Health Care Systems: Japan, Germany, France & UK

This video gives an overview of four different health care systems: those in Japan, Germany, France and the UK. I draw a map, comparing the relationships between different players: the government, doctors, insurers, employers and people/patients.
An article that was helpful for me in preparing this video is the following:
Gusmano, M. K., Laugesen, M., Rodwin, V. G., & Brown, L. D. (2020). Getting The Price Right: How Some Countries Control Spending In A Fee-For-Service System: Study examines mechanisms commonly used by some countries to set and update health care prices. Health Affairs, 39(11), 1867-1874.
www.healthaffairs.org/doi/abs...

[@canyoupleaserunfast]

This video IS NOT long enough :) your explanations are straighforward and interesting. It shed a lot of light on some things from my past. I live in the UK, but I still pay for private med insurance, as if you are not dying - accessing correct healthcare is very difficult, there's not enough doctors, treatments, appointments. So if you are not dying - the waiting times are very very long, or sometimes it feels like playing a lottery, because you might get the correct treatment or you might not... And you wouldn't know as a patient. I am thinking of moving to Japan at some point in my life so was wondering about the healthcare system there, which brought me here. I didn't expect such an amazing insightful video about the healthcare systems! Very interesting! Thank you very much.

[@brianphan6344]

I am Health Policy & Management student at NYU Wagner and this was a super helpful video in understanding different healthcare models! The breakdowns was super easy to follow. This could be a series with more countries, I think the Scandinavian countries would be interesting to look at.

[@victormn47]

To add: The Netherlands: Everyone has to pay insurance, employed or not. The amount is the same, but you can choose between many different ones with different coverages (but with some baseline minimum coverages). If your salary (including social security if you are unemployed) is below something, you can get a part of your insurance reimbursed (almost all of it).

[@ortegagr8ness]

Thank you for making this video. It gave me a lot of prospective of how different each form is. I have a lot more respect for how each system tries to solve its healthcare needs.

[@jondurand2795]

Super neat. Any idea where I can find out how Canada works in this format so I can compare that?

[@gimpscalawag]

Very informative

[@Mluong45]

What books about healthcare systems do you recommend to read?

[@goodtoGoNow1956]

Adding Italy would have been VERY interesting to me.

[@CC-kl4nh]

Read a book about PPOs and HMOs and systems 15 years ago.

[@colko64]

As a German I know only our system. I think you got it wrong. There is no global fund, where all the money is collected and there is no voucher. People have to choose their health insurance, over 80% choose the public ones. They pay around 8% of their gross income, 7% is paid by the employer to their insurance "company" (public health insurer are no companies!). The government is setting the rules and pays for the costs of the not-employed, like kids, spouses, pensioners, unemployed etc. There are no "specialist" doctors unions, but 4 major players on the "medical site" of the negotiation table: independent doctors ("niedergelassene Ärzte), hospitals, pharma industry and pharmacists. Public health insurance is neither government nor privately organized but a "self governed body" where employers and employees were represented by elected members of the board.

[@schnelma605]

87.3% are statutory insured. Statutory health insurer are all non-profit organizations 10.3% are privately insured (selectable if self-employed or high income) 2.4% government agencies (for police, soldiers, refugees ...) In the case of statutory health insurance: Employees and employers each pay around half to the health insurer. The health insurer have financial compensation between themselves according to the risk structure of the insured. In German: Risikostrukturausgleich in der gesetzlichen Krankenversicherung (RSA). For didactic reasons, simply calling it "global fund" is fine by me. Voucher is not meant literally. I think she makes that clear in the video.

[@tomipcfto]

These are pretty helpful. I’ve watched the comparison video between Canada, UK, and Germany 2-3 times now and I’ll probably come back to this from time to time. Are you aware of the Ontario Premier’s proposal to allow residents to purchase extra services (outside of the extra services they already can buy)?

[@AshleyHodgson]

I was not aware of that proposal. It would be interesting if it passed!

[@TremereTT]

The German system isn't complete . it's a multi tier system . As it has mandatory insurance for regular employees and private ensurance for state employed(teachers, administration, mps), self employed and people with very high incomes . And then there is "freie Heilfürsorge"(=all medical bills directly covered by the state ) for the forces, police, firefighters, prison personnel and prisoners. The private insurance pay the doctors way more than the mandatory ensurances. And they are without a fixed budget and they can decide to not ensure you or up your premiums based on your risk ...so you get fat or an allergy , then they will up the charge . Age is/was somehow reflected in the charge . yet for state employees the private ensurance primium is coverered fully by the state of it exceeds a certain value .... Also doctors often bill unbillable treatments to private ensured patients or the same treatment twice with different wording ... many private ensurances reemburse the private patients costs dispite the wrong bills , as it might then lose the patient if they force him to go back and tell the doctor he trusts that he is s fraud and should correct the bill... private patience are given privileged treatment by doctors while mandatory ensured patients treated like everyone that the doctor would have to treat for free if they spent the budget that is allocated per quarter per patient per resident doctor. so you get appointment allocated in the next quarter of the year if possible and you get to wheight longer in the waiting room if private patients spontaneously get squeezed in ....

[@mac_uk5464]

I know the USA people don't like the UK system, but having a Insurance company in the midle is just increasing the costs. You cam have private medical insurance in the UK if you wan't to pay for it. One of the jobs of NICE is to select what medicines or what price the Government will pay for the medicines, this is to keep the costs down. Plastic surgery is not covered by NHS unless it is disfiguring, so no DD on NHS. We pay NI (National insurance) tax on our wages, this coveres health care, unemployment & pension.

[@canyoupleaserunfast]

NHS is underfunded and struggling a lot. This video explains a lot about what has happened to me tbh, I've had treatments prescribed that only helped with symptoms, but weren't actually addressing the cause and doctors shrugging shoulders, prescribing painkillers or antibiotics because, as I understand now - adressing the cause was too costly, or they have maxed out the "allowed quantity" of that particular treatment. In other words in NHS , if you are not dying, you gotta be lucky to get the right treatment, because there's not enough for everyone. Some of the longterm treatments (longterm course of antibiotics) I've received made serious damage, which took me years to reverse, some of them (physiotherapy) vere lousy and for which I had to wait for 6 month. If you are dying, then NHS will operate you for free, which is amazing and also happened to me. Unless you are dying, if you are not lucky enough - your issues will just get brushed under a carpet and rot. I am paying for private med insurance now, can access preventative care with ease and I have regained my health back, and can actually live a normal life, which I never thought was possible. However I get hit by a car the private healthcare is not gonna help, my life will be in the hands of the NHS.

[@nathanbrown492]

hmm, for the German and French systems, both insurers and doctors don't have a choice in not following the global rates?

[@governancesection9422]

France is misspelled in the thumbnail.

[@AshleyHodgson]

Thank you! I'll fix it now.

[@itcomputer.support8583]

fun fact: if prices for insurance increase year after year claiming demographics, the output is more and more limited in quantity and costs... what will happen? X-D the insurers won, the doctors & the patients lost... #corruption makes it possible