Throughout this series of articles, I have covered systems of health care such as the Bismarck, Beveridge and National Health Insurance models, but this week it is a different type of system. It is actually a non-system. This is what is referred to as paying for health care out-of-pocket.
The out-of-pocket model is what is used in most of the poorest countries on earth. While many of these countries have minimal health insurance available, a large majority of their population does not even come close to being able to afford it. If citizens need health care, they pay for it on the spot or they don’t receive it at all.
Some of the countries that have the highest rate of citizens who pay out-of-pocket for their care, according to a World Health Organization report from 2003, include Myanmar at 82.2 percent, India at 82.1 percent and Nigeria at 76.8 percent. The rate in the U.S. is 14.7 percent and 3.1 percent in the U.K.
In these countries, where more than three quarters of the population have to pay for health care each time they receive it, the average life expectancy is understandably lower. Some of the countries with the lowest average age expectancies include Mozambique at 32 years, Zambia at 35 and Malawi at 38, according to the U.S. Census Bureau. As expected, these countries are in the category of having non-systems.
While the out-of-pocket model is generally thought of as being present only in poor countries, it is a reality for many Americans. This is what the system looks like in America to the 40 million-plus who are uninsured. Hospitals in the U.S. cannot turn away someone who is acutely ill, even if they are uninsured. This practice is usually reserved only for those on the verge of death. Otherwise, patients have to pay out-of-pocket or go without treatment.
The rate of citizens who are insured is much higher in America than some of the countries I mentioned who cannot provide any kind of care for their citizens. We are a wealthy nation though, and 40 million citizens is a lot to have left out to dry.
We truly are the only advanced nation who does not have a system set up to provide for every citizen. This is a moral issue, and since we have the means to accomplish positive reform, why haven’t we done so?
This doesn’t mean that a Beveridge or NHI model is the right thing, but I hope that this series has helped to show that there are other options on the table. Avoiding an out-of-pocket model of health in any sense and for any number of citizens should be the goal of any nation that considers itself to be an example for the rest of the world.
Editor’s Note: This article is part of a series, to view the rest of the articles, visit the links below: