Episode 144: Bonus Episode: European Healthcare

Previously in Europe

• Episode: Episode 144: Bonus Episode: European Healthcare
• Website: Previously in Europe
• Feed URL: http://simplecast.com/podcasts/2120/rss
• Duration: 01:10:48
• Published: 2019-08-21 01:00

Healthcare models in the EU

A lot of focus, especially in the US is on "Europe has universal social medicine" but the reality is much more complicated. Could do some examples such as: - Germany's weird insurance system - Ireland is garbage - The NHS - Whatever Sweden does??? - Greece and economic problems does what?

The EU does health good?

Well... sort of? It's not done at an EU level so you have different systems per country and even then access will differ even if the system sounds the same.

Health insurance card thing (E111)?

Get it out of the way quickly because for those from outside the EU it probably seems confusing.

Since 2004/05 there's been a card for all the EEA countries and Switzerland which makes traveling in Europe easier - the idea being you're covered by your home country's system so the state you're visiting will get reimbursed by your country of residence, where you qualify for health coverage anyway.

It's for emergency care and ongoing care for chronic illnesses (e.g. you can't travel because you need dialysis - you could get it once in the country you're visiting during your trip)

Health Consumer Powerhouse

A Swedish think tank that produces comparisons of healthcare systems across Europe via their production of the EuroHealth Consumer Index ranking systems.

I'd normally be skeptical about a think tank that advises on health policy but it really seems like a useful relative metric

They use a 1000 point scale to compare countries. It makes for an interesting but long read on the topic.

https://healthpowerhouse.com/publications/

Some takeaways that are generally relevant when considering healthcare:

• Spending money is not necessarily good. It is cheaper to run a system with lower waiting times inherently... but also spending money is good because it gets you there... there's a sweet spot.

• This seems to largely come from referral systems intended to prevent clogging up of specialist time.. but there's a clear relationship between overall waiting time for specialist treatment and whether you have to go through a referral system. Many of the best funded systems have this and it affects their waiting times negatively.

• There are some standards they've picked as cut offs such as particular waiting times (CT scan 7 days, GP same day access, interestingly they used Paediatric Psychiatry access to give an example of a hard to access service and used that as a kind of bonus question to divide up results). Ireland has a better system in theory than some other countries but it has by far the worst waiting times scores...

• A 6th of the whole score is access to prevention, again hammering home the "your system can sound good on paper but...".

• Then there's access to new drugs, which really pushes down the less wealthy countries... Western European countries end up near the top partially because of this as a factor.

• "With the possible exception of Switzerland and The Netherlands, there are no countries, which excel across the entire range of EHCI indicators.". They point out specifically Sweden as an example where it's mostly great but the waiting times have become a problem for a number of key services.

• Money doesn't buy accessibility (that also requires thought and planning) but it does buy better outcomes... There's a pretty clear correlation between discharge/death ratios and per capita spending

This is the wonky way of looking at how they compare, and the main take away is that generally Europe does healthcare okay.. but everywhere in Europe (except apparently Switzerland) messes it up in some key way. Things that relate to progressive socialized medicine:

• End user cost
• Inequalities (e.g. Italy is one public system but they note Rome and the North score well but the South scores badly...). In systems public and private care these are of course more class orientated than regional alone (e.g. Spain)
• Complexity of the system for the end user

Some types of system seem more prone to these than others. Ideal system? Ehhhh

A monstrous spreadsheet of most European countries categorised by my somewhat arbitrary system:

https://docs.google.com/spreadsheets/d/1dLHD6dln6UExBU9KKV4wXuXXaMP70UALFyDe6IF7Gv8/edit#gid=0