

By Helena Merriman

BBC News

The US Senate is preparing for one of the biggest debates in its history after it voted to hold a debate on a landmark health bill. If passed, the legislation could lead to some of the biggest changes in US healthcare in decades. But how do other healthcare systems around the world compare and what changes are they going through? China: Barefoot to bureaucracy If President Obama is facing difficult challenges addressing healthcare in the US, how does the country with the largest population and one of the world's fastest growing economies organise its healthcare? China's health system is as counter-intuitive for a so-called communist government as its economic model. Instead of operating under a socialist model, it has a hybrid system combining employer based insurance and social service supplements. Not everyone in China can afford to go to the official state sanctioned clinics But many people cannot afford to pay for healthcare. Professor Li Ling, senior advisor to China's Ministry of Health, says that prices are a barrier for many people. But she says the government is trying to improve health services. "The target is that by 2020 we will have a universal system and people will only pay for 20% of treatment," she told the BBC World Service. But in the meantime, some are making use of the increasing number of cheap, illegal clinics operating particularly in the rural areas. Before the economic reforms of the 1980s, China was famous for having a strong network of primary care - or 'barefoot doctors' who looked after people in villages under rural schemes which covered everyone. But after the market-orientated reforms, the private sector took over, a user-pays system was introduced, and the primary care system began to fall apart. While the hope is that the new model will better serve China's population from a cost, quality, and availability perspective, at the moment, it is simply proving too expensive for many people. India: Caring for millions India, with a similarly large population and growing economy, is to a certain extent travelling in the opposite direction. Rather than moving from a 'socialist' to a private model, India is aiming to move from a mainly private service to increase public health spending. At the moment, 75% of health spending comes out of people's own pockets. As Surja Kant Mishra, the Minister of Health in West Bengal admits, there is simply not enough public spending on health. India still faces high levels of infectious disease such as HIV and tuberculosis "The health spending in India has been abysmally low," he told the BBC's World Today programme. "The target is 2 to 3% of GDP but even I would say that is nothing...government spending has to be increased." The other major problem India faces is the huge divide between rural and urban areas. Rahul Bose, a community worker in West Bengal tells a story which illustrates the problem well. "There was this lady who came to my house at eight in the morning," he says. "She had been bitten by a snake at four in the morning, but since there were no male members in the house, she was not able to leave the house. When I took her to the hospital, the doctors delayed treatment for two hours and so she died in my car." Cultural attitudes towards women in rural areas, as well as problems of distances from health centres both prove major challenges for improving health. India is also still facing high levels of infectious diseases, such as HIV and tuberculosis and has one of the worst child malnutrition rates in the world. South Africa: After the Revolution Perhaps the country which has had the greatest change in health care in the smallest amount of time is South Africa. After the end of apartheid in 1994, health care was revolutionised. The idea was that services should be available for everyone, regardless of race. South Africa now has a large public sector and a smaller but fast-growing private sector. But the system is overstretched. While the state contributes about 40% of all expenditure on health, the public health sector is under pressure to deliver services to about 80% of the population. Despite this, most resources are concentrated in the private health sector, which caters to just 20% of the population. In May, Doctors in Pretoria marched to demand a 50% wage increase There is also a shortage of doctors, who are often lured into the private sectors or overseas where pay is better. While the country's former President, Thabo Mbeki, was criticised for not acknowledging the depths of the AIDS crisis, experts now say that things are now slowly improving. Last month, the government allocated nearly $120m to deal with the pandemic. But leading AIDS researcher, Dr Franchesca Barnadie, says that South Africa needs to use that money more wisely by investing in primary health care. "We need to take away treatment from the care of doctors with the exception of complicated cases and give it to primary health care nurses because of the burden of illness" she told the BBC World Service. UK: Failing some? If you asked many people around the world where they would least mind falling ill, it is likely that many of them would say the UK. The British are often critical of their health service, but last summer, an attack on the National Health Service (NHS) from a Conservative MEP on American TV, resulted in an outpour of online support via Twitter and Facebook. While the British pay for the National Health Service through their taxes, it is free at the point of use. It is also relatively efficient. Britain spends half as much per capita on healthcare than the US for a system which covers everyone. Dr Sam Everington, a Doctor working in East London, says that Britain's strong primary care is one of the reasons for its efficiency. FROM BBC WORLD SERVICE Please turn on JavaScript. Media requires JavaScript to play.

More from BBC World Service "We know that in hospitals everything is far more expensive," he told the BBC World Service. "But in primary care you have doctors with a lot of knowledge and skill which can sometimes avoid those investigations, so it controls some of those costs of the NHS." But criticisms remain. Some argue that too many costs are being sneaked into a system which was meant to be free at the point of use. Others say that it is not effective at delivering healthcare in what is now a market-orientated world. There are also limits on what the NHS can afford, so the National Institute for Health and Clinical Excellence (NICE), makes decisions about which treatments and drugs should be provided by the NHS. Generally, things like cosmetic surgery or lifestyle treatments like Viagra are not provided. But more controversially, some drugs to treat diseases like cancer or Alzheimers are not available. Those whose treatments are deemed not to be cost-effective, such as David Cook who has advanced kidney cancer, often feel that the system has failed them. "In the UK they are saying I am a terminal case and therefore to give me another couple of months of life is not worth it," he told the BBC World Service. "The medical treatment I have had under the NHS has been absolutely outstanding. I just feel let down by the model they are operating under."



Bookmark with: Delicious

Digg

reddit

Facebook

StumbleUpon What are these? E-mail this to a friend Printable version