International Profiles of Health Care Systems, 2012
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International Profiles of Health Care Systems, 2012 Australia, Canada, Denmark, England, France, Germany, Iceland, Italy, Japan, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States Edited by: Sarah Thomson, London School of Economics and Political Science Robin Osborn, The Commonwealth Fund David Squires, The Commonwealth Fund Miraya Jun, London School of Economics and Political Science The Commonwealth Fund November 2012 The Commonwealth Fund is a private foundation that promotes a high performance health care system providing better access, improved quality, and greater efficiency. The Fund’s work focuses particularly on society’s most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults. The Fund carries out this mandate by supporting independent research on health care issues and making grants to improve health care practice and policy. An international program in health policy is designed to stimulate innovative policies and practices in the United States and other industrialized countries. International Profiles of Health Care Systems, 2012 Australia, Canada, Denmark, England, France, Germany, Iceland, Italy, Japan, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States The Commonwealth Fund November 2012 Editors: Sarah Thomson, London School of Economics and Political Science Robin Osborn, The Commonwealth Fund David Squires, The Commonwealth Fund Miraya Jun, London School of Economics and Political Science Additional editorial support was provided by Joris Stuyck Abstract: This publication presents overviews of the health care systems of Australia, Canada, Denmark, England, France, Germany, Japan, Iceland, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States. Each overview covers health insurance, public and private financing, health system organization, quality of care, health disparities, efficiency and integration, care coordination, use of health information technology, use of evidence-based practice, cost containment, and recent reforms and innovations. In addition, summary tables provide data on a number of key health system characteristics and performance indicators, including overall health care spending, hospital spending and utilization, health care access, patient safety, care coordination, chronic care management, disease prevention, capacity for quality improvement, and public views. To learn more about new publications when they become available, visit the Fund’s Web site and register to receive e-mail alerts. Commonwealth Fund pub. no. 1645. Contents Table 1. Health Care System Financing and Coverage in Fifteen Countries 6 Table 2. Selected Health System Indicators for Fifteen Countries 7 Table 3. Selected Health System Performance Indicators for Eleven Countries 8 Table 4. Provider Organization and Payment in Fifteen Countries 9 The Australian Health Care System, 2012 11 The Canadian Health Care System, 2012 19 The Danish Health Care System, 2012 26 The English Health Care System, 2012 32 The French Health Care System, 2012 39 The German Health Care System, 2012 46 The Icelandic Health Care System, 2012 53 The Italian Health Care System, 2012 59 The Japanese Health Care System, 2012 66 The Dutch Health Care System, 2012 72 The New Zealand Health Care System, 2012 79 The Norwegian Health Care System, 2012 86 The Swedish Health Care System, 2012 93 The Swiss Health Care System, 2012 99 The United States Health Care System, 2012 106 6 The Commonwealth Fund Table 1. Health Care System Financing and Coverage in Fifteen Countries Health system and public/private insurance role Benefit design Private insurance role (core benefits; cost-sharing; noncovered benefits; private facilities or amenities; Government role Public system financing substitute for public insurance) Caps on out-of-pocket (OOP) spending Exemptions & low-income protection Australia Regionally administered universal public in- General tax revenue; earmarked income tax ~50% buy coverage for private hospital costs No. Safety nets include 80% OOP rebate Low-income and older people: Lower cost- surance program (Medicare), joint (national & noncovered benefits if physician costs exceed AUS$1,198 sharing; lower OOP maximum before 80% & state) public hospital funding [US$1,247] subsidy Canada Regionally administered universal public Provincial/federal tax revenue ~67% buy coverage for noncovered benefits No No cost-sharing for Medicare services. Some insurance program (Medicare) cost-sharing exemptions for non-Medicare services, e.g., drugs outside hospital; varies by province Denmark National health service Earmarked income tax ~55% buy coverage for cost-sharing, No. Decreasing copayments with higher Drug OOP cap for chronically ill (DKK 3,410 noncovered benefits, or access to private drug OOP spending [US$585]); financial assistance for low- facilities income and terminally ill England National health service General tax revenue (includes employment- ~11% buy for private facilities No general cap for OOP. Prepayment certifi- Drug cost-sharing exemption for low- related insurance contributions) cate with £2 [US$3.20] per week ceiling for income, older people, children, pregnant those needing a large number of prescrip- women and new mothers, and some tion drugs disabled/chronically ill; transport costs for low-income France Statutory health insurance system, with all Employer/employee earmarked income and ~90% buy or receive government vouchers No. €50 [$US64] cap on deductibles for con- Exemption for low-income, chronically ill and SHI insurers incorporated into single national payroll tax; general tax revenue; earmarked for cost-sharing; some noncovered benefits sultations and services disabled, and children exchange taxes Germany Statutory health insurance system, with 154 Employer/employee earmarked payroll tax; Cost-sharing + amenities (~20%); Substitute: Yes. 2% income; 1% income for chronically ill Children exempt competing SHI insurers (“sickness funds”) in general tax revenue 10% opt-out of SHI system for private cover- + low income a national exchange; high income can opt age only out for private coverage Iceland National health service General tax revenue None, except to cover first six months of Yes. Caps vary for 4 groups, based on age, Exemptions for children under 18 and preg- residence before eligible for national system disability, and employment status nant women Italy National health service National earmarked corporate and value- ~15% buy coverage for access to private No. €46.15 [US$59] copayment on outpa- Exemptions for low-income older people/ added taxes; general tax revenue and re- facilities and amenities tient care; limited copayment (regional rates) children, pregnant women, chronic condi- gional tax revenue on drugs tions/disabilities, rare diseases Japan Statutory health insurance system, with General tax revenue; insurance contributions Majority buy coverage for cash benefits/ No. Coinsurance reduced to 1% after 80,100 Low-income monthly OOP ceiling: 35,400 approx. 3,500 noncompeting public, cost-sharing yen [US$999] monthly cap yen [US$441]; reduced cost-sharing for quasipublic, and employer-based insurers young children and older people Netherlands Statutory health insurance system, with Earmarked payroll tax; community-rated Private plans provide universal core benefits; No. Annual deductible of €220 [US$282] cov- Children exempt from cost-sharing; pre- universally mandated private insurance insurance premiums; general tax revenue 90% buy for noncovered benefits ers most cost-sharing mium subsidies for low-income (national exchange) New Zealand National health service General tax revenue ~33% buy for cost-sharing, access to special- No. Subsidies after 12 doctor visits/20 pre- Lower cost-sharing for low-income, some ists, and elective surgery in private hospitals scriptions in past year chronic conditions, Maori and Pacific island- ers; young children mostly exempt Norway National health service General tax revenue <5% buy for private facilities NOK 1,980 [US$346] Exemptions for children <16 yrs somatic, <18yrs psychiatric, pregnant women and for some communicable diseases (STDs) Sweden National health service General tax revenue <5% buy for private facilities Yes. SEK 1100 [US$164] for health services & Exemption for children and pregnant SEK 2200 [US$328] for drugs women Switzerland Statutory health insurance system, with Community-rated insurance premiums; Private plans provide universal core benefits; Yes. 700 CHF [US$742] max after deductible Income-related premium assistance (30% re- universally mandated private insurance general tax revenue majority buy for noncovered benefits and ceive); some assistance for low-income; some (regional exchanges) amenities exemptions for children, pregnant women United States Medicare: age 65+, some disabled; Medicaid: Medicare: payroll tax, premiums, federal tax Primary private insurance covers 56% of No Low-income: Medicaid; older people and some low-income (most under age 65 cov- revenue; Medicaid: federal, state tax revenue population (employer-based and individual); some disabled on Medicare ered by private insurance; 16% of population supplementary for Medicare uninsured) International Profiles of Health Care Systems, 2012 7 Table 2. Selected Health System Indicators for Fifteen Countries New United United Australia Canada Denmark France Germany Iceland Italy Japan Netherlands Zealand Norway Sweden Switzerland Kingdom