In the insurance industry, we have so much pain for medical expense in the US. Most travel insurance plan worldwide, coverage in the USA are excluded unless paying more insurance premium. I have experienced some cases in the US, where I think horrible. An example of a hemorrhagic stroke in California cost 400,000 USD which our company could pay the only ¼ of the cost, left the rest for the patient, compared to a case in the UK with the same condition and treatment, cost only 9,000 USD. The case in the UK, the patient, even was prescribed a one-week stay for an occupational therapy course which already charged in the packages while in the US did not. Recently we have a case of a car accident on a highway in San Francisco, our customer who was in the accident was repatriated with an air ambulance following by a ground ambulance to a hospital a less than 10 miles away. Only the air ambulance cost 55,000 USD. Even only with mild external injuries, the total expense cost almost 20,000 USD. Unlike the US, New Zealand has a no-fault scheme which the government covers all car accident regardless of coverage from private insurance.
In the US, due to the unreasonable cost and complex billing, we hire a cost containment company to negotiate with hospitals and its provider. The company could make the billing amount dropped to 90%. In many cases, out-of-pocket payment upon counter can give patient up to 50% discount too. The US, compared to other OECD countries, has the highest healthcare spending and more than a half are from the private sector while the rest mostly less than 10%. I think, apart from financial risk management hospital has to do as a result of the previous unpaid bill which often made the patient a bankruptcy, there has much to do with medical malpractice lawsuit in the states. At the emergency department, guidelines and protocols require numbers of lab test, imaging procedure and specialist; even the condition is just a common, to make sure “thoroughly checked” of any abnormal. Another case from our customer, for example, was a 6,000 USD for a common cold at the emergency department in New York. For me, besides implementing the affordable, what the US has to do to reduce the spending is lowering of administrative cost which made up to around 30% of the expenditure.
I think what made the US’s system unique and expensive, while the overall outcome is not going with the spending is the politico-economic system of the nations, the free market. There is no cost control mechanism for the healthcare industry the same as other. The patient can’t check and compare the cost of an elective procedure. The price will be told only when the treatment is done and are already liable to pay. Pharmaceutical and medical technology company can sell drugs and medical equipment with any price they want. Badly enough, competing of prices seemed does not work due to increasing of merging and acquisition of hospitals network, the pharmaceutical company, medical equipment and supplies and health insurance. For sure, physician fee in the states is high, and often numbers of specialist assigned for ED and admission. The higher physician fee and salary are relatively due to medical education cost in the states. The education loan is another trouble and cause of healthcare spending. Like Khun Tullaya said above, the most expensive system does not mean best-improved health outcome and system. There are so many factors involved.
For me, there are options of systems worldwide; concepts of UHC is not only a public-funded single-payer like the UK. It can be a private payer like in the Netherlands where citizens are mandated to buy private insurance at a low price, regulated by the government. In Thailand, lucky enough that UHC has been implemented. I, myself as a worker in private sector can have peace of mind that if I got a condition what my employer’s private insurance does not cover, I could seek coverage from my social security scheme which is a system of the UHC. The most concerns for me is, besides financing of the system especially UCS, shortages of healthcare worker are a big issue. The government should do more work to produce more healthcare professions especially general practitioner and nurse. Comparing to our region, physician per patient is still in critical with only less than 1/1,000. Most importantly, private’s hospital attracting of the healthcare worker. The government should think more about inequality and disparity in healthcare in our country. An example is in Canada, where healthcare is not allowed by law to be a product of luxury and privileges. Almost of general practices in the country are regulated to work for public hospitals. For Thailand, the workload in the network hospital is another factor that makes well-trained healthcare worker leaves the system or even leaves the healthcare sector, and country while importing of healthcare workers is not a good option.