For our look at economic policy, regulations, interest groups, ideology, and health policy
Several European countries have health insurance, just like America does. The difference is that their governments regulate what insurance must cover and what hospitals and doctors are allowed to charge much more aggressively than the U.S. does.When I described surprise medical bills to experts who focus on different Western European countries’ health systems, they had no idea what I was talking about. “What is a surprise medical bill?” said Sophia Schlette, a public-health expert and a former senior advisor at Berlin’s National Statutory Health Insurance Physicians Association. “Seriously, they don’t happen here.”
Almost all Germans are covered by a variety of health-insurance like “sickness funds,” which are financed through taxes. Almost all doctors and hospitals accept these plans. About 90 percent of Germans never see a bill for their doctor’s visit, and the rest are covered by private insurance, which usually reimburses whatever they get charged. According to the researchers Roosa Tikkanen and Robin Osborn at the Commonwealth Fund, there’s a flat copay for people who are hospitalized, capped at a maximum of 280 euros—or about $315 U.S. dollars—for a 28-day stay. And doctors, too, are not allowed to charge more than the payment rates that are negotiated between the sickness funds and the doctors’ associations. A very small number of the country’s physicians are private and don’t accept the sickness funds, but they have to tell patients how much they’ll charge before the patient is treated, removing the surprise element.
In France, there are no provider networks, so no doctor can be “out of network.” Doctors’ associations negotiate their fees with the universal public health-insurance program every few years. As a result, says Paul Dutton, a history professor at Northern Arizona University who has studied the French system, “I’ve walked into an office [in France] with my kids where it’s just a receptionist and a doctor. There’s not these back-office wars” over what to charge patients.
