• What’s the health system worth to you?

    KaiserEDU.org has posted summaries of eight non-U.S. health systems: UK, Canada, France, Singapore, Japan, Germany, Switzerland, and Spain. Also provided are links to international data and additional analysis by various organizations. This is all good background for the following:

    Imagine a cash offer in some amount X per year. If you accept the cash then presto, your current health system is swapped out for one of those in a country listed above. How much cash (X) per year would be required for you to accept each of those health systems? (Negative numbers are permitted. That is, how much would you pay for each of those systems?)

    I thought of this while pondering a related question: would I decline to move to one of those countries because of its health system? I don’t believe the health system would be relevant to my decision to move to any wealthy democracy. That suggests it shouldn’t take too much cash to convince me to accept a system from a wealthy democracy. I might even pay something for it. I admit it is hard for me to put a dollar figure to this. I’m comfortable saying that, on average, it is approximately zero with some confidence interval of a tiny fraction of my income.

    Feel free to suggest wealthy democracies for which I should demand a large amount of cash to accept their health systems, though tell me why. Expand beyond the countries listed above if you wish.

    Later: Naturally, not everyone accepts the WHO’s rankings of health systems, but it is a handy way to get some sense of which might be broadly preferable to others. Brief summaries of health systems of many nations can be found at Wikipedia.

    • Having lived in Switzerland and enjoyed their health care system, I would certainly pay more for it (however, the cost of their health care system, like all of the others, is less than our current bloated, inefficient, ineffective, overpriced system).
      We also had many friends who lived in France and really loved the French system also.
      I know of no one who would prefer the US system.

    • I am still not a UK fan, but I would pay a premium for France, Germany or Switzerland. Not having to fill out all of the claims would be nice.


    • It’s worth exactly same price to me as the flatscreen TV “system”, which is to say– nothing–beyond whatever it is I need to pay for services actually rendered.

      • Good comments so far.

        @Richard – You get the game here, right? The fictitious payment is just a way to get you to think about how important health systems are to you. If you’re indifferent, then you’d pay $0. If you care passionately about the Swiss system, say, then you’d pay something to have it. If you think the U.S. system is the best in the world then someone would have to pay you to switch. To say that you only want to pay for “service actually rendered” dodges the exercise. Maybe you’re saying “none of the above.” OK, fine. Then what would you pay to achieve that? How much do you care?

        I’m sure there are different policies in the various countries that affect the price of flat screen TVs and the quantity and quality of the entertainment you can obtain on them. There is a system. Mock it if you wish, but that doesn’t make it go away.

    • I am an American who has used the UK, German, and Japanese health systems extensively. I currently receive above average health insurance through my (unionized) job. I would accept a straight swap for the Japanese system, would pay an additional $100 per month for the NHS, and pay ~$150 per month for the system of care I enjoyed in Germany. That each of these systems is in fact far less expensive than what I actually pay in the United States is a nearly constant source of frustration…

    • I don’t know if the front pagers ever take requests but here is one subject I always have wanted to see addressed:

      Although most people in the UK use the NHS I understand that private insurance is also available. I think supplemental plans are the primary focus but I have also heard there are a much smaller number of people who purchase insurance as their primary form of medical coverage. If this is true, how do costs on those plans compare with the United States? I realize that this is an apples to oranges situation but it still would be interesting to look at cost increases under an entirely different set of pressures.

    • Whether you realize it or not, we play the same game in the USA. It is called Medicaid.

      I dont have enough digits to count the number of times I have cared for folks who moved to NY because of the safety net nature and generosity of the coverage here.

      I am agnostic on the depth and breadth of our benefits, they are what they are (keep in mind we are #1 out of 50 for per capita Mcaid costs), but folks have decided, “what’s it worth to get a home health aide,HIV medications, DME, etc., when they “relocate” to NY.

      Fifty different health systems right here on our shores, and while not apple to apples to your question, close enough and people are playing their cards frequently.

      Seriously though, to answer your question, lets assume you have a strong family history of heart disease, I might analyze which countries dispensed AICD’s, transplants most generously. Polycystic kidney disease, Who dialyzes and transplants (ProPublica piece aside). You get where I am going.

      I assume however, you meant clean slate of health, prepare for unknown intangibles, pick a system. I am more devious and calculating than that.


      • @Brad F – It’s an honest question. One can answer it any way one likes. It was an eye opener to me to think about it in the way I posed. As I wrote, I began with the “would I move or not” form of the question. Health care is not something I’d consider. I really don’t think the system matters to (most) people as much as they pretend it does. To think otherwise would suggest most people have optimized and selected where they live based in part on the health system. Sure, some do (as you say), but the vast majority don’t. No way.

    • You might also ask the question, how much would the median income person in your society pay to switch their country to a different health system. I suspect the typical reader of your blog might have a different answer. Health care for the rich is not so different across wealthy countries.

    • As one of those very well off people, I would still pay extra to have a health care system like that of France, Germany or Switzerland, based upon what I have read. The paperwork hassles and long waits are quite annoying in our system. Imagine not having to worry if you want to see a physician outside of your network.


    • Let me suggest that there are two important axes which should be considered:
      1) Risk aversion: in all countries on the list that I’m familiar with, there’s much less financial risk than in the US. This is even the case for me with a large group plan from a well-to-do employer. I’m terrified that I might have a kid with birth defects or I might develop some sort of chronic condition that will eat away at our family’s savings. In France, for example, you’re covered at 100% when you have chronic diseases (there’s community rating leading to premiums not changing either), and with complementary insurance you’re covered at 100% anyway.
      2) Cost of care / insurance: if we’re talking about paying for a new health system and then you or your employer pay premiums and cost sharing, then we should care about the fact that health care costs are simply lower in all of these countries compared to the US. Of course, you might get less in certain dimensions, such as access to PET scans or certain drugs.