Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, February 14, 1993 TAG: 9302140329
SECTION: HORIZON PAGE: D-6 EDITION: METRO
SOURCE: ROBERT BARR ASSOCIATED PRESS
DATELINE: LONDON LENGTH: Long
HEALTH CARE FOR ALL: HOW OTHER COUNTRIES DO IT
President Clinton's campaign promise to make affordable medical care available to all "as a right, not a privilege" may be difficult to keep.But many countries have done it already, for much less money than the United States invests in a system that still leaves at least 33 million people with little or no protection.
The United States devoted 12.4 percent of its gross domestic product to health care in 1990, about twice the proportion Britain spends on a National Health Service available to everyone.
Japan's universal plan costs 6.7 percent of GDP. Germany spends about 8 percent, while Canada and France provide universal care for 9 percent of GDP, according to the Organization of Economic Cooperation and Development, whose 24 members include the United States and leading Western industrial nations.
Seventeen of the OECD countries put more public money into health care than the United States, where 57.6 percent of expenditures come from insurance and other private sources.
Money is not the only measure, however. Patients in some countries do without sophisticated care or a choice of doctors, and wait months or years for non-emergency surgery. Many health systems require partial payment by the patient.
None of the systems is without problems and some countries are making significant reforms, among them Germany, the Netherlands, Italy, Sweden, Argentina and Zimbabwe.
Several nations are turning to the free market to encourage competition and greater efficiency.
In Sweden, everyone is guaranteed coverage in the health system, run by county councils. Patients pay about $20 for a visit to a doctor. When necessary, they are sent to other county facilities for specialist treatment.
Swedes have complained about the anonymity of the system, so the government proposes to bring back the family physician.
During his presidential campaign last year, Clinton cited the Germany system as one the United States could follow.
Germans pay anywhere from 8 percent to 16 percent of their salaries - the average is 13.1 percent - to belong to one of the country's "sickness funds."
Retired people, those on welfare and the jobless are covered at government expense.
About half the population, especially blue-collar workers, have no choice of which fund they will join and the wealthy are permitted to drop out of the system.
Last year, when the program's deficit was estimated at $7.7 billion, Parliament adopted legislation that says reimbursements to doctors from insurance funds cannot outstrip income from insurance premiums. For two years, it also limits the rise in hospital fees to that of incomes.
Canada switched from free-market medicine to a university health system in 1971. Canadians are enrolled automatically in a health plan that allows them a choice of doctors and hospitals in their province. Dentistry, drugs and private rooms generally are not included, but can be covered by private insurance.
Japan introduced equal medical care and insurance for everyone in 1963. According to the Health and Welfare Ministry, the average payroll deduction for insurance is 8.2 percent, although some Japanese pay as little as 3 percent, depending on the plan.
Insurance covers 70 percent to 90 percent of all medical services. Patients pay the rest, with a maximum of $484 a month.
The Japanese system has become increasingly costly for the government as the number of elderly and other unemployed people grew from 6.4 percent of the population in 1965 to 33.5 percent in 1990.
France's national health plan is part of its social security system, financed by the government and by a payroll tax of 6.8 percent for workers and 12.6 percent for employers.
It covers roughly 70 percent of doctor fees, drugs and other prescriptions, including aspirin, birth control, eyeglasses and dental braces.
For most of the remaining 30 percent, there is private insurance partially subsidized by employers. About 80 percent of French citizens participate in these "mutuelles."
Italy is embarking on a three-year program to reduce costs and improve service through increased competition and some privatization.
Merit promotions are to replace political appointments in local administration. Starting in 1995, Italians will be permitted to buy their own insurance coverage, and will receive tax refunds if they do.
Health Minister Francesco de Lorenzo says Italy is not abolishing socialized medicine.
Britain has been promoting competition within its National Health Service, which provides care for all. Local health authorities are being permitted to negotiate contracts with hospitals, and doctors can negotiate with hospitals in arranging care for their patients.
Israelis have a choice of four funds, which cost $150 to $200 a month per family, excluding dentistry.
Prescription medicines are heavily subsidized and separate insurance coverage can be purchased for treatment abroad. About 7 percent of the people are not covered, particularly recent immigrants.
The largest fund is $1 billion in debt. Under legislation being drawn up by Health Minister Haim Ramon, Israelis would pay directly to the government and it would reimburse clinics.