International Health Care Systems

Seven Country Health Care Survey

Which country’s citizens believe that their medical system needs a complete overhaul? According to a a study published in Health Affairs (“…Adults’ Health Care Experiences In Seven Countries, 2007“), one third of Americans believe that we need to “rebuild completely” our health care system.

Minor Changes Needed Fundamental Changes Needed Rebuild Completely HC Spending per capita HC Spending / GDP EMR
Australia 24% 55% 18% $3,128 9.5% 79%
Canada 26% 60% 12% $3,326 9.8% 23%
Germany 20% 51% 27% $3,287 10.7% 42%
Netherlands 42% 49% 9% $3,094 9.2% 98%
N. Zealand 26% 56% 17% $2,343 9.0% 92%
UK 26% 57% 15% $2,724 8.3% 89%
US 16% 48% 34% $6,697 16.0% 28%


Despite the fact that the U.S. has the highest healthcare spending per capita and the highest spending as a percentage of GDP, it seems that Americans are not happy with the quality of care they receive. One reason, is that Americans are paying more for their health care. We pay more as a society, but probably more importantly for these ratings, Americans pay more out-of-pocket when they do fall ill. “One-fifth of U.S. adults reported serious problems paying medical bills in the past year—more than double the rates in the next highest countries.”

The U.S. does have the shortest waiting time for elective surgery, but the U.S. does offer the sick very many same-day physician appointments. Only Canada (22%) fared worse than the U.S. (30%) in terms of the number of sick patients who could get a same-day appointment.

The Health Affairs article also concludes that the U.S. health care system is very fragmented. This is problematic for many reasons. First, it is very difficult to implement electronic medical records (EMR) in a fragmented system. As the chart above shows, only Canada has a smaller EMR penetration rate. Also, a fragmented system means that additional resources must be used to coordinate care between primary care providers, specialists, hospitals and other forms of care.

Nevertheless, fragmented care is not all bad. The computer industry is highly fragmented yet consumers do not generally complain about the quality of computers. Similarly, a fragmented health care system can allow certain providers to experiment with new medical treatments and new health management techniques. For instance, Dr. Jay Parkinson is serving younger patients with 24 hour access to email and instant messenger and of course in person consultation if needed (See “Physician House Calls“). This innovative form of care would not have been possible in a more centralized system.

Without a doubt, the American health care system could be improved. The manner in which this is accomplished will be one of the most important questions faced by our generation.