Which Healthcare System is Best? Crash Course Public Health #7

Are you ready for the understatement of the century? Health care is complicated. Across the 200 or so countries on Earth, there are a lot of different ways people receive health care. In this episode of Crash Course Public Health, we’re going to break down the building blocks that are used to create a health care system and take a look at four of the most common models.

Chapters:
Introduction to Health Care Systems 00:00
Six Building Blocks 2:03
Beveridge Model 5:18
Bismarck Model 6:37
National Health Insurance Model 7:09
Out-of-Pocket Model 7:35
Goals of Healthcare 10:45
Review & Credits 11:44

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[EdricLysharae]

In the US, many companies use health insurance as leverage to retain their employees, while garnishing their wages. Corporate America is fighting a single-payer system because it will give many employees more employment mobility: They can quit a low-paying, dead end job without fear of paying uninsured medical/pharmaceutical bills.

[CriticalPosthumanism]

People always say that Germans don't have humour,
but we have.
It's just like healthcare.
Most Americans don't get it.

[kalez]

As someone who moved from the US to Canada, I am constantly surprised by the positive differences in Canada's healthcare system, not saying that it is perfect, there are plenty of things that still need improvement, but so much better than the US.

[kajerlou]

I'm an American living in South Korea, I've spent 3 years here so far and counting.

The biggest advantage to Korean healthcare imo, is that I can reliably make same day appointments for basically anything, including directly see a specialist without a referral. This is a long and outlandish process often time in the states.

The other thing, is waiting rooms, I've never spent more than 10 minutes in a Korean waiting room. On the other hand in the states, I'd spent hours in the waiting room only to go to a examination room, wait on a nurse, then wait eventually for the doctor to come in, then wait testing, etc. Ultimately, my average visit to a Korean hospital including examination, discussion, testing, diagnosis and picking up prescriptions takes about 1 hour. In the states it'd take several hours and possibly multiple visits.

Then cost, thanks to the Korean national healthcare, my bill out the door, prescriptions included comes to about $30usd.

[Omnilatent]

Tiny correction: The system might be called Bismarck but it wasn't founded by him - he implemented it cause the workers and their political parties fought for it. Bismarck then implemented that in order to appease the working class. It wasn't like he wanted to do them a favor.

That's also a hint for you guys over in the US: You'll need to fight for universal health care!

[ajmb]

As a health care provider, truly appreciate the concise, yet thorough and simple explanation of what "health care" is.

[HexerPsy]

Where I am from the Bismark model is mostly used. Government sets a standard package of care and requires all people to have insurance.
Private insurance companies compete on price to attract customers.
Also because its required, government will subsidies low income individuals to pay for the insurance fees.

There are several more tweaks and rules to reduce costs. But as an individual, it costs me about 2000eu a year, and I can get into several accidents and not pay a cent more.

[connorpeppermint]

"our health care system is broken."
FACTS. In the United States (one of the wealthiest nations on earth) we have people rationing their life saving medication so they can afford to eat. The amount of people in the US that die every year from not being able to afford Healthcare is incalculable.

[PaulTheadra]

As a nurse, I'm always wary of explanations of the US' healthcare systems, but this is spot on. The rest of the world enjoys piece of mind, while those in the US debate the cost of an ambulance transport during a possible MI. #DFTBA

[ArtsyChick]

I'm sure this comment section is going to be filled with civil and professional discourse regarding healthcare /s

[Gandellion]

A factoid about the Beveridge Model is that it was inspired (at least in part though I’m not sure about other influences) by the system that the Great Western Railway put in place around their railway works where I live in Swindon. That was back in the 1800s, and because basically the whole of the community was employed by this organisation they were able to create a system where everyone paid into the healthcare system there, making it free at the point of access.

[griggiorouge]

how can the medical information system be used for academics without breaking the privacy of medical records? I believe such privacy issues are easily solved and records should be available for medical students all around but without any identification of patients. the real privacy problem is that hospitals and providers dont want their errors to be seen... ... ...

[ChadPANDA...]

I think India's healthcare system quite more compex than out of pocket .

For example goverment has 'ayushman bharat yojana' and other such social programs which basically provide free healthcare to poor and elderly.

My grandfather was infected by COVID this year and his treatment cost was paid fully by government.

BUT as india is still a lower middle income country there is inequality in healthcare facilities number and quality and affordability. The reason our healthcare is bad is different from USA's reason .

Hope that gives more context 👍

[JoshuaT]

Truly believe the socialism method is best. If I have to pay the government instead of a private company my healthcare. Government can fight to lower cost and when ever an Unforeseen medical event that costs a lot of money, the government will pay for it. Out of pocket shouldn't exist in the US who claims to be a wealthy nation.

[Ynhockey]

From pretty much all available data, the most effective model is a hybris semi-private model, such as in Singapore, Taiwan and Israel. On the one hand, most of the system is funded by public money (national insurance, health tax, etc.). However, the providers are not only private, but there is healthy competition between them, therefore people can pay more to get a better experience – but fundamental care is free. In Singapore, people get the same quality of healthcare in hospitals, but one can pay money for a private room, better meals, etc. Usually the sums are pretty high (profitable), so this subsidizes actual care for people whose care is only paid for by public money. The competition between providers also incentivizes them to negotiate for better medicament prices, access to more imaging institutes etc., and other perks for their customers. Many people in these countries have multiple private insurances, in order to cover better care, but the ongoing costs are ridiculously low by the standards of other wealthy countries.

[au_au]

If we also talked about why changing a bad public hc system is so hard, the impression I have is that developing a hc system is something extremely path-dependent. Politicians decide how things will be, but when a HUGE budget is already being allocated to anyone, be private companies or public servants, this creates lots of interests in discussions about changing a given policy, and politicians will tender to those interests whatever be the system in place.

[philoslother]

I live in India and our healthcare system is not an 'out-of-pocket' system, for example:

Contraceptives are free
Abortions are free
All medicine is free (the cheap and easy ones to provide, paracetamol, fever meds, flu meds)
All vaccines are free
IUDS are free
Abortions are free
All birth control methods are provided free of cost

Hospitals also serve patients for free (In reality, there's usually no capacity and you can bribe the officials to get priority treatment but this is mostly a problem in overcrowded cities, not in the rural areas where most of us live), but your video is still great!


Edit: this video doesn't answer the question

The answer is: the French healthcare system is the best

[DefectoPerfect]

In America even with Insurance people still don't go to the hospital because it still costs too much.

So many people who technically have access to healthcare, but in practice do not.

The most popular and successful programs seems to follow the Beveridge model such as Medicare. However in recent years there's been massive cuts to medicare and VA. People who are not aware are misinformed to believe it's because the model doesn't work rather than the cuts to it's funding and support.

[Beryllahawk]

I knew this episode was going to make me pull a lot of faces, and it did. The information presented is really great - and I know you only have so much time to devote. As you said: Not an Encyclopedia! It just makes me feel a little bitter and sad to understand yet again that healthcare systems are damn complicated, and there really isn't just one system that WORKS, for everybody, everywhere, every time. (But I really wish there were.)
As someone who is not insured - but whose husband IS (we're in the US, he's on disability because of failed kidneys)... I can say this much.
Health information systems are SO much better than they were even 25 years ago, and I am incredibly grateful for that. Without that, managing my husband's health would be nigh-on impossible. A person with non functional kidneys has to watch dozens and dozens of factors - just as an example, there are no fewer than seven groups of foods he has to sharply limit in his diet, and that's not getting into the dozen or so medications he has to take. The clinic does a huge range of blood tests on him every single month, and there's just SO MUCH information in those tests... Without the system that the clinic and associated hospital has in place, we'd never keep track of it all. But because we DO have that access, we can literally know just how he's doing. I can go and pull up a graph of, say, his platelet count - for a year or even two years of past tests - inside of fifteen minutes if I need to. That's incredibly helpful and reassuring - because if I can do that, so can any doctor that has to see him. Even if he falls again and has to go to the emergency room - I can feel confident that the staff and doctors there will know EXACTLY what his health info is, and get him diagnosed accurately, treated in as timely a manner as they can, and get sent home the moment it's okay to do so. All of those are things I don't know if I could have counted on back when my son was born. Everything was on paper still, and though they had systems to handle that, it was still a LOT slower to get a given packet of information.
At the same time... It feels horribly wrong that if you happen to be poor, your health is basically up to Fate. Even insurance doesn't mean you get good health care: my mother in law died of liver cancer without ever receiving a single treatment, because her insurance WOULD NOT cover chemo. Being not insured at all, I live in fear of ever having REALLY bad health issues. Even managing high blood pressure is made far more difficult than it ought to be, and at the state level - well my state basically says "too bad for you, go work full time." (Saying this to a person caring full time for a dialysis patient is beyond cruel, but it's literally just how my area IS about the matter.)

Still. I can remain grateful that I am able to care for my husband's needs at all, and grateful that I'm around to complain about high blood pressure rather than already being dead. It just feels like in this day and age - I should be able to expect more than "at least it isn't worse." You know?

[twilightgeneral]

It might be hard to definitively rank Healthcare systems, but I feel very confident in saying that the US would be very, very far from the top.