Comparing Health Care Systems as an Expat

Waszyngtona Ave and Devil's Bridge, Krakow, Poland for health care

Waszyngtona Avenue and Devil’s Bridge, Krakow, Poland

Would You Like a Samashko with that Beveridge?

In this article we are going to give a rundown of different public health care systems from around the globe. As an expat your mission (especially if you have a family or loved ones involved) is

  1. to organize access to the best possible health care in any given place and
  2. actively try avoid having to use it for anything more than routine procedures!

Generally speaking for expats we recommend organizing private care as a “default setting” and flirting with the public system as you get more established on the ground. That being said, how the public system is organized in any given country has a huge affect on how the private system is organized, so this article will give you a framework to think about the situation. Stay tuned for more posts with practical guides and checklists.

Remember that as an expat your host country’s public health system is not exactly designed for you – it is designed for locals who finance it from taxes in some shape, form, or fashion. To some extent being an expat makes you an outside observer and you don’t have to play along with the pyramid scheme bureaucratic aspects of many national programs. In our opinion this is right where you want to be!

Some background

For readers interested in some of the academic debates about national health systems, here are some of the best web links:

Here’s a summary of the different systems:

Note: it is difficult to lump any particular country’s system into one category. Everyone (politicians, patients, doctors, insurers, etc) have all been putting their own national spin on each particular system, however here are the basic types:

  • National – one centralized, (usually government) health insurance company
    Example: Canada
  • Bismarck – decentralized but heavily regulated insurance companies compete for clients, who are required to pick one
    Example: Germany – yes, it is named after Germany’s own Otto von Bismarck
  • Beveridge – health care is provided as a public service, like a library
    Example: the UK (it is named after the British politician)
  • Samashko – this is what I would call “Beveridge on steroids;” a communist style, centrally managed system. This is not quite so relevant today but I’m including it as something to watch out for, plus it has the best name of any system!

    Example: Poland although the system is being rapidly modernized

  • Hodgepodge – mixed up, with different elements for different segments of the population
    Example: the USA, think Medicare, Medicaid, Obamacare, etc

Conclusions

Each system has its pros and cons and there are some real political shakedowns taking taking place out there to fund some national systems. But for an expat the main factors are:

  1. quality of care available at the end of the day
  2. if it is possible to save money somehow by using the public system as opposed to private

In this light the conclusion is that the rather more free market oriented Bismarck style systems have better overall quality of care which you can access even if you wind up having to pay extra for it. However if you want to access the Bismarck style system at the same price as local nationals you will probably have to be employed locally and jump through all the hoops of being a “normal” resident. In a Beveridge system, on the other hand, you may be able just to show up and use the services (one way to think about it is that it’s like the library, you just need a library card).

What to watch out for

One thing to be wary of is a heavily regulated (or historically regulated) Samashko style systems where it may not be practical (or even allowed) for doctors/hospitals/clinics to treat some conditions. This essentially creates a state monopoly for care for more serious conditions. As an example, in Poland if you have the flu or need an X-ray there are plenty of private clinics where you can be treated, but for more serious conditions you will end up in a public hospital simply because that is the best available. This is changing fast and is moving in the right direction but needs to be kept in mind.

More posts to follow on practical aspects of healthcare in a foreign country.

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