Chris Van Es

Amerikas Gesundheitswesens: kein Vorbild

TORONTO – Die historische Reform des US-amerikanischen Gesundheitswesens, der Affordable Care Act, von Gegnern als „Obamacare“ verschmäht, liegt dem Obersten US-Gerichtshof zur Entscheidung vor, und das ist Anlass genug, daran zu erinnern, dass die Anzahl der Amerikaner ohne Krankenversicherung 2010, in dem Jahr, in dem das Gesetz erlassen wurde, ein Rekordhoch erreichte. Ungefähr 50 Millionen US-Bürger (ein Sechstel der Bevölkerung) zahlen ihre Arztrechnungen aus eigener Tasche.

Die Rezession von 2008 ist nicht der einzige Grund für diese erstaunliche Zahl, auch langfristige politische Entscheidungen sind dafür verantwortlich. Global, aber besonders für schnell wachsende Volkswirtschaften, ist die Lektion einfach: das amerikanische Modell der privaten Gesundheitsversorgung ist zu vermeiden.

Die USA gehören zu den wenigen Ländern mit hohem Einkommen, die das Gesundheitswesen nicht durch ein öffentliches Versicherungssystem finanzieren. Im Durchschnitt geben die wohlhabenderen Länder ca. 11 Prozent ihres Bruttoinlandsproduktes für das Gesundheitswesen aus, davon sind mehr als 80 Prozent öffentlich finanziert, und nur 14 Prozent der Ausgaben betreffen Leistungen, die von Patienten direkt bezahlt werden. Die öffentliche Finanzierung (bzw. in einigen Fällen staatlich regulierte Versicherungsfonds, die auf eine öffentliche Finanzierung hinauslaufen) deckt die meisten ärztlichen Leistungen ab, die Privatversicherungen tragen nur ergänzend mit minimalen Extraleistungen dazu bei.

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