Global Health Blogs with Professor Swahn

In the past year, our world experienced something that many would have never thought would ever occur…a global pandemic. The Coronavirus or as some would like to abbreviate it as COVID-19, became an enemy of the world and with that has caused strain on healthcare systems and economies on numerous countries across the globe (Peter G. Peterson Foundation, 2020). As great as America is, it is no exception and we got hit relatively hard by this. Did the American population have a fighting chance before being attacked by this microscopic enemy? Although we have a “healthcare system” in place, was it good enough to support our population?  How did we do compare to other countries, say Germany to be specific? For the remainder of this blog, I shall discuss a comparative analysis of how our healthcare system (i.e., The United States of America!) compares to Germany’s healthcare system prior to the 2020 coronavirus pandemic.

               The United States of America although a very young country compared to the rest of the world, has made a name for itself and progressed enough to be a top tier country. It also stands out in many ways compared to the rest of the world from its government, the melting pot of our society, the fact we use the imperial system of measurement and specifically our topic of discussion, our healthcare. The United States has no single nationwide system of health insurance, but instead a combination of health insurance provided by the government and private marketplace (Ridic et al., 2012). Most of the health insurance purchased in the United States is comprised of employer-based health care coverage (Ridic et al., 2012). Germany on the other hand has what is known as a dual public-private system (InterNations GO, 2012). In Germany it is mandatory to have some form of health coverage whether it is public health insurance or private health insurance (InterNations GO, 2012). Just like in the United States most employers supply insurance to their employees, however when deciding insurance plans in Germany, it is completely transparent which is a huge advantage, but we will get to that later. Germany has free public healthcare, but it only covers ‘” medically necessary” care which is funded by their social security, and the purpose of the insurance policy is to cover hospital and outpatient medical treatment (i.e., pregnancy) (InterNations GO, 2012). Compared to the rest of the Organization for Economic Cooperation and Development’s (OECD) which has maintained a gross domestic product (GDP) spending of roughly 11%, in this case Germany with 11.7% for healthcare spending from 2010 to 2019, America on the other hand has increased spending from 16.3% to 17.0% (Peter G. Peterson Foundation, 2020). Figure 1 illustrates this by comparing how America is nearly doubled that of 9 other OECD countries. You can how with America’s GDP of ~17%, it increases the OECD average. On Figure 2 we get a little more in depth by looking at how the United States spends nearly twice the average per capita healthcare spending (Peter G. Peterson Foundation, 2020). Figure 2 compares how the United States is nearly double that of Germany (approx. $4,426) by average per capita costs of healthcare.

Figure 1: Healthcare Expenditures in the United States are significantly higher than those of other developed countries.

Figure 2: U.S. per capita Healthcare spending is almost twice the average of other wealthy countries.

Now does spending more than other countries mean we are better, well not exactly, but there are pros to higher spending in our healthcare system being high quality of healthcare services, minimal waiting lists for major procedures, different Medicare options, and adequate number of resources (theclintoncourier.net). If you have the money to pay for premium health insurance, we have the right care for you. By absorbing more money from higher insurance plans, patients get access to more advanced medical facilities and overall better health care from advanced equipment to highly qualified doctors. This in turn due to high costs of medical care under America’s direct-fee system, medical facilities in the United States are equipped to battle a variety of diseases and illnesses (theclintoncourier.net). Having adequate resources and options for different Medicare plans are bonuses that allow individuals or families to decide on what they will need and what they can afford. Along with the higher spending comes lower wait times at hospitals, due to the amount available per population size in each area. The United States compared to other OECD countries have some of the lowest wait times to see a surgeon or specialist (theclintoncourier.net).

With pros comes some of the cons of America’s high spending healthcare system. These would include limited insurance coverage, lack of transparency, no preventative care and the big one being how expensive our healthcare costs us. It is no surprise by now that the rest of the world knows we spend a lot on everything, but do individuals really spend a lot on their care? The answer is yes, Americans pay high premiums for their insurance with out-of-pocket costs, and if individuals do not have insurance well then, they still must pay through fee for service plans. The standard plans Medicare (government insurance) offers, is not always enough to cover costs and American always worry about going bankrupt due to high medical bills (theclintoncourier.net). Lack of transparency is a big deal as well, because with having high costs and limited insurance options, people also must guess on what their cost of care will be. Peoples lack trust in the medical system in America, is their because they “don’t know what they are buying” when getting treated. To add icing to the cake after all the bills and high costs are taken care and treatment has been administered, the physicians or surgeons do not advocate for preventative care to ensure the reason for the patients visit does not happen again. By not educating or offering quality follow up services, patients especially older patients tend to have to be seen repeatedly thus billing insurance again and again (theclintoncourier.net).  

Now that we know the pros and cons of the American healthcare system, how does this compare to Germany? The benefits of the German healthcare system are decreased number of prescription dependencies, does not have a 100% socialized single-payer system that most Americans fear, reasonable cost for hospitals and prescription drug co-pays, ability to purchase private insurance, no penalty for switching from public to private insurance if employed, high quality care and doctors are readily available (Gaille, 2019). Most of the pros are simple enough to understand, but what is meant by not having a 100% socialized single-payer system? In Germany you still pay for health insurance, however the individuals who are excluded from paying, but still receive medical care are elderly, disabled, unable to work, or individuals living in poverty (Gaille, 2019). This is because of their limitation to afford insurance, but to the German population that should not exclude them from receiving quality medical care like the rest of the population.

There are downsides to the great healthcare system in Germany however, being; doctors do not make as much money, limited distribution of medications, private insurance does not always cover pre-existing conditions, mandatory public health insurance unless you do not qualify, and it is illegal to not carry health insurance if you live in Germany (Gaille, 2019).

References

Gaille, L. (2019, April 21). 19 Pros and Cons of German Healthcare System. Vittana.org. https://vittana.org/19-pros-and-cons-of-german-healthcare-system

InterNations GO. (2012, November 22). Health Insurance and the Healthcare System of Germany Explained. Internations.org; InterNations GO. https://www.internations.org/go/moving-to-germany/healthcare

Mills, A. (2014). Health Care Systems in Low- and Middle-Income Countries. New England Journal of Medicine, 370(6), 552–557. https://doi.org/10.1056/nejmra1110897

Peter G. Peterson Foundation. (2020, July 14). How Does the U.S. Healthcare System Compare to Other Countries? Www.pgpf.org. https://www.pgpf.org/blog/2020/07/how-does-the-us-healthcare-system-compare-to-other-countries

Ridic, G., Gleason, S., & Ridic, O. (2012). Comparisons of Health Care Systems in the United States, Germany and Canada. Materia Socio Medica, 24(2), 112. https://doi.org/10.5455/msm.2012.24.112-120

The Clinton Courier. (2020, September 14). The Pros and Cons of the US Health-Care Model (the Direct-Fee System). The Clinton Courier. https://www.theclintoncourier.net/2020/09/14/the-pros-and-cons-of-the-us-health-care-model-the-direct-fee-system/

Tikkanen, R., & Abrams, M. (2020, January 30). U.S. health care from a global perspective, 2019: Higher spending, worse outcomes? Www.commonwealthfund.org. https://www.commonwealthfund.org/publications/issue-briefs/2020/jan/us-health-care-global-perspective-2019