aside Can US Save Monies But Provide Quality Healthcare At Lower Costs To More Consumers?

Image result for photos of republicans introducing their AHCA BILLThe real reason that US Congressional republicans haven’t given up on their Trump/ Ryan repeal and replace Obamacare plan (AHCA) is that they need the savings as predicted by the CBO (Congressional Budget Office) as a precursor to their tax reform plans. The republicans in the “freedom caucus” will never consent to tax cuts that are not paid for and which add significantly to the deficit.

Here’s the dilemma. There is no way to accomplish this goal while expanding better healthcare coverage to more peoples while lowering the costs unless the republicans start thinking outside of the box.

Image result for photos of republicans introducing their AHCA BILLCurrently, the ACA mostly resembles the plan that has been implemented by the Netherlands where its government provides universal coverage with the use of insurance companies. It has been asserted by a Washington Post expert that if the republicans went all the way towards duplicating the Netherlands’s system, that the republicans could save billions of dollars while improving the quality, access and affordability for more Americans. This would still keep US healthcare costs at about 17% of our GDP (Gross Domestic Product).

While, I personally wish that the US would emulate the highly ranked Taiwanese healthcare system which costs its country about 6.6% of its GDP with better healthcare outcomes, I realize this is not likely because its delivery system does not rely on healthcare insurance companies. But maybe we can copy some of its best practices as described below.

Image result for photos of republicans introducing their AHCA BILLHere is the rest of the story…

On 5/3/17 Sarah Kliff of the Washington Post penned the following article, “How to save $705 billion in health costs: Be like the Netherlands.

“Here’s one way America could cut $705 billion in health care costs: Act more like the Netherlands.The Dutch are far from the most thrifty spenders when it comes to health care. In the Commonwealth Fund’s new comparison of 13 countries, the Netherlands is the second-highest spender as a percent of their economy (coming in, to no great surprise, right after the United States).And here’s some encouraging news: When you look at how the Dutch health care system works, it’s not actually a huge leap from how we’ll deliver care here in the United States when the big pieces of the Affordable Care Act come into effect.The Netherlands inched slowly toward universal coverage; in the 1940s, it created entitlement programs that provided basic health care to about 68 percent of the population, mostly lower- and middle-income citizens.In 2006, the Netherlands passed a sweeping health reform law that – much like the Affordable Care Act – requires citizens to purchase health insurance coverage from a private insurance company. How much a Dutch citizen pays for health insurance is tethered to his or her income; about two-thirds of people there receive some kind of subsidy from the government.”Image result for photos of republicans introducing their AHCA BILLThe Dutch aren’t especially aggressive in regulating health care prices when compared to other European countries. Hospitals, for example, get to set prices for about half of their services if they’re under a government determined cap. And the Netherlands has become increasingly hands off in price regulation in recent years. In 2005, for example, it stopped regulating prices for physical therapy.””But where they have gotten more aggressive on two other fronts: Risk selection and primary care.””As they implemented universal coverage, the Dutch put huge effort into ensuring that health plans were not cherry-picking healthy individuals with low health care costs. They’ve done so by, as Ezra has written previously, tracking health status with incredibly specificity, paying attention to individuals past hospital use and pharmacy records to get of sense of what they’ll spend in the future. Then, the Dutch government pays more to the insurance companies who take on the sicker individuals.”Image result for photos of republicans introducing their AHCA BILL“On primary care, the Dutch require each citizen to register with a general practitioner, who often ends up acting as “gatekeepers” to more expensive care.”“Insurers may provide their gatekeeping GPs with incentives to stimulate integrated and coordinated care, resulting in integrated care organizations that give a prime role to primary care,” a 2008 Health Affairs paper notes. Some large insurers are experimenting with some form of bonuses for, and risk sharing with, GPs. For instance, one major insurer offered GPs a bonus for prescribing generics.””Gatekeeping isn’t always popular in health care; the HMOs that came to prominence in the 1990s lost customers in droves, who were sick of limited access to specialists. But that system doesn’t look to have an adverse impact on health care. Survival rates for cancer here and in Netherlands are comparable; the Dutch do even better than us when it comes to treating cervical cancer.”

Image result for photos of republicans introducing their AHCA BILL“The Netherlands certainly isn’t doing the best at health care spending – if we got our per capita costs down to those of lowest-spender Japan, for example, we’d slash $1.25 trillion from our annual health costs. And it does not make a perfect comparison to the United States: When the country passed its universal coverage law its costs were already significantly lower than ours, as the country had passed cost-containment legislation in the 1970s.

There are definitely significant differences between us and the Dutch – and it’s not just our footwear choices. But as we move toward implementing a health insurance system that bears a strong resemblance to that of the Netherlands, the country does provide a more optimistic preview of where we might be headed.

Taiwan is consistently top rated for its healthcare delivery system

Taiwan has been ranked the #1 country  in the world for its healthcare delivery system while only paying 6.6% of its (GDP) gross domestic product on health care, as compared to 17% in the USA( Source: Horban, Rose. “Different Cultures, Different Systems: Comparing Health Care in the U.S. and Taiwan. “North Carolina Health News. 28 August 2013.)

Highlights of Taiwan’s Health Care System (Source: New York Times and North Carolina Health News.org)

• Taiwan citizens have health insurance “Smart Cards” with memory chips, giving instant access to medical history, what medications a person takes and the results of prior hospitalizations.
• Dr. Wui Chiang Lee of the Taiwanese Ministry of Health said many of the poor are “nearly 100 percent subsidized” by the Taiwan government and “the subsidy depends on income and profession.”
• Barcodes are used on patient wristbands and records “to keep from making mistakes.”
• All hospitals “have electronic medical records linked into the main system, a concept health care planners in the U.S. say they want and which is being pushed by the federal Affordable Care Act.”
• Co-payments are “so low that they seldom offer a financial barrier to services.”
• Patients may visit specialists without getting a referral.
• Patients may choose any doctor or hospital they want, unlike in the USA, where patients are limited to providers within a health insurance plan’s network.
• Covered health care includes prevention, Western-style primary care, hospitalization, Chinese massage, acupuncture, traditional herbal medicine, mental health, dental, vision and long-term care.
• For employed citizens, the employer pays 60%, the employee pays 30%, and the government pays 10%.
• The Taiwan government fully subsidizes premiums for the poor, with partial subsidies for veterans, the self-employed and farmers.
• Co-payments are approximately $2 for clinic visits, $4 for hospital outpatient departments, and 10% for the first 30 days of hospitalization and 20% beyond 30 days.
• Prescription co-payments are approximately 20% of the drug and are “capped at $6 for each prescription,” the New York Times reports.
• Taiwan sets a “ceiling on the total co-pays, so patients won’t face bankruptcy.”
• The Taiwan system is paperless, allowing doctors and hospitals to get paid in two weeks or less and keeping administrative costs down.

Related Articles:

Healthcare in the Netherlands | Healthcare | Expatica the Netherlands  http://www.expatica.com/nl/healthcare/Healthcare-in-the-Netherlands

Compare and Contrast: US Health Care and the Netherlands Health https://www.slideshare.net/Maddox5329/compare-and-contrast-us-health-care-2013

Netherlands tops health care rankings, with UK in 14th place – Telegraph http://www.telegraph.co.uk › News › Health › Expat Health 2015 –

Health Care Around the World: Taiwan & Its ‘World’s Best’ Medicalhttps://www.umhs-sk.org/blog/health-care…world-taiwan/Caribbean-Medical-Schools 2014

4 comments

  1. Gronda, good post. We area failing to use data driven analysis to see what is working and why and what is not and why. I love several things about the Taiwan system, but the electronic records is a huge step forward in quality control, reducing errors and contra-emptive medications that can be toxic or negate the effect when taken together.

    Here in the states, we also have several demand driven increases – we are one of the most obese countries in the world and we are aging. We are train wrecks waiting to happen. Plus, our system incents providers to encourage more spending from its patients. Finally, dealing with adverse selection is key. We did it the right way with Medicare Part D, but Congress defunded that mechanism to watch the ACA fail under its own weight.

    I don’t think we can ever get to a full national health care system here given the might of the Healthcare Industrial Complex, yet we can make little strides. Introducing Medicare at a younger retirement age, e.g. or using it as public option under the ACA where competition is non-existent.

    I do believe in using data to drive decisions and not rhetoric. Keith

    • Dear Keith,

      I am right on board for using credible, well researched data before creating policy and laws but unfortunately, too much of what the legislators do is colored by their ideology or their own self interests instead of just doing what is best for their constituents.

      We need to to better as citizens in holding our legislators accountable for their actions.

      Ciao, Gronda

      • Gronda, the comment about doing what is best for the constituents is perception and flavored by what they told the constituents. A large swath of Trump supporters would have been harmed by the repeal and replace ACA bill that was pulled, but my guess is they would believe otherwise. The NC HB2 law that was just repealed was sold on fear, so repealing it upset a lot of people, even though the fear was not backed up by measurable data. Keith

        • Dear Keith,

          You are so right! The US House republicans may very well come from districts with constituents who do not think like me and the US congressional representatives would feel obligated to represent their constituents’ wishes.

          Whoever sold the NC HB2 law cost the state lots of revenues on fear mongering based on ideology instead of balancing what is right for all voters.

          Ciao, Gronda

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