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2009-11-25 07:58:00
By Helena Merriman
BBC News
The US Senate is preparing for one of the biggest debates in its history after
it voted to hold a debate on a landmark health bill.
If passed, the legislation could lead to some of the biggest changes in US
healthcare in decades.
But how do other healthcare systems around the world compare and what changes
are they going through?
China: Barefoot to bureaucracy
If President Obama is facing difficult challenges addressing healthcare in the
US, how does the country with the largest population and one of the world's
fastest growing economies organise its healthcare?
China's health system is as counter-intuitive for a so-called communist
government as its economic model.
Instead of operating under a socialist model, it has a hybrid system combining
employer based insurance and social service supplements.
But many people cannot afford to pay for healthcare.
Professor Li Ling, senior advisor to China's Ministry of Health, says that
prices are a barrier for many people.
But she says the government is trying to improve health services.
"The target is that by 2020 we will have a universal system and people will
only pay for 20% of treatment," she told the BBC World Service.
But in the meantime, some are making use of the increasing number of cheap,
illegal clinics operating particularly in the rural areas.
Before the economic reforms of the 1980s, China was famous for having a strong
network of primary care - or 'barefoot doctors' who looked after people in
villages under rural schemes which covered everyone.
But after the market-orientated reforms, the private sector took over, a
user-pays system was introduced, and the primary care system began to fall
apart.
While the hope is that the new model will better serve China's population from
a cost, quality, and availability perspective, at the moment, it is simply
proving too expensive for many people.
India: Caring for millions
India, with a similarly large population and growing economy, is to a certain
extent travelling in the opposite direction.
Rather than moving from a 'socialist' to a private model, India is aiming to
move from a mainly private service to increase public health spending.
At the moment, 75% of health spending comes out of people's own pockets.
As Surja Kant Mishra, the Minister of Health in West Bengal admits, there is
simply not enough public spending on health.
"The health spending in India has been abysmally low," he told the BBC's World
Today programme.
"The target is 2 to 3% of GDP but even I would say that is nothing...government
spending has to be increased."
The other major problem India faces is the huge divide between rural and urban
areas.
Rahul Bose, a community worker in West Bengal tells a story which illustrates
the problem well.
"There was this lady who came to my house at eight in the morning," he says.
"She had been bitten by a snake at four in the morning, but since there were no
male members in the house, she was not able to leave the house.
When I took her to the hospital, the doctors delayed treatment for two hours
and so she died in my car."
Cultural attitudes towards women in rural areas, as well as problems of
distances from health centres both prove major challenges for improving health.
India is also still facing high levels of infectious diseases, such as HIV and
tuberculosis and has one of the worst child malnutrition rates in the world.
South Africa: After the Revolution
Perhaps the country which has had the greatest change in health care in the
smallest amount of time is South Africa.
After the end of apartheid in 1994, health care was revolutionised.
The idea was that services should be available for everyone, regardless of
race.
South Africa now has a large public sector and a smaller but fast-growing
private sector. But the system is overstretched.
While the state contributes about 40% of all expenditure on health, the public
health sector is under pressure to deliver services to about 80% of the
population.
Despite this, most resources are concentrated in the private health sector,
which caters to just 20% of the population.
There is also a shortage of doctors, who are often lured into the private
sectors or overseas where pay is better.
While the country's former President, Thabo Mbeki, was criticised for not
acknowledging the depths of the AIDS crisis, experts now say that things are
now slowly improving.
Last month, the government allocated nearly $120m to deal with the pandemic.
But leading AIDS researcher, Dr Franchesca Barnadie, says that South Africa
needs to use that money more wisely by investing in primary health care.
"We need to take away treatment from the care of doctors with the exception of
complicated cases and give it to primary health care nurses because of the
burden of illness" she told the BBC World Service.
UK: Failing some?
If you asked many people around the world where they would least mind falling
ill, it is likely that many of them would say the UK.
The British are often critical of their health service, but last summer, an
attack on the National Health Service (NHS) from a Conservative MEP on American
TV, resulted in an outpour of online support via Twitter and Facebook.
While the British pay for the National Health Service through their taxes, it
is free at the point of use.
It is also relatively efficient. Britain spends half as much per capita on
healthcare than the US for a system which covers everyone.
Dr Sam Everington, a Doctor working in East London, says that Britain's strong
primary care is one of the reasons for its efficiency.
"We know that in hospitals everything is far more expensive," he told the BBC
World Service.
"But in primary care you have doctors with a lot of knowledge and skill which
can sometimes avoid those investigations, so it controls some of those costs of
the NHS."
But criticisms remain.
Some argue that too many costs are being sneaked into a system which was meant
to be free at the point of use.
Others say that it is not effective at delivering healthcare in what is now a
market-orientated world.
There are also limits on what the NHS can afford, so the National Institute for
Health and Clinical Excellence (NICE), makes decisions about which treatments
and drugs should be provided by the NHS.
Generally, things like cosmetic surgery or lifestyle treatments like Viagra are
not provided.
But more controversially, some drugs to treat diseases like cancer or
Alzheimers are not available.
Those whose treatments are deemed not to be cost-effective, such as David Cook
who has advanced kidney cancer, often feel that the system has failed them.
"In the UK they are saying I am a terminal case and therefore to give me
another couple of months of life is not worth it," he told the BBC World
Service.
"The medical treatment I have had under the NHS has been absolutely
outstanding. I just feel let down by the model they are operating under."