Healthcare in Europe

Healthcare delivery on the European continent has traditionally reflected a strong government presence in design that echoes political history and cultural expectation. The vast majority of countries have established publicly funded and administered healthcare systems that rely primarily on tax revenue and a high level of public trust. In general this structure has been associated with a high level of efficiency, access, and quality of care across many western European countries. A study conducted in 2007 by the World Health Organization (WHO) measured and ranked the efficiency of 181 countries healthcare systems. All of the nations in the top 7 were located in continental Europe and included France, Italy, and Spain.

Using single payer and hybrid models as routes to success in healthcare delivery

Both France and Italy have utilized a single-payer model in providing coverage of medical services directly to all citizens and legal residents who reside within their borders. Important features of this model include financing that comes in the form of both income/corporate and value added tax revenue. Choice is a central feature in both systems as individuals are free to choose their providers, often this begins with a general practitioner who has the authority to both prescribe medication and refer patients to specialists.

A second approach to healthcare in Europe has been established in Germany and involves a public-private partnership approach similar to that which served as the foundation of the Affordable Care Act recently passed in the United States.  Under the German model health insurance coverage is mandatory for all citizens and legal residents and is provided by non-profit, heavily regulated insurers.

These two strategies have produced generally positive results in both access, quality of care, and efficiency.  France and Italy have achieved nearly universal coverage and boast above average life expectancies, low infant mortality rates, and low administrative costs[i].

Russia

In stark contrast to the high quality of care being provided by the countries discussed above is the growing health crisis in Russia. On the surface it would seem that they have implemented a functional universal healthcare system operated by a central government agency in the Ministry of Health. However the Russian system is one marred by a general lack of public trust in insurance providers, government corruption, an inability to offer adequate health services in rural areas, and an adherence to a “polyclinic” style of delivery that emphasizes quantity of patients served over quality of care. These issues are reflected in a relatively low life expectancy[ii], high infant mortality[iii], and with only 6% of GDP devoted to providing health services there doesn’t appear to be the resources available to introduce meaningful reform.

Effect of European austerity on drug coverage

The future of universal healthcare systems across Europe is uncertain due to the recent economic downturn that has forced many countries such as Italy, Greece, and Spain to drastically cut government spending.  An area of healthcare that has been especially impacted by cuts is prescription and over-the-counter drug coverage. Countries have responded to austerity by reducing negotiated drug costs while at the same time shifting the burden of payment to its citizens. For example Italy has introduced an additional €10 co-pay on all prescription drug orders. Drug companies operating in Europe have experienced an associated reduction in product sales and instituted large-scale layoffs[iv] that have worsened already tenuous economic conditions on the continent.

 

Sources

Novak, S. (2012, February 13). Austerity in Europe Puts Pressure on Drug Companies. Retrieved May 13, 2013, from New York Times: http://www.nytimes.com/2012/02/24/business/austerity-in-europe-puts-pressure-on-drug-companies.html?pagewanted=all&_r=0

OECD. (2012). OECD Health Data: 2012. Retrieved May 13, 2013, from OECD: http://www.oecd.org/els/family/CO1.1%20Infant%20mortality%20-%20updated%20081212.pdf

Reuters. (2013, April 28). Austerity Having A 'Devastating Effect' On Health, Researchers Find. Retrieved May 13, 2013, from Huffington Post: http://www.huffingtonpost.com/2013/04/29/austerity-health-reduces-healthcare-increases-depression_n_3175576.html

The Commonwealth Fund. (2012, November). International Profiles of Healthcare Systems: 2012. Retrieved May 13, 2013, from thecommonwealthfund.rog: http://www.commonwealthfund.org/~/media/Files/Publications/Fund%20Report/2012/Nov/1645_Squires_intl_profiles_hlt_care_systems_2012.pdf

University, J. H. (2012, March 8). Structure of the German Healthcare System. Retrieved May 15, 2013, from American Institute for Contemporary German Studies: http://www.aicgs.org/issue/structure-of-the-german-health-care-system/

 

 

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[i] [i] Life expectancy:

France: 78 M/85 F

Italy: 80 M/ 85 F

 

Infant Mortality:

France: 3.3/1000

Italy: 3.36/1000

 

[ii] Russia life expectancy: 60.4 M/74.1 F

[iii] Russia infant mortality: 15.13 per 1000

[iv] Pharmaceutical job cuts (2007-2012):

AstraZeneca-28,000

Novartis-2,000

Pfizer-6,000