US healthcare overhaul: five lessons from abroad

From Taiwan to France to Singapore, many countries offer more comprehensive coverage at a cheaper cost.

John Moore / Getty Images
Nurse Amy Grover gives Bernardo Cardoz a checkup in Aurora, Colo. Some in the US have looked abroad for systems and practices from which America could learn.

In Singapore, hospitals publish the cost of every treatment, from hip replacement to dengue fever, so consumers can choose medical options as if they're buying jeans.

In Germany, people suffering from fatigue or back pain can get a three-week stay at a "wellness" retreat in the mountains – all paid for by health insurance.

In Taiwan, people who go to the hospital swipe a card that gives doctors their basic medical information – one reason the country has among the lowest healthcare administrative costs in the world.

Around the globe, many nations have innovative or unusual programs in their quest to provide the best healthcare for their citizens. Sometimes the programs work well. In other cases, they could use an MRI themselves.

As the United States grapples with the largest potential reform of the healthcare system in modern history, experts here have been scouring the world for lessons from other countries. One conclusion seems clear: No one has a flawless system.

Providing affordable medical care for citizens who want it is one of the most complex problems facing modern governments. Two fundamental forces – the rising cost of medical procedures and demographic changes that are leading more people through hospital doors – are spurring many governments, not just the US, to at least tinker with their systems.

Even so, it's also clear that the US faces singular challenges. Almost every country in the developed world ensures that all its citizens have access to some kind of care when they need or want it. The US is the exception.

Most countries also manage to provide that healthcare for about half the cost of the US and with better overall health outcomes, such as lower infant mortality rates, as well as with greater overall patient satisfaction.

"It's not likely that the US will adopt another country's healthcare system," says Karen Davis, president of the Commonwealth Fund, a nonprofit research foundation that focuses on healthcare. "But it's important to look at some of the innovative things other countries are doing – we spend more than twice what other [major industrialized] countries do and are the only one that doesn't provide universal coverage."

Still, no cookie-cutter solution to the problem exists, either here or anywhere else. Each nation's healthcare system is unique, a reflection of its history, culture, and values. In countries like France, healthcare is considered a universal right but it's also mandatory for individuals to have health insurance.

Germany's had a national healthcare system since 1883, when Otto von Bismarck built on the idea of medieval guild cooperatives to create broad-based care. Taiwan has one of the world's newest national systems. Set up in 1995, its goal was to incorporate the best ideas from around the world.

One thing that all of the countries with the most successful systems seem to have in common is ensuring that everyone who needs or wants healthcare can get it without going bankrupt. That has proved to be important in not only improving the physical well-being of a country, but also in keeping costs down.

The rationale is that when people have health insurance, they're more likely to get preventive care as well as early treatment for medical conditions, which, if left untreated, could end up being very costly. While some people choose approaches other than conventional medicine, many millions more rely on the healthcare system and see it as flawed in one serious way or another.

As lawmakers in Washington wrangle over an overhaul that is still far from assured, they are trying to find the right balance between Americans' legendary sense of self-sufficiency and societal obligation, between free-market principles and government stewardship.

No one expects the US to mimic the often-cited British and Canadian systems, in which the government is the sole or central player.

"National health services save a heck of a lot of money and are much cheaper, like in Spain and Britain," says Robert Blendon, who follows the politics of healthcare at Harvard University's School of Public Health in Cambridge, Mass. "But I don't think Americans would pay much attention to them."

Whatever comes out – if, in fact, anything does – will be uniquely American. In the meantime, here are a few other countries' approaches to one of the more pressing issues of contemporary times.

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