What Can the U.S. Learn About Health Care from Spain?
In 2009, Spain's single-payer health care system was ranked the seventh best in the world by the World Health Organization (Socolovsky, 2009). By comparison, the U.S. health care system ranted at 37 (Satiroglou, 2009). The Spanish system offers coverage as a right of citizenship that is constitutionally guaranteed. Spanish residents pay no expenses out-of-pocket, with the exception of a few select services. They do pay for drug costs themselves and many complain about long waits to see specialists to get certain procedures. However, on average the Spanish health care system ranks better than that of the United States in many categories. Almost everyone is an agreement that the U.S. health care system is in need of serious reform. However, deciding exactly what these reform should be as a point of contention among providers, lawmakers, and average citizens. This research explores both the U.S. And Spanish health care systems. It will address the issue of whether a national health care system, such as that which is found in Spain is the solution for the ailing system in the United States.
The U.S. System
Health care economists in the United States assert that although health care spending per capita may be higher than in any other OECD nation, the long-term rates of spending have been similar. However, White (2007) demonstrates that long-term growth rates have been exceptionally high as well. The author surmised that institutional features were responsible for high long-term growth rates in health care spending. This trend has been occurring steadily for close to the past three decades. White considers several factors to be causal in this growth rate. They are an aging population, general economic growth patterns, expansion of technological capabilities in medicine, and other factors such as expansions in health insurance coverage and financing options within the delivery system (White, 2007).
Nearly 17.4% of the GDP in the United States was accounted for by health spending. This is 9.5% higher than the OECD average (OECD, 2011a). Several factors about the U.S. health care system draw the attention of researchers and critics. The U.S. has a higher number of MRI units and CT scanners per million at 34.3. The OECD average is 22.1. There are also 3.5 beds per million people, which compares to an average of 2.7 per million in other OECD nations in the world (OECD, 2011a). The United States is one of the wealthiest nations in the world and has a high amount of technology and resources available to its citizens. Yet, it ranks considerably below Spain in terms of provision of that care. Japan, Switzerland, Italy, Spain and Australia have the highest life expectancies in the world (OECD, 2011a).
The United States has many resources available to its citizens, yet they have many health problems that could easily be resolved. For incidence, the U.S. has one of the highest obesity rates among OECD countries and these rates continue to climb (OECD, 2011a). One has to ask how a country that has the resources available that the United States does can rank so poorly in provision of health care to its citizens. The U.S. has one of the highest government spending rates for recipients of public aid among OECD countries (OECD, 2011a). Yet, it has some of the lowest standards of care among OECD nations.
Medicare is the primary delivery system for governments subsidized health care services. Currently, several sections of the Medicare System have been frozen due to inflationary increases in Social Security checks. Increases in Social Security offset small rises in Medicare premiums. The U.S. Health care system must continually make changes to adjust to gaps in coverage, such as the Affordable Care Act, which reduces prescription drug costs for people who fall into a gap in Medicare coverage (Sebelius, 2011). The government subsidized portion of the U.S. health care system must continually adjust to prop up portions of the system and to provide coverage for those who need it. However, the focus remains on only one portion of the system at a time, rather than taking a holistic approach to facing the problems that plague the entire system. This is a different approach than that taken by countries who have a national health care system in place. The U.S.treatment of the health-care system makes it seem as if the government is continually running around trying to fix portions that are falling apart, rather than providing the entire system with a solid base of operation. One of the key differences between the health care system in the United States and that of Spain is the viewpoint and approach that is taken by each of these countries. The United States can be seen as trying to micromanage the system, rather than providing a solid base for the system as a whole. The national health care approach can be seen as taking a holistic viewpoint of national health care problems.
Demand for health care services in the United States has continued to increase at a rate of approximately 11% since 1960 (Klees, Wolfe, & Curtis, 2010). Health care in the United States is funded through a number of different sources, rather than a single source. These sources include individuals' out-of-pocket expenses, private health insurance, philanthropy and charitable donations, non-patient revenues such as revenues from gift shops or parking lots, private insurance, individual employers and federal funds (Klees, Wolfe, & Curtis, 2010). This funding model is complicated and inefficient. As private payers become less able to pay for services public funds must pick up the tab. This places an even greater strain on the system, leading to more need to prop it up in some manner.
Government subsidized programs in the United States such as CHIP, Medicare, and Medicaid are only available to certain segments of the society. They are not available to every citizen, as they are in countries that have national health care programs. Government funded programs in the United States are only available to those who are older, disabled, significantly below the Federal poverty line, and uninsured children (InsureKidsNow.gov, 2011). The U.S. Census Bureau found that health insurance coverage was linked to family income for all demographic groups. This survey linked a lack of health insurance coverage to poverty (DeNavas, Proctor and Smith, 2011). Those that are very poor were eligible for government subsidies such as Medicaid. However, those that did not qualify for government programs and who could not afford health insurance were uninsured at the time of the survey (DeNavas, Proctor and Smith, 2011). This means that it is not the very poor who do not have health insurance in the United States, but rather those that fall into an income level just above the eligibility limits. There is a segment of the population that is unrepresented by the current health care system in the United States.
The United States differs in health- care growth compared to other OECD countries. One explanation for this may be how health care is financed in the United States as compared to other OECD nations. Three approaches to Health Care financing have been identified. They are:
1. public-integrated -- this is where the government acts as both insurer and provider of services
2. public-contract -- this is where the government or a centralized social insurer purchases services from private providers
3. private insurance/provider -- In this structure private insurers purchase services from private providers (White, 2007).
Nearly all high income OECD countries use the public-integrated mode or the public-contract model. The United States stands out in its resistance to these other models. The United States relies almost entirely on private insurance/provider model (White, 2007). Both the public-integrated and public-contract models give the government or another oversight agency considerable leverage over medical providers. They can use this leverage to place limits on medical spending. In some cases, this has led to a different mix of services than is seen in the United States. These models are an excellent cost limiting tool (White, 2007).
The United States has resisted staunchly to the adoption of the health care models used in a majority of OECD nations. As result, the insurance providers and medical service providers have almost complete control over their pricing structures and expenditures. These differences have contributed to the health care finance crisis in the United States. The net result of unbridled spending limits has led to per capita spending that is more than double that in other OECD nations (Anderson & Frogner, 2006). This growth rate has serious implications for the U.S. economy. Anderson & Frogner suggests that the United States is not getting a high return for its expenditure, based on life expectancy, quality of life, and pother factors that indicate a healthy health care system. The U.S. is spending a lot of money on health care, but they are not providing the level of care that could be expected for the amount of money being spent (Anderson…