Posts Tagged ‘system’

Health Care Systems Around The World: Spain’s Health Care System

Tuesday, April 5th, 2011

Health Care Systems Around The World: Spain’s Health Care System

Health care is guaranteed

Spain’ national health care system operates on a highly decentralized basis, giving primary responsibility to the country’s 17 regions.  The Spanish Constitution guarantees all citizens the “right” to health care- including equal access to preventative, curative, and rehabilitative services.  Coverage under the Spanish system is nearly universal, estimated at 98.7% of the population.  The federal government provides each region with a block grant.  The money is not earmarked – the region decides how to use it. 

Physicians are assigned

Spanish patients cannot choose their physicians, either primary care or specialist.  Rather, they are assigned a primary care doctor from a list of physicians in their community.  If more specialized care is needed, the primary care physician refers patients to a network of specialists. One may not go “out of network” unless the patient has private health insurance.  This has sparked an interesting phenomenon whereby sick Spaniards move in order to change physicians or find networks with shorter waiting list.

 Waiting times are inevitable

Waiting lists vary from region to region but are a significant problem everywhere.  On average, Spaniards wait 65 days to see a specialist, 71 days to wait for a gynecologist, and 81 days for a neurologist.  The mean waiting time for a prostectomy is 62 days and for hip replacement surgery is 123 days.  Some health services that US citizens take for granted are almost totally unavailable.  For example, rehabilitation, convalescence, and care for those with terminal illness are usually left to the patient’s relatives.  There are few public nursing and retirement homes, and few hospices and convalescence homes.

Private health care and insurance is growing

As with most other national health care systems, the waiting lists and quality problems have led to the development of a growing private insurance alternative. About 12% of the population currently has private health insurance.  Overall, private insurance payments amount for 21% of total health care expenditures.  More commonly, Spaniards pay for care outside of the national health care system out of pocket. In fact, nearly 24% of health care spending in Spain is out of pocket – more than any European country except Greece and Switzerland, and even more than the United States.  Here again, a two-tier system has developed, with the wealthy able to buy their way around the defects of the national health care system, and the poor consigned to substandard services.

Modern medical technologies are in short supply

There are also shortages of modern medical technologies.  Spain has one-third as many MRI units per million people as the US and just over one-third as many CT units, and fewer lithotripters.  Some regions, like Ceuta and Melilla do not have a single MRI unit.  All hospital-based physicians and approximately 75% of all other physicians are considered quasi-civil servants and are paid a salary rather than receiving payment based on services provided.  As a result Spain has fewer physicians and fewer nurses per capita than most European countries and the US.

Mostly, Spaniards are happy with their health care system

Even so, Spaniards are generally happy with their system where nearly 60% describe their system as good, the second highest favorability rating in Europe. However, Spaniards do want more choice of doctors and hospitals, and they want the government to do a better job of dealing with the waiting lists.

Interesting factoids about Spain

The biggest industry in Spain is tourism Madrid, Spain’s capital city, is located in the exact center of the country The low birthrate registered in Spain is the result of the high unemployment, coupled with steep housing cost.  These factors make it difficult for most people in Spain to buy houses big enough to accommodate more than two children Spanish (Castilian Spanish) is not the only language spoken in Spain.  There are at least four other major languages spoken plus other variations and dialects.  The major other languages are Galician, Basque, and Catalan You won’t find corn or flour tortillas in Spanish food.  In Spain, tortillas are a popular egg and potato dish Soccer is Spain’s most popular sport Around 40% of Spaniards between 17 and 24 are smokers Spain has one of Europe’s highest rates of AIDS Prescription medications can be acquired over the counter at medicine shops

 

 

House Speaker Nancy Pelosi continued her health care push Wednesday, touting the bill’s benefits for young people and seniors. Meanwhile, the head of the House Republican Conference slammed the measure saying the American people don’t want it. (March 17)
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Health-care bill passed 60-39 could mirror Canadian style rationing system

Monday, March 28th, 2011

Health-care bill passed 60-39 could mirror Canadian style rationing system

The health-care bill, which is President Obama’s top domestic priority, would extend insurance to about 30 million people who now lack it, expand the reach of Medicaid for the poor, and impose new rules on health insurance companies. It would cost about 1 billion over 10 years, but raise more than that in new taxes and fees and cuts in Medicare. Democrats win the vote 60-39 over Republican objections.

With the economy struggling to break the chains of a job-destroying recession. Under Obama-care, Americans will be forced to buy government-approved health insurance and anyone earning a middle class wage will have to pay for it out of their own pocket. Federal subsidies will only be provided for people who are not offered coverage by their employer and earn below the 400 percent poverty level. Families whose employers drop their plan will be forced to buy it on their own – at a cost of over ,000 dollars a year. “The Senate health care bill gives employers two powerful incentives to stop offering health insurance coverage to their workers,” writes Terry Jeffrey

“First, if an employer does offer coverage, its lower-wage workers will lose the federal insurance subsidy they would otherwise get.
Secondly, if an employer does not offer coverage, the 0-per-worker fine it faces will be far less than the premiums it would pay if it did offer coverage.”

Families struggling in this deep recession who earn a combined total greater than ,200 and don’t have their health care covered by their employer will be hit with a mandatory annual fee of about ,000 according to the Congressional Budget Office’s analysis of the final Senate health-care bill.

There is nothing voluntary about Obama’s health-care mandate:

The Senate has dismissed concerns over the individual insurance mandate and the tax penalty imposed on those who don’t meet that requirement. If you refuse to pay the penalty or you refuse to provide any information on your health-care status on your tax return, you will face the prospect of being audited by the Internal Revenue Service. This is supposedly a “voluntary mandate” and the IRS can’t do anything against you if you refuse to pay the penalty. They claim that because page 340 (A) and (B) of the bill waives criminal prosecution of taxpayers and says that no liens or levies can be filed on the taxpayer’s property. That claim is wrong.

Congressional Budget Office’s (CBO) itself made clear that the financing of health-care reform is based in substantial part on generating 7 billion in “penalty payments” from individual taxpayers and employers.

The IRS, which is known for its habit of disregarding court decisions that disagree with its interpretations of the law, may use audits and the ability to find problems in a taxpayer’s finances in areas totally unrelated to the health care mandate to force compliance with the mandate and coerce payment of the tax penalty imposed by Reid’s bill. according to The Heritage Foundation, The very idea of using the taxing powers of the state to force compliance with this law is one that should shock the conscience of everyone, even those who support “reforming” our health care system.Obama’s answer to the question posed by George Stephanopoulos
in an interview,  “Under this mandate, the government is forcing people to spend money [to buy insurance], fining you if you don’t. How is that not a tax?’’

“George,’’ chided Obama, “the fact that you looked up Merriam’s Dictionary . . . indicates to me that you’re stretching a little bit right now.’’

Merriam-Webster’s definition of “tax’’ – “a charge, usually of money, imposed by authority on persons or property for public purposes.’’

One place to look to see what the universal coverage would do is the state of Massachusetts, about 200,000 state taxpayers remained uninsured in the beginning year of 2008, it hasn’t made insurance more affordable, Massachusetts has the highest health insurance premiums in the nation. It rose by 7.4 percent in 2007, 8-12 percent in 2008 and will expect to rise 9 percent this year who knows what 2010 will bring, according to Jeff Jacoby who’s article entitled Mandatory insurance: Yes, it’s a tax, addresses the promise Obama’s made not to raise taxes on any American family earning less than 0,000 a year, contradicts that by supporting legislation that would force every American to carry health insurance or pay a hefty penalty to the IRS.

Some of the taxes that will be imposed on the public under the new health-care bill that has people taken back with concern: according to H.R. 3590 Patient Protection and Affordable Care Act.

Section 1501 – Requirement to maintain minimum essential coverage – Individuals will be required to maintain health insurance. Those that do not will be assessed an annual tax penalty of 0. The tax penalty is scheduled to escalate in subsequent years. Consequently, Massachusetts residents that do not maintain health insurance will be assessed a tax at both the state and federal level.

Section 9001 – Excise tax on high cost employer-sponsored health coverage – This provision levies an excise tax of 40 percent for any health coverage plan that is costs over ,500 per year for single coverage and ,000 per year for family coverage. Since this was protested vigorously by unions and public employees, the Senate caved and granted a massive concession. The tax is not levied on the individual receiving the tax free benefit, but is levied on the insurance company or plan administrators that provide the employee the benefit. How absurd is that?

Section 9008 – Imposition of annual fee on branded prescription pharmaceutical manufacturers and importers – This piece of the legislation imposes a .3 billion excise tax on the pharmaceutical industry. The tax is allocated across the industry and is based on market share, not on income. This tax starts immediately and is non-deductible for the corporation being taxed. These companies will still be required to pay their federal income taxes.

Section 9009 – Imposition of annual fee on medical device manufacturers and importers – This section imposes a billion excise tax on the medical device industry. The fee is allocated across the industry based on market share, not on income. This tax starts immediately and is non-deductible for the corporation being taxed.

Section 9010 – Imposition of annual fee on health insurance providers – Another excise tax. This one is assessed on the health insurance industry in the amount of .7 billion taxed out and is also based on market share. How can the imposition of billion in excise taxes (section 9008, 9009 and 9010) on the health care industry reduce costs to consumers? Does anyone else suspect these companies will have to pass these costs over to consumers?

Section 9013 – Modification of itemized deduction for medical expenses – For those incurring significant medical costs, your ability to deduct these expenses will be decreased. This legislation increases the adjusted gross income threshold for claiming an itemized deduction from 7.5 percent to 10 percent.

Section 9015 – Additional hospital insurance tax on high-income taxpayers – This increases the Medicare tax on wages by 0.50 percent on individuals making in excess of 0,000 and married couples making over 0,000. This will be effective starting January 1, 2013. (As a side note, individual income taxes are already scheduled to increase in 2011, with the highest rate already increasing by 4.6 percent. This will be in addition to the tax increase as outlined here in Section 9015.)

“Average premiums per policy in the non-group market in 2016 would be roughly ,800 for single policies and ,200 for family policies under the proposal,” according to the Congressional Budget Office’s (CBO).

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Simple Steps That Employers Should Practice to Increase Their Value of the Health Care System

Thursday, February 24th, 2011

Simple Steps That Employers Should Practice to Increase Their Value of the Health Care System

In the United States, there are a lot of employers who see health care benefits as the enemy. This is due to the fact that some health care providers fix their attention on the growing cost of the services that are included in the health care package, and this has led them to take steps to lower the rates. Most countries have put this subject on the sideline and they expect that the government will take care of the issue. Some of these health care providers hope that the insurance companies of the patients, or the government will take on this responsibility.

One thing that employers fail to understand is that no matter how hard they try to avoid the subject of health care issues, it will forever haunt them, no matter what kind of health care system is being implemented. The responsibilities of these health care insurance companies include the liability of paying the medical costs, absenteeism, and any other health related issues that they have to pay due to poor health.

According to one study in the United States, most employers use up millions of dollars paying for the indirect expenditure due to unfortunate health condition rather than spending their dollars in health benefits. The expenses that the employers have to pay when it comes to poor health are significantly higher. Conditions like diabetes, heart conditions, and respiratory troubles are among those medical conditions that can cost an employer a fortune, and getting out of this situation will not solve the problems of these health care providers because it will continue.

Most European countries have discovered that investing in the health of their employers by providing them with wellness programs will significantly increase the productivity of their employers, thus decreasing the amount of money that they have to pay for the cost of poor health. One of the approaches that the employers use is bargaining for the best and maximum amount of discounts that they can get from other health plans providers and third party health proprietors. Often they are constantly searching for companies that can help them to provide better deals for their employers. This action on the part of the employers can cause confusion among their employees.

Due to the increase of health care costs, some employers have passed on their responsibility of paying the cost of the health care to their employees. Many of the steps that these employers take as far as health care issues are concerned has cost them more. So, one vital thing that any employer can do to improve their health care system is to consider the value of the health care services and not just the cost alone. After all, it is the results that both employers and employees are after. The main objective of this approach is to increase the value of the services and not to reduce the costs of the overall health care benefits.

The article is written by Nammy Mike. If you want to find out more useful articles, please visit Health Care and Skin Diseases


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