International Differences in Healthcare Systems

The Burden of Disease

As the World Health Organization has noted, there are major differences in the causes of death. In a fact sheet, they estimate that for 2002, in low-income countries, nearly one third of deaths occur among children under 14 and less than one quarter of people reach the age of 70. Infectious diseases and the complications of pregnancy and childbirth are the leading causes of death. In high-income countries, more than two thirds live past age 70, and they tend to die of chronic diseases. Middle-income countries fall in between. However, chronic diseases (cardiovascular diseases in particular) are the leading causes of death across all categories of nations. The healthcare systems must accordingly determine what resources are required to meet the health needs of their populations.

An ongoing difficulty is that health expenditures are highly skewed. In general, the sickest 20% of the population accounts for about 80% of health expenditures, and this persists in all age-sex categories. In turn, this distribution of health expenditures affects the implication of various funding models, particularly since those identified as being at high risk of incurring high expenditures are not desirable customers for insurers.

The Role of Public Health

The foundation of all healthcare systems is public health. Ensuring clean water, clean air, and communicable disease control is a vital starting point for preventing disease and disability. So is appropriate engineering (road traffic accidents are leading causes of death in low- and middle-income countries), availability of safe and healthy foods, avoidance of tobacco, and other interventions coming under the rubric of “health promotion/disease prevention.” In that sense, death by chronic disease is a success story; it means that people are living long enough to be affected by these conditions.