The Grass Is Not Always Greener: A Look at National Health Care Systems Around the World

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Critics of the U.S. health care system frequentlypoint to other countries as models forreform. They point out that many countriesspend far less on health care than the UnitedStates yet seem to enjoy better health outcomes.The United States should follow the lead ofthose countries, the critics say, and adopt a government‐​run, national health care system.

However, a closer look shows that nearly allhealth care systems worldwide are wrestling withproblems of rising costs and lack of access to care.There is no single international model for nationalhealth care, of course. Countries vary dramaticallyin the degree of central control, regulation,and cost sharing they impose, and in the role ofprivate insurance. Still, overall trends from nationalhealth care systems around the world suggestthe following:

  • Health insurance does not mean universalaccess to health care. In practice, many countriespromise universal coverage but rationcare or have long waiting lists for treatment.
  • Rising health care costs are not a uniquelyAmerican phenomenon. Although othercountries spend considerably less than theUnited States on health care, both as a percentageof GDP and per capita, costs are risingalmost everywhere, leading to budgetdeficits, tax increases, and benefit reductions.
  • In countries weighted heavily toward governmentcontrol, people are most likely toface waiting lists, rationing, restrictions onphysician choice, and other obstacles to care.
  • Countries with more effective nationalhealth care systems are successful to thedegree that they incorporate market mechanismssuch as competition, cost sharing,market prices, and consumer choice, andeschew centralized government control.

Although no country with a national healthcare system is contemplating abandoning universalcoverage, the broad and growing trend isto move away from centralized government controland to introduce more market‐​oriented features.

The answer then to America’s health careproblems lies not in heading down the road tonational health care but in learning from theexperiences of other countries, which demonstratethe failure of centralized command andcontrol and the benefits of increasing consumerincentives and choice.