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Many single-payer (nationally funded) healthcare systems pay a lot less for drugs, services, and equipment than US insurers do. They have a monopsony and therefore a lot of buying power–makes sense, right? Erik recently has a revelation that calls this logic into question… though without any clear answers.

Sources

In this case Wikipedia for each country’s size and the biggest healthcare providers in the US.

Of note: https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita

47 Comments

  • Chris, March 25, 2019 @ 11:26 am Reply

    Couple thoughts. I think contrasting the US system’s buying power primarily with the UK system is a mistake. The NHS is a vertically integrated buyer, they buy the raw materials of healthcare – pharmaceuticals, labour and capital equipment rather than buying the completed product of a healthcare service. They buy things further down the value chain and are a near monopsony at each level.

    As a monopoly provider as well as a monopoly funder, They also don’t see competition between hospitals for staff, quality of patient experience or amount of services offered. In danger of speculation here, but taking MRI machines (of which there are 5 times as many per capita in the US vs the UK) – a US hospital might feel pressured to have one or more purely for prestige or to offer a greater variety of service for market capture which will increase the cost of all their products. While a UK hospital will have to justify it’s need to a d̶e̶a̶t̶h̶ ̶p̶a̶n̶e̶l̶ regional budget committee.
    On quality of patient experience it’s worse in the UK, presumably as there is little incentive to prioritise experience over the health metrics measured by Governance bodies, we see time and again despite very strong support for the system UK patients express lower satisfaction with the the service revived than those from other countries.

    I don’t have decent data on this, but I believe NICE (who decide what treatments are funded in the UK) are a bit less generous than both US insurers and the Single Payer bodies in other comparable countries.

    MRI stat
    https://www.healthsystemtracker.org/chart/per-capita-u-s-three-times-many-mri-machines-comparable-countries-average/#item-start
    Some satisfaction numbers
    https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2012.1338

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