3 ms·

Much of Europe works perfectly well with out health insurance.

by msh 12y ago

jonsen 12y ago
It is still insurance when administered by the government and payed through taxes.
- _delirium 12y ago
  I think that differs quite a bit by country. At least in Denmark it's administered in a considerably different manner, more like any other public spending that decides on priorities and allocates resources. Some parts of it do have actuarial elements that parallel what an insurance company would do (pooling risks across the population), but many don't. The cost of many things is well known in advance and has little uncertainty (especially when the whole country is taken in aggregate), and it's just a public-health choice whether to pay for it or not. Routine childhood vaccinations are a clear example, which are just budgeted as a public-health measure, like water purification or whatever. Hospitals have an element of risk-pooling when individual patients are looked at, but at the public level are run more like fire departments or police departments, which also have an element of risk pooling. I guess you could argue that fire departments are really some kind of state-administered fire-response-insurance system, but I'm not aware of that being a common approach. Data and statistics and people to look at them are still needed though, of course, but they are looking at more "real" problems, like which procedures best improve morbidity-adjusted life expectancy. I know in some other countries, like Germany, it is set up much more closely to insurance, in the sense that procedures have prices, are billed out to patients, who are covered by insurance plans that reimburse patients for costs, etc., in which case I imagine the bureaucracy is much more insurance-like.
- fsloth 12y ago
  The dynamics of the financial incentives involved are a bit different with goverment provided health care and private clinics funded through medical insurance. Private clinics which are the main receivers of insurance money are often owned by the doctors. Thus, they have an incentive to over-charge, over diagnose and run expensive labs whenever they can. I'm not saying it happens, just that the incentive is there. Government provided healthcare offers no financial incentives for practicioners to over-diagnose - on the contrary this system then incentivizes to be as prudish as possible with the public resources. I'm not saying one or the other is better or worse, just that they are not equal in every way.
fsloth 12y ago
Weeel now. As an example Finland - while there is a fairly functional state paid health service, most affluent people take the health insurance anyway and go to private clinics for day-to-day needs to avoid the public queues. Most eployees have a compulsory medical coverage by the employers, which is a bought service from the private clinics. Thus the medical scene is a bit more complex than "state pays it all". It can require quite a bit of effort to get proper medical attention in the public side unless one is ill in a critical, easy-to-diagnose form. Best places in the world to have a cancer or such though, since the state pays most of the treatment (thus Breaking Bad creates quite strong cultural dissonance initially).
- ptaipale 12y ago
  In Finland, there's not really a compulsory medical coverage by employers. The only compulsory part is planning and processes to prevent work-related health hazards and harms, and to protect and advance workplace safety, ability to work and health. (See law 2001/1383) So, some paperwork is mandatory, no actual health care. The reason many employers voluntarily provide an actual health insurance (or simply reimburse private-sector medical costs directly) is that it is one of the few tax-free benefits that employers can give to people, so it works efficiently as an additional compensation. And of course, because employee absences are costly, it makes good sense to try to keep them in good health. The public sector health care does practically nothing in terms of preventive health care for people between 25-65 and in employment (except for maternity-related things). This is left to employers.
  - deleted 12y ago
    [deleted]
  - fsloth 12y ago
    "So, some paperwork is mandatory, no actual health care." The way the law is brought to action is that the private clinics have specific service tiers which they offer to employers, of which even the basic one covers consultation by a general practitioner. The easiest way for employers to fulfill the letter of the law is to buy the service. Which means that working adults seldom tend to the public services unless they are really ill, which means more business for the private clinics and increases the appeal of a health insurance (it's easier). This is getting really obscure for this forum, but as a reference: The specific law is https://www.finlex.fi/fi/laki/ajantasa/2001/20011383 https://www.finlex.fi/fi/laki/ajantasa/2001/20011383 Which in google translate is https://translate.google.com/translate?sl=fi&tl=en&js=y&prev=_t&hl=en&ie=UTF-8&u=https%3A%2F%2Fwww.finlex.fi%2Ffi%2Flaki%2Fajantasa%2F2001%2F20011383&edit-text= https://translate.google.com/translate?sl=fi&tl=en&js=y&prev...
yummyfajitas 12y ago
Clearly the state budget planners have no need to compute the expected future health care expenses of the state.
Htsthbjig 12y ago
Much of Europe has mandatory public health insurance if you work. It also has voluntary private health insurance. What you probably are referring to is that USA has not private health insurance at all. In the US only your employer could give you insurance, so it is not personal and private, but collective, if you try to do on your own it is prohibitively expensive.

Much of Europe works perfectly well with out health insurance.

by msh 12y ago

Much of Europe works perfectly well with out health insurance.

jonsen 12y ago

It is still insurance when administered by the government and payed through taxes.

_delirium 12y ago
I think that differs quite a bit by country. At least in Denmark it's administered in a considerably different manner, more like any other public spending that decides on priorities and allocates resources. Some parts of it do have actuarial elements that parallel what an insurance company would do (pooling risks across the population), but many don't. The cost of many things is well known in advance and has little uncertainty (especially when the whole country is taken in aggregate), and it's just a public-health choice whether to pay for it or not. Routine childhood vaccinations are a clear example, which are just budgeted as a public-health measure, like water purification or whatever. Hospitals have an element of risk-pooling when individual patients are looked at, but at the public level are run more like fire departments or police departments, which also have an element of risk pooling. I guess you could argue that fire departments are really some kind of state-administered fire-response-insurance system, but I'm not aware of that being a common approach. Data and statistics and people to look at them are still needed though, of course, but they are looking at more "real" problems, like which procedures best improve morbidity-adjusted life expectancy. I know in some other countries, like Germany, it is set up much more closely to insurance, in the sense that procedures have prices, are billed out to patients, who are covered by insurance plans that reimburse patients for costs, etc., in which case I imagine the bureaucracy is much more insurance-like.
fsloth 12y ago
The dynamics of the financial incentives involved are a bit different with goverment provided health care and private clinics funded through medical insurance. Private clinics which are the main receivers of insurance money are often owned by the doctors. Thus, they have an incentive to over-charge, over diagnose and run expensive labs whenever they can. I'm not saying it happens, just that the incentive is there. Government provided healthcare offers no financial incentives for practicioners to over-diagnose - on the contrary this system then incentivizes to be as prudish as possible with the public resources. I'm not saying one or the other is better or worse, just that they are not equal in every way.

fsloth 12y ago

Weeel now. As an example Finland - while there is a fairly functional state paid health service, most affluent people take the health insurance anyway and go to private clinics for day-to-day needs to avoid the public queues. Most eployees have a compulsory medical coverage by the employers, which is a bought service from the private clinics. Thus the medical scene is a bit more complex than "state pays it all". It can require quite a bit of effort to get proper medical attention in the public side unless one is ill in a critical, easy-to-diagnose form. Best places in the world to have a cancer or such though, since the state pays most of the treatment (thus Breaking Bad creates quite strong cultural dissonance initially).

ptaipale 12y ago
In Finland, there's not really a compulsory medical coverage by employers. The only compulsory part is planning and processes to prevent work-related health hazards and harms, and to protect and advance workplace safety, ability to work and health. (See law 2001/1383) So, some paperwork is mandatory, no actual health care. The reason many employers voluntarily provide an actual health insurance (or simply reimburse private-sector medical costs directly) is that it is one of the few tax-free benefits that employers can give to people, so it works efficiently as an additional compensation. And of course, because employee absences are costly, it makes good sense to try to keep them in good health. The public sector health care does practically nothing in terms of preventive health care for people between 25-65 and in employment (except for maternity-related things). This is left to employers.
- deleted 12y ago
  [deleted]
- fsloth 12y ago
  "So, some paperwork is mandatory, no actual health care." The way the law is brought to action is that the private clinics have specific service tiers which they offer to employers, of which even the basic one covers consultation by a general practitioner. The easiest way for employers to fulfill the letter of the law is to buy the service. Which means that working adults seldom tend to the public services unless they are really ill, which means more business for the private clinics and increases the appeal of a health insurance (it's easier). This is getting really obscure for this forum, but as a reference: The specific law is https://www.finlex.fi/fi/laki/ajantasa/2001/20011383 https://www.finlex.fi/fi/laki/ajantasa/2001/20011383 Which in google translate is https://translate.google.com/translate?sl=fi&tl=en&js=y&prev=_t&hl=en&ie=UTF-8&u=https%3A%2F%2Fwww.finlex.fi%2Ffi%2Flaki%2Fajantasa%2F2001%2F20011383&edit-text= https://translate.google.com/translate?sl=fi&tl=en&js=y&prev...

yummyfajitas 12y ago

Clearly the state budget planners have no need to compute the expected future health care expenses of the state.

Htsthbjig 12y ago

Much of Europe has mandatory public health insurance if you work. It also has voluntary private health insurance. What you probably are referring to is that USA has not private health insurance at all. In the US only your employer could give you insurance, so it is not personal and private, but collective, if you try to do on your own it is prohibitively expensive.