health care to all citizens anywhere and anytime at a very low cost via a mandatory work-based or community-based health insurance policy with the national government funding the cost for the elderly and those unable to afford the cost. The Japanese concept of universal care was originated by government legislation but that does not translate to socialized medicine. In fact, 80% of the hospitals in Japan are privately owned more than the US and virtually all doctor’s offices are private businesses.

In the Australian healthcare system responsibilities are mixed between the federal and state governments, and the public and the private sectors. The Australian government is a Commonwealth with six states and two territories. The Commonwealth shoulders the development of national health policies, regulations, and funding. The states and territories cover what the Commonwealth does not including the execution, oversight, and regulation of public health services and providers. The goals of the healthcare system include the improvement of the social, physical, and economic environment of citizens at risk for poor health, reduction of health risk exposures, and education for patients to make appropriate health choices.

So what is the point of all this? Well certainly not to try and give a comprehensive view of other health care delivery systems, but to show that other countries are tackling the health care issue with varying success with varying models. Ultimately, my goal is to raise the awareness that universal access does not singularly mean socialized medicine – there are other games in town. So when the debate hopefully fires up again and the rhetoric is flying, remember there are multiple ways to give access to care.

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