Great Britain

Access:

Benefits:

Costs:

Financing:

Administration:

Providers:

Quality:

6.1% of G.N.P. Costs are contained by putting
limits on what doctors can charge and
hospitals spend.

National government pays for 98% of health care, with 89% coming from income taxes, 9% from employer-employee contributions, and 2% from consumers for uncovered benefits and private care.

Overall responsibility rests with national government which sets policy and allocates resources and provides oversight of hospitals and the practice of Family Practitioners. General Practitioners are self-employed, but paid by the National Health Service on a feefor-service basis with the government setting limits on charges. Hospital doctors are salaried and can accept private patients, but not many do. The national government pays all hospital costs but limits what they can spend.

Life expectancy is 75 years, which ranks third.
Infant mortality is 8.8 per 1,000 births,
which ranks fifth.

Japan

Access:

Benefits:

Costs:

Universal

* physician services

* hospital stays, including accommodations, tests and lab work, surgery

* home care

* prescription drugs

prenatal and well-baby care

* nursing home care

* dental care

6.7% of G.N.P. Costs are contained by the
national government setting standard fees for
all services. Also, medical consultants are
hired to look for unnecessary charges.
reject about 8% of claims submitted.

They

Financing:

1)

public funds cover about 7% of health
costs, mostly for administration.

2)

Administration:

Providers:

Quality:

3)

the Aged program covers about 24% of costs
and covers retirees. The national
government supplies 20% of the costs,
local governments 10% and employer-based
insurance programs 10%.

compulsory insurance programs cover 57%
of all costs. They are financed through
employment-based premiums which is 8-9% of
wages with the employer picking up an
average of 63% of those costs.

direct patient payments cover about 12% of all health care costs, usually in copayments.

The national Ministry of Health and Welfare regulates public doctors by setting fees and reviewing practice methods. The Ministry also sets policies for hospitals with public hospitals operated and financed by local governments. The Ministry also sets rates and standards for private hospitals.

Private doctors and hospitals can excess
bill. Public hospitals are staffed by medical
personnel paid by the government and are
closed to doctors in private practice.

Life expectancy is 76 years, which ranks
second. Infant mortality is 5.2 per 1,000
births, which ranks second.

Access:

Benefits:

Costs:

Financing:

Administration:

Providers:

Quality:

West Germany

Universal

* physician care

* dental care

* treatment by allied health professionals

* hospital stays, including accommodations,
tests and lab work, and surgery

* home care

* prescription drugs

* preventive care, including prenatal and wellbaby care

* mental health

* nursing home care

9.3% of G.N.P. Health care costs are controlled by the Federal government using a capitation plan through which local sickness funds are financed on a per patient basis rather than a per services basis.

The

sickness funds then set rates for what doctors and hospitals are paid for services.

90% of West Germany's health care is financed
through Compulsory Health Insurance (CHI) and
paid for with payroll taxes. The employer
puts in 4% of wages, the employee 5%.
Social Welfare system pays for services of
National Assistance recipients through Federal
taxes. 11% of West Germans buy private
insurance to supplement CHI. 2% of the
population is considered too wealthy for CHI.
They either pay directly for services or buy
insurance privately.

National Committee selected by CHI physicians and CHI fund boards develop standards for sickness funds and allocates the money sickness funds pay providers. The lump-sum payment made to a sickness fund is typically based on a per person capitated basis. sickness fund sets fees and pays doctors and hospitals to deliver health care. Hospitals are private and work under contract with the local sickness fund.

Doctors are self-employed but are usually members of physician associations related to one or more local sickness fund. All hospitals receive financing from both CHI and 'National Assistance.

Life expectancy is 75 years, which ranks
third. Infant mortality is 8.5 per 1,000
births, which ranks fourth.

Access:

Benefits:

Costs:

Financing:

Administration:

Providers:

Quality:

United States

Affordability

Benefits vary widely depending on the type of insurance an individual has or can afford.

11.2% of G.N.P and rising. The government controls some costs through Medicare and Medicaid limits. These controls apply more towards hospitals, since physicians are allowed to excess bill Medicare patients.

Individuals pay 29% of all health care costs
out-of-pocket. Private insurance only covers
31% of the population and of this beneficiaries
are required to pay premiums, deductibles,
co-payments, and for uncovered services.
Medicare pays 17% of health care costs and is
paid through payroll deductions, premiums, and
general revenues. Medicare beneficiaries must
also contribute premiums, deductibles, copay-
ments, and uncovered services. Medicaid pays
10% of health care costs and is paid through the
Federal and state governments mostly out of
income taxes. The government also operates the
Indian Health Service, the Veterans Admini-
stration, and provides medical services for
military personnel through general revenues. 3%
of health care costs are financed privately by
charities and other givers.

There is no government body charged with overseeing the American health care system. Due to this decentralization, hospitals and physicians spend much of their time in filling out forms.

Physicians are self-employed and paid through
out-of-pocket expenses, insurance payments, and
Medicare and Medicaid payments. Physicians do
not have to accept Medicare assignment and are
free to excess bill Medicare beneficiaries.
Physicians are not allowed to excess bill
Medicaid beneficiaries. Both government
programs currently pay on a fee-for-services
basis although it looks like Congress will
change this soon. Hospitals can be either
private or public with public hospitals
subsidized primarily through local and state
governments. Hospitals, like doctors, work on a
fee-for-service basis, except for Medicare which
pays for what service the patient requires.

Life expectancy is 74 years, which ranks
sixth. Infant mortality is 10.4 per 1,000
births, which ranks sixth, but is much higher
for minorities. A Black baby born in Memphis or
Detroit has a smaller chance of surviving its
first year than a baby born in Costa Rica.