Since evaluation of health care in the United States is a difficult task, evaluating health care in other countries is even more difficult, if not impossible. When representatives travel from country to country to study medical care and facilities, the host country will naturally present the best it has to offer.
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One xample might be that no controlled nutritional system exists in the United States. The individual has the final decision in a democracy about what he chooses to eat or feed his children. While health authorities are advocating nutritional diets, many schools are still supplying their students with food machines that deliver “junk food” and giving high fat and carbohydrate lunches.
By contrast, in Norway the government plans to guide its peoples` nutritional choices through standing policies, public education, and research. It will, for example, favor the purchase of skim milk over whole milk and of fish and poultry over meat. It will discourage the use of feed concentrate in cattle and dairy operations.
In the United States the individual has the final decision about how many children he or she wants to have, although financial pressure has caused birth rates to drop. In China family planning has been carefully guided through education, group discussions (persuasion), and group approval. Appropriate behavior change is praised until the new attitude and way of life become habit.
The escalating cost factor for medical care in the United states probably centers around lack of fee controls. Independent practitioners are still free to set prices for their services, although insurance companies usually will not reimburse above a certain amount for a specific treatment or surgery.
The extreme alternate to the individual fee-for-service approach is complete government control in which the practitioner receives either a set salary or a set amount for each person he treats, or a combination of both.
Great Britain presents an example of a National Health Service in a non-Communist country. The system initially enrolled over 90 percent of the population and covered all health costs. Now people are paying for some dental work, eyeglasses, and prescriptions. The doctors reportedly do not like the system because they feel dictated to and dependent on the state. Since they are paid a basic salary plus so much for each person they see, a better salary can only be made through pushing people through the office visit faster. Doctors have formed together in threatened strikes and work slowdowns to protest the system.
Patients seem generally satisfied with the British system even though waiting lines are long, both to see the doctor for an affice visit and to have elective surgery. For those who are dissatisfied, private physicians and hospital beds are still available, although in a small percentage. Fees are still controlled, however.
Other differences in health orientation among countries exist. For example, one study comparing hospitalized Americans with hospitalized Scots found that Americans received almost twice as many drugs as their Scottish counterparts who had the same symptoms. Another study showed that Swedish hospitals do less extensive X-rays and laboratory testing per patient than do United States hospitals.
Why these differences exist is difficult to say, but perhaps some of the reasons are that : (1) the United States is a drug-oriented society; (2) doctors in the United States are using “tools” (drugs or X-rays) more than clinical insight and counseling; (3) the threat of lawsuit in the United States causes doctors to do more diagnostic work; (4) patients in the United States may be more demanding than their counterparts in othercountries.
People in the United States value their independence and ability to choose-whether it be a specific doctor, a certain food, or an over-the-counter drug. Americans prefer to make some wrong choices over having all choices made for them. Because of this basic philosophy, a national health insurance will have to be tailored to democratic ideals, which will be no easy task.
References :
Ringer, Kurt,”The Norwegian Food and Nutritional Policy,” American Journal of Public Health, 1977.
Winikoff, Baverly,” Nutrition and Food Policy : The Approaches of Norway and the United States,” American Journal of Public Health, 1977.
Wan, Virginia,” Application of Social Science Theories to Family Planning Health Education in the People`s Republic of China,” American Journal of Public Health, 1976.
“Britain`s Health Scheme,” Newsweek, July 19, 1948.
“Angry Doctors,” Newsweek, January 14, 1957.
Lawson, D., and J. Hershel,” Drug Prescribing in Hospitals: An International Comparison,” American Journal of Public Health, 1976.
Neuhauser, Duncan, and Egen, Jansson,” Doctors and Hospitals in Sweden,” Scandinavian Review, September, 1975.
Murray, RB and Zentner JP., Nursing Concepts for Health Promotion, Second Edtion, Prentice-Hall, Inc, Englewood Cliffs, N.J, 1979.
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