At some point in our lives, a situation like this might become a reality. If and when that time comes, we want our answer to each of those questions to be a resounding yes. But these seemingly simple decisions depend on so many different factors. And in many places in the world, there are those who would hesitate to reach out for healthcare services so readily.
Healthcare accessibility can be broken down into three main elements. First and foremost is cost – how much will you have to pay to be taken care of? Can you afford it, or would the financial burden push you to shrug it off and hope it’s nothing serious? The second is infrastructure – is there a healthcare clinic nearby? Is it easy to get to? Third and last is physician competence and trust in the system – do you believe in the ability of those who work at a hospital and clinic to be able to help you?
In Canada, healthcare is funded by a combination of taxpayer and out-of-pocket funds. Public health insurance covers many healthcare services, including doctor’s appointments, emergency room visits, and medical tests and surgeries, vastly reducing the costs that an individual would have to pay out-of-pocket. However, our medical system still suffers from pitfalls like long wait times, lack of prescription drug coverage, and disparate conditions in rural areas. What lessons can we learn from other countries in terms of healthcare accessibility?
South Korea, the United Kingdom (UK), and Belgium are amongst the world’s top-rated countries based on a unified healthcare index, which evaluates health care systems by infrastructure, medical professionals, cost, availability of medicine, and government readiness. What distinguishes the health care systems of these countries from others?
South Koreans enjoy the benefit of a universal healthcare safety net known as the National Health Insurance Service (NHIS), which combines all health insurances under a single national health insurer, funded both privately and publicly. 96.3% of its population is covered by this program, and in general, the quality and efficiency of medical care are very high. Even for outpatient services, individuals do not wait long to get treatment, nor does it cost as much as it would in Canada or the United States. In fact, having a procedure done in South Korea may be 30-85% cheaper than having the same procedure done in North America. Additionally, even though most hospitals in South Korea are privately owned, they are managed by the Ministry of Health and Welfare, which works to enforce national healthcare standards. Because most hospitals are privately owned, the government is able to focus more of its healthcare spending on insurance and community hospitals for the lower-income segments of the population.
In the UK, healthcare is covered by a publicly funded system known as the National Health Service (NHS). The NHS covers visits to primary care physicians, specialists when referred by a general physician, and maternity services. While it does not cover drugs prescribed for outpatient treatment, the NHS has significant market power such that it can influence the global price of drugs based on its own assessment of the fair value of drugs – this typically keeps prices lower. The UK also does have privatized medical care, which typically serves a niche market limited to planned procedures. This private healthcare market emerged under a need to reduce waiting times for planned surgeries, thus bridging a gap in the government subsidized healthcare system.
In Belgium, health insurance is mandatory as part of enrolling for social security and covers all citizens. Both employers and employees must contribute to health insurance, and rates are based on a percentage of gross salary. There is a privatized system of healthcare in Belgium that runs alongside the public subsidy – some doctors will provide both state-funded and private treatment. Many residents will choose private insurance policies to top up their state coverage, giving them access to private healthcare options. Belgian public health insurance also covers basic dental needs, prescription drugs, and maternity costs in addition to costs for doctors, hospitals, and clinics. As a result, more and reliable healthcare funding and less disparities in services based on income/type of insurance since the funding is distributed more evenly.
Canada often is compared with its neighbour the United States in terms of healthcare, and the general attitude is that our system is superior, although there are also lessons to be learned from the American privatized system of medicine. The USA approaches healthcare as a “free market”, as an opportunity to make profit, and not as a conduit for the wellbeing of its citizens. There are different types of insurance companies, offering different types of care and coverage for different sectors of the population, making this system disjointed, inefficient, and costly. However, the USA still ranks among the top 30 countries in the world with regard to healthcare. How is this possible?
Because of its focus on profiting off healthcare spending, there are also more investment opportunities in researching technological advancements, and many highly educated doctors flock to the USA seeking higher salaries and medical innovation. Many prominent hospitals in the United States are tied to prestigious universities conducting ground-breaking research in the field of medicine.
So what are some lessons to be learned from these countries? A unified system generally tends to decrease costs and increase efficiency. The reluctance around privatized healthcare systems comes from the fear that they may exacerbate an already growing gap between the wealthy and impoverished, but if privately-owned hospitals and privatized insurance are used in a way that is complementary to the public system, as it is in South Korea, Belgium, and the UK, the results may lead to better healthcare standards, reduced waiting times, and more accessible coverage for all.