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That scenario certainly would have helped my wife and I after paying premiums for private insurance for decades. And when the chips were down the private insurance failed us but medicare didn't, but came very late in her illness.
How come we never get any Europeans on these comparative health care threads? Well, other than the occasional Brit... These discussions always tend to be the Canucks vs. the Yanks.
I was kind of hoping for that to. I put in my 2 cents near the beginning of the thread because the Canadian system is what I know, but I was really looking for the countries I didn't know. I really enjoyed reading about the Dutch system, not what I'd expected! I was grateful for the European posts we got, although when it comes to healthcare on an English language forum about the USA where Canadians are the largest foreign group or posters, you know what it'll inevitably turn into.
I was kind of hoping for that to. I put in my 2 cents near the beginning of the thread because the Canadian system is what I know, but I was really looking for the countries I didn't know. I really enjoyed reading about the Dutch system, not what I'd expected! I was grateful for the European posts we got, although when it comes to healthcare on an English language forum about the USA where Canadians are the largest foreign group or posters, you know what it'll inevitably turn into.
I'm actually interested in how the Dutch system manages to keep costs down. If I'm not mistaken, a previous poster - Dutch, I believe - mentioned that insurance companies are free to set their own premiums. If that is the case, I wonder what the regulations are that prevent them from raising premiums in an unreasonable manner like they do in the US. Also, if there is more than one insurance company active, I wonder how they can get a large enough pool to maintain low costs; especially in a small country like the Netherlands.
We really should be studying these systems, don't you think?
Last edited by Captain_Fingers; 12-26-2012 at 09:32 PM..
Reason: typo
I'm actually interested in how the Dutch system manages to keep costs down. If I'm not mistaken, a previous poster - Dutch, I believe - mentioned that insurance companies are free to set their own premiums. If that is the case, I wonder what the regulations are that prevent them from raising premiums in an unreasonable manner like they do in the US. Also, if there is more than one insurance company active, I wonder how they can get a large enough pool to maintain low costs; especially in a small country like the Netherlands.
We really should be studying these systems, don't you think?
I really do, and I should do more since healthcare is actually my field. I know more than the average Joe, but my knowledge tends to be fairly basic regarding international systems because it's just plain a ton of work to learn all these details about the world's many countries and what outcomes come of different regulations and how external factors impact the whole thing in order to have some context to what you're seeing. I will endeavour to learn more in the coming months, however, and I'll post what I learn here.
See bolded. Why is that a flaw? I would hope that a mix of both private and public insurance would be competitive, or a mix of both, meaning the public can pick and choose regulated private insurance that suits them, a supplement, while public insurance is always there as a safety net.
It is a flaw because getting a private insurance is mandatory for some professions (e.g. self-employed and strangely - state employees), so they don't have a choice. Vice-versa, the public one is compulsory for everyone until you earn a certain amount of money - you can't really pick what may suit you best.
Another flaw about this is that people with a private insurance are often treated much better because the doctors can charge the private insurances about 2.5 times as much as the public insurances, for the exact same treatments. Not that publicly insured people are treated badly, but they have to wait longer for appointments and stuff like that.
It is a flaw because getting a private insurance is mandatory for some professions (e.g. self-employed and strangely - state employees), so they don't have a choice. Vice-versa, the public one is compulsory for everyone until you earn a certain amount of money - you can't really pick what may suit you best.
Another flaw about this is that people with a private insurance are often treated much better because the doctors can charge the private insurances about 2.5 times as much as the public insurances, for the exact same treatments. Not that publicly insured people are treated badly, but they have to wait longer for appointments and stuff like that.
Perhaps you're highlighting a flaw of that specific implementation, and not necessarily a flaw inherent to the private / public combination.
I'm highlighting a flaw of the private/public combination in Germany because that's what jmking responded to.
Fair enough. I do, however, agree with his contention that as a principle, the combination could work. For example, you could envision a setup where basic coverage could be public and affordable, and other types of coverage could be private. One could quibble about where the demarcation would be, but I imagine most people would agree that exotic cosmetic surgery, for instance, should be privately covered, whereas, say, doctor's visits for the flu should be public.
From your description it would seem that Germany's implementation could be tweaked some, although I'm frankly surprised to hear about something less than perfect in Germany..
Last edited by Captain_Fingers; 12-27-2012 at 05:46 AM..
Reason: Typo
I'm actually interested in how the Dutch system manages to keep costs down. If I'm not mistaken, a previous poster - Dutch, I believe - mentioned that insurance companies are free to set their own premiums. If that is the case, I wonder what the regulations are that prevent them from raising premiums in an unreasonable manner like they do in the US. Also, if there is more than one insurance company active, I wonder how they can get a large enough pool to maintain low costs; especially in a small country like the Netherlands.
We really should be studying these systems, don't you think?
That poster was me
Wikipedia has an excellent article about healthcare in The Netherlands, you could read it if you're interested. I think this section about insurance more or less answers your questions:
The Netherlands has a dual-level system. All primary and curative care (i.e. the family doctor service and hospitals and clinics) is financed from private obligatory insurance. Long term care for the elderly, the dying, the long term mentally ill etc. is covered by social insurance funded from earmarked taxation.
Private insurance companies must offer a core universal insurance package for the universal primary curative care, which includes the cost of all prescription medicines. They must do this at a fixed price for all. The same premium is paid whether young or old, healthy or sick. It is illegal in The Netherlands for insurers to refuse an application for health insurance or to impose special conditions (e.g., exclusions, deductibles, co-payments, or refuse to fund doctor-ordered treatments). The system is 50% financed from payroll taxes paid by employers to a fund controlled by the Health regulator. The government contributes an additional 5% to the regulator's fund. The remaining 45% is collected as premiums paid by the insured directly to the insurance company. Some employers negotiate bulk deals with health insurers and some even pay the employees' premiums as an employment benefit. All insurance companies receive additional funding from the regulator's fund.
The regulator has sight of the claims made by policyholders and therefore can redistribute the funds it holds on the basis of relative claims made by policy holders. Thus insurers with high payouts receive more from the regulator than those with low payouts. Thus insurance companies have no incentive to deter high cost individuals from taking insurance and are compensated if they have to pay out more than a threshold. This threshold is set above the expected costs. Insurance companies compete with each other on price for the 45% direct premium part of the funding and should try to negotiate deals with hospitals to keep costs low and quality high. The competition regulator is charged with checking for abuse of dominant market positions and the creation of cartels that act against the consumer interests. An insurance regulator ensures that all basic policies have identical coverage rules so that no person is medically disadvantaged by his or her choice of insurer.
Hospitals in the Netherlands are mostly privately run and not for profit, as are the insurance companies.[14] Most insurance packages allow patients to choose where they want to be treated. To help patients to choose, the government gathers (Zichtbare Zorg) and discloses information about provider performance (kiesBeter). Patients dissatisfied with their insurer can choose another one at least once a year.
Insurance companies can offer additional services at extra cost over and above the universal system laid down by the regulator, e.g. for dental care. The standard monthly premium for health care paid by individual adults is about €100 per month. Persons on low incomes can get assistance from the government if they cannot afford these payments. Children under 18 are insured by the system at no additional cost to them or their families because the insurance company receives the cost of this from the regulator's fund.
All I know is if your lucky enough to live in a country with National Health Care. Then I envy you. Because I have Health Insurance here in the USA. Yet I have so many copayments, on top of the monthly premium they are adding up. I will be cutting back on things for awhile in this new year, because I got a bunch of these bills in the mail this week.
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