Which Country Has the World's Best Health Care?

All the substance you want, and no wasted words

The book: Which Country Has the World’s Best Health Care?, (Public Affairs, Hachette Book Group, 2020, 453 pp.)The author: Ezekiel J. Emanuel, M.D.Who is? Vice President for Global Initiatives and Co-Director of the Healthcare Transformation Institute, University of Pennsylvania (and winner of the Dan David Prize for medical ethics in 2019). Author or editor of 14 books and over 300 articles; the publisher asserts Dr. Emanuel is “the world’s most cited bioethicist.”Book’s Bottom Line: No country has the world’s “best" health care, but some are clearly better than others in providing health care to their citizens.How does he know? Because he did the research.Like what? Emanuel and his team of researchers studied in detail the health care systems of eleven countries, two in North America, six in Europe, and three in the Far East. The countries were, respectively, United States, Canada, United Kingdom, Norway, France, Germany, Netherlands, Switzerland, Australia, Taiwan, and China. These countries were selected because they vary in financing and delivery of health care, they are often cited in debates in the U.S. over comparisons with American care, and the countries can make plausible claims to being ideal in one or more health care delivery ways.One chapter is devoted to each of the eleven countries. Each country is assessed on the same eight “topics” (which include 22 “dimensions”):1. History of the health care system (how it got to where it is now).2. The extent of the country’s population served and the range of services provided.3. How the system is financed.4. What patients are expected to pay ‘out-of-pocket’5. How health care services are delivered (i.e., what subgroups are served, who are the providers, and where do they provide services)6. What human resources the system has to meet demands for the services promised and provided7. How prescription drugs and their prices are regulated by the system8. What challenges the system faces in the future if it is to continue to provide what is promised and intended.Some challenges are “universal,” while others may be specific to a given system. Universal challenges to all systems include:1. Increasing cost pressure of services, and cost containment in providing all the services promised by the system.2. The increasing cost of pharmaceuticals3. Reducing inefficiency in provision of care and eliminating unnecessary care.4. Coordination of care for patients with chronic illnesses and, similarly,5. Reducing the mismatch between health care delivery institutions and the needs of patients with chronic illnesses6. How to finance long-term care services7. The provision of adequate mental health services, in part to reduce the cost of other health services used.All the above are discussed at length in the chapters for each country, and in a final comparison chapter, where the countries are summarized in text and tables.What does Emanuel conclude regarding the United States, based on his research?The United States spends ~18% of its GDP on healthcare ($10,700 per capita), far ahead of second highest Switzerland (~12%, $9,700 per capita) but underperforms the other ten countries on most of the 22 dimensions in the book—sometimes by a great deal. It ranks near the bottom overall, just above China (so much for international Superpowers).So, are we doomed? No, says Emanuel.Although it is not feasible to “lift and shift” a health care system from some other country and just plunk it down in the USA, the author lists six “lessons” from his research on the eleven countries that can help the United States provide a health care system that better meets the needs of Americans and allows all of us to take genuine pride in our health care system. The implementation of each lesson is discussed in practical detail in the book, along with a justification for its inclusion among the six; I merely list the lesson headings below.Lesson 1: Ensure universal coverage via auto-enrollment and larger subsidies.Lesson 2: Cover children at no additional cost to parents and families.Lesson 3: Reduce the current complexity of the system.Lesson 4: Emphasize and increase the reimbursement for primary care.Lesson 5: Adopt and implement best practices for the care of patients with chronic and mental health conditions.Lesson 6: Join other countries in coordinated regulation of drug prices.Experts, and readers of the book, may have other “lessons” they believe offer better opportunities to improve the health of Americans, but—after reading the book—I found it difficult to dismiss any on Emanuel's list. Whatever the case, improvement is needed and it is possible. The alternative of continuing “as is” is financially untenable, continues the downward spiral of the health of significant numbers of American citizens, and jeopardizes the future of the United States as a respected—and respectable—member of the nations of the world.We can do this.

Great book to read if you are in the medical field. An interesting book to read if you are not in the medical field.

Dr. Emanuel has presented an easy-to-read framework in his evaluation of the U.S. healthcare system and how it compares with others among developed countries in the world. He provides a set of filters for his analysis and makes important distinctions pointing to who has the best efficiency and access to care, who offers the best pharma coverage and a host of other quality metrics that help the reader make an informed decision about what works and what doesn't when considering the impact of policy decisions. And for those wondering how our system became so complex, Dr. Emanuel provides a deep history of the evolution of each system, making comparisons among them that help to explain why adjustments in policy can be so complicated, given the structure of legacy parties in each eco-system.Who should read this book? Anyone who works in the healthcare sector or whose business is touched by the changing regulations, financial models and emerging digital health technologies that impact access and the affordability of quality care. As we are surely going to experience another round of challenges to the ACA in the coming year, it's important that everyone has a baseline understanding of the issues and drivers of healthcare outcomes and costs. If we are going to engineer a way for the U.S. to offer coverage for all, we must understand the factors that enable or inhibit us in achieving this objective. Dr. Emanuel's book will help us in this discussion.

A very thorough roundup of how various nations across the globe finance and deliver medical and long-term care that provides useful background to those who research and formulate public policy and regulation of medical care and pharmaceuticals.While the author criticizes the United States for having the most complex and expensive, other nations also have various degrees of fragmented finance and delivery and less than optimal care coordination. However, with the exception of Switzerland, none come with the degree of expense as America’s market-based scheme where market forces have not stemmed rising costs. A number of suggestions are made to achieve this while keeping intact major components of commercial and government insurance programs including increasing drug price regulation and use of electronic records. The author recommends retaining employer medical benefit plans and combining Medicare, Medicaid and non-group plans subsidized though the Obamacare exchanges into a single program as devised by the Center for American Progress and U.S. Representative Jan Schakowsky. However, the author suggests, states would still have to continue to contribute to the costs of Medicaid, a major state budget strain that has grown more burdensome since the 2008 recession. Why not simply end Medicaid and make it part of an expanded Medicare the author envisions?

This is a very timely book and makes exhaustive research into some of the most representative healthcare systems around the world. It's a worthwhile read but not an absorbing one. It is a research document and has a tendancy to be boring. It's the nature of the subject. The book is particularly revealing about the shortcomings of the US plan in comparison with some highly efficient systems on multiple continents.

Came within delivery specifications and good packaging. I've read about half of it now... it's quite informative and comprehensive which is a good thing.

Thanks to this book I was able to understand how healthcare systems around the world are financed and delivered. The author excels and outlining each system in an informative and consistent way.+ Informative and consistent methodology.- readers may find it a slog to get through especially early.

Written by an eminent American scholar with extraordinary policy experience, this book offers a good overall summary of how several high-income countries organize, financing, and manage their health care systems. The book is good but not without flaws. Experts from specific countries will pick up on minor errors or misrepresentations here and there. And the structure of the chapters is a bit formulaic, resulting in some repetition within country descriptions. All of that said, the book is more approachable than comparative reports written more specifically for experts in health care policy.

As a Canadian who has travelled a lot of the world and in pre-Covid days spent winters in Hilton Head SC, I have got tired of defending the Canadian Health Care System with Americans. I believe that this book gives a clear and honest assessment of the health care management systems in both countries as well as several other countries. Not to say one is better than the other but rather I can now say they both are equally imperfect!