Healthcare System Comparison: Canada v. UK v. Germany
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- Опубліковано 29 чер 2024
- This video compares three classic health care systems: The Single Payer Health Care System (Canada / Traditional Medicare), the Beveridge Health Care System, (United Kingdom / Veterans Affairs), and the Bismarck Health Care System (Germany / Medicare Advantage). This video provides a way of visualizing the difference, and explains each one.
0:00 - Overview
1:08 - Single Payer / Canada / Traditional Medicare
3:17 - Beveridge System / UK / Veterans Affairs
6:02 - Bismarck System / Germany / Medicare Advantage
It's refreshing to hear someone who actually knows the correct title for the British system is 'The Beverage System'.
Some clarifications from Germany:
- The german social security system is NOT part of the government, all branches as pension funds, public health insurers, unemployment fund etc. are self governing and autonomous bodies. All members are voting their represantatives to the boards, half by the people, half by employers.
Government set the rules and pays subventions because children and non-earning spouses are covered without any additional costs in the public system
- The premium is paid half by the employer and half by the employee, like taxes via pay check
- You can't opt out of the public system unless you earn more than 5,200€/month (or you're a civil servant or a student). Below that, you have to be insured in the public system, above you can stay in the public system.
If you earn more tha 4,700€/month, the premiums aren't rising anymore.
- No public health insurer can deny access to anyone. They have to insure you even if you need the most expansive treatments. The public health insuring companies are paying to a risk balancing fund, which gives money to insurers with more costly members. Again, no government involvement beside setting the rules. And no voucher system!
-You can have additional health insurance to the public insurance for glasses or single room in hospital or dental implants.
- In the private insurance system, payments could be lower for younger people but are rising drastically with age. You have to pay extra for children and spouses. So many who could choose private insurance stay in the public system or try to re-entry when getting older.
- And last but not least, you have to be health insured when living in Germany, no way out!
This is great information! Thank you for posting!
@@AshleyHodgson Where are you from ??
Danke für die Informationen 😊
Amazingly informative, thank you so much for clearing these complex differences up!
Great video! I very much enjoyed your explanation. Clear and concise.
THe best unbiased description I have seen.
Thanks! this is a great and straightforward explanation for those who are learning about health care systems (like me).
¿De dónde eres?
Great video, thank you!
Great differentiation of the health care systems.
Great explanation!!!
That was very interesting, thanks!
Excellent presentation!
Brilliant explanation!!!!
Excellent explanations.
Great video!
Thanks so much for this!
thanks so much ma'am appreciate the overview
Your videos help me so much 🎉
Very well done.
Thank you !
I would love to see this examined through the lens of Game Theory. Thank you for breaking this down.
Great video. Think it's plain to see why the expression in Healthcare exists: "Bismarck beats Beveridge & Single Payer" hands down.
In the US Medicare Advantage system the government gives insurance companies more money for sicker patients too but it hasn’t stop the insurance companies from denying payment for needed treatments. Definitely wouldn’t want that if I could help it.
Nice video Ashley. After reading some of the comments I just wanted to ask viewers if any other country such as Canada, the UK or Germany have separate, large medical systems in place to provide healthcare to the current service members and their families and other facilities just for military veterans who had served in the military. I suspect they do not. I suspect the very large (expensive) military hospital, Tricare medical clinic system and the V.A. medical centers are only found in the USA.
I worked for a manufacturer of medical imaging systems which resulted in my working in private (for profit) hospitals, military and V.A. hospitals and government Tricare clinics. The government facilities were always well run, and patient focused. They were not driven by profit and the difference in the work climate was very apparent. They were well equipped and under-utilized since they don't help care for the general population.
Medi-Care in Canada was formed by a Scotsman, who was born in the same Scottish village as I was. Camelon.
The UK example seems to me to be wrong. There is no real 'insurance' in the Beveridge model. The government funds the system from taxation. Some of the taxes bear the label "National Insurance' but it's taxation.
Wait??? Does the united kingdom not use the national insurance model which has elements of both Bismarck and Beveridge ? Im from the UK and im studying the health systems so?????
@Phone Mojo No. She is absolutely correct. National Insurance has nothing whatsoever to do with the NHS - indeed it predates the NHS by almost 30 years. National Insurance funds the benefits system ie: Unemployment benefit, Maternity benefit and the state pension. It is 'insurance' against periods when one is unable to work - hence the title 'National Insurance'. The NHS is funded through income tax and general taxation (VAT & various duties on goods and services). As well as introducing the National Insurance scheme (which was initially in the form of stamps), William Beverage (along with Conservative MP & then Health Minister - Henry Willink) was also instrumental in overseeing the formation of what was to become known as the NHS. Aneurin Bevan & the Labour party, gained power in the 1945 election and, rather unfairly, took the credit . The rest, as they say, is history.
wow thank you
so which of the three is better and cheaper for the patient?
Thank you!! Omg! What reference did you get this from? I’m literally writing a paper on this topic!
This is mainly from reading about the topic in a variety of sources over the years. The book I would recommend to learn more about international systems is The Healing of America by T.R. Reid.
I think the UK’s Bismark system is the most efficient way as it removes the middleman which is the health insurance. The government takes accountability from the tax they’re receiving from the people.
UK has beveridge system
free healthcare doesn't always equate to quality healthcare. UK doctors and nurses are underpaid and overworked
Explain the pros and Cons of Bismarck Health care system
I try to.
First of all, everybody is covered, no one is left behind.
Second, the dual system provides good health care for everyone and good income for doctors. Private insurance is kind of subventioning the health system by oaying more than twice for the same treatment as public insurances do. Downside, doctors prefer private insured patience and there are waiting times for specialists (but not for emegencies).
Third, the dual system provides competition between privat and public insurance companies. Both wanting the young high income people. Private companies are cheaper for them at first, provides mostly better service at the doctor ir in hospital. But when you have children or your getting older, public insurance is way cheaper. And you could buy additional insurance for the goodies.
BUT, private health insurances are under fire in Germany, for being selective, for being so much more expansive over life time for nit so much better service.
@@colko64 how is UK or France’s healthcare compared to this system?
Very Informative.
But it does not address the falsehood that there is any realistic competition between insurance companies.
Health is not like buying a car or a TV or a tooth brush. When your sick and you need help your not going to want to shop around. Nor I would argue should anyone have to. I believe-
The most efficient system will be the simplest system. Less overhead gives you more resources for actual healthcare.
Single payer is the least overhead system. This system would fund a healthcare management government body.
A healthcare management body, funded by the single payer body and staffed by people specifically educated on healthcare and who understand best management practices will be best equipped to make choices about how and where to put resources.
The healthcare management body, funded by the single payer system then would work with the independent doctors, nurse practitioners and hospitals who would compete to provide services at lowest costs.
Thank you! Your video explains the various health care systems most countries typically use. I often refer it to people to help them understand.
Canada clarification:
It is a single payer system but is in a uniquely dangerous position: Currently the ONLY country in the world that doesn't allow its citizens to purchase private health insurance for procedures covered under Provincial Medicare. It has led to an inefficient Gov't rationed monopsony with historic levels of people dying on waitlists or waiting for surgeries. Every other country in the world, whether they have a Single payer system, Beveridge system, etc... also allow a fully functioning private sector except Canada. It has become so politicized that the health care system was taken to court by Chaoulli vs Quebec in 2005. Believe that it only resulted with the Gov't allowing the PHICs (private health insurance companies) to provide coverage for only a few services: cataracts, hip replacements and knee surgery. Very restrictive on what the PHICs were allowed to cover.
Next, the Supreme Court of Canada will be hearing BC's Cambie surgeries case to hopefully put an end to these restrictions. It is 2022 and, Canada needs a second buyer for its health care costs besides just the one: Gov't/Taxpayers. Second buyer, being PHICs. The Gov't needs to release its stranglehold over PHIC's and allow them to cover ALL procedures that are offered in the public sector. This would provide the incentive for the free markets to operate effectively and build more clinics & hospitals. The costs are eating up too much of the Provincial budgets and Education, Roads, etc... are now all suffering as most of the $ goes to healthcare.
Many people's first response are these two:
1) This would create a two tiered system and only the "rich" would get the best help.
Rebuttal: In BC, there is already priority given to certain groups of people for private health care above every other resident:
- Federal Workers
-Worksafe BC members (who are injured on the job)
-Prisoners
Whether people are low, medium or high income earners, it is their right to spend their hard earned money the way they choose. If someone wants to pay into a PHIC to purchase more diagnostic services than what the gov't currently "allows", then that should be THEIR choice.
2) If Canada allows privatization it immediately becomes like "The States" or Swtizerland
Couldn't pick two systems that could be more opposite than each other. The level of privatization in the States and Switzerland is very high. If a hybrid system was allowed, Canada would become more like Denmark, Sweden, Taiwan, S Korea's system. Single payer systems that realized decades ago, that health care costs were fiscally unsustainable with one buyer. Countries that also allow a fully functioning private sector, a hybrid model.
Hogwash
@@jonmce1 What exactly is "hogwash"? You're welcome to refute the comment with evidence to the contrary. It's pretty spot on.
Only thing I would add is:
- It still uses Block funding rather than patient focused funding. Most OECD countries switched to this payment method a decade ago. The Canadian Medical Association has suggested this funding method for around the same time. Builds incentive into the system. Rather than $ transferred to hospitals in block chunks, money follows the patient. With patient focused funding, hospitals receive money WHEN they provide a service. With old style block funding, services end up being an expense and drawn out of the budget. So, the last thing a hospital wants is patients.
- National credentialing system. No need for 13 different colleges which just increase administrative bloat. The waste of tax payers money is astounding. In comparison, Germany = 1 Admin for every 14,000 people. Canada = 1 Admin for every 1,400 people.
No country on this planet has the level of Gov't monopoly over healthcare like Canada & Provinces. The only thing that fixes it is when the Gov't puts a $40 billion bandaid every decade or so. Paul Martin in 2005, called it a "fix for a generation" which didn't even last for a generation & now another $40 billion from Trudope in 2023.
-Canadians should be in an uproar that the Supreme Court of Canada in April of 2023 dismissed the Cambie case. Watch some Dr. Brian Day videos and maybe wake up to the "hogwash". Or, alternatively, use Canada's MAID service as treatment.
@@maverick4022 Did you seriously just tell someone to kill themselves over an internet argument? You need to chill dude.
Also love how the reasoning for why healthcare services should be allowed to be privatized is basically just 'because it is sometimes in other places' and 'people can buy what they want' instead of actually addressing questions of ethics.
If someone wants to spend 100k of their own money on a series of MRIs why does that matter? Because it still takes away the ability to use that scanner for other people who actually need it. Instead of letting rich people cut the line we should be focusing on removing administrative bloat and investing in people's health.
Good
7:32 abizmal spelling
Jokes aside, thank you. This is a great video.
Does any country have a system where ONLY emergency room visits are "free" or rather covered by taxes and then u deal strait with the insurance and doctor or better yet, just the doctor for additional services you may need or want? Or where u can opt in or out BY CHOICE of whether or not you want to pay the tax to get the services? Or...is the government always involved in every healthcare system?🤔lol I'm just learning about the different types of healthcare around the world and it confuses me so much. Seems complicated.😆I prefer the holistic route and food/self care being the greatest health investment u can make but I acknowledge modern medicine has its time and place and can be a matter of life or death.✌
Everywhere else in the developed world there is the feeling that affordable health care is not a "nice thing to have" but a human right.
No healthy food nor healthy living with the right amount of sports nor healthy life and work balance could avoid every health risk like appendicitis, broken bones, or the "bad genes" cancer. Or giving birth, to say something positive.
To me as an european the US health care system looks crazy as hell, the frightening way. No sickness should be a financial burden to anyone. Being broke cause you can't pay the medical treatment is insane.
And the American Way is the most expensive one. Leaving the vulnerables behind is costing more money and more lifes than necessary.
@@colko64 no sickness should be a financial burden to anyone? That doesn’t make sense: medical care costs money and somebody has to foot the bill; if it is not the person who is sick, it will be somebody else (for example, the taxpayer). And, in the second place: What about the sickness produced by irresponsible behavior? If I do everything right, why should I pay, as a taxpayer, the medical bills of the people who do things wrongly and get sick because of their behavior?
I would like to really believe the Uk has lower corruption in comparison to the USA. Please do correct if am wrong, would love to know your thoughts… part of my dissertation
I think you should give more prominent credit to T. R. Reid ("Healing of America"), whose basic models, language, and examples you are using here. (He in turn gave credit to Uwe Reinardt.) I see that you mention Reid in a reply to another comment, but Reid deserves more credit for making simple and transparent what is often hidden behind American exceptionalism and lost-in-the-weeds health economics. Just sayin'!
There is something inherently wrong with shareholders making a gain from people being sick or/and disabled due to accident.
USA military health insurance TRICARE I remember the whole family was yearly 450 dollars
I’m sorry the VA healthcare system is not an insurance company. It is a benefit offered to the veterans. Please refrain from using insurance company for the VA healthcare system
How do German insurance companies survive if they aren’t for profit?
They survive good. :-)
They get their money they need from the pool (nearly) all germans are paying in. That are "special" insurance companies, existing only for HCS.
You don't have to make profit to survive. I would say, this is a fundamental wrong idea in the american HCS for example.
The concept looks strange in the eye of an American, but the oublic health insurance companies, or Krankenkasse aka sickness funds aren't companies in the "capitalistic" meaning.
They're neither privately owned companies with shareholders nor are they governmental organisations. Legally they have the same status as the protestant or catholic church in Germany.
As they don't have to pay shareholders, there us no need for profit. All the money, they get, premiums from employers and employees, subsidiaries from the government, goes to paying the medical bills, for administration and a little fraction as reserve for bad times and balancing bad risks between several insurance funds.
It works astonishingly well, even with some flaws like overpaid managers.
@@colko64 so it’s like an ngo or a charity?
@@lukeduffy6179 No, in a very broad sense, they're part of the government, because the government is setting the rules and the premiums and provides more than 70% of the fundings.
But the government it is taking no part in managing them. The Krankenkassen are self organized. The premiums are no taxes and are not collected by the german equivakent if the IRS. So in a narrow sense, they're not part of the government.
Some Krankenkassen were founded by employers, so called company sickness funds (Betriebskrankenkassen), usually by very big companies like VW. Or by associations of employees, like the Techniker Krankenkasse, sickness fund for technicians, founded by engineers.
But most of the sickness funds were founded locally by the chambers of trade, commerce and crafts and the local sections of the labor unions, Allgemeine Ortskrankenkassen, AOK (literally general local sickness fund).
A few years ago, they were more thsn 1400 Krankenkassen, some with only hundreds of "members" as the insured people are called, but they were merging to bigger units.
The largest Krankenkasse is the Techniker with more than 10 million members, in 2019 they had a total revenue of almost 29.2 billion Euros and expenditures of 29.7 billions (in 2018 they had a surplus of 500 millions).
Some of the expenditures:
2 billions for Krankengeld, sickness money:
German workers are fully paid by their employer for the first 6 weeks of an illness (notice, not 6 weeks per year, but up to six weeks for every non-censecutive illness). After this period the sickness fund pays a "Ersatz"-wage, 70% of your usual wage as long as 78 weeks.
167 millions for dialysis
559 millions for transportation, mostly ambulance but also for cabs if your unable to drive
Almost 400 millions for early detection of cancer and other serious diseases
974 millions for preventive treatments, like Pilates and courses for healthier cooking, but also courses for drug addicts.
284 millions for vaccinations.
But also 1.1 billion for administration.
@@colko64 >It works astonishingly well, even with some flaws like overpaid managers.
Compared to stockholder companies, that's hardly the case. Even that flaw is a strength when compared directly.
Until you eliminate the preditory tactics of malpractice the costs of medical care will never go down
UK healthcare system is broken…Even if you go to the Accident and Emergency, patients wait to die in the hospital😢
Actually if you earn nothing in germany you still have to pay 200 eur per month.
The German health system is bad. Please do not copy
why do you say so? I personally prefer the dutch system- but it is closer tot the German than to the other two.