Health Care: Out-of-Pocket

by Published: Nov 4, 2009

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:

  1. The Health Care Debate
  2. Health Care: The Bismarck Model
  3. The Beveridge Model of Health Care
  4. Health Care: The National Health Insurance Model
  • http://mleonardo6.weebly.com/ Allen Dilliard

    Just the thing I wanted, amounts to just 2 days now!