The Publicly funded medicine reference article from the English Wikipedia on 24-Jul-2004
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Publicly funded medicine

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Publicly funded medicine is a level of medical service that is paid wholly or in majority part by public funds (taxes). Publicly funded medicine is often referred to as socialized medicine by its opponents, whereas supporters of this approach tend to use the terms National Health Services, universal healthcare, or "single payer healthcare". It is seen as a key part of a welfare state (see Welfare State for an interpretation in UK terms).

Publicly funded medicine may be administered and provided by the government, but that is not an obligation: there exist systems where medicine is publicly funded, yet most health providers are private entities. The organization providing public health insurance is not necessarily a public administration, and its budget may be isolated from the main state budget. Likewise, some systems do not necessarily provide universal healthcare, nor restrict coverage to public health facilities.

Table of contents
1 Publicly funded medicine throughout the world
2 Arguments for and against publicly funded medicine
3 Hybrid systems
4 See also

Publicly funded medicine throughout the world

The majority of industrial societies have publicly funded health systems that cover the great majority of the population. For some examples, see the British and other National Health Service systems (e.g., medicare (Canada) and Medicare (Australia)). The role of the government in healthcare provision is however a source of continued debate where opinions diverge sharply. Even among countries that have publicly funded medicine, different countries have different approaches to the funding and provision of medical services.

Arguments for and against publicly funded medicine

Proponents of publicly funded medicine cite several advantages: universal access to high quality care, equality in matters of life and death, reduction in the percentage of societal resources devoted to medical care (in other words public systems cost less than private systems), because of the removal of the profit percentage, the reduction of contractual paperwork, and the creation of uniform standards of care. Proponents often support these arguments by comparing the state of health of the population after adoption of publicly funded medicine with the state prior to such adoption. The political popularity of National Health Services demonstrates that these advantages (particularly the universal availability of high quality care) are widely seen as overwhelming by those who have experienced them.

Critics of publicly funded medicine fall into differing groups each citing different disadvantages. One group criticizes the lack of egalitarianism espoused by proponents by pointing to the existence of parallel private providers (either locally or internationally) that remove the equality of service. Since private providers are typically better paid, those medical professionals motivated by remunerative concerns migrate to the private sector. According to the critics these are the best practitioners, creating an inequality in quality of care. These critics note studies that show many Canadians go to the United States for care, but the opposite is not true. This ignores the fact that Americans would find it difficult, if not impossible, to qualify for healthcare in Canada without establishing themselves as Canadian residents first, whereas it is relatively easy for Canadians to buy healthcare in the US.

These critics also tend to ignore the fact that in many cases doctors are so well paid, whichever system is in use that prestige is often more important to them than remuneration. This is very much the case in the United Kingdom where private medicine is seen as less prestigious than public medicine by much of the population. As a result the best doctors tend to spend the majority of their time working for the public system, even though they may also do some work for private healthcare providers. The British in particular tend to use private healthcare to avoid waiting lists rather than because they believe that they will receive better care from it.

Economic liberalss in America oppose such systems, espousing the view that the government has no place in health care much less mandating and managing it. This group points to the advantages that capitalism has provided in advancing medical technology and practice; that competition is good and allows consumers to decide what they wish to provide; and to the long waits for procedures that occur in some publicly funded medical systems. According to them, socialized medicine tends to result in waiting lists for or even do not fund procedures that middle-class Americans consider fairly routine, such as MRIs for sports injuries, or elective angiograms. They claim it will result in a harmful reduction of choice for those who can afford private healthcare but not necessarily both private healthcare and a healthcare tax. They argue that many of the problems found in mostly private-funded healthcare systems are the result of bad regulation, and propose as a counterplan to change the laws and regulations which they claim result in soaring costs and the pricing of low-income people out of the market. Proponents of socialized systems regard limited availability of non-essential procedures and lack of consumer choice as less important than the fact that such a service provides care more equitably, and ensures that a high level of care is available to all when it is essential. They argue that this group of critics ignores the fact that only consumers who can afford healthcare have any effect on how the market provides it.

Another group of critics focuses on the cost-benefit decisions inherently made by the publicly funded medical boards. Because these decisions invariably affect humans and their medical well-beings, they are particularly controversial. This group points to decisions by various boards based on value judgments not to provide certain services, such as circumcision, cosmetic surgery, contraception, abortion, mental health care, immunizations, often with serious negative consequences. This criticism ignores the fact that such decisions will be made whichever system is in use: in the public case by people; in the private case by money or the lack of it.

Both proponents and critics of publicly funded healthcare have serious arguments in their favour, and their relative weights depend partly on circumstances, and on individual values. As a result, most countries end up with some kind of compromise between public and private health provision. In a general sense, the triage concept in medicine supports the idea of applying resources where they can be most effective in clinical terms. The difference of opinions about National Health Services is therefore not primarily one about facts, but about values.

Hybrid systems

It possible for medicine to be socialized in its funding but privately provided. For instance, United States healthcare for the elderly, also known as Medicare, is financed from taxation, but often provided by privately owned hospitals or physicians in private practice. Another example is France where Social Security is a public entity which refunds patients for care in both private and public facilities; the majority of French doctors are in private practice. In some systems, patients can also take private health insurance, but choose to receive care at public hospitals, if allowed by the private insurer.

From the inception of the NHS model (1948), public hospitals in the United Kingdom have included "amenity beds" which would typically be siderooms fitted more comfortably, and private wards in some hospitals where for a fee more amenity is provided. These are predominantly used for surgical treatment, and operations are generally carried out in the same operating theatres as the NHS work and by the same personnel. These amenity beds do not exist in other socialized healthcare systems, like the Spanish one, among others.

From time to time the NHS pays for private hospitals (arranged hospitals) to take on surgical cases for which the NHS facility does not have sufficient capacity. This work is usually, but not always, done by the same doctors in private hospitals.

See also