Imagine you needed an MRI.
Now, depending on where you live, it could be free, or cost hundreds of dollars.
And it’d be the same whether you needed your appendix removed.
Or a CT scan.
We can all agree that our health is important.
But unfortunately, where you live can be the difference between not having to worry about
doctor’s bills, and avoiding the hospital because you know there’s no way you’d
be able to afford it.
Different countries choose to approach health care in different ways.
One thing a lot of countries have in common is universal coverage.
That means all their citizens have access to healthcare.
They usually also control which drugs are available and subsidised, and also what prices
hospitals and doctors can charge.
Some countries have mainly publicly-financed healthcare, like Canada.
Others make it mandatory to buy regulated private insurance, like in Switzerland.
In places like France and Germany, you must buy statutory health insurance provided by
non-profits.
Singapore requires its citizens to have a mandated savings account.
In Australia, care is free or subsidised through the publicly-funded Medicare.
You can choose to get private insurance for faster access and the choice of a private
hospital.
It’s a good system, but not perfect - one year, 1.3 million Australians put off seeing
a doctor when they needed to, because they said they couldn’t afford it.
So does that mean countries should be spending more to help the poor access healthcare?
This is how much some countries spend on healthcare as a share of the economy.
The country that spends the most is the US.
Yes the population is big, but it also spends the most per capita.
But people in the US don’t visit the doctor a lot more than other countries.
And despite the money, it’s ranked low on both life expectancy and infant mortality rates.
Let’s dig a little deeper.
Here’s the split between public and private spending.
It’s this part that makes US healthcare so expensive.
In the US, the price for the same procedure can vary widely, even in the same hospital.
You’re charged a different amount depending on what insurance you have - because the US
does not have universal health care.
Some people are eligible for government-run programs.
The government can help negotiate prices down for this group.
For everyone else covered by private insurance, it’s the job of those companies — and
there are THOUSANDS of them — to negotiate those costs down on their own.
Millions of people in the US are uninsured, but it’s still less than the number before
coverage under the Affordable Care Act began.
And if you don’t have insurance, you're most likely paying the highest price of all,
because you have no-one negotiating for you.
Hospitals and doctors can charge you much more for the same service.
And because of all that money they make, you can see how there’s little incentive for
big pharmaceutical companies and hospitals to lower prices.
If you live in the US, you can expect on average to live at least two whole years less than
other similar countries.
One country you might be surprised to find so close on the chart to the US is its poorer neighbour, Cuba.
That’s because, despite being a controversial country in many ways, healthcare in Cuba is
protected as a fundamental human right - it’s free and universal.
They focus on cost-effective, preventative care, with about triple the number of doctors
for its population than other richer countries, and many of them based in local neighbourhoods.
Annual check-ups and vaccination is mandatory.
So even though it spends far less on healthcare, its citizens can expect, on average, to outlive Americans.
The UK also has free universal healthcare.
The Government provides healthcare, funded by the taxpayer, through the National Health Service.
Most treatments are free of charge to everyone except visitors and illegal immigrants, but
even those groups can access emergency care.
All prescription drugs are also free or subsidised.
But while the costs are low, the NHS also controls which new treatments and drugs the
government should allow and pay for.
The UK has relatively high cancer mortality rates, partly because some of the more expensive
and newer cancer drugs aren’t available in the country, because they haven’t been
deemed cost-effective.
That’s measured by NICE by whether a drug would cost more than 20,000-30,000 pounds
for each extra year of quality life it would provide - anything above this limit tends
not to be recommended for public subsidies.
Australia does the same thing through the Pharmaceutical Benefits Advisory Committee,
although they don’t have an explicit threshold.
The US, on the other hand, has no agency regulating drug prices.
So while this means there’s technically full access to all drugs deemed safe by the
FDA, pharmaceutical companies can charge whatever they want.
Whatever.
They.
Want.
So whether you can afford it is another question.
So why doesn’t the government just force them to lower prices?
Because big money means big power, especially in places like Congress.
Those high selling prices also attract investors, which in turn helps with research and innovation
towards new cures.
And this benefits not just the US, but the rest of the world too.
The real dilemma for the US is whether the trade-off between more accessible drugs and
innovation is worth it.
So what is the best way to go about healthcare?
Some countries offer a cost-efficient solution but don’t give access to all treatments
and drugs.
Innovation is great for improving drugs, but it comes at a steep cost which makes its way
back to the consumer and patient.
There’s no golden solution, but at the end of the day, a country’s main goal should
be prioritising the health of their citizens.
So as you can imagine, it's really hard to boil down several different healthcare systems
in just a few minutes, so we've had to leave out a lot of small detail.
So I've put a heap of links down below which will go into a lot more detail about that
and also a few links about the data sets we've used.