Healthcare by country

Question

This piglix contains articles or sub-piglix about Healthcare by country

Answer 1

Healthcare in the Netherlands

Healthcare in the Netherlands can be divided in several ways: three echelons, in somatic and mental health care and in 'cure' (short term) and 'care' (long term). Home doctors (huisartsen, comparable to General Practitioners) form the largest part of the first echelon. Being referenced by a member of the first echelon is mandatory for access to the second and third echelon. The health care system is quite effective in comparison to other western countries but is not the most cost-effective. Costs are said to be high because of over-use of in-patient care, institutionalised psychiatric care and elderly care.

A network of 160 primary care centres has been established, with open surgeries 24 hours a day, 7 days a week.

Hospitals in the Netherlands are mostly privately run and only for profit, as are the insurance companies. Most insurance packages allow patients to choose where they want to be treated. To help patients to choose, the government gathers (Zorginzicht) and discloses (KiesBeter) information about provider performance [1]. Patients dissatisfied with their insurer can choose another one at least once a year.

In 2015 the Netherlands maintained its number one position at the top of the annual Euro health consumer index, which compares healthcare systems in Europe, scoring 916 of a maximum 1,000 points. The Netherlands has been in the top three countries in every report they have published since 2005. On 48 indicators such as patient rights and information, accessibility, prevention and outcomes, the Netherlands secured its top position among 37 European countries for the fifth year in a row. The Netherlands was also ranked first in a study comparing the health care systems of the United States, Australia, Canada, Germany and New Zealand.

Ever since a major reform of the health care system in 2006, the Dutch system received more points in the Index each year. According to the Health Consumer Powerhouse, the Netherlands has 'a chaos system', meaning patients have a great degree of freedom from where to buy their health insurance, to where they get their healthcare service. But the difference between the Netherlands and other countries is that the chaos is managed. Healthcare decisions are being made in a dialogue between the patients and healthcare professionals.

A comparison of consumer experiences over time yielded mixed results in 2009, and a 2010 review indicated it was too early to tell whether the reform has led to gains in efficiency and quality.

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Answer 2

Healthcare in Moldova

The Moldovan state has a universal health care system.

Health care in Moldova known dynamic development in the past years, the hospitals being equipped with ultra-modern equipment, the new surgical blocks and general medical departments being built in Chisinau - capital city. The birth rate is at one and a half children per woman. Public expenditure on health was 4.2% of the GDP and private expenditure on health 3.2%. There are about 264 physicians per 100,000 people. Health expenditure was 138 US$ (PPP) per capita in 2004. In 2011, accordingly to World Bank, the health expenditures per capita was at about 223 US$.

The largest national emergency aid service is concentrated and is being in service within Chisinau - the capital region of Moldova. Nowadays in Chisinau operate 60 ambulance municipal cars, instead of 92 how is required and a douzen cars of private emergency service - Calmed. Everyday there are registered and served 800 emergency calls within Chisinau and more than 2000 emergency calls within the whole Moldova per day. The core of emergency system in Chisinau is National Scientific and Practical Centre for Emergency Medicine, having 620 beds, enrolling 3138 of personnel.

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Answer 3

Health care in Poland

Health care in Poland is delivered through a publicly funded health care system called the National Health Fund (in Polish: Narodowy Fundusz Zdrowia), which is free for all the citizens of Poland provided they fall into the "insured" category (usually meaning that they have their health insurance paid for by their employer, or are the spouse or child of an insured person). However, private healthcare use is very extensive in Poland. Patients who are uninsured have to pay the full cost of medical services. According to Article 68 of the Polish Constitution everyone has a right to have access to health care. Citizens are granted equal access to the publicly funded healthcare system. In particular, the government is obliged to provide free health care to young children, pregnant women, disabled people and to the elderly. According to a study conducted by Stratega Poland in 2013, 65% of Polish citizens and 91% of pregnant women also used private health care.

Emergency Medical Services (Polish: Ratownictwo Medyczne, RM) in Poland are a service of public, pre-hospital emergency healthcare, including ( ambulance service, provided by the individual Polish cities and counties. These services are typically provided by the local, publicly operated hospital, and are generally funded by the government of Poland. In a number of cases, the hospitals contract these services to private operators. In addition to publicly funded services, there are a variety of private-for-profit ambulance services operating independently.

The following is a listing of the clinical and university hospitals in Poland:

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Answer 4

Healthcare in Portugal

Healthcare in Portugal is provided through three coexisting systems: the National Health Service (Portuguese: Serviço Nacional de Saúde, SNS), special social health insurance schemes for certain professions (health subsystems) and voluntary private health insurance. The SNS provides universal coverage, although recently measures have been implemented to ensure the sustainability of the service, for example, the introduction of user fees to be paid for at the end of treatments. In addition, about 25% of the population is covered by the health subsystems, 10% by private insurance schemes and another 7% by mutual funds. The Ministry of Health is responsible for developing health policy as well as managing the SNS. The Health Regulatory Entity (ERS) is the public independent entity responsible for the regulation of the activity of all the public, private and social healthcare providers.

The National Health Service (SNS) is the system by which the State assures the right to the health protection, in the terms established by the Portuguese Constitution. It was created in 1979 and operates under the supervision of the Ministry of Health.

The SNS is characterized as being national, universal, general and free. It is national as it should be provided nationwide, although presently it still only covers Continental Portugal. It is universal as all Portuguese citizens and foreign residents have access to it. It is general as it comprehends the whole range of healthcare, including the health surveillance and promotion, the disease prevention, the diagnosis and treatment of patients and the social and medical rehabilitation. It is free, as the system is public funded, with the health services being tendentiously free of charge for the users. However, some fees are charged, these not being used to finance the system but serve mainly to moderate and filter the unnecessary access to the services (e.g. to avoid that a person with a minor cut in a finger go to the hospital emergency department instead of going to a local primary health care unit).

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Answer 5

Healthcare in Qatar

Healthcare standards in Qatar are generally high. Qatari citizens are covered by a national health insurance scheme, while expatriates must either receive health insurance from their employers, or in the case of the self-employed, purchase insurance. Qatar's healthcare spending is among the highest in the Middle East, with $4.7 billion being invested in healthcare in 2014. This was a $2.1 bllion increase from 2010. The premier healthcare provider in the country is the Hamad Medical Corporation, established by the government as a non-profit healthcare provider, which runs a network of hospitals, an ambulance services, and a home healthcare service, all of which are accredited by the Joint Commission.

Development in healthcare was expedited in the mid-1900s after the country saw considerable monetary returns from the oil industry re-allocated into the expansion of the healthcare system. Currently, health coverage is nationwide. Qatar has made developing a world class public health system one of its key goals through its National Vision 2030 initiative.

In 2012, the country announced its plans to introduce a universal health care system. The universal health care program has 5 stages, to be fully implemented by 2015. In the 2014 GCC Healthcare Report released by Alpen International, Qatar's healthcare sector was ranked as the fastest growing in the GCC.

The Supreme Council of Health, which oversees the health sector, announced the "Qatar Health Facilities Master Plan" (QHFMP) program in 2014. As part of the program, as many as 48 healthcare infrastructure projects are set to be developed in Qatar by 2020. It is intended to foster competition between state and private health providers. A Qatar Medical Research Council has been established. The Sidra Medical and Research Center, planned to open in 2017 is to translate research into practical treatments.

The Medical School at Qatar University is to open in 2015. The Weill Cornell Medical College in Qatar has been training clinicians since 2002. About 10% of the healthcare workforce are Qataris.

The government has established the National Health Insurance Company which manages and operates Seha, the national health insurance scheme. From July 2013 it has covered Qatari females aged 12 and above for gynaecology, obstetrics, maternity and related women’s health conditions. From 30 April 2014, it provides comprehensive insurance coverage to Qatari nationals for basic health care needs, which includes almost all medical, dental and optical treatment except cosmetic surgery, alternative medicine and over-the-counter drugs.

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Answer 6

Healthcare in Romania

Romania offers benefits of an universal healthcare system. The state finances primary, secondary and tertiary healthcare. Public health campaigns are independently financed by the Government of Romania. The Ministry of Health of Romania is required to manage and supervise the public healthcare sector. For 2013, the budget allocated for the healthcare sector is US$2.6 billion (8.675.192.000 lei), or roughly 1.7% of the GDP.

The access to healthcare is guaranteed by Article 34 in the Constitution of Romania, which specifies that the state is obliged "to guarantee the sheltering of healthcare".

Every citizen of Romania is entitled to cost-free, unrestricted medical procedures, as established by a physician only if they present themselves with a health card as of 9th of September 2015, proving to have paid insurance. Citizens of the European Union, alongside with Romanian citizens without paid insurance have the right to free emergency medical assistance.

The concept of universal healthcare has been implemented in name only in Greater Romania. However, the patients were still required to pay some medical costs, and in some cases, the fees were too high. In consequence, healthcare was virtually only available to the middle class and upwards. The working class were in the position of having to use free clinics or hospitals run by charities.

The first concept of public healthcare appeared in 1700. At the time, it was a common practice for foreign doctors to be brought in to provide healthcare for the upper class. Philanthropists ran their own charity hospitals, and provided free healthcare for the peasants.

The National Red Cross Society was founded on 4 July 1876. The first president of the Romanian Red Cross was Dimitrie Ghica, between 1876 and 1897. The Romanian Red Cross is the only humanitarian organization with a functional network across the country. It has 47 subsidiaries, 1,996 under subsidiaries and 1,307 commissions.

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Answer 7

Healthcare in Russia

The Constitution of the Russian Federation has provided all citizens the right to free healthcare under Mandatory Medical Insurance since 1996. In 2008, 621,000 doctors and 1.3 million nurses were employed in Russian healthcare. The number of doctors per 10,000 people was 43.8, but only 12.1 in rural areas. The number of general practitioners as a share of the total number of doctors was 1.26 percent. There are about 9.3 beds per thousand population—nearly double the OECD average.

Expenditure on healthcare was 6.5% of Gross Domestic Product, US$957 per person in 2013. About 48% comes from government sources. About 5% of the population, mostly in major cities, have health insurance.

Pre-1990s Soviet Russia had a totally socialist health care model—the Semashko system with a centralized, integrated, hierarchically organised with the government providing state-funded health care to all citizens. All health personnel were state employees. Control of communicable diseases had priority over non-communicable ones. On the whole, the Soviet system tended to primary care, and placed much emphasis on specialist and hospital care.

The integrated model achieved considerable success in dealing with infectious diseases such as tuberculosis, typhoid fever and typhus. The effectiveness of the model declined with underinvestment, with the quality of care beginning to decline by the early 1980s, though in 1985 the Soviet Union had four times the number of doctors and hospital beds per head compared with the USA. Overall, the quality of Soviet medical care was low by developed world standards. Many medical treatments and diagnoses were unsophisticated and substandard (with doctors often making diagnoses by interviewing patients without conducting any medical tests), the standard of care provided by healthcare providers was poor, and there was a high risk of infection from surgery. The Soviet healthcare system was plagued by shortages of medical equipment, drugs, and diagnostic chemicals, and lacked many medications and medical technologies available in the Western world. Its facilities had low technical standards, and medical personnel underwent mediocre training and had no financial incentives to improve performance. Soviet hospitals also offered poor hotel amenities such as food and linen. Special hospitals and clinics existed for the nomenklatura which offered a higher standard of care, but which was still often below Western standards.

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Answer 8

Health care in Spain

According to the Organisation for Economic Co-operation and Development, total health spending accounted for 9.4% of GDP in Spain in 2011, slightly above the OECD average of 9.3%. The Spanish health care system is considered one of the best in the world, in 7th position in the ranking elaborated by the World Health Organization. Spain is the 1st country in the world in organ transplants. The public sector is the main source of health funding in nearly all countries. In Spain, 73% of health spending was funded by public sources in 2011, very close to the average of 72% in OECD countries. Since 2010, real term spending on healthcare has declined in Spain.

In an emergency you can go straight to a hospital A&E. For any other type of hospital treatment you’ll need a referral from a doctor. There are public and private hospitals. Only the public hospitals provide free treatment. Some hospitals offer both private and state healthcare services, so make sure the staff knows which service you want. When you go to hospital you’ll need to show your social security card or proof of private insurance. If you are discharged from a hospital and need medication, you have to take the hospital medical report to a pharmacy for the prescription to be fulfilled, as hospital doctors don’t issue prescriptions.

In Spain patients have the right to read their own patient records, but there is evidence that this right is not well publicised.

In Spain, provision of health care services is decentralized in several autonomous communities. As of 2001, decentralization was present in the communities of Andalusia, the Canary Islands, Catalunya, Valencia, Navarra, Galicia, and Pais Vasco. In 1998, an analysis of the effects of higher autonomy on legislative performance and policy outcomes for health care observed a positive effect on legislative performance, but no effect on actual policy outcomes. The analysis noted that a possible explanation for this disconnect was that autonomous communities had only experienced higher autonomy in the policy area of health care for a short time, and positive effects on policy outcomes could take longer to manifest. In 2009, an analysis of data collected by the Spanish National Health Survey in 2001 showed that autonomous communities with decentralized health services tended to have better equity performance in their health care services. In 2014, an analysis of data collected by the Spanish Center on Sociological Research between 1996 and 2009 found that for twenty variables of public satisfaction with health care services, decentralized communities performed worse over time on three measures of primary or specialized care and one measure of hospital care. Decentralization had no effect over time on two measures of primary or specialized care and two measures of hospital care. No statistically significant trend was observed for twelve of the twenty measures of satisfaction. The authors of the analysis stressed that the data was limited due to the subjective nature of patient reported quality of health care, and the inability for many citizens to properly evaluate performance of health care services.

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Answer 9

Healthcare in South Africa

In South Africa, private and public health systems exist in parallel. The public system serves the vast majority of the population, but is chronically underfunded and understaffed. The wealthiest 20% of the population use the private system and are far better served. In 2005, South Africa spent 8.7% of GDP on health care, or US$437 per capita. Of that, approximately 42% was government expenditure. About 79% of doctors work in the private sector.

In 2013 it was estimated that vacancy rates for doctors were 56% and for nurses 46%. Half the population lives in rural areas, but only 3% of newly qualified doctors take jobs there. All medical training takes place in the public sector but 70% of doctors go into the private sector. 10% of medical staff is qualified in other countries. Medical student numbers increased by 34% between 2000 and 2012.

There are more than 400 public hospitals and more than 200 private hospitals. The provincial health departments manage the larger regional hospitals directly. Smaller hospitals and primary care clinics are managed at district level. The national Department of Health manages the 10 major teaching hospitals directly.

The Chris Hani Baragwanath Hospital is the third largest hospital in the world and it is located in Johannesburg.

The public sector uses a Uniform Patient Fee Schedule as a guide to billing for services. This is being used in all the provinces of South Africa, although in Western Cape, Kwa-Zulu Natal, and Eastern Cape, it is being implemented on a phased schedule. Implemented in November 2000, the UPFS categorises the different fees for every type of patient and situation.

It groups patients into three categories defined in general terms, and includes a classification system for placing all patients into either one of these categories depending on the situation and any other relevant variables. The three categories include full paying patients—patients who are either being treated by a private practitioner, who are externally funded, or who are some types of non-South African citizens—, fully subsidised patients—patients who are referred to a hospital by Primary Healthcare Services—, and partially subsidised patients—patients whose costs are partially covered based on their income. There are also specified occasions in which services are free of cost.

Because of its abundant cases of HIV/AIDS among citizens (about 5.6 million in 2009) South Africa has been working to create a program to distribute anti-retroviral therapy treatment, which has generally been limited in low economic countries. An anti-retroviral drug aims to control the amount of virus in the patient’s body. In November 2003 the Operational Plan for Comprehensive HIV and AIDS Care, Management and Treatment for South Africa was approved, which was soon accompanied by a National Strategic Plan for 2007–2011. When South Africa freed itself of apartheid, the new health care policy has emphasised public health care, which is founded with primary health care. The National Strategic Plan therefore promotes distribution of anti-retroviral therapy through the public sector, and more specifically, primary health care.

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Answer 10

Healthcare in Singapore

Healthcare in Singapore is mainly under the responsibility of the Singapore Government's Ministry of Health. Singapore generally has an efficient and widespread system of healthcare. Singapore was ranked 6th in the World Health Organisation's ranking of the world's health systems in the year 2000. Bloomberg ranked Singapore’s healthcare system the most efficient in the world in 2014.

Singapore has a non-modified universal healthcare system where the government ensures affordability of healthcare within the public health system, largely through a system of compulsory savings, subsidies, and price controls.

A key principle of Singapore's national health scheme is that no medical service is provided free of charge, regardless of the level of subsidy, even within the public healthcare system. This mechanism is intended to reduce the over-utilisation of healthcare services. Out-of-pocket charges vary considerably for each service and level of subsidy. At the highest level of subsidy, although each out-of-pocket expense is typically small, costs can accumulate and become substantial for patients and families. At the lowest level, the subsidy is in effect nonexistent, and patients are treated like private patients, even within the public system.

Singapore's system uses a combination of compulsory savings from payroll deductions to provide subsidies within a nationalised health insurance plan known as Medisave. Within Medisave, each citizen accumulates funds that are individually tracked, and such funds can be pooled within and across an entire extended family. The vast majority of Singapore citizens have substantial savings in this scheme. One of three levels of subsidy is chosen by the patient at the time of the healthcare episode.

Medishield is a low cost insurance scheme intended for those whose savings are insufficient to meet their medical expenses. Premiums can be paid out of Medisave accounts. A new scheme, Medishield Life, was agreed by parliament in January 2015. Co-insurance payment rates are to be reduced from 10–20% to 3–10% and the lifetime claim limit is to be removed. Eldershield is part of the Central Provident Fund which insures against the cost of private nursing homes and related expenses. It already has more than a million policy holders. Medifund is a safety net for those who are unable to meet their assessed contribution. Risks are not pooled, so an individual may be exposed to catastrophic expenses.

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