by Douglas J. Besharov and Douglas M. Call, Wilson Quarterly, Autumn 2010
A common misconception is that Europe is home to socialized medicine, probably because it has long provided universal health care. But with a few notable exceptions, such as Britain’s National Health Service, most European systems require consumers to pay more money out of pocket for medical care than Americans do. According to Jacob F. Kirkegaard of the Peterson Institute for International Economics, “In reality, America’s health care system is already more ‘socialized’ than in most European and other developed countries.”
Although U.S. employer-provided health insurance plans increasingly require beneficiaries to bear more costs themselves—through paying deductibles, coinsurance, and direct payments to medical professionals—such cost sharing is still much more common in Europe. In 2006, out-of-pocket payments made up about 12 percent of total U.S. health care expenditures. The average in Europe was about 17 percent, with a low of six percent in the Netherlands and a high of about 31 percent in Switzerland.
In many European countries, patients often make direct payments to physicians—to purchase treatment that is excluded from coverage, to move up in the queue, or to get better service. In France, individuals directly pay between 10 and 40 percent of their own costs, with different rates for drugs, lab work, and other services. Such cost-sharing requirements are means tested. In France, low-income consumers are eligible for free government-provided supplemental insurance that pays for any cost sharing, and in Switzerland, households receive an income-based subsidy.
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