Carlo's Think Pieces

Reflections of a Filipino in the Netherlands

Universal health care: tips from Europe

Posted by butalidnl on 19 March 2009

There has been much talk about the proposal to have universal health care in the US. This is not a simple matter of getting the millions of people without health care insurance to get coverage. Some changes in the overall system need to be made in order to minimize costs and maximize efficiency. Perhaps some lessons could be learned from the experiences of other countries with universal health care.

Family Doctor as “Gatekeeper”.
In European countries with universal health care, the family doctor is the first stop for anybody who feels sick. This doctor fixes the problem if possible, or refers one on to a specialist if this is necessary.  People who try to go straight to the hospital or specialist without this referral run the risk of having no insurance coverage for these.

This system minimizes the overloading of specialist doctors, especially with cases that are relatively simple to treat. It also lowers the “threshold” for going to the doctor, which in turn helps to ensure that ailments are reported and treated earlier.  Another advantage of having a “gatekeeper” function is that there is at least one doctor who knows everything going on with the patient medically – the various specialists report regularly to the family doctor. Thus, when various treatments are done simultaneously, someone can help to ensure that they don’t work against each other.

No Malpractice Suits
A significant part of the growth in health costs in the US is to cover the cost of malpractice insurance. This is due to the common practice of patients sueing the doctors if they make a mistake in treating them. This is not common in Europe.

Perhaps it would not be possible to completely do away with malpractice suits, but at least there should be limits set on the amounts awarded as damages.

Another problem with malpractice suits is that doctors tend to do more tests on the patients than they otherwise would do, in order to minimize the chance of getting sued.  The additional tests would of course cost more money.

Everybody should have Health Insurance Coverage
In order to have universal health insurance, everyone should be required to have their health insurance. Even temporary residents, or visitors should be required to prove they have health insurance when in the country.  This should not be optional.

With everybody covered by health insurance, some things are simplified. For one, people can readily avail of health facilities e.g. hospitals with the minimum of administration procedures. (Emergency treatment is an exception to the rule that all patients should go through the family doctor.) Also, the system of having the health insurance company determine which treatment you can get, and where you can get it, could be ended.

Government Supervision
The government could also make guidelines re which treatments should be covered by the health insurance. Also, insurance companies are not allowed to refuse to cover some people because of their health history or their unhealthy practices (e.g. smoking). However, giving discounts to people with lesser risk of health problems is allowed.

The governments in Europe own most of the health infrastructure, even though hospitals etc.  are administered independently.  Thus, there is no real need to make a profit from hospitals.

The health department should set the guidelines re doctors fees, the use of medicines (e.g. that generic drugs are preferred), and hospital costs. This could be implemented in cooperation with health insurance companies, who also want to standardize and minimize costs.

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