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Chapter 19 American Health Care in International Perspective Joe White © 2008 Delmar Cengage Chapter 19 American Health Care in International Perspective Joe White © 2008 Delmar Cengage Learning.

Comparing Possibilities • Range of comparison – Offers insight on just what is possible Comparing Possibilities • Range of comparison – Offers insight on just what is possible in the field of health care – This is particularly useful when America, or any other country, contemplates health care reform 2 © 2008 Delmar Cengage Learning.

Comparing Cause-and-Effect • Pooling experiences in health care worldwide – Shows how certain actions Comparing Cause-and-Effect • Pooling experiences in health care worldwide – Shows how certain actions lead to predictable (or unpredictable) reactions 3 © 2008 Delmar Cengage Learning.

Comparing Cause-and-Effect • For instance: – Successful adoption of national health insurance appears linked Comparing Cause-and-Effect • For instance: – Successful adoption of national health insurance appears linked to making insurance compulsory for a broad sector of society (based on income) 4 © 2008 Delmar Cengage Learning.

Comparing Cause-and-Effect • For instance: – Aging does not raise health care spending per Comparing Cause-and-Effect • For instance: – Aging does not raise health care spending per se • Far more important is how much a society pays in health care costs 5 © 2008 Delmar Cengage Learning.

Comparing Preferences • Preferences often dependent on one’s position in a society – Especially Comparing Preferences • Preferences often dependent on one’s position in a society – Especially one’s professional affiliation 6 © 2008 Delmar Cengage Learning.

Comparing Preferences • Many health care positions and popular conceptions – Actually arise from Comparing Preferences • Many health care positions and popular conceptions – Actually arise from the opinions of established groups – Cost-savings arising from preventive care are, for instance, often stressed by public health workers 7 © 2008 Delmar Cengage Learning.

Comparing Preferences • Shape of a particular national health care system – Often contingent Comparing Preferences • Shape of a particular national health care system – Often contingent on just which views, and therefore interests, are valued over others 8 © 2008 Delmar Cengage Learning.

“International Standard” of Health Care • Just about every major industrialized country offers health “International Standard” of Health Care • Just about every major industrialized country offers health coverage to nearly all citizens • U. S. stands out (negatively) in this regard – 40 + million lacking coverage today 9 © 2008 Delmar Cengage Learning.

“International Standard” of Health Care • Most other countries cover all “medically necessary” procedures “International Standard” of Health Care • Most other countries cover all “medically necessary” procedures – With the definition thereof differing between systems 10 © 2008 Delmar Cengage Learning.

“International Standard” of Health Care • While many in other countries receive “decent” care “International Standard” of Health Care • While many in other countries receive “decent” care – Some others more – Many in the U. S. also receive decent care, with some receiving far more • But with many others receiving minimal or no care 11 © 2008 Delmar Cengage Learning.

“International Standard” of Health Care • In other countries: – Insurance is not purchased, “International Standard” of Health Care • In other countries: – Insurance is not purchased, but financed by the State through any number of mechanisms • In American context: – ACCESS TO CARE is often determined by the ability to pay – Infirm often pay more than others, as do larger families 12 © 2008 Delmar Cengage Learning.

“International Standard”’ of Health Care • Cost control is handled differently in other countries “International Standard”’ of Health Care • Cost control is handled differently in other countries – Number of payers strictly circumscribed, and savings coming from the pooling of buyers • Plethora of buyers exist on the American market – Few effective cost control measures 13 © 2008 Delmar Cengage Learning.

Limits of Comparison • Nations and peoples are unique in some ways – Therefore Limits of Comparison • Nations and peoples are unique in some ways – Therefore comparisons aren’t always foolproof 14 © 2008 Delmar Cengage Learning.

Limits of Comparison • International comparison does little to reveal alternatives in health delivery Limits of Comparison • International comparison does little to reveal alternatives in health delivery systems – As there is such diversity within the U. S. on this count 15 © 2008 Delmar Cengage Learning.

Chapter 19 Summary • Efficacy of international comparisons in health care arises from their Chapter 19 Summary • Efficacy of international comparisons in health care arises from their capacity to offer insights on possibilities – Cause-and-effect relationships, and preferences • United States diverges considerably from the “international standard” in health care 16 © 2008 Delmar Cengage Learning.

Chapter 19 Summary • Far higher health spending: – Does not seem to translate Chapter 19 Summary • Far higher health spending: – Does not seem to translate to significantly better health outcomes in U. S. • When compared to those in other nations 17 © 2008 Delmar Cengage Learning.

Chapter 19 Summary • Those in similar (professional) positions worldwide – Tend to have Chapter 19 Summary • Those in similar (professional) positions worldwide – Tend to have similar preferences – But different systems can shape broader political positions • Just which interests have the upper hand in policy debates 18 © 2008 Delmar Cengage Learning.