In all nations, social policy is a very large public investment. Course 1 will explore the size, structure, and outcomes of U.S. social policy and compare this policy to those of similar developed countries. The course will also probe the values this policy represents and the values debate regarding about how big our welfare state should be— in other words, how much of our education, housing, health, income support, and social services the government should supply and how much individuals should supply for themselves. This course addresses issues of power, oppression, and white supremacy. The course is part of a sequence in social policy that has an HONORS TRACK. This track will prepare the learner for masters-level work in policy, which involves reading the literature, writing concise summaries and probing critiques. Over the sequence the learner will develop a policy analysis that will create a foundation for professional policy analyst assignments.
Healthcare
Loading...
Del curso dictado por Columbia University
What Is the Welfare State? A Cross-National Comparison
2 calificaciones
Columbia University
2 calificaciones
Curso 1 de 5 en SpecializationSocial Policy for Social Services & Health Practitioners
De la lección
Comparing U.S. Social Policy with Europe: Investment & Effects
This module will compare US and comparable western nations in a country's approach to education, health care and income stability. The module will address the relative place of the US in the structure of it welfare state.
Conoce a los instructores
John RobertsonPolicy Lecturer
School of Social Work, Columbia University in New York City
In this video lecture, we're going to look at
a cross-national comparison thinking about health and health expenditures,
to get a sense of amongst the industrialized nations,
particularly those in Europe and in the United States,
how differently do we handle health and health care.
So, let me start by showing you a graph that was in the Wall Street Journal recently,
which focuses on the difference in the cost of health care.
This is the green line here is the OECD average.
So, these are the developed nations around the world that includes the United States.
The darker lines behind your individual country lines,
which I can't highlight for you here,
and the red line is the United States health care expenditure.
The green box at the end of all of
this is that projection of what future health expenditures will be,
and you see that we don't have an OECD projection,
so it's not as interesting to us.
But what we do see here is that the US is spending
about 17 percent of its gross domestic product on health care,
and the average OECD country is spending 10 percent.
So, the US is spending
a much higher percentage of its income on health care than are other nations.
So, let's take a look at why that might be.
So, this is a graph of health care spending comparing Poland,
the United Kingdom, Canada,
Germany, and the US.
You can see in this US slide that the US is here spending about
$11,000 per person on health care where Germany is spending Just under $6,000.
Canada is spending about $5,000.
United Kingdom is spending about $4,500,
and Poland is spending just over $2,000 per person,
in US dollars comparable.
So, not only are we spending a higher percentage of our gross domestic product,
but also spending a much higher dollar expenditure on health.
So, this is also a slide from the Wall Street Journal,
which is comparing health outcomes.
You can see here that if we are looking at health outcomes,
we are thinking about life expectancy at birth.
So, at the time you're born,
how long do we expect you on average to live?
And we can see that in 1970,
the US which is the red line here was just about 71,
and the OECD was just about 72.
So, they were quite close together.
Over time they've actually come apart a little bit,
and now the US has about 78 and the OECD average is 82.
So, if health care is providing that kind of basis for people to have longer life,
then our system is not doing as well as others.
So, here we are with cancer,
and these are the number of days that you will live after a cancer diagnosis.
You can see here that the US is converging with the OECD,
but we're not doing better.
Here we see higher diabetes rates in the US than in the OECD countries.
Infant mortality at birth,
we're seeing that the US has had a decline in infant mortality at birth.
But nevertheless are instrumentality of birth
stubbornly stays higher than the OECD average.
So, the coronary heart disease story is a little better news.
The US has converged pretty closely to the OECD,
and we've seen pretty dramatic rates of decline of coronary heart disease.
This is largely due to public health smoking campaigns,
and to dietary, and exercise campaigns that have been working,
and they've been working, they brought down coronary heart disease.
Respiratory disease, which is heavily connected to air quality and so
forth has declined a lot in the OECD and remain relatively flat in the United States.
So, you can see here that whereas the United States,
it's health care story,
is not significantly different than the OECD on average,
it is, in most cases,
slightly worse than the OECD average,
although we're spending almost twice as much per person.
So, why does the US have significantly higher than other developed nations?
What's going on that we're spending so much more?
But one issue is that the US spends a great deal more on research and development,
the development of medicines, and so forth.
So, that's a major expense.
Other countries are what we would call free riders.
They take advantage of research done in the United States,
and use it to improve health care.
So, that does push up our costs.
The US has very high medical malpractice costs and
these includes the insurance costs directly to medical providers.
But more importantly, they include many many levels of testing that is done,
that probably is medically unnecessary but it's
absolutely essential to defend against the medical malpractice suit in court.
So, other nations tend to regulate medical practice more,
so what can be done is more regulated by the health care system,
but decreasing the overall freedom of doctors
but they do not engage in medical malpractice the way we do in the United States.
A third reason is that doctors earn much more here.
We value doctors very highly.
We pay them very well.
So, doctors from anywhere in the OECD,
if they come to the United States will earn more money.
A fourth reason is that the US has significantly higher administrative costs.
So, in most other OECD countries,
the bill is simply sent to the payer and the payer pays it.
But in the US, you have multiple levels of screening about the bill.
So, there'll be one or two or maybe three insurance companies.
Some of the cost is related to directly back
to out-of-pocket payments by the person themselves.
Insurance companies negotiate for different rates.
This means if you go into a doctor's office here,
you'll see three or four people working on insurance billing.
If you go into a hospital,
you'll see a whole departments,
and then the insurance companies themselves have whole departments.
So, this administrative cost increases the cost of US health care.
The final one is that the US has higher poverty,
and higher poverty leads to higher health care needs.
So, issues of nutrition, issues of safety,
issues of access to health care actually pushes up the cost of our health care in the US.
So, the World Health Organization said in 2009 that
the US was 23rd in the world because of the disparity.
Many many Americans didn't have health insurance,
and still even with the ACA,
we still have almost 10 percent of our population without health insurance.
We have lower life expectancy.
We have larger numbers of low birth weight babies and
more premature mortality from treatable diseases.
So, the US health care system is a complicated one.
Some of the best health care in the world is in the United States.
I'm sitting in New York.
Certainly, there are three or four hospitals here that
people come from all around the world to receive health care.
But also in Manhattan Island,
there are some health care systems that are really not functioning very well at all.
They're in poor neighborhoods,
people don't have access to care,
and this lack of consistency causes health care professionals to rate our system as
not being as complete and doing as good a job as the other OECD countries.
So, in the next video,
Dr. Heidi Allan will be here to talk
about her investigation of
the effect of health care investment in her Oregon State study.
So, I hope you'll be back.
I look forward at you being back.
I know you'll enjoy it.
Then when I return,
we'll be moving on to talk about income issues.
Explora nuestro catálogo
Inscríbete de manera gratuita y obtén recomendaciones personalizadas, actualizaciones y ofertas.
Coursera brinda acceso universal a la mejor educación del mundo, al asociarse con las mejores universidades y organizaciones, para ofrecer cursos en línea.
© 2019 Coursera Inc. Todos los derechos reservados.
