Status
Available
Call number
Genres
Collection
Publication
Hachette USA (2020), Edition: Illustrated, 464 pages
Description
"The preeminent doctor and bioethicist Ezekiel Emanuel is repeatedly asked one question: Which country has the best healthcare? He set off to find an answer. The US spends more than any other nation, nearly $4 trillion, on healthcare. Yet, for all that expense, the US is not ranked #1 -- not even close. In Which Country Has the World's Best Healthcare? Ezekiel Emanuel profiles 11 of the world's healthcare systems in pursuit of the best or at least where excellence can be found. Using a unique comparative structure, the book allows healthcare professionals, patients, and policymakers alike to know which systems perform well, and why, and which face endemic problems. From Taiwan to Germany, Australia to Switzerland, the most inventive healthcare providers tackle a global set of challenges -- in pursuit of the best healthcare in the world."--Book jacket.… (more)
User reviews
LibraryThing member arosoff
This is very interesting--at least if, like me, you're a healthcare dork. If you're not, this might be a bit dry--you probably don't really care about how the Swiss use a point system quite like the US' RVU, do you?
Rather than answering the question up front, Dr. Emanuel profiles 11 health
It turns out that the US does do a few things well--we're good at innovation in care delivery and payment methods. (We invented and exported the DRG system for payments. You're welcome.) What we are not good at is ensuring affordability and access, and despite people in the US thinking our system gives freedom of choice, in practice we score poorly due to our use of insurance networks. Also, sadly, mental health is an issue in many countries, not just the US.
There were some weaknesses in the book. For example, in the UK chapter, the vast majority of the discussion was on finance and structure, with very little devoted to care delivery. THis is a particular omission for the NHS as so much care is delivered via GP surgeries, and all that's mentioned is the existence of multiple providers in surgeries. If I hadn't lived in the UK for several years, I would never have known that specialist care in the UK is delivered in hospitals. There's also an embarrassing error in describing the National Insurance rates in which he says that higher-rate taxpayers pay 2% NI on *all* income, rather than on income above the NI threshold. While dental care was mentioned briefly in some chapters, it was not in all of them. I also would have liked to have seen some mention of obstetric care, which varies widely between countries. Dr. Emanuel likes to focus on "quality" care but doesn't always give definitions or metrics for determining quality, which would have made the point more effective. And as he himself admits, comparisons can sometimes be dicey because of differences in measures. Long term care can also be split between medical and social care systems, making it difficult to measure.
Nonetheless I think it's a worthy entry that should be more widely read. There's an unfortunate tendency in the USA to equate universal healthcare with single payer, which is not true, and there are many pieces under the hood that need to be coordinated. The countries in the book use a variety of systems (Emanuel places them in 5 categories--all of which exist in the US also!) None of them manage to provide care at no out of pocket cost in all categories, as Bernie Sanders proposed, though other than Switzerland, cost sharing for covered categories tends to be small. Only the Netherlands and Germany have dedicated funding for long term care. He concludes with some suggestions for improving the US system.
Rather than answering the question up front, Dr. Emanuel profiles 11 health
Show More
systems, including the USA, to see how each country works and what it does well--and doesn't. Each chapter follows a similar structure, describing the system, its payment model, how care is delivered, how drugs are financed, and the challenges facing the system. Not-really-a-spoiler alert: No country is "best": each has strengths and weaknesses. For example, Canada's system is simple and accessible for hospital and medical care, but scores poorly because standard healthcare does not cover pharma and the provincial plans do not cover most outpatient non-MD providers, a particular issue for mental health. Switzerland provides an enviable level of choice, but at a high cost--a family of 4 in Geneva may pay CHF 1800 a month for insurance, with limited income based subsidies, and then has to pay cost sharing on top. It turns out that the US does do a few things well--we're good at innovation in care delivery and payment methods. (We invented and exported the DRG system for payments. You're welcome.) What we are not good at is ensuring affordability and access, and despite people in the US thinking our system gives freedom of choice, in practice we score poorly due to our use of insurance networks. Also, sadly, mental health is an issue in many countries, not just the US.
There were some weaknesses in the book. For example, in the UK chapter, the vast majority of the discussion was on finance and structure, with very little devoted to care delivery. THis is a particular omission for the NHS as so much care is delivered via GP surgeries, and all that's mentioned is the existence of multiple providers in surgeries. If I hadn't lived in the UK for several years, I would never have known that specialist care in the UK is delivered in hospitals. There's also an embarrassing error in describing the National Insurance rates in which he says that higher-rate taxpayers pay 2% NI on *all* income, rather than on income above the NI threshold. While dental care was mentioned briefly in some chapters, it was not in all of them. I also would have liked to have seen some mention of obstetric care, which varies widely between countries. Dr. Emanuel likes to focus on "quality" care but doesn't always give definitions or metrics for determining quality, which would have made the point more effective. And as he himself admits, comparisons can sometimes be dicey because of differences in measures. Long term care can also be split between medical and social care systems, making it difficult to measure.
Nonetheless I think it's a worthy entry that should be more widely read. There's an unfortunate tendency in the USA to equate universal healthcare with single payer, which is not true, and there are many pieces under the hood that need to be coordinated. The countries in the book use a variety of systems (Emanuel places them in 5 categories--all of which exist in the US also!) None of them manage to provide care at no out of pocket cost in all categories, as Bernie Sanders proposed, though other than Switzerland, cost sharing for covered categories tends to be small. Only the Netherlands and Germany have dedicated funding for long term care. He concludes with some suggestions for improving the US system.
Show Less
Original language
English
Physical description
10 inches
ISBN
1541797736 / 9781541797734