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Making the Rounds

The World's Healthcare Systems

By Catherine Wayland

In United Kingdom

The National Health Care Services (NHS) is the public health care system founded in 1948 that covers residents, overseas students, refugees, and asylum seekers. The public health system or NHS, is free, comprehensive and high quality. Priority groups of low income earners and children under 16 years of age, also receive free dental and eye tests. This public system is not without its gatekeepers. A general practitioner or GP must be the first step in the process. A U.K. resident does not go directly to a specialist without a GP referral. According to the World Health Organization, (WHO) taken in 2001, the UK has an average of 163.93 physicians per 100,000 inhabitants compared to 279.0 in the U.S. and 229.1 in Canada. Midwives are another integral part of the U.K health system. They are key providers of health services to pregnant women and children. Private health insurance is available to those wanting to “jump the queque” in receiving a non-emergency elective procedure that could take 1-2 years in the public system.


In Argentina

In Argentina, there are different levels of public and private healthcare. In this country, the the Social Security programs administered by trade unions, known as obras socials, function as the primary form of health insurance and cover about half the population. Another state-run social security program called the Programa de Assistancia Medica Integral (PAMI), insures the elderly and disabled. A network of public hospitals, funded and operated by provincial and municipal governments, provides care free of charge for the uninsured. Private insurance plans also exist, generally serving a small, affluent minority.


In Italy

Italy is ranked very high with the World Healthcare Organization for quality health care services. Research shows that it is ranked in the top 10 (by contrast, the U.S. only holds 37 th place, despite being the highest spender.) Italy has a national health plan (Servizio Sanitario Nazionale), which provides for hospital and medical benefits. Even U.S. and Canadian residents who are legally resident in Italy can apply to join the nationally supported plan. Eligibility for the plan depends on certain criteria, (ie your nationality, work permit, etc.). If you are a resident of Italy and covered by the national health plan, hospital services will be provided to you and your dependents free of charge. Visitors or persons not enrolled under such a plan, are expected to pay full hospital charges and then claim a reimbursement from their insurance provider.


In Africa

The Council for Health Services Accreditation for Southern Africa (COHASA) regulates many hospitals under its jurisdiction to meet standards. However, Africa’s healthcare system is notably divided by public and private sectors. The continued and aggravated epidemic of HIV/AIDS puts a great deal of strain on the already stressed system. There is a great deal of competition for what comes into the country as far as medicine and equipment. The government since the end of Apartheid is now focused on making access to the general population. This is a system in growth mode as it is also in the midst of terrible crisis.


In Japan

The Japanese health care system is highly regulated by the government and “combines a mainly private provision of services with mandatory health insurance.” All doctors in Japan are paid the same fee for each service. It does not matter the better educated doctor or higher quality of service delivery. The fees are uniform. Specialists are not differentiated from general practitioners. People are assigned an insurer according to their employment situation. Those employed in businesses are covered by the Social Insurance System (SIS). This is similar to the States where employers pay in combination with the employees and their contributions to the benefits. The unemployed, elderly, and self-employed including doctors and lawyers, are covered by the National Health System (NHI) system. The NHI is funded by the government and employed members of the system. There is a third type of insurance developed for the aging, called long-term care insurance. The healthcare in Japan is comparable to the U.S.


In Canada

The healthcare system in Canada is public. Everyone has free and equal access to healthcare providers (which naturally generates a lot of demand). Providers bill the government for services rendered. Government pays providers with the money it obtains from progressive taxation. Government has the power to restrict healthcare spending (which leads to long waiting lists and wait times). It is illegal in Canada for private healthcare providers to compete with the government.


In France

France has a public health insurance system that supports everyone in the country. The reimbursements are uniform. The system is divided into workers, self-employed and agricultural workers. The public system covers around 75% of total costs. The remaining 25% is what can cause inequalities. The 25% is covered by out of pocket or supplementary insurance. In 2000, a program was established to guarantee that the poor received top care and supplementary insurance. The care is unlimited in France meaning no referrals are necessary and you can see a doctor as many times as you like. The system because it is mostly public is regulated by the state to keep costs contained on medicine and equipment. It is a public/private hybrid in which they spend less and get more.


In Spain

Spain has a national healthcare system. It provides free healthcare to citizens, foreign residents of Spain, and their respective dependents. Anyone who is employed in Spain and contributes to the Spanish social security system is covered under the national health plan. Additionally, retirees and pensioners from other EU countries are also covered. There is a private health care system that co-exists next to the public one. The private system is meant to be complimentary to the public system in regards to specialized care. The quality of healthcare in Spain is generally very good.


Please note: some of this research is as old as 2002, so please not only consider that only one source was used per country, but that the information might be abit dated. We at IF still found it worthwhile to gather a view of world health care systems and get the discussion rolling. Please write us with any updates or thoughts and reactions to

A second note: this article has focused on healthcare through treatment from doctors, clinics and hospitals in a public or privately supported system. What was found quite interesting in the research was distribution of medicine in various countries. In some countries it is necessary to see a doctor to obtain a certain medicine, in some countries it is not. The questions that were not answered is “What is considered over the counter medicine? Under-the-counter? How do pharmacies play a role in healthcare? The answers to those questions are large enough for a second article.

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