Lessons for America: comparing health systems across Europe

Forbes published a package of articles and opinion pieces called "Public Vs. Private Health Care," which compares health care systems across Europe.

"Most European countries provide near-universal health care for their residents, yet they spend between one-third to one-half what the U.S. spends on health care for its citizens," Forbes reports. "France and Germany, which are widely viewed as having among the best health care systems in Europe, with few complaints about rationing of services and queuing, spend 11% and 10.4% of their economic output, respectively, on health care. The U.S., by comparison, expends 16% of its gross domestic product in this area, according to the Organisation for Economic Co-operation and Development. The U.K., which also provides universal health care through its National Health Service, spends 8.4% of its GDP on health care, making it one of the cheapest health care systems in Europe." The UK system, however, "has been dogged in recent years with complaints of long waits and too few beds. One of the reasons the two Continental powerhouses do better than Britain is that they have a higher proportion of doctors to the public." Citizens in France and Germany visit the doctor more often than those in the U.S. or the U.K (Raghavan, 9/2).

The German system: "Unlike many countries with national health--Canada, say, or the U.K.--where private insurance generally supplements public coverage, Germany has two separate systems that coexist, with private plans indirectly benefiting from the cost controls of the public system. Whether they have public or private coverage, most Germans love their care." Forbes adds that "One of the primal fears about reform in the U.S.--that it would create a two-tier system where privately insured patients would get better care and shorter waits--is largely a nonissue in Germany" (Raghavan, 9/1).

The British system: "There are still big problems at the NHS, despite the Labour government's increased spending over the past decade." One such problem is long wait times for specialists: "The Commonwealth Fund found last year that Britain was one of the worst offenders in the developed world when it came to waiting times, with 33% of adults waiting two months or longer for specialist attention for a chronic condition over the past two years. France, Germany and the Netherlands all had better readings, at 20% to 25%, while the United States had 10%" (Reynolds, 8/4).

The Spanish system: Spain has the highest rate of organ donation in the world, with 34.2 donors per million deaths in 2008. "Spain's system of presumed consent, in which patients would have to opt out of donating their organs after death rather than the current system of having to 'opt in' (the latter being prevalent in the U.S. and most of Europe), is seen as one of the major reasons." But another contributing factor is an organization that coordinates the donation system, which "brought in 'transplant coordinators' in 1989, doctors and nurses in the intensive care units of Spain's public hospitals with specialized training to deal with organ donations" (Ram, 9/2).

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This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.