Saturday, December 31, 2011

Healthcare Competition 8: Centralization vs. Deregulation of Healthcare

Last December 5, I posted my paper on Taiwan's National Health Insurance (NHI) system in a facebook group, Pharma Cares. It has attracted a brief exchange of ideas with Dr. Melissa S. Guerrero, the former Director of NCPAM (National Center for Pharmaceutical Access and Management) - DOH. I did not have time to re-read the papers that she posted, but I think readers of this article would benefit from those links that Doc Melissa gave.

I only asked permission from her to post our exchange in CHAT googlegroups, the online discussion group of  Coalition for Health Advocacy and Transparency, which I did. I thought readers of this blog would be happy to check the various papers and studies that she suggested, so I decided to post the exchange in this blog as well.

  • Hi all, may I share with you some facts and opinion about Taiwan's National Health Insurance (NHI), and how these can be considered in the proposed revisions to PhilHealth and "universal healthcare",

    • Mhyanne Panganiban-Dioso ang dami po senate bills proposing ammendments sa PHIC..
      December 14 at 10:04pm · 

    • Nonoy Oplas Meron din bang bills deregulating the health insurance sector? I think all bills are for further centralization of the sector, and that's where many problems come, like in the case of Taiwan.
      December 15 at 6:05am · 

    • Melissa Guerrero There are many success stories too of centralized healthcare with strong government financing and regulations--- Germany, UK, Netherlands, Australia. Meanwhile, deregulating the health insurance sector is like going to the direction of the USA which is the most inefficient, wasteful and inequitable system which Obama now finds difficult to dislodge given the lobbying of the for-profit HMO industry. We don't really wanna go there.
      December 19 at 4:07am · 

    • Nonoy Oplas But I read that UK system is inefficient too, here are the 5 scary stories, In addition, it's bleeding financially, like what's happening in Canada, Taiwan, etc.

      December 19 at 6:51am ·  · 

    • Melissa Guerrero There is no perfect system. In fact from here I can see that there are still inefficiencies they can do without (they're funding bariatric surgery for example). But it is backed up by evidence that the UK NHS is the most efficient and compared to the US has far better health outcomes given that it spends half than the US does. US on the other hand, has the biggest health spending, has the most uninsured, and the worse child health outcomes among developed countries.
      December 19 at 7:52am · 

    • Nonoy Oplas Thanks for that study doc melissa. I think the authors failed to mention that the main reason why healthcare in the US is very expensive is because of their litigious and medical malpractice system. A physician normally pays $250,000 insurance per year, protection against suing by patients between now and up to 18 yrs in the future (in the case of OB Gyne specialists). So physicians will jack up their fees to recover that quarter million investment in insurance alone.
      December 19 at 7:59am · 

    • Melissa Guerrero The point is why would we choose a system which doesn't work? Even US citizens are complaining and jumping to canada borders to get affordable medicines. My American health economist friend complains his system doesn't work. Everyone in the Western world is asking the US: "then why are you letting drug companies make your system go bust?"
      December 19 at 8:03am · 

    • Melissa Guerrero Well there are the litigations but they are also known to have the highest prices of medicines like the Philippines. Too much specialization, no gatekeeping, laiseez faire health market (that doesn't work and is in fact dangerous in health economics, that's why there's a separate science).
      December 19 at 8:05am · 

    • Nonoy Oplas The news report and Pritchard paper mentioned Switzerland as having an inefficient health system. That's the opposite from a news report that I read and discussed here, Swiss people are required to have a health insurance, but they are not required to get from only one supplier, the govt. There is competition, people have choices.

      December 19 at 8:08am ·  · 

    • Melissa Guerrero Why does US health care cost so much?
      December 19 at 8:12am · 

    • Melissa Guerrero ‎"The myth that competition has been key to cost containment in the Netherlands has obscured a crucial reality. Health care systems in Europe, Canada, Japan, and beyond, all of which spend much less than the United States on medical services, rely on regulation of prices, coordinated payment, budgets, and in some cases limits on selected expensive medical technologies, to contain health care spending.5 Systemwide regulation of spending, rather than competition among insurers, is the key to controlling health care costs."
      December 19 at 8:31am · 

    • Nonoy Oplas Thanks for the links, I will chew them and make a discussion paper later. But Japan is constantly mentioned in the papers you gave. My friend who lives in Japan says the healthcare system there is heavily indebted, close to bankruptcy. The Japan govt shoulders 95% of hospitalization bill, so physicians over-charge, they don't prescribe generics, mostly branded innovator drugs. Patients also abuse, even if they need to stay only 2-3 days in hospital, they stay 1 week, they pay only 5% of the total bill, why not over-stay. If you put allowance for abuse, people will exploit it. Japan is now the most indebted country on the planet, the only difference is that the bulk of its debt is domestic, not foreign.
      December 19 at 12:14pm · 

    • Melissa Guerrero That's why when we do universal coverage, we have to be wise on where we spend money and how much.
      December 19 at 2:08pm · 

    • Melissa Guerrero I also don't believe in a free-for-all healthcare system. No country can afford that. The Singapore 3M model is worth looking at in how they finance health care. Government comes in during catastrophic spending but citizens are required to have savings for usual hospitalization (Medisave). There should be personal responsibility as well to minimize abuse. I think that is what is missing in the UK and other health systems where government shoulders everything. But no doubt, there should be a social safety net that's either funded through tax or single-payer health insurance.
      December 19 at 3:11pm · 

    • Nonoy Oplas Yes, I also believe that PhilSick need not be abolished, it can be retained as last resort or add-on health insurance, people should assume more personal responsibility in healthcare, including personal finance via health insurance -- a private HMO, a cooperative or community healthcare, an LGU-sponsored healthcare. So people will have 2 insurance, one that is mainly private or NGO, another for PhilSick. The latter will be used only when one is really sick that he/she has to be hospitalized. For outpatient, dental, annual medical check up, Philsick cannot be used, one has to utilize the private/NGO/LGU healthcare services.
      December 21 at 8:53pm · 

    • Nonoy Oplas Btway, permission to use this exchange doc melissa, i want to post ths in our CHAT googlegroups? thanks.

I hope to read and make my own discussion by next year, on the papers that Doc Melissa gave.

Happy New Year friends.

See also: