Planet Health Care

BOSTON — Health care reform was the main event in Washington, D.C., again this week.

With good reason: the fate of America’s troubled system will no doubt affect the $14 trillion U.S. economy for good or ill, depending on how the drama plays out.

Moreover what happens in the U.S., which produces more than 20 percent of global economic output, matters greatly to the economies of the rest of the world.

So, yes, play close attention to the health care debate and all the politics behind it.

But while members of Congress are spitting on each other about creeping socialism, death panels to kill Grandma and the pros and cons of a public option, GlobalPost correspondents have been quietly searching for ground truth, health care-style.

Their mission: To find out what’s really happening in the hospitals, clinics and waiting rooms around the world. What works? What doesn’t? And which of these global lessons should America adopt, consider or avoid?

Over the past two months our correspondents have amassed a wide variety of insights and observations — from a sick China, to a healthy Confucian influence in Taiwan, to a booming India, a healthy Australia, a faltering South Africa, as well as the various schemes in Germany, France and the United Kingdom.

Here’s a quick tour of Planet Health Care, or more simply: 10 things you need to know about what’s happening around the world right now.

1) China is attempting to reform its giant health care system — with mixed results.

China’s system was once a model of low-cost and efficient delivery that served millions of patients. But as its socialist economy broke down in the 1980s, so did its health care system. Since 1980, the percentage of personal income Chinese spend on health care has doubled. In 2006, a survey showed that nearly half of Chinese people refused to see a doctor when they fell ill. Meanwhile, some 200 million are uninsured.

So earlier this year Beijing set out to fix it. Health care reform is being rolled out in stages through 2011, beginning with a basic opt-in insurance program for hundreds of millions of rural residents.

To document these sweeping changes, correspondent Kathleen E. McLaughlin and photographer Sharron Lovell traveled from the remote mountains of Guizhou to the top hospitals in Beijing. Here’s their three-part report, The China Syndrome.

2) Health care in rural China is bad, and in some areas, non-existent.

As Kathleen and Sharron report, many villagers in remote Guizhou province — one of China’s poorest — suffer a predicament that is all-too-common among China’s estimated 800 million rural residents. Faced with a health care system so fragmented and underfunded, the sick often go bankrupt trying to get better.

While things are still grim, there have been early successes. Basic insurance unveiled this year has encouraged more Chinese to visit doctors. “Before the patients would only come in when they were seriously ill,” one doctor said. “Now they come for treatment when they first get sick.”

3) Need an appendectomy in China? That’ll be $34, please.

Sound like a bargain? Not so fast.

In an attempt to guarantee health care access to all citizens, 20 years ago China’s government set maximum hospital rates. It hasn’t allowed prices to be raised since, despite the country’s dramatic economic growth, higher personal income and rising inflation.

So that $34 doesn’t cover much. Instead, costs are made up in other ways, such as rampant over-prescribing of often unneeded medication — causing problems in personal and public health — as well as unnecessary testing and other treatments where doctors and hospitals can charge more.

4) Taiwan, meanwhile, has one of the best health care systems in the world.

But it wasn’t always that way.

In 1995, 40 percent of Taiwanese had no health insurance. Today, nearly every one of the country’s 23 million residents is covered. Taiwan spends 6.5 percent of its gross domestic product on health care (versus almost 16 percent in the U.S.), and more than 80 percent of the population is happy with the system.

In this comprehensive special report, Taipei correspondent Jonathan Adams examines why Taiwan’s system is so effective, and how its unique political situation allowed reform to happen.

He also discovered an interesting link with Confucianism. 

"Throughout Chinese history, Confucianism says the government has to take care of the people, no matter what," said Michael Chen, of Taiwan’s Bureau of National Health Insurance. "So we are obligated to make sure 100 percent of the population is covered."

5) Australia offers coverage for all citizens. But 40 percent still opt to buy private insurance.

According to Sydney correspondent Alan Mascarenhas, the great strength of Australia’s system is affordability and access. It offers cradle-to-grave health care for everyone and covers most or all of the costs for physician consultations, as well as specialists’ fees and X-rays and pathology tests. Treatment in public hospitals is free.

Though as Mascarenhas points out, it’s far from perfect. About 40 percent of Australians choose to purchase private insurance, making them eligible for treatment in more exclusive, privately-run hospitals.

6) Slumdog doctors in India? Hardly.

With the health care debate raging in the U.S., many Americans aren’t waiting to see how it ends: they’re flying to India to get treatment.

As correspondent Saritha Rai reports, the number of Americans seeking cardiac bypass surgeries, organ transplants, complex spinal surgeries and other medical procedures is surging. A top hospital in Bangalore says it’s treated almost 600 so far this year, triple last year’s figure. Another says its volume of U.S. patients has doubled.

India appeals to many Americans thanks to the prevalence of English, while its high-tech hospitals, well-trained doctors and sophisticated treatments are an easy sell.

7) South Africa is making a big health care push, too.

South Africa’s health care record isn’t so great — child mortality rates are rising, while incompetence and denial on the part of former president Thabo Mbeki’s administration allowed the AIDS epidemic to reach gigantic proportions.

The two factors are connected: South Africa has the highest number of HIV-positive women in the world, making transmission of the disease to children a serious problem.

But as correspondent Nicolas Brulliard reports, the new government is acknowledging South Africa’s health challenges and, more importantly, beginning to tackle them.

8) Germany’s  system is rarely cited as a model for the U.S. Maybe it should be.

That’s the conclusion of correspondent Paul Hockenos in Berlin, who writes about his own experiences with Germany’s mix of public and private plans. Here’s how Paul puts it: "As an American living in Germany and working as a freelance writer, I have health insurance through a multi-payer, non-profit insurance company. I can walk into any doctor’s office in all of Germany, show my provider’s plastic card, and receive treatment without ever seeing a bill. I can go to another doctor the next day and do the same — and the day after that. I pay a $15 cash fee on the first visit of every quarter, and a modest percentage of the cost of most prescriptions."

9) The U.N. says France has the world’s best health care. The U.S. is 37th (just above Cuba).

The French also live two years longer than Americans, with half the infant mortality rate. According to correspondent Mort Rosemblum (who’s had an EKG in Beijing and fought off a Balkans pneumonia in a Paris hospital), health care in most of the world isn’t a market. It’s a basic human right.

10) The British love their National Health Service (and they’ve got the Twitter feed to prove it).

When Britain’s NHS briefly became a punching bag in the U.S. reform debate, we asked London correspondent Michael Goldfarb to find out what the locals really thought of their system. It turns out they like it. A lot. Even Conservative Party leader David Cameron is a fan, while the Twitter feed of the "We love the NHS" campaign crashed last month due to heavy traffic.