International Comparisons

The way healthcare systems are funded and organised varies considerably across Europe and the rest of the world.

There are three basic models of healthcare:

• Tax-based systems like the NHS provided by the government and financed mainly through taxation. Denmark, Sweden and Finland have similar approaches.
• Non-profit social insurance systems that provide compulsory coverage for everyone. Usually, the health system is financed by employer and employee contributions through payroll deductions. This is the system in Germany and France.
• Privately-funded systems paid for through private health insurance taken out by employers or individuals or by direct payments to health providers. This model is prevalent in the United States.

In many countries these systems overlap and complement each other.

Almost every system faces similar finance and delivery problems. The fundamental goal of all of them is to provide access to quality care for all people.

However, some achieve this better than others. The United States, for example, spends almost twice as much of its gross domestic product (GDP) on healthcare as the UK but millions of people have no health cover.

In Scotland, the NHS provides equal access to health services which are provided free of charge at the point of contact.

The variations in funding systems and the health of populations makes comparisons across international boundaries extremely complex. Likewise, international rankings of healthcare systems vary substantially, depending on the criteria used for the comparison.

In 2000 the World Health Organization produced the World Health Report which attempted to rank the various health systems of the world. The UK emerged in 18th place out of 125 countries with France judged to have the best system.

More recently, an analysis was carried out by the Commonwealth Fund, a private US foundation with an interest in promoting a high-performing healthcare system. It compared data on the performance of six different health systems on five key indicators – producing long, healthy and productive lives; quality; access; equity; and efficiency.

The result was that the UK took first place, followed by Germany, Australia, New Zealand, Canada and the United States. (Note: source British Medical Journal, June 28, 2008, 1469-1471.)

Patient charges vary, as well, across different countries. Direct and precise comparisons are, again, difficult but some key points are:

• Patients in most countries pay some form of charge towards their medication, one exception is the Netherlands.
• In most countries patients pay a percentage of the cost of medication. In Scotland, a flat rate prescription charge is levied. This is currently £5 and is being phased out by 2011.
• In Germany, France and Italy patients often have to pay around £10-£15 for a single dental filling.
• Visits to the GP are free in Scotland but not in many European countries. In Germany, for example, a charge of £7.90 applies.

Iris Rickhoff
Economist, Scottish Government