Having regularly taught courses in the U.S. and Canada on international healthcare systems over the past five years, I was interested in your March 31 International Healthcare report, Why over there isnt over here (March 31, p. 32). Unfortunately, there were a number of inaccuracies and omissions.
While you write that In addition to the U.K., Canada, Japan and Taiwan also have opted for single-payer systems, the only countries with true single-payer systems of which I am aware are Cuba and North Korea. Although the U.K. has the National Health Service, it also has a thriving private sector that is used to relieve the public systems waiting lists. Canadas system is based on individual healthcare plans run in and by each province and territory using general guidelines set by Health Canada. The federal governments contribution to this distributed system is not more than about 20%. As for Japan, there are multiple payers. What is relevant, however, is that the country has a single payment schedule that is not adjusted for geographic differences.
The next inaccuracy concerns the statement: System size alone will have a great bearing on the effectiveness of a financing approach. In my experience, size (and hence, scalability) is one factor that does not influence the success of a financing approach. A much more important consideration, for example, is culture.
Further, it is incorrect that no comparative percentages were available for other countries with respect to distribution of healthcare expenses. The Organization for Economic Cooperation and Development, or OECD, has extensive data on the mix of spending sources and uses in each member country. For example, Canada, France, Germany and Japan all spend more on pharmaceuticals as a percentage of healthcare spending than the U.S. does.
Finally, contrary to the implication about the U.S. being unique in its primary-care shortage, according to the OECD: Specialists now account for more than half of all physicians in most OECD countries, with the exceptions of Australia and Belgium, where GPs continue to outnumber specialists, and France, Portugal, New Zealand and Turkey, where their numbers are equal.
Many opportunities exist to borrow best practices from other countries, but we need to get the facts straight first.
Joel Ira Shalowitz
Health industry management
Kellogg School of Management