| Title | : | Which Country Has the World's Best Health Care? |
| Author | : | |
| Rating | : | |
| ISBN | : | 1541797728 |
| ISBN-10 | : | 9781541797727 |
| Language | : | English |
| Format Type | : | Kindle Edition |
| Number of Pages | : | 611 |
| Publication | : | First published June 16, 2020 |
Which Country Has the World's Best Health Care? Reviews
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A readable, in-depth examination of strengths and challenges of 11 different countries' health care funding and care delivery systems. The author wastes no time in walking back the buzzfeed nature of the title and, instead of coming up with a simple ranking, looks at where each system is doing well and poorly across the issues of controlling health care costs in general, the increasing costs of prescription drugs, inefficiencies in providing care, increasing coverage for the entire population, coordination of care for chronic illnesses, increasing mismatch between healthcare systems and the population needs (often in terms of too many or too few hospital beds), increasing mental health care needs, increasing long term care needs, and ability to innovate and try new solutions for providing, covering, and paying for health care.
After introducing the issues, the book goes deep on a historical and structural analysis of the health care systems of the USA, Canada, UK, Norway, France, Germany, the Netherlands, Switzerland, Australia, Taiwan, and China. He covers these in extensive (excessive) detail. To be honest, this part of the book really dragged for me, and it's the majority of the book. But policy wonks will be really interested. I did really like learning at a high level about each system. In the US, we often get a very stereotyped view of the systems in Canada and Europe when there are profound differences (such as the existence and amount of private insurance companies) between each country. And notably, every system has strengths and issues; there is no such thing as the universally perfect system. The historical circumstances that led to the creation of each system also make it really hard to say the features of one system should be lifted wholesale to another system.
In the final analysis, the US system compares pretty dismally compared to all of its peers except China. The one exception, is in the area of health coverage, health care, and health care funding innovation. The US is up the with the Netherlands and the UK in terms of willingness to experiment and pilot new solutions in each of these areas.
One the whole an interesting look at different health care systems that avoids a superficial ranking but didn't quite avoid overwhelming this reader with details. -
Healthcare industry nerd's delight. I like the holistic perspective this book is bringing to a messy, complicated topic.
But the drawback is that it's quite boring and dry. Just plain facts, figures, history, statistics. Mind-numbing after a while to hear. I've been forced to skip ahead multiple times now.
Overall, it seems to be a good reference to have on the desk. But not an engaging, interesting read. -
This is very interesting--at least if, like me, you're a healthcare dork. If you're not, this might be a bit dry--you probably don't really care about how the Swiss use a point system quite like the US' RVU, do you?
Rather than answering the question up front, Dr. Emanuel profiles 11 health systems, including the USA, to see how each country works and what it does well--and doesn't. Each chapter follows a similar structure, describing the system, its payment model, how care is delivered, how drugs are financed, and the challenges facing the system. Not-really-a-spoiler alert: No country is "best": each has strengths and weaknesses. For example, Canada's system is simple and accessible for hospital and medical care, but scores poorly because standard healthcare does not cover pharma and the provincial plans do not cover most outpatient non-MD providers, a particular issue for mental health. Switzerland provides an enviable level of choice, but at a high cost--a family of 4 in Geneva may pay CHF 1800 a month for insurance, with limited income based subsidies, and then has to pay cost sharing on top.
It turns out that the US does do a few things well--we're good at innovation in care delivery and payment methods. (We invented and exported the DRG system for payments. You're welcome.) What we are not good at is ensuring affordability and access, and despite people in the US thinking our system gives freedom of choice, in practice we score poorly due to our use of insurance networks. Also, sadly, mental health is an issue in many countries, not just the US.
There were some weaknesses in the book. For example, in the UK chapter, the vast majority of the discussion was on finance and structure, with very little devoted to care delivery. THis is a particular omission for the NHS as so much care is delivered via GP surgeries, and all that's mentioned is the existence of multiple providers in surgeries. If I hadn't lived in the UK for several years, I would never have known that specialist care in the UK is delivered in hospitals. There's also an embarrassing error in describing the National Insurance rates in which he says that higher-rate taxpayers pay 2% NI on *all* income, rather than on income above the NI threshold. While dental care was mentioned briefly in some chapters, it was not in all of them. I also would have liked to have seen some mention of obstetric care, which varies widely between countries. Dr. Emanuel likes to focus on "quality" care but doesn't always give definitions or metrics for determining quality, which would have made the point more effective. And as he himself admits, comparisons can sometimes be dicey because of differences in measures. Long term care can also be split between medical and social care systems, making it difficult to measure.
Nonetheless I think it's a worthy entry that should be more widely read. There's an unfortunate tendency in the USA to equate universal healthcare with single payer, which is not true, and there are many pieces under the hood that need to be coordinated. The countries in the book use a variety of systems (Emanuel places them in 5 categories--all of which exist in the US also!) None of them manage to provide care at no out of pocket cost in all categories, as Bernie Sanders proposed, though other than Switzerland, cost sharing for covered categories tends to be small. Only the Netherlands and Germany have dedicated funding for long term care. He concludes with some suggestions for improving the US system. -
The author doesn't so much ask which country in the world has the best health care as which country should the United States try to emulate in order to become the country with the world’s best health care within the next ten to twenty years (author thinks this is doable). So in his final determination he mostly focuses on which countries the US system is closer to in style so that all the infrastructure doesn’t have to be thrown away. That said, his outlook is very, very American despite his suggestion that people from other countries might find the data in his book interesting. I mean, I did find some of it interesting but I got frustrated with the delivery and had to do some independent research to clarify what he was trying to say.
The good:
The goal of describing and comparing several different health care systems across the world was an interesting one, and I definitely learned something about what different kinds of systems are out there.
The bad:
I found more clearly written summaries of the health care systems he discussed online. He tried to compare the countries across specific metrics but I found that the individual chapters didn’t always mention the same things. The broad topics were the same, but sometimes he would make a comment about, say, ambulances in one chapter that wasn’t discussed throughout.
It felt like the different chapters were written, finalized, and then some were shuffled about since he started commenting and comparing to the German health care system in chapters before the actual German chapter, for example. There was no need to do this since he had a chapter at the end that actually compared all of the countries.
I started to question his expertise once he started sounding surprised that market forces weren’t making people spend their precious time researching and selecting the absolute best and most efficient health insurance package for them. One, that can be a lot of work and two, health care is notoriously one of the areas where people don’t shop around so market forces don’t work very well. Like I said above, his outlook was very American.
I think his discussion on the different systems was mostly accurate but he definitely oversimplified and ended up contradicting himself, at best. He talked a lot about public versus private aspects but was very sloppy about specifying whether the private aspects were for profit or not.
I still don’t really understand the American health care system.
So yeah, I don’t really recommend this book, although The Commonwealth Fund has a great section on its web site on international health care system profiles if you’re interested in learning more about the topic. -
Comprehensive but boring. Good to have on your shelf if you forget how Norwegians pay for drugs. Bad to listen to as an audiobook (unless used as a sleep aid).
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Zeke is the least well-known of the high-achieving Emanuel brothers. I have done business with Ari who runs the William Morris Endeavor Agency and have admired Rahm's work as Obama's Chief of Staff and mayor of Chicago, but this is my first encounter with Zeke. They say that he is the smartest of the three. That's quite an accomplishment since his brothers are no dopes, but after reading this book, I believe it could be true. This is an intense well-researched book that explores the history and structure of health care systems in a number of countries. The bottom line is that they are all complex and they all have their strengths and weaknesses. The US is nowhere near the top, but our health care system isn't as completely horrible as it is often made out to be, and since innovation is one of its strong suits, we may be able to fix many of the problems and get back on par with other countries with systems that are fairer, simpler, cheaper and closer to providing universal coverage. If I had a choice, I'd pick Norway or Taiwan or maybe the Netherlands as having the system that I would most like to emulate, but it isn't as simple as that. Each country has its own unique political, social and cultural tendencies that present challenges and opportunities, so you can't just clone another country's system that works well for them, and it is almost impossible to make radical changes in any system overnight.
The avalanche of facts and figures in this book is mind-numbing. It's better as a reference manual for a policy wonk than as casual read, but I have a lot of respect for the reseach and analysis that went into the book so I came out of it feeling that Dr. Emanuel's reasoning and conclusions were sound. I'd be happy to see him put into a position in government where he could really make a differnce in addressing some of the glaring problems that the US health care system faces. -
(3.5/5) Straight facts. No cap.
Pretty boring read considering it’s read more like an academic rather than a story. But it’s about healthcare, so what do you expect? Still learned a lot though, especially about other countries’ healthcare systems. -
Which Country Has the World’s Best Health Care? (2020) by Ezekiel J. Emanuel is a serious comparison of a number of health care systems around the world. Emanuel is an oncologist and bioethicist.
The book has chapters on the health systems of the US, Canada, the UK, Norway, France, Germany, the Netherlands, Switzerland, Australia, Taiwan and China.
Each chapter describes how many people the system covers, what it covers, how it’s paid for, how drugs are paid for, how hospitals and physicians are paid for, how mental health care is handled, how many doctors and nurses there are per person, how long term care is paid for, if there is choice in the system and how much the system costs.
It’s really dry but it’s really good. It’s not an easy read unless your idea of a good read is a Vaclav Smil book. But, like a Smil book it is very much worth a read.
The book shows how path dependent health care is in each country. It’s surprising, for instance, to find that the Nazis overhauled the medical system in the Netherlands and that quite a lot of those changes remained. Emanuel also makes the point that universal health cover in most countries is actually fairly recent.
The book concludes with a chapter on how Emanuel evaluates the systems overall and which ones he thinks are the best.
Which Country Has the World’s Best Health Care is a really good book, but not a light and breezy read. It’s definitely a book well worth a read for anyone who is interested in health care. -
OK, so diving into the funk and minutiae of health care systems is not normally my jam. I do not even know if I understand my health care situation; probably don't in all probability. However, the type of not easy and probably unanswerable type of question that the title poses interested me enough to pick it up.
After finishing this book, my non-expert opinion is that Emanuel does a good job of showing a layperson the pros and cons of and challenges facing some 11 developed countries. It is a lot more informative than stating it is not a simple question with a easy answer or it's path dependent or something that skirts the why of why people--especially those dissatisfied within the U.S. health care system--want to know this answer.
I tried to treat this read like a marathon taking my time rather than marathoning it. Trying to absorb all of the detail at least for a few weeks. Then I checked my due date; vaguely panicked and gestured. Then I actually marathoned the remaining 2/3 in 2 days. So, my memory might be even more shaky than usual.
Pros
-Although probably very broad strokes of explaining each system given the number of systems explained in one book, I overall feel a smidge more informed about what these other 10 countries have going for them. For example, I now know that universal coverage often does not always mean single-payer government. Knowledge is power and all that.
-Relates to my first pro, but I specifically wanted to point out how I now I know the areas that a good health care system needs to excel. I knew from being in a health system that wait times, affordable, and pharmacy costs are issues that should be actively controlled or addressed. However, the spelling out of the importance of simplicity of use and delivery of care makes sense, but I am not sure I would have caught on to its importance in itself to a good system.
-Pages 350-end are so nice and straightforward after all of the history and explanation of the different systems by themselves. Informational tables without charts that overwhelm you.
-Also, the last few pages with Emanuel's six recommendations on how to change the U.S. System based on what was learned by examining the other 10 systems. Change is hard to hope for when it requires some heavily opinionated powerful people to agree with something that could help millions of people they do not necessarily have to answer to literally.
-Not really a pro, but I wanted to point out how easy I am affected by subject matter that interest me when I whooped out loud when Taiwan was the outlier that covers dental. Like I am so glad no one has to buy supplemental insurance for dental. Although some things not being covered did not make sense to me, but I forgot already because it fascinated me that Traditional Chinese Medicine is mainstream enough in that culture.
-Learning that the struggle to transition to electronic health records-Emanuel is pro EHRs b/c data and care coordination is his thing-is still somehow ongoing for a lot of countries. Come on, Switzerland. Only your bank accounts need this much secrecy.
-Nurse practioners and nurses deserve all the flowers and respect. Really all medical staff though I feel like specialists already get proper amount of societal respect.
Cons
-SO MANY ACRONYMS! Acronyms, chart figures, and detailed insurance allowances and methods of financing was good NyQuil reading. It made it difficult to enjoy the read until I decided to marathon it. I know it comes with the territory of the subject matter, but it still would be a deterrent for me recommending this book to others.
-Relates to first point, but it is so dense of a read most of the time as someone who does not eat health care system information for breakfast. The amount of times my head would start nodding off in broad daylight due to the exact acronym commission having dominion over primary care while another acronym entity oversees outpatient care and payments might not overlap nor physician choice and then my head just turns off from the bureaucracy or the tediousness. I know it is important to know in order to know the system, but it was a personal struggle that demands extra attention.
-Why are there at least 3 different countries that use the term Medicare for a health care system? Someone should just play rock, paper, scissors in order to call dibs. It's a good term, but not that good. I personally like NHS if I have to pick a system name.
Took me too long to wade through the information overload, but glad I got to the last comparison pages that gave me what I craved. I will not be an expert about all these different health care systems, but I have a bit of a better primer about those systems and how systems that are good in different ways are good because of these measures they put in place. Maybe someday some people in the U.S. can push for changes that are similar to measures in the other examined countries and proven effective.
tl;dr: Yeah, there is no answer to the question; the question is the excuse for explaining 11 different health care systems. Also, if one is within the U.S. health care system, realizing the specific areas the country sucks at compared to other countries of comparable economic statuses is a bit funny in a "oh, oh we don't do something many other countries have done successfully because?" type of funny.
Oh, and if I was a random bored rich medically conscious person, I would visit Norway except for long term care then I would try Germany. Taiwan sounds interesting even if funding and overworked hospital staff seems troubling. -
An excellent comparative study of selected advanced countries/ economies in providing their residences with ‘universal medical care’. Netherlands, Germany and Norway, while needing some improvement, are close to be stellar examples of universal coverage.
China and US need major work to achieve universality and systemic efficiencies.
If you have an interest in this type of book, you will find it easy to read. Very well researched. Thoughtful. Insightful. It will depress you a little bit if you are a US reader....... -
This book was a somewhat tough read, pages, and pages of pretty dry information and analysis but despite that I think it should be required reading for anyone who wants to have a serious opinion on the healthcare debate.
The book examines the healthcare systems in 11 countries (US, Canada, UK, France, Germany, Netherlands, Switzerland, Norway, Taiwan, China, Australia) and compares performance across some 22 dimensions like coverage, drug price costs, waiting times, comprehensiveness, simplicity, etc. It goes country by country, but the conclusion looks at the dimensions across the countries and sums up with some lessons the US could learn from the analysis.
I learned so much from this book just about how healthcare systems can be structured, all the different things that impact the various dimensions. Single payer is not the same as universal, insurance can be public or private independently from public or private “delivery systems”. Under what conditions should a doctor be paid a salary vs per procedures. To what extend should general practitioners serve as a gate keeper to specialists. How electronic are one’s health records, how accessible are they to different care providers? How do we finance long-term care, how do we deal with mental health issues? Are drug prices based on rates in other countries, or on a cost-benefit analysis or do we just let them charge whatever they want (and different prices for different markets)?
I also didn’t come away with a ton of strong opinions because it’s done so differently in so many countries and no one has it all figured out, especially long-term care which almost no one is willing to confront. -
This is a 5 star book if the following apply to you:
1) very very interested in healthcare policy
2) already have a very good understand of healthcare policy, mostly from a US centric focus.
3) have a very high tolerance for poor/rote/boring writing
If the above does not fit, then I'd say read the disclaimer, introduction, last 2 chapters, and coda. Or put another way, everything except the country analysis. That said, there's probably still some stuff in these sections that might not be super clear/intuitive for someone who isn't well versed with healthcare policy already. Emanuel does not do a great job of explaining the basics of healthcare/policy, but it's really hard to blame him for this, because that sort of good introduction would likely require another book in itself.
I really need to emphasize how boring and bad the writing is again. The sentence structure repeats itself very frequently. At times when stating statistics his writing is so muddled it becomes hard to decipher the detail. Part of me doesn't blame him, because this is a policy wonk comparative analysis book. By nature it's repetitive, but I still don't think that's a good excuse for how painfully boring and slow this was to read at times.
I think this book would have been IMMENSLEY improved if each detailed section (coverage/financing/payment/delivery of care/pharmacy regulation/human resources) began with a bullet point list or data chart summary. This way you'd have guiding points to refer to while reading his poorly composed sentences. The writing could be reserved for extra detail or nuance that isn't captured by the highlighted statistics. Or at the least have an index in the back that summarizes all the quantitative measures. Hell I'd take an excel spreadsheet I can download and look at while reading. I guarantee Emanuel made something like this for this book, so it'd be great if he could share it with us. Furthering this point, he did include a number of charts throughout the book, including great ones for Pharmacy Pricing regulations, by country financing summaries, and several in the last chapter summarizing his analysis. These were great and I would have loved to see more. It would have only aided the writing.
Now that I've got the majority of my complaints out of the way, I think both the methodology of his analysis and conclusions are spot on and terrific. His method for analysis and the sections of healthcare he focused on are almost identical to what I'd choose. He also correctly identified the challenges between comparing across countries, and was very honest about the shortcomings in his work. For the most part, he used smart/correct metrics to evaluate each section of healthcare. I did have some minor complaints, I wish he was more clear about dollar totals and rates. It seemed like everything was annualized, but I think using PMPM when discussing individual cost rates would have been better and more easily comparable across countries. Additionally, his lack of understanding of premium pricing, and more specifically family + rate basis pricing hurt his criticism there a bit, but it's hard to fault him considering that calculation is yet another US convoluted pricing mechanism that is unnecessarily difficult.
Anyway, ending with positives. The six lessons section is great, I more or less agree with all of it. If all six of these occurred, I think you would have one of the best health systems in the world. Although, I'd probably throw in a few more changes (mostly centered around employee sponsored insurance). I've got some other loose thoughts, but there's zero chance anyone has read this far in the review anyway so I'll end here. -
A very good overview of some of the major health systems among the developed nations of the world including Canada, Norway, UK, Germany, France, Australia, Taiwan, China, the Netherlands, and, of course, the US. Not surprisingly, the US ranks worst in this group, except for China. That is not to say that the US doesn't have some things it does well. The US system is the most innovative in a variety of ways, and we do a bit better than many at coordinating care for chronically ill patients, but by most measures we are near the bottom. The US system is the most expensive (and still is outperformed by the others in many measures), leaves a large number uninsured and is the most complicated to navigate of all the systems.
We could do better, and the author outlines some specific ways we could improve. We could also learn from other countries to see what has worked and what has not. Americans have often been poor at doing this, to our detriment. One thing that may disappoint some readers is that the author does not identify which health system is the best overall, but he does do an excellent job at showing why those that are near the top, such as the UK and the Netherlands, are considered so good. Even the better systems also have challenges they have not conquered, and he points these out as well. -
Ezekiel Emanuel dives deep into a question he gets asked over and over as a health policy expert: "which country has the best healthcare." It seems everyone is agreement about the United States not having the best, but which one does?
Ezekiel dives deep into the healthcare systems of 11 different countries, including the US, getting into the weeds of the history of it, delivery care system, financing, pharmacy, and challenges faced by each country. This background, although having the tendency to be a little wonkish, provides the reader with a great understanding of the different healthcare systems in place around the word. It also helps the readers understand the nuances and the "path dependency" of different systems.
While it is no surprise, the book doesn't actually name a country, however, it does outline certain criteria for evaluating a healthcare system and ranks those. Additionally, the book concludes with recommendation for improvement of the US system.
Overall a great read for those truly looking to understand health policy proposals, what a "Medicare for All" looks like, or just looking to understand the complexities of healthcare systems across the world. -
If in a hurry and yet still want know which country has the world's best health care - read chapter 12. And then chapter 13 will let you know where the healthcare system in USA needs to improve in.
Reader can then zoom in to the details of the nations that want know about . I found the historical narrative for each country useful - about how the healthcare system evolved and how it is caught in local politics.
Many good details. Many facts. One unsaid trend is the brain drain of healthcare staff from less developed nations to developed nations; and the high cost / relative lack of staff in rural places of all nations. Good reference work indeed.
Interesting that Singapore was mentioned at the start of the book as a nation with good and relatively low cost (in GDP teems) healthcare but was not featured as a country study.
And a tad unfair that corruption was featured quite highly as a factor in China's system even though I suspect financial foul play and manipulation (legally or otherwise) is present in other nations too? -
Really enjoyed this book. A great read, and a subject in which we should all be much better informed. Having lived in three of the countries included in this book, and with friends that live in another two -- it was very truthful, and insightful to see how each of the countries measured up against each other in each of the categories the author created for this book.
I really wish that our policymakers could realize that, with all this information available, it's not difficult to see what works and what doesn't, and to apply the best of the best to our own scenario here in the U.S. We can only hope for that day when our politicians understand that healthcare is also a basic right for citizens. This country has so much to offer in the field of healthcare, except its universal availability, which compares more closely to the dark ages. Healthcare has become a luxury almost unaffordable but to those fortunate enough to have company health benefits. How progressive is that? -
How do the United States, Canada, United Kingdom, Norway, France, Germany, Netherlands, Switzerland, Australia, Taiwan, and China's healthcare systems compare? You've come to the back right place.
Emanuel takes a system level perspective necessary for anyone in health care policy or system improvement. When comparing health care systems, there is no one best because the values and measured outcomes are too many. In this book, the history and challenges outlined for each country were my favourite, and the figures to describe financing, payment, and pharmaceutical regulations were terrific.
Head to the last couple chapters for the major takeaways. Included is an historical analysis and comparison between; coverage, financing, payment, delivery, pharmaceutical regulation, and workforce. -
If you’re a professional who follows healthcare (such as a journalist), this is an essential book. If you’re not, it’s a bore. I’d like to give it 5 stars because it’s an important subject and the research is so well done, but it’s as dry as the Gobi at noon in mid July.
The research is comprehensive, well conducted, and systematically presented in a simple, straightforward manner.
If you’re not reading this as a professional and you don’t need all the detail, just read Chapter 12, which nicely summarizes the data and the conclusions. Chapter 12 is worth the price of the book.
I wish Japan’s healthcare system had been included in the study. It’s not perfect, but my guess is it would be highly rated on most of the dimensions used in the evaluations -
The author profiles the Healthcare systems of 11 countries of the World using a unique comparative structure - history of evolution of the system, coverage, financing, payment, delivery of healthcare services, Pharmaceutical coverage and price controls, Human Resources, challenges in the healthcare system - to know which systems perform well and why and which face endemic problems. I would recommend this book highly not only to healthcare professionals, patients and policymakers but also anyone interested to get a concise view of different forms of healthcare systems prevalent in the developed world and to make sense of the same.
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I think someone for whom data is enough, this book is great. Emanuel is really diligent and consistent about about a wide range of metrics. Sadly, his ability to contextualize healthcare policy decisions or provide any sort of hypothesis as to why certain barriers exist is really poor (perhaps because of the genre?), which is why I’ve rated it so low.
I found this interminably dull. I often said (aloud!), ‘That’s nice, but why or, even better, what do you think about that, Zeke?’ His conclusions are more interesting(ish), but read as flat or obvious if you’ve been paying attention to any of the data he’s presenting.
Also, I’d like to be a Dutch citizen now. ✌️ -
I must confess I did not read every word of this book.. I browse it... I found it very well written and very detailed, well researched and organized. It was interesting to better understand the various country selected (11 including USA) health care systems. (spoiler alert.. none is perfect!!) There is also a discussion to compare them and how the USA could improve its system without changing it completely. A good read during these days discussions on our health care system.
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A well researched statistics heavy book comparing the healthcare systems of 11 countries. Each chapter delves into the detail of the health care system in each country with the final chapter answering the question on which country has the world's best health care. Probably not for everyone owing to its researched based nature, the book might appeal to readers interested in understanding the nuances on heath care systems across the high income countries.
