As our nation struggles to adjust to the changing face of health care, we should check on the success of other developed countries in maintaining the health of their own citizens. For the most part, governments throughout the civilized world elected long ago to build national health care systems that cover everyone. Is it working?
At first glance it appears that the United States is the laggard. Despite the fact that we spend far more on health care as a percentage of GDP than any other nation on earth, the return on investment is inadequate.
The U.S. spends approximately 17.6 percent of GDP, and the Netherlands, the second highest, spends only 12 percent. The average for developed countries is a little over half the U.S. figure at 9.6 percent, according to the Health Data 2012 report from the Organisation for Economic Co-operation and Development, an international economic organization based in France.
Furthermore, life expectancy in the U.S. is more than one year less than in the average developed country, even though we have almost twice as many CAT scan machines and 2.5 times as many MRI machines per capita. We also have the highest rate of obesity.
But closer inspection reveals that countries with universal health care have their own struggles. I am currently in New Zealand on a medical service mission with the Polynesian Voyaging Society and find that the health care system here is far from idyllic.
It turns out that private health insurance is in high demand. While New Zealand spends 10.1 percent of GDP on health care, according to the Southern Cross Health Society, 1.35 million people currently seek private, elective care each year. That is almost one-third of the population.
New Zealanders are not alone in their growing demand for private health care. The problem is comparable in England, Japan and Canada.
As birthrates decline and populations age, chronic conditions requiring elective procedures continue to mount. Joint replacements and cardiac bypass surgery are two of the biggest culprits.
With national budget constraints, waiting lists continue to grow. For those with osteoarthritis who need a joint replacement, the result is more pain and a prolonged period of disability. Waiting for cardiac bypass surgery increases the chance that the patient will have a heart attack before definitive care is rendered.
With lower national budgets for health care, diagnostics work-ups may be slower and less likely to employ costly imaging. Missed diagnoses not only affect outcomes, but also the cost to the system, because care for advanced disease is usually more expensive.
Perceived shortcomings of national health care systems have resulted not only in increased demand for private health insurance; people also look abroad for care.
Today, health tourism is booming in Thailand, India and Malaysia. Faced with the need for a total knee replacement and now uninsurable for this condition in the private sector, patients look to pay out of pocket. The same procedure can be done in some Asian destinations for a fraction of the cost. For the most part, providers in these countries are trained in modern universities, and quality of care is very good.
The quest to provide broad access to quality care at a reasonable cost is a universal challenge. People throughout the OECD resort to private insurance or reach into their pockets to pay for services abroad that cannot be secured in a timely fashion from their own national health care systems.
Meanwhile, in the U.S., health care reform designed to increase and protect access continues to drive new efforts to control cost. True, so much more can be done to enhance education and prevention, improve coordination of care and minimize waste. Still, the cost of available care options using high-tech diagnostics, pharmaceuticals and procedures is difficult to manage.
While most developed countries are well ahead of the U.S. in offering universal access to their citizens, in order to manage costs, at times they have no choice but to curtail care.
As we in the U.S. continue to implement health care reform and ensure more secure access to care, cost pressures will only mount. In response, we will continue to innovate and build solutions that are uniquely American, but we will also have to make some difficult choices.
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Ira Zunin, M.D., M.P.H., M.B.A., is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.
