As I mentioned in the pub, I was going to start posting some information about National Health plans of other countries.

As we hear more and more about the credit a National Plan will bring to the US economy, I eventually plan to find the debit side of the ledger.  One example of a debit to the States is the Premium Tax.  I believe every State in the Nation has a 1 to 2 percent tax on Gross Premiums collected.  National Health will bring the loss of the premium tax that should be used in the balance sheet.  There is more but that is not what will be part of this diary.

My information is in MS WORD format, footnoted and I've edited it down to about 34 pages. I'll be copying and pasting my info (footnotes included).  I'll post anywhere from one to several countries each day; countries are presented in alphabetical order..  Finally when I reach the last day, I will post a bit of information on the US Medicare plan.

As soon as I drink my wheat grass juice, I'll start the diary.   Yum!?!?!  Well my wife says just looking at the stuff is a big yuck!

Here we go.

Everything You Ever Wanted to Know about National Health Plans ….and maybe more.

Australia – New Zealand

"Public hospitals: who’s looking after you? The difficulties in encouraging patients to use their private health insurance in public hospitals"

Private health insurance (PHI) is an important part of the Australian health system. During the introduction of the recent PHI reforms it was argued that, without the reforms, the public hospital system would undoubtedly collapse under the increased demand for public health services. The increase in PHI coverage might also have been expected to result in an increase in the revenue earned by public hospitals as a result of treating privately insured patients. However, the decline in numbers of privately insured patients using their PHI in public hospitals has continued, with adverse impacts on public hospital budgets in some states.

Cost containment and Gatekeepers
Three central goals of fairness are equity, efficiency, and accountability.

A basic requirement of justice is that those with equal needs have equal opportunities to access care. However, patients with equal needs do not have equal opportunities to access to certain services such as rheumatological services in Australia. Access to a rheumatologist varies considerably between the States and Territories and the PBS criteria require a rheumatologist to apply for the biologicals on behalf of the patient.  

Not everyone who has a rational case for subsidised access to a particular form of healthcare can gain access to it. The important responsibility of clinicians, who are, in effect, the 'gatekeepers', to manage the expectations of patients as well as their disease was thus impaired.   

The health sector in Australia faces major challenges including an aging population, spiraling health care costs, continuing poor Aboriginal health and emerging threats to public health. At the same time, the environment for policy making is becoming increasingly complex. In this context, strong policy capacity - most commonly understood as the capacity of government to make 'intelligent choices' between policy options is essential if governments and societies are to address the continuing and emerging problems effectively.

Since 1995 Australian health insurers have been able to purchase health services pro-actively through negotiating contracts with hospitals, but little is known about their experience of purchasing. Many of the traditional tools used to generate competition and enhance efficiency (such as selective contracting and co-payments) have had limited use due to public and political opposition. Adoption of bundled case payment models using diagnosis related groups (DRGs) has been slow.

Private health insurers also face a complex web of regulation, some of which appears to impede moves towards more efficient purchasing. In introducing the 1995 contracting reforms, the Commonwealth Minister proposed that one of the central objectives was to transform private health insurers from "passive bill payers" into active purchasers of services for their members  

"Increased public hospital bed numbers are crucial if we are to reduce waiting times, ease the Emergency Department pressures, improve patient care, and have patients in the most appropriate clinical setting for their condition.  "The AMA supports the move to establish hospital boards, and will work with government to develop the appropriate model, which will need to include clinicians. Much of the Plan depends on cooperation and take-up from the States and Territories.

The fact is, however, at present access to the best doctors is erratic and left to the wealthy. Further, exposure to medical errors seems more of a problem for public than for private patients.

Australia has got a real problem with medical errors in the health care system. It is estimated at between 3.2 and 5.4 per cent in the US, 9 per cent in Denmark, 10 to 11,7 per cent in the UK but a shocking 10.6 to 16.6 in Australia (Bedkober, B., IPA Review, March 2007).

The figure of 10 per cent was just recently confirmed in a government report. According to Wilson (“Quality in Australian Health Care”, 1995) one in six hospital admissions generates an adverse event, half of which is preventable and six in every 1,000 admissions are ending in a preventable death from an adverse event including complications.

In this two-tier system the majority of public patients end up on waiting lists and only private patients get access through their referring doctors to what they believe are the best performing hospitals or specialists.

References

[1] Public hospitals: who’s looking after you? The difficulties in encouraging patients to use their private health insurance in public hospitals
[2]Access to high cost medicines in Australia: ethical perspectives
[3] Evaluating health policy capacity: learning from international and Australian experience.
[4] Buying best value health care: Evolution of purchasing among Australian private health insurers
[5] Coalition's Health Plan Sets the Right Course But Lacks Funding Detail
[6] Road map for Australian health care reform - Part I

The web sites are included for interested parties to check on.

Tomorrow is Canada.