SF Chronicle: Health Care Lessons from Europe

European health care is universal, but contrary to popular perception, it is not all nationalized. Facing rapidly aging populations, many European countries have gone much further than the United States in using market forces to control costs. At the same time, regulations are stronger and often more sophisticated.

Most of Europe spends about 10 percent of its national income on health care and covers everyone. The United States will spend 18 percent this year and leave 47 million people uninsured.

Europe has more doctors, more hospital beds and more patient visits than the United States. Take Switzerland: 4.9 doctors per thousand residents compared with 2.4 in the United States. And cost? The average cost for a hospital stay is $9,398 in relatively high-cost Switzerland and $17,206 in the United States. […]

Far from leading to poor quality and rationing, both countries and Germany, where government has a much larger role in health care, outperform the United States on many quality measures. These are not just broad measures such as life expectancy that could reflect higher U.S. poverty or obesity. Even Britain, much maligned by opponents of government-run health care in America, has made greater strides in preventive care.

“The data are pretty clear,” said Peter Hussey, a Rand Corp. analyst. “Everybody (in the United States) is at risk for poor-quality care.”

Americans often confuse intensive care with quality, said Beth Docteur, a consultant and former health official at the Organization for Economic Cooperation and Development, a group of 30 industrialized countries. […]

The Germans apply especially rigorous scientific analysis to determine which medical procedures work and which don’t. Critics here argue that such “comparative effectiveness research” leads to rationing or even “death panels.” Recommendations this month by a U.S. government panel to cut back on mammograms have heightened such fears.

Karl Lauterach, director of the Institute of Health Economics at Germany’s University of Cologne, described Germany’s approach as “protecting patients against ineffective and highly inefficient care.”

“If Americans experience a more intensive medicine, is this higher quality? The answer is absolutely not,” Docteur said. “A lot of these surgeries and procedures may not even be appropriate for the patient. People are being exposed to risks of hospitalization and risks of adverse events that can exceed the actual benefits.”

The Dutch address what experts consider a critical market failure: The profit-maximizing incentive among health insurers to dump sick people. In Holland, insurers can profit by covering the sick. Some even market plans to diabetics, a practice that would be unthinkable here. The Dutch do this through a complex scheme that pays insurers more for covering the sick.

San Francisco Chronicle – Health care lessons from Europe

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