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Spoiler alert They conclude that Switzerland is the best system in the world. But different judges seem to have different priorities and it's clear that at le

Spoiler alert They conclude that Switzerland is the best system in the world. But different judges seem to have different priorities and it's clear that at least some of them are judging not the best healthcare system in terms of just cost or quality of care, but on how feasibly the foreign system could be implemented in the United States. In any case, it's a stupid metric. Unless there was a single healthcare system that had the best healthcare at the lowest cost, which I think is the combination that most people are looking for, there is clearly no objectively "best" system. Even determining things like quality care in the first place is difficult. Still, it was interesting to read comparisons of the various countries' health systems. It's a worthwhile read.

Y7ZCQtNo39 9y ago
If you live the United States, it is not a stupid metric. We should be focused on improving our system in ways that realistic and possible to achieve. Discussion of great ideas that could never be implemented would be largely academic when considering how the American system can be improved.
- RobertoG 9y ago
  Fair enough, but, at least, they should speak about how those reference countries are doing against the rest. In the World Health Organization ranking (1), of all the countries compared in the article, the only one that appears between the first ten in any of the categories (except cost) is France and, in only one metric, Australia and the UK. Not pointing that seems a strange omission. 1. https://en.wikipedia.org/wiki/World_Health_Organization_ranking_of_health_systems_in_2000 https://en.wikipedia.org/wiki/World_Health_Organization_rank...
  - smcl 9y ago
    That's not correct - are we looking at the same table? There are more of the reference countries in the top 10 of the various categories (except cost). Here's the number of times each appear in the top ten categories in the Wikipedia article you posted: Canada: 1 Singapore: 1 Germany: 0 Switzerland: 3 France: 3 UK: 2 Australia: 1 The other larger* countries that feature in the top-ten of these categories - Japan, Sweden, Spain, Austria - all have universal healthcare. I'm not sure where you stand, but it seems that no matter how you slice it Americans are getting a raw deal with their healthcare. * = those roughly the same population as the smallest country on the list - Switzerland - or more
    - RobertoG 9y ago
      You are right, I was wrong. Specifically, I don't know how I missed Switzerland there. Obviously, I should double check before posting.
- hueving 9y ago
  It's still a stupid metric if the judges scores contain subjective priorities because that makes it impossible to make a clear argument about the outcome.
- FireBeyond 9y ago
  The title of this article is "The Best Healthcare System In The World". I am fairly certain the designers of such systems did not consider "the ease, cost, or willingness of the USA to implement the same thing".
mjevans 9y ago
One of the major features of the British NHS system is virtually /eliminating/ the billing department. I really think that should be considered as a major feature as well. Not receiving hospital bills months after a procedure and you thought things were all taken care of.
- gerdesj 9y ago
  The only time you even consider thinking about money is for prescriptions and dental treatment and those are fixed price and subsidised and many exemption exist. A trip to A&E never involves money. The only thing you might get after the event is follow up appointments. A very quick run down on how we pay for all this: All employees (its a little more complicated for the self employed) have tax deducted at source, called Pay As You Earn (PAYE). There are two components: Income Tax - banded according to income and National Insurance (NI) - also banded. The NI contribution is generally to cover the NHS and Social Security, State Pension etc. Class One NI rates: https://www.gov.uk/national-insurance/how-much-you-pay https://www.gov.uk/national-insurance/how-much-you-pay so 12% up to £45,000 gross salary and 2% above that. Most people in the UK do not need to worry about filling in a tax return.
- refurb 9y ago
  I'm not sure what you mean by eliminating billing. Physicians and other healthcare professionals still need to bill for their services, no? That's what most of the paperwork is. Figuring out what code to bill under, someone verifying that, sending payment, etc. I agree that not billing patients reduces paperwork, but that's a relatively small part of overall billing.
  - dflock 9y ago
    Successive conservative governments have introduced a fake internal market into the NHS, deliberately fragmenting the previously integrated system and forcing the severed parts to sell services to each other. The money they use to buy services from their former colleagues all comes from their individual budgets, which is centrally funded from taxation. They still don't bill patients, they just furiously do pointless paperwork to swap tax money behind the scenes. Prior to this, it was a more integrated system, where all staff just worked for one central entity - the NHS - and were just paid a salary. Medical supplies, drugs etc... were all centrally procured, as required. Turns out that if you're buying drugs for 65 million people, you can get amazingly good deals from pharmaceutical companies and quickly build up incredible procurement expertise. This is all thrown away once you smash it up, though.
FireBeyond 9y ago
Absolutely. As someone who has received health care in France and Australia, this has nearly zero relevance in determining which system is the better: > "This seems to work well in Australia, but in the U.S. the public system most likely would be badly underfunded. Therefore, France would be superior." Essentially: "This system can't be the best in the world because it wouldn't work in one of the most horribly broken in the world, sabotaged or otherwise." The utter irony? France's system would be MORE expensive. But because they decide that Australia's (cheaper) system would be underfunded (and yet somehow France's would be fully funded?!?) it's worse: "The French health system is relatively expensive at 11.8 percent of G.D.P., while Australia’s is at 9 percent."

Y7ZCQtNo39 9y ago

If you live the United States, it is not a stupid metric. We should be focused on improving our system in ways that realistic and possible to achieve. Discussion of great ideas that could never be implemented would be largely academic when considering how the American system can be improved.

RobertoG 9y ago
Fair enough, but, at least, they should speak about how those reference countries are doing against the rest. In the World Health Organization ranking (1), of all the countries compared in the article, the only one that appears between the first ten in any of the categories (except cost) is France and, in only one metric, Australia and the UK. Not pointing that seems a strange omission. 1. https://en.wikipedia.org/wiki/World_Health_Organization_ranking_of_health_systems_in_2000 https://en.wikipedia.org/wiki/World_Health_Organization_rank...
- smcl 9y ago
  That's not correct - are we looking at the same table? There are more of the reference countries in the top 10 of the various categories (except cost). Here's the number of times each appear in the top ten categories in the Wikipedia article you posted: Canada: 1 Singapore: 1 Germany: 0 Switzerland: 3 France: 3 UK: 2 Australia: 1 The other larger* countries that feature in the top-ten of these categories - Japan, Sweden, Spain, Austria - all have universal healthcare. I'm not sure where you stand, but it seems that no matter how you slice it Americans are getting a raw deal with their healthcare. * = those roughly the same population as the smallest country on the list - Switzerland - or more
  - RobertoG 9y ago
    You are right, I was wrong. Specifically, I don't know how I missed Switzerland there. Obviously, I should double check before posting.
hueving 9y ago
It's still a stupid metric if the judges scores contain subjective priorities because that makes it impossible to make a clear argument about the outcome.
FireBeyond 9y ago
The title of this article is "The Best Healthcare System In The World". I am fairly certain the designers of such systems did not consider "the ease, cost, or willingness of the USA to implement the same thing".

mjevans 9y ago

One of the major features of the British NHS system is virtually /eliminating/ the billing department. I really think that should be considered as a major feature as well. Not receiving hospital bills months after a procedure and you thought things were all taken care of.

gerdesj 9y ago
The only time you even consider thinking about money is for prescriptions and dental treatment and those are fixed price and subsidised and many exemption exist. A trip to A&E never involves money. The only thing you might get after the event is follow up appointments. A very quick run down on how we pay for all this: All employees (its a little more complicated for the self employed) have tax deducted at source, called Pay As You Earn (PAYE). There are two components: Income Tax - banded according to income and National Insurance (NI) - also banded. The NI contribution is generally to cover the NHS and Social Security, State Pension etc. Class One NI rates: https://www.gov.uk/national-insurance/how-much-you-pay https://www.gov.uk/national-insurance/how-much-you-pay so 12% up to £45,000 gross salary and 2% above that. Most people in the UK do not need to worry about filling in a tax return.
refurb 9y ago
I'm not sure what you mean by eliminating billing. Physicians and other healthcare professionals still need to bill for their services, no? That's what most of the paperwork is. Figuring out what code to bill under, someone verifying that, sending payment, etc. I agree that not billing patients reduces paperwork, but that's a relatively small part of overall billing.
- dflock 9y ago
  Successive conservative governments have introduced a fake internal market into the NHS, deliberately fragmenting the previously integrated system and forcing the severed parts to sell services to each other. The money they use to buy services from their former colleagues all comes from their individual budgets, which is centrally funded from taxation. They still don't bill patients, they just furiously do pointless paperwork to swap tax money behind the scenes. Prior to this, it was a more integrated system, where all staff just worked for one central entity - the NHS - and were just paid a salary. Medical supplies, drugs etc... were all centrally procured, as required. Turns out that if you're buying drugs for 65 million people, you can get amazingly good deals from pharmaceutical companies and quickly build up incredible procurement expertise. This is all thrown away once you smash it up, though.

FireBeyond 9y ago

Absolutely. As someone who has received health care in France and Australia, this has nearly zero relevance in determining which system is the better: > "This seems to work well in Australia, but in the U.S. the public system most likely would be badly underfunded. Therefore, France would be superior." Essentially: "This system can't be the best in the world because it wouldn't work in one of the most horribly broken in the world, sabotaged or otherwise." The utter irony? France's system would be MORE expensive. But because they decide that Australia's (cheaper) system would be underfunded (and yet somehow France's would be fully funded?!?) it's worse: "The French health system is relatively expensive at 11.8 percent of G.D.P., while Australia’s is at 9 percent."