International Health Systems

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South Africa

South Africa’s population is 43,791,000 (for comparison, that’s about 10 million more people than live in the state of California). Since 1994, South Africa has been trying to reverse the social effects of apartheid. South Africa’s infant mortality rate is 59 per 1,000 live births. Men have a life expectancy at birth 47.7 years, for women it is 50.3 years. South Africa spends 7.1 per cent of its GDP on health and its 1997 per capita expense was $268-USD.

South Africa’s health system consists of a large, under-resourced public sector (serving 80 percent of population) and a small private sector for high income earners (18 percent of the population). Primary health care is free to everyone but highly specialized services are available in the private sector to those who can afford it. The government contributes about 42 percent of all expenditures on health. The remaining 58 percent of health expenditure is paid by private sources in insurance premiums and out-of-pocket payments.

Because of problems in South Africa’s healthcare system, there is a shortage of medical professionals. High levels of emigration of medical professionals to other countries drain South Africa’s resources. Newly graduating South African doctors and pharmacists must now complete a year of compulsory community service in understaffed hospitals and clinics. Most South Africans see inexpensive, traditional herbal medicine healers before seeking treatment from a physician. These traditional healers carry out more than 80 percent of the country’s medical consultations.

In spite of the addition of the “right to healthcare” in their post-apartheid 1996 constitution, South Africa’s health care system continues to face problems of heavy reliance on out-of-pocket payments and an uneven distribution of facilities and personnel, all of which lead to inadequate and unequal access to health services

*Compiled by Jeanine Valrie, February 2004

Sources:
Xinhua News Agency. “WHO urges Africa to utilize traditional medicine.” Health System Trust. 3 July 2001. http://news.hst.org.za/view.php3?id=20010705 (15 Feb 2004).

Bassett, Hilary. “Healthcare in South Africa.” MedHunters Magazine. Summer 2002 http://www.medhuntersmagazine.com/PDFstories/summer2002/HealthcareInSouthAfrica.pdf (10 Feb 2004).

Jackson, Katherine T. “Critical: South African nursing officials discuss impact of health care shortage on continent’s AIDS crisis.” Inside UVA Online. March 14-27, 2003. http://www.virginia.edu/insideuva/2003/05/south_africa.html (15 Feb 2004).

“Healthcare in South Africa.” South Africa: Alive with possibility; The Official Gateway.
http://www.southafrica.info/ess_info/sa_glance/health/923086.htm (17 Feb 2004)

The World Health Report 2000. “Health Systems: Improving Performance.” World Health Organization. 2000.

Sweden

Sweden has a population close to that of New York City - 8.8 million people. The country has an infant mortality rate of 3.6 per 1,000 live births and a life expectancy at birth of 76.9 years for men and 81.9 years for women. Sweden spends 8.4% of its GDP on health care, the 1998 per capita expense was $1,746. Sweden has had its current universal health care system since 1962. Tuition for medical and nursing education is free, and students generally take loans for living expenses of around $9,000-US per year.

The Swedish health care system is financed by both incomes and patient fees. County councils own and operate hospitals, employ physicians and run the majority of general practices and outpatient facilities. Other physicians work in private practice and are paid by the counties on a fee-for-service basis.

Co-pays, which were mandated in 1970, are capped, with limits on how much a person is required to contribute annually. For example, patients over age 16 pay $9 per day for hospitalization. The maximum individual expense for hospital and physician services is approximately $108 per year. The maximum individual expense for prescription drugs is $156 per year. Once these sums are met, care is covered at 100%.

Taiwan

Taiwan enacted its single-payer national health insurance program in 1995; in all estimates, it has been very successful. Taiwan enacted the program (from multiple insurance companies, like the United States) to the single-payer system with no measurable increase in costs, while insuring more than 8 million Taiwanese citizens who previously lacked insurance. While utilization did increase, its costs were largely offset by the enormous savings under single-payer. Taiwan also did not report any increase in queues or waits for services.

The United Kingdom

Britain has a population size of 57 million, nearly three times the number of people in Texas. The infant mortality rate in the United Kingdom is 5.7 per 1,000 live births, and life expectancy at birth is 74.6 years for men and 79.7 years for women. Britain has had a National Health Service (NHS) since 1948. 6.7% of GDP goes towards health expenditures, and the 1998 per capita expense was $1,461-US.

The British government is a purchaser and provider of health care and retains responsibility for legislation and general policy matters. The government decides on an annual budget for the NHS, which is administered by the NHS executive, regional, and district health authorities. The NHS is funded by general taxation and national insurance contributions and accounts for 88% of health expenditures. Complementary private insurance, which involves both for-profit and not-for-profit insurers, covers 12% of the population and accounts for 4% of health expenditures.

Physicians are paid directly by the government via salary, capitation, and fee-for-service. GP’s act as gatekeepers. Private providers set their own fee-for-service rates but are not generally reimbursed by the public system. Specialists may supplement their salary by treating private patients. Hospitals are mainly semi-autonomous, self-governing public trusts that contract with groups of purchasers on a long-term basis.

The British government this year has announced a huge funding increase for the NHS. Specifically, it will receive 6.2% more in funding every year until 2004. Current plans to improve the system over the next five years include hiring 7,500 more specialists, 2,000 GP’s and 20,000 nurses; providing 7,000 more acute beds in existing hospitals and building 100 new hospitals by 2010; demanding that GPs see a patient within 48 hours of an appointment; and finally, guaranteeing that patients wait no more than three months for their first outpatient appointment with a specialist and no more than six months after that appointment for an operation.

The Resources and Priorities for the NHS (PDF File). A statement made by the UK’s Secretary of Health.

Bibliography

Multiple Country References

1. OECD Health Data 2000. Available at www.oecd.org.
2. National health systems of the world, Volume 1: The countries, Roemer, MI, 1991, New York: Oxford University Press.
3. Multinational comparisons of health care: Expenditures, coverage, and outcomes, Anderson, G (with Axel Wiest), Oct. 1998, The Commonwealth Fund.
4. Primary care: Balancing health needs, services, and technology, Starfield, B, 1998, New York: Oxford University Press.

Single Country References

1. Austria:
   “Questionnaire on the Austrian health system”, Widder, Joachim, MD, PhD, Vienna University General Hospital Department of Radiotherapy and Radiobiology, 2000.
   “Questionnaire on the Austrian health system”, Theurl, E, Austria University, Institut fur Finanzwissenschaft der Universitat Innsbruck, A-6020 Innsbruch, 2000.
2. Belgium and the Netherlands:
   “Belgium and the Netherlands revisited”, Van Doorslaer, E & Schut, FT, Journal of Health Politics, Policy and Law, Oct. 2000.
3. Denmark:
   Health care in Denmark, published by The Ministry of Health, 1997.
4. France:
   “Health care under French national health insurance”, Rodwin, VG & Sandier, S, Health Affairs, Fall 1993.
5. Germany:
   “The German health system: Lessons for reform in the United States”, Jackson, JL, Arc