INTRODUCTION In one of my dental public health courses, I had a chance to read the novel “The Eleventh Hour” to learn about the American healthcare system. One major feature of the U. S. health care system is the fact that hospitals are so controlled by the insurance companies that they are not always given an incentive for choosing the best treatment option for the patient. In other words, it lacks government involvement (McDermott & Stocks, 2005).
The novel also describes how a financial approach to make money and a healthcare approach to save patients are real problems that society is having to deal with and the people it hurts the most is the patients. This extramural rotation offered me a comparative perspective on several leading healthcare systems. I was astounded that countries, such as Denmark, Germany, and United Kingdom, which are less economically powerful than the United States, offer a better healthcare deal to their citizens. More impressively, they also produce better health outcomes and near universal coverage of health services.
In all of these countries, the connecting theme seems to be ‘socialized medicine’, where, profit motive is largely removed from the health industry. It is a noble stance indeed to accord such dignity to healthcare. In my opinion, these health systems expose all the problems we are facing with the current American health delivery model. With a broad understanding that Denmark has a universal healthcare system, I came to this beautiful Nordic country with the assumption that people would have less severe of a dental problem (both quantity and the severity of cases) than what we have been seeing here at the University of Iowa.
In fact, the amount of patient is less in Aarhus but some patients that I saw had similar severity of dental caries and other dental problem as I have seen here at the College of Dentistry. However, the quantity of caries is much less and definitely not to the extent of rampant caries or full mouth extractions. I was not sure if dental coverage is part of the Danish universal health care system so I also assumed that people who seek care at the dental school are those live nearby the dental school, cannot make an appointment with local dentists, or they are coming to the school to help train new dentists for their communities.
After the rotation, I have a better understanding of the Danish healthcare system. BACKGROUND The Danish health service is a public healthcare system predominantly financed through general taxes. Healthcare is organized in such a way that responsibility for services provided lies within the lowest possible administrative level, usually the county councils. There is universal, free and equal access for all 5. 4 million citizens (Sorensen, 2015). There is an optional private healthcare sector but it is very small and insignificant compared to the larger public system.
In general, people only have pay for very few procedures such as fertility treatments (third attempt onwards), non-essential cosmetic surgery, most of their own dental care and a portion of prescription medication. Doctor visits and hospitalization, including tests, treatment, follow-up care, and some medication, are fully covered (the Denver Post, 2009). Since dental care is not part of the universal healthcare, people who go to the dental school are to receive free dental care.
Most of the procedures are free at the dental school such as anterior restorations, extractions that are done by dental students, and even implants replacing congenital missing teeth. Patients only have to pay a small fee for posterior restorations (3 surfaces of more), fix and removable prosthodontics, endodontic, orthodontic treatments, or extractions that are done by faculties. According to Sorensen, there are 2 healthcare sectors in Denmark: primary and hospital care. Primary healthcare is for general health problems and the first point of contact if you require general medical treatment.
Services in this sector are available to everyone, and include treatments from general practitioners, dentists, physiotherapists, etc. Hospital care is for patients who require more specialized medical treatment such as intensive care (Sorensen, 2015). The Danish universal healthcare system comes with a price. According to OECD’s Health Data 2009, Denmark’s health cost per person, public and private, was $3512 (the cost is more than double that amount in the U. S. ). However, it covers 100 percent of the population while less than 80 percent of the U. S. populations are covered or only partially covered (the Denver Post, 2009).
Even though it is a much cheaper healthcare system compared to the U. S. , it is indeed a very high quality healthcare system. The Danish health service promotes efficiency, high quality, and enables free choice of provider by users (although I think that the “gatekeepers” concept still applies to the Danish universal healthcare system, where patients cannot go to any specialist directly and have to be referred by their general practitioners). As I mentioned previously, medical treatment in Denmark is available to all Danish residents and EU citizens free of charge.
There are more hospital beds and doctors per capital than in the U. S. Free emergency treatment is available to visitors from all other countries (Sorensen, 2015). ANALYSIS The reason why the Danish healthcare system is cheaper is because it is a lot simpler to manage. The government managed single-payer system greatly alleviates administrative costs and minimizes patient co-pay. There are no medical insurance companies or lawyers operating for profit or financial background check. The government also negotiates with healthcare providers so that the Ithcare providers so that the costs are not unreasonable.
One of the main reasons why the U. S. ealthcare system is expensive is due to profit-motive of insurance companies and higher administrative costs inherent in private healthcare. However, the Danish universal healthcare system results in a higher overall tax rate (40-50 percent of income taxes). I am not sure if this is something the American populations are willing to go through to have a universal healthcare system. In other words, healthy people are paying for the treatment of the sick people through their taxes but the system is simpler and less profit-oriented that it ends up being cheaper for everybody (the Denver Post, 2009).
People often say the U. S. healthcare system is very expensive and wasteful but some can argue that it also rewards innovation (technologies and pharmaceutical industries). Even though I am impressed with the success of nationalized healthcare management in Denmark, I am not sure if I am willing to pay 40-50 percent of my income for taxes to maintain such a universal healthcare system. In Denmark, medical and dental students go to school for free and they also receive a monthly stipend of around $800 compared to the U. S. where professional educations are much more expensive.
With the average dental student loan debt of $250,000 for in-state students and $400,000 for out-of-state students, paying very high income taxes makes it impossible for dental students to pay back their student loans. It is a difficult situation that needs more work. It is my hope that through active public organization and dialogue with the political class that a better and nearly universal healthcare system can be realized in the United States one day.
