Book Review Number 50

Which Country Has the Best Health Care – Ezekiel J. Emanuel

Ezekiel Emanuel is an American oncologist, bioethicist and senior fellow at the Center for American Progress. He is the current Vice Provost for Global Initiatives at the University of Pennsylvania and chair of the Department of Medical Ethics and Health Policy.

Dr, Emanuel sets out to profile the healthcare systems in 11 wealthy developed countries in an effort to identify the best, or at least where excellence exists. His assessment includes the United States, Australia, Canada, China, France, Germany, the Netherlands, Norway, Switzerland, Taiwan, and the United Kingdom. He evaluates each system on 22 different dimensions in 5 categories: Coverage; Financing; Payment; Delivery; Pharmacy Prices. The information is presented in substantial detail including graphical representations. And he discusses the challenges each country is going to face in the coming decade.

Once the author presented the individual analysis of each country’s system he then compared the systems with each other. He makes the point the each system has its strengths but also has its weaknesses. He chooses not to identify the best country because all have challenges. So he identifies those countries he calls “top tier”; they include Germany, the Netherlands, Norway, and Taiwan. He also identifies the “best performing countries” in each of his 22 dimensions as well as those that are “notably poor performers”. Sadly, the US is identified as one of the poor performers in 12 of the 22 dimensions.

Finally, the author identifies 6 lessons for improving the US healthcare system, They are:

  • Ensure universal coverage with auto-enrollment and larger subsidies;
  • Cover children at no additional cost to their parents and families;
  • Simplify the American health care system;
  • Emphasize and increase the reimbursement for primary care;
  • Adopt and implement best practices for the care of patients with chronic and mental health conditions;
  • The United States needs to join the rest of the world in regulating drug prices.

I found this book vastly more authoritative and in depth on healthcare than I am qualified to address. Generally though I was pleased to find that it is mostly in agreement with a piece that I wrote some time ago on the subject of the US healthcare system. If you want to read what I wrote you can find it on my blog in the category “My Credo”.


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