What is it about?

This paper assesses the performance of 3 industrialized nations that have pursued market-based financing models, focusing on equity in access to care, care quality, health status, and efficiency. We conclude that the most inefficient system is where the insurance market has achieved its maximal development and that care industrialization contributes to the comparatively poor performance of the U.S., Dutch, and Swiss health systems.

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Why is it important?

1. Europe spends 6%–7% less of its GDP on health than the USA. If social security were privatized across Europe, more than a trillion U.S. dollars could shift to commercial health insurance companies and hospitals. Economic actors outside the health sector have no interest in supporting such move. 2. “If,” wrote Nolte and McKee, “the U.S. could reduce amenable mortality to the average rate achieved in the 3 top-performing countries, there would have been 101,000 fewer deaths per year by the end of the study period” – and 75,000 if it were reduced to the OECD average. Conversely, if Europe aligned itself with U.S. performances, it could lose up to 107,000 or 125,000 lives annually from mortality amenable to care, using the OECD average or those of the 3 top performing countries, respectively. Patients' and doctors' organizations should better be aware of this.


European physicians’ and patients’ organizations could effectively join forces to lobby political parties and employers’ organizations in favour of policies facilitating access to professional care. There are scientific reasons to believe that to do so, they should resist attempts to privatize the lucrative part of social security in health across the continent.

Prof. Jean-Pierre Unger
Institute of Tropical Medicine, Antwerp, Belgium

Read the Original

This page is a summary of: Commercial Health Care Financing: The Cause of U.S., Dutch, and Swiss Health Systems Inefficiency?, International Journal of Health Services, May 2019, SAGE Publications,
DOI: 10.1177/0020731419847113.
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