A great book on this is Healing America by T.R. Reid, who saw doctors in eight countries about his bum shoulder and wrote about their healthcare systems. Interestingly, single-payer isn't the only good option, or even necessarily the best.
Canada was the only country with single-payer like we talk about in the U.S. The U.K. is single-payer but also single-provider, the doctors work for the government-run healthcare system.
But the best results were in France, Germany, and Japan. They function a lot like Obamacare (multiple insurance companies, though all non-profit, and mandates to buy insurance). However, they add several critical features:
- Government controls on the price of services. Doctors make a lot less money than in the U.S.
- No claim denials allowed for anything on the national price list. If a doctor prescribes it, prompt payment is guaranteed.
- Good digital medical records.
According to Reid, a lot of German doctors don't bother hiring office staff. They swipe your medical card, get all your records, prescribe what they want, and get paid in a week. They can charge less because their costs are lower.
At least one of those countries also has subsidized tuition for medical school, I think Japan. Japan has the lowest costs (only 5% GDP on healthcare, with great outcomes despite an aging population of smokers), and the tightest cost controls; e.g. they make do with simple MRI machines without a lot of bells and whistles, but they do the job, and an MRI costs $100. Japan implements their mandate in an interesting way: you're free to not pay, but if you go to the doctor and you want it covered, you have to pay your back premiums.
Anyway, it's a fascinating book if you're interested in this stuff.
I've never been to a doctor in Germany that doesn't have office staff (though I suspect that it would be possible). You still need someone to deal with incoming calls, organizing the file cabinet and looking through the insurance rule changes of the week. Usually this is done by people who do limited medical work on patients as well (think nurse). Having one employee per doctor is not uncommon.
Doctors only send their bills once every three months and payment takes a while after that - a week would be a dream. Insurance can deny payment if they determine it wasn't medically necessary (and they do checks if they find a trend) but that comes out of the doctor's pocket. And for expensive things (like psychotherapy or dental) it needs to be preapproved by the insurance but they are are very limited in what they can deny.
And good digital health records? I don't think I will live long enough to see that in Germany. The only thing that leaves your doctor's office digitally (within they are free to work with paper or computer or whatever they wish) are the procedure and a short code for the diagnosis. If you need to see a specialist, paper still gets send around.
Edit: I just read the Germany chapter of that book. While it contains some (not really significant) errors and is a bit outdated (now six years old) I would still recommend that book based on this chapter.
> Japan implements their mandate in an interesting way: you're free to not pay, but if you go to the doctor and you want it covered, you have to pay your back premiums.
Canada was the only country with single-payer like we talk about in the U.S. The U.K. is single-payer but also single-provider, the doctors work for the government-run healthcare system.
But the best results were in France, Germany, and Japan. They function a lot like Obamacare (multiple insurance companies, though all non-profit, and mandates to buy insurance). However, they add several critical features:
- Government controls on the price of services. Doctors make a lot less money than in the U.S.
- No claim denials allowed for anything on the national price list. If a doctor prescribes it, prompt payment is guaranteed.
- Good digital medical records.
According to Reid, a lot of German doctors don't bother hiring office staff. They swipe your medical card, get all your records, prescribe what they want, and get paid in a week. They can charge less because their costs are lower.
At least one of those countries also has subsidized tuition for medical school, I think Japan. Japan has the lowest costs (only 5% GDP on healthcare, with great outcomes despite an aging population of smokers), and the tightest cost controls; e.g. they make do with simple MRI machines without a lot of bells and whistles, but they do the job, and an MRI costs $100. Japan implements their mandate in an interesting way: you're free to not pay, but if you go to the doctor and you want it covered, you have to pay your back premiums.
Anyway, it's a fascinating book if you're interested in this stuff.