LESSONS US TAKES FROM A SINGLE PAYER SYSTEM IN MANAGING HEALTCARE COST: FRENCH HEALTHCARE SYSTEM

Year 2014, Sayı: 6, 28 - 52, 01.12.2014

Özlem Göçmez Kadir Gürsoy

Abstract

Healthcare spending in the US is characterized as being the most costly per person while health system is not delivering superior results on health outcomes. There have been many explanations that the US having the highest healthcare spending, such as prices, high prevalence of new-technology, chronic diseases and administrative cost. This study focuses on the structure of the US healthcare system and discusses the results for replacing the present public-private system with a single payer public system to restrain or reduce healthcare spending. In this context, the paper analyzes the US and France healthcare systems and then compares both systems in terms of costs. Finally the paper concludes the US payer system has not been exercising the same monopsony power that has enabled the French healthcare system keeping costs considerably lower, while proving equal, if not better care

Keywords

US healthcare system, French healthcare system, single payer, health spending

AMERİKA’NIN SAĞLIK HARCAMALARINI KONTROL ALTINA ALMAK İÇİN TEK GERİ ÖDEYİCİLİ SİSTEMLERDEN ÇIKARACAĞI DERSLER: FRANSIZ SAĞLIK SİSTEMİ

Abstract

Amerikan sağlık sistemi, sağlık çıktılarında iyi sonuçlar alamamakla birlikte, ülkedeki kişi başına düşen sağlık harcamaları çok yüksektir. Amerika’nın en yüksek sağlık harcamalarına sahip olmasının en önemli nedenleri sırasıyla, yüksek fiyatlar, ileri teknolojinin sık kullanımı, kronik hastalıklar ve yönetim giderleridir. Bu çalışmada, Amerikan sağlık sisteminin yapısına odaklanılıp,
sağlık harcamalarının azaltılması ya da kısıtlanması için mevcut kamuözel çok yapılı karmaşık sistemin tek ödeyicili (monopson) kamu sistemi ile değiştirilmesi durumu tartışılmıştır. Bu çerçevede her iki ülkenin de sağlık sistemlerini incelenmiş, sonrasında sağlık harcamaları ve maliyetler açısından karşılaştırılmıştır. Amerikan ve Fransız sağlık sistemleri birbirine yakın sağlık çıktıları üretirken, Amerikan’ın sağlık harcamalarını önemli ölçüde düşük tutmaya katkı sağlayan monopson güce sahip olmadığı sonucuna ulaşılmıştır.

Keywords

ABD sağlık sistemi, Fransa sağlık sistemi, tek ödeyici, sağlık harcamaları

References

• Aitken M, Ernst R. Berndt and David M. Cutler, Prescription Drug Spending Trends In The United States: Looking Beyond The Turning Point, Health Affairs, 28, no.1 (2009):w151-w160
• Allonier C et al (2008). Enquête santé protection sociale 2006, un panel pour l’analyse des politiques de santé, la santé publique et la recherche en économie de la santé. Paris, Institut de recherche et documentation en économie de la santé (IRDES rapport 1701) http://www.irdes.fr/EspaceRecherche/ BiblioResumeEtSommaire/2008/rap1701.htm.
• Anderson, G. F., Reinhardt, u. E., Hussey, P. S., & Petrosyan, V. (2003). It’s The Prices, Stupid: Why The United States Is So Different From Other Countries. Health Affairs, 22(3), 89-105.
• Cases C (2006). French health system reform: recent implementation and future challenges. Eurohealth, 12:10–11.
• Centers for Disease Control and Prevention. The State of Aging and Health in America 2013. Atlanta
• Chevreul K., Durand-zaleski, I. Bahrami, S. Hernández-quevedo, C., & Mladovsky, P. (2010). France: Health system review. Health Systems in Transition (European Observatory on Health Systems and Policies), 12(6), 1-291.
• Davis K., Schoen C., Stremikis K. (2010). Mirror, mirror on the wall: How the performe of US healthcare system compares internationally, 2010 update. Commonwealth Fund. June 2010.
• Davis K., Schoen C., Stremikis K. and Squires D. (2014). Mirror, mirror on the wall: How the performance of US healthcare system compares internationally, 2014 update. Commonwealth Fund. June 2014.
• Ginsburg, P. B. (2008). High and rising health care costs: Demystifying U.S. health care spending. Robert Wood Johnson Foundation, 1-32. Retrieved from http://www.rwjf.org/files/research/101508. policysynthesis.costdrivers.rpt.pdf
• Glaser W. A. (1991). Health Insurance in Practice: international variations in financing, benefits, and problems. Jossey-Bass Publishers: Oxford, UK. http://dx.doi.org/10.1787/health_glance-2011-53-en http://dx.doi.org/10.1787/health_glance-2013-en
• http://www.businessweek.com/articles/2013-04-10/the-reason- health-care-is-so-expensive-insurance-companies
• http://www.irdes.fr/EspaceAnglais/Publications/WorkingPapers/ DT22PrefDocSchemePolitFrenchExpGatekeeping.pdf
• Irvine, B (2002), updated by Clarke, E (2011) and Bidgood, E (January 2013) Healthcare Systems:The USA, Civitas Publishing
• Kanavos P. and S. Vandoros (2011), Drugs US: are prices too high?. Significance, The Royal Statistical Society, March 2011, pp.15-18.
• Koechlin F., L. Lorenzoni and P. Schreyer (2010), Comparing Price Levels of Hospital Services across Countries: Results of a Pilot Study, OECD Health Working Paper, No. 53, OECD Publishing, Paris.
• Laugesen M. J., Glied S.A. (2011). Higher Fees Paid To US Physicians Drive Higher Spending For Physician Services Compared To Other Countries. Health Affairs 2011;30:1647-1656.
• Naiditch M, Dourgnon P (2009). The preferred doctor scheme: a political reading of a French experiment of gate-keeping. Paris, Institut de recherché et documentation en économie de la santé(IRDES document du travail 22)
• National Health Expenditures, 2012 Highlights
• OECD (2011), “Coverage for health care”, in Health at a Glance 2011: OECD Indicators, OECD Publishing.
• OECD (2013). OECD Health Data, 2013.
• OECD(2) (2013), Health at a Glance 2013: OECD Indicators, OECD Publishing.
• Pfeffer, J. (2013), The Reason Health Care Is So Expensive: Insurance Companies
• Squires, D. A. (2011). The U.S. Health System in Perspective: A Comparison of Twelve Industrialized Nations. The Commonwealth Fund, 16, 1-14.
• The Commonwealth Fund (2013). Internatıonal Profıles of Healthcare Systems, 2013. Commonwealth Fund pub. no. 1717.
• The u.S Health Care System: An International Perspective, Fact Sheet 2013, Department for Professional Employees
• Thomson, S., & Mossialos, E. (2009). Private health insurance in the European Union: Final report prepared for the European Commission, Directorate General for Employment, Social Affairs and Equal Opportunities. Political Science (pp. 1-9).
• Victor G. Rodwin and Simone Sandier (1993). Health Care Under French National Health Insurance. Health Affairs. 1993:12(3);111.
• White C, M. Bond A, D. Reschovsky J, (2013) High and Varying Prices for Privately Insured Patients Underscore Hospital Market Power, Center for Studying Health System Change, HSC Research Brief No. 27, September 2013