Abstract
Are there any medical sociologists who believe in the notion of American “exceptionalism” and resist considering US healthcare policy in comparative perspective? Alternatively, are there any who question whether comparisons of seemingly vastly different settings can yield fruitful lessons for the US? This paper seeks to convince the dubious in the worlds of both academia and healthcare policymaking that a comparative lens best illuminates the successes and failures of American health care and the unique framework within which it operates. We have much to learn from the experiences of other countries, not only about healthcare policy but also about the political and social parameters and the norms and values that shape it and its outcomes. Moreover, despite apparent differences, there are important similarities between our struggles and those of other countries. Understanding how and why their efforts have succeeded or failed can inform a more fruitful direction for American endeavors.
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Notes
- 1.
Saltman’s assertion ought not to be taken too far. European countries have contained costs better than the US, but they continue to be concerned about high health care expenditures and continue to search for methods of control.
- 2.
Examples here will be drawn from the experiences of Canada, Britain, and Germany.
- 3.
In explaining President Bush’s threatened veto of an expansion of the State Children’s Health Insurance Program, a former advisor said the President’s objections are “philosophical and ideological. [An expansion] would move the nation toward a single payer system with rationing and price controls” (Pear 2007).
- 4.
In 2007 the Census Bureau revised the figure downward by two million. The data do not distinguish insured and under-insured.
- 5.
Also, polls conducted by the Kaiser Family Foundation find that Americans rank health care second only to Iraq as the issue they most want presidential candidates to talk about, and coverage for the uninsured ranks higher than costs as an issue they would like to see more focus on (http://www.kff.org/kaiserpolls/upload/7655.pdf).
- 6.
The proportion of salary that workers in the US contribute to private insurance varies from a low of about 2% to well over 7%. Note too that under the new individual mandate in Massachusetts, some previously uninsured individuals who do not qualify for state assistance will have to pay more than 7% of their income for private coverage.
- 7.
It took several decades for the government to fold into the system unemployed people, students, and others who were not members of employment-based sickness funds.
- 8.
Both Canada and Germany have for-profit insurers but regulations in both are much tighter than in the US.
- 9.
Primary Care Trusts (PCTs) now control 80% of NHS expenditures. They contract with General Practitioners and hospitals to meet the needs of their constituents.
- 10.
Most hospitals responded to the DRGs by reducing lengths of hospital stays and by various forms of cost shifting, including the development of more outpatient services and day surgeries.
- 11.
Each of these three main forms of compensation also contain perverse incentives – fee for service may reward the provision of inappropriate services, capitation may reward the denial of appropriate services, and salary may undermine productivity (Robinson 2001).
- 12.
The Centers for Medicare and Medicaid Services have developed comparable measures for hospitals, home health agencies, end-stage renal dialysis centers, and Medicare Advantage Plans, which are provided by managed care organizations.
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Ruggie, M. (2011). Learning from Other Countries: Comparing Experiences and Drawing Lessons for the United States. In: Pescosolido, B., Martin, J., McLeod, J., Rogers, A. (eds) Handbook of the Sociology of Health, Illness, and Healing. Handbooks of Sociology and Social Research. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-7261-3_5
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