Comparing Health Systems Around the World

Dr. Claudia Chaufan is an associate professor for the schools of Nursing and Sociology at UCSF.  Originally a medical doctor from Argentina, she became interested in the social determinants of health when she moved to the United States.  She subsequently earned a PhD in Sociology from University of California, Santa Cruz in 2006 and now teaches “Global and Comparative Policies and Systems” at UCSF.  One of the highlights of the class is a documentary film series comparing multiple health systems across the world, which is open to all.  The documentaries are screened Wednesday at 5 p.m. in room U460.  The remaining screenings are listed below

Synapse:  Can you tell me a little about your background and education?

Chaufan:  My education was very conventional for the time.  I went to medical school directly after high school as was common in Latin America. It was a bit rocky, due to formal education then lacking in understanding of how to truly be health professional. Now that I have the sociology background I feel it has truly rounded out my understanding of how medicine should be practiced.  I had a training (like a residency) focus on endocrinology—diabetes, etc.  

Then I spent years as a practicing physician in Latin America. I was very involved in patient education and chronic disease self-management, especially with diabetes.  If I had been able to continue practicing medicine here in the States, I would have liked to continue this work, but I never became licensed here because the process was too cumbersome.  

After moving to the United States, I landed a job as health educator with Latinos.  I had come here with such high ideals of the United States having the best healthcare in the world, and I was in shock at the lack of care for all.  Public hospitals were a shock. So then I pursued a PhD in sociology in order to understand social determinants of health.

Synapse:  What brought you to the U.S.?

Chaufan: I came for a yearlong adventure and vacation.  Then I met my husband here and stayed.

Synapse:  What shocked you most about U.S. healthcare?

Chaufan: The first shock was the bad quality of care in the poor population—physicians not correctly treating and educating, especially with things like diabetes.  You have to understand the basics very well since it is a self-managed disease.  You can educate the patient to put the pieces together.  It’s not ideal to do it by just an insulin regime.  People don't have regimented lives.  But then I saw the social system and the problems of access.  I was so shocked at lack of access.  I’m used to walking into a hospital and being seen. 

There is a lack of funding in Argentine, but they see all of the patients.  Here, people don’t go because they can’t afford it.  So that’s when I decided I wanted to study many health systems to see where healthcare was done well.

Synapse:  Can you talk about some of the health systems you have studied?

Chaufan: Argentina is poor, but here in the United States there is so much money. How is more money not bettering health [care]?  When I started studying I found Physicians for a National Healthcare Program advocating for single payer. I began to understand healthcare systems and saw that many Americans don't understand what single payer means or how it works. So I invented a class around this concept. No such class existed at the time where I was doing my PhD at UCSC.

Sociology teaches us that the comparative approach is important to understand our lives. I devoured books until I nailed down the basic issues and prototypes and systems.  The key to understanding each system is finances: who pays, and how the burden of finance is distributed.

Then comes the actual healthcare that is given, but the organization of how it is delivered is so important.  There are three models, and in the class we study several countries that have implemented each model. 

There is the National Health System where it is financed and administered publically—such as in Britain.  There is the mutual funds approach like Germany uses.  Finally there is the single payer system that Canada uses, where the funding is publically administered even though some of the physicians and hospitals may be private.                                                                                

The class developed over the years.  When I started teaching I didn't teach Cuba or any South America.  In 2009, I found material about Cuban healthcare and introduced the country.  I wanted to see it for myself so I took study tours to the country and read about history and policies. 

One year I found news that Taiwan had implemented a single payer system. Taiwan was added to my curriculum, then I was invited by chance to teach there for spring semester 2012!  So I designed a course for the students there.  I learned an enormous amount from them and their doctors, nurses, patients, the medical school and their policy folks.  

Synapse: Can you tell me a little about the documentaries?

Chaufan: Well, I based them around the countries and themes we study to understand the three main systems.  We used to watch Sicko by Michael Moore, but now everyone has seen it. It’s illustrative and lively but also has some critical errors. So I have chosen, among others, Sick Around the World. The producer of Sick Around the World draws parallels between Germany and the U.S. employer-based insurance, which are very different since in our system people are simply purchasing commercial insurance through an employer rather than individually, whereas in Germany they contribute to a social insurance pool.

Synapse: Do you think we can make a difference as individuals?

Chaufan: Not alone, but we can collaborate and join in organization together.  Like workers who have more power in unions, we need collaborations that are participatory and united.  Ordinary people have a lot more say in how to run their lives when they are united. We have no choice. We need to make a change.

There are democratically elected governments that are responsible for wonderful public health benefits.  Even in poor countries like Cuba they have free medical and nursing schools that train kids in the village to become doctors without having to leave their village.  It builds the primary care infrastructure and it is all funded by the state as a single payer.  If young people in the United States understand all of these alternatives they will start demanding change.

Synapse: What is the last thought you would like to leave our readers with?

Chaufan: It all goes back to what kind of healthcare system we want and, in fact, what kind of country we want. Unless we want a place where only the privileged can lead a decent life and realize their dreams, we have to get rid of the appalling corporate structure. We need a publicly financed system.  Medicare, improved and expanded for all.  We need to get rid of the profit-driven business model that is running our healthcare. We have fabulous doctors, nurses and professionals—all extraordinarily well-trained people. Nothing about the education needs to change.  We just need to take back our power and dollars back and build a public system.  

Hannah Patzke, RN,  is a first-year student in the Advanced Practice Public Health Nursing program.  

List of Documentaries

Project Censored – discusses the media distortion we find from all of the major media centers in the United States.           

The Healthcare Movie – an award-winning documentary that that contrasts the private healthcare system in the United States with the public system in Canada.                                                                                                                

Sick Around the World – available at http://video.pbs.org/video/1050712790/ - discusses the successes and failures of healthcare in five other capitalist democracies around the world.

Salud! – A discussion of healthcare in Cuba.  How one of the poorest countries has an amazing healthcare system, as well as serving other countries.                                                                                                        

The Revolution Will Not Be Televised (May 14, in U460 at 5 p.m.) – a documentary about April, 2002, Venezuelan military coup that attempted to depose President Hugo Chavez.  This documentary was filmed during the actual events and shows a perspective dramatically different than that which was presented in the US media. (Available at http://topdocumentaryfilms.com/the-revolution-will-not-be-televised/ )                                                                  

The Congressional Hearing (May 21 in U460 at 5 p.m.) - called by Bernie Sanders on challenging the Affordable Care Act on its focus on privatization and having insurers still in the driver’s seat.