AMDEES

EHR Functional Countries

Belgium, Population: 10,431,477

Healthcare is of high quality and is financed through both social security contributions and taxation. Health insurance is compulsory. However, health care is delivered by a mostly private system of independent medical practitioners and hospitals. Most of the time each provided service is directly paid by the patient and reimbursed later on by health insurance companies. Belgian health care system is supervised, and financed by the federal government, the three Communities and the three Regions, i.e., six distinct Ministries (the Flemish Community and Region have merged).

Bulgaria, Population: 7,093,635

Bulgaria has a universal, mostly state-funded healthcare system. The National Health Insurance Fund (NHIF) pays a gradually increasing portion of the costs of primary healthcare. Employees and employers pay an increasing, mandatory percentage of salaries, with the goal of gradually reducing state support of health care. Between 2002 and 2004, healthcare expenditures in the national budget increased from 3.8% to 4.3%, with the NHIF accounting for more than 60% of annual expenditures. In 2010, the healthcare budget amounted to 4.2% of GDP, or about 1.3 billion euro.

Cyprus, population: 1,120,489

Health care is provided by the Government Medical Services and the private medical sector. The Government Medical Services can be used by any person who chooses to be treated as a Government Medical Institution.

Free of charge or at reduced fees care is provided by the Government Medical Services to certain groups of the population as described below. Patients not belonging to these groups pay the fees prescribed from time to time.

The government medical institutions are administered by the Ministry of Health through the Department of Medical and Public Health Services and are financed by general taxation through the budget.

Persons making use of the private medical sector pay the fees out-of-pocket. Certain groups are covered by medical funds, operated by trade unions or employers. These funds provide full or partial coverage of medical expenses incurred by their members.

Denmark, Population: 5,529,888

The public health services are extensive and of quality, Denmark’s state healthcare service is highly efficient and offers good quality care to its citizens. Its structure is decentralized; local authorities are the decision-makers in executing healthcare policy. The Ministry of the Interior and Health issues guidelines, which the local authorities must follow.

England, Population: 62,698,362

The National Health Services (NHS) is the publicly funded healthcare system in England responsible for providing the majority of healthcare in the country. The NHS began on 5 July 1948, putting into effect the provisions of the National Health Service Act 1946. It was based on the findings of the Beveridge Report, prepared by economists and social reformed. The NHS is largely funded by general taxation including National Insurance payments, and it provides most of its services free at the point of use, although there are charges for some people for eye tests, dental care, prescriptions, and aspects of personal care.

Estonia, Population: 1,282,963

The Health Insurance Fund covers the costs of health services required by the person in case of illness regardless of the amount of social tax paid for the person concerned. The purpose of health insurance in Estonia is to cover the costs of health services provided to insured persons, prevent and cure diseases, finance the purchase of medicinal products and medicinal technical aids, and provide the benefits for temporary incapacity for work and other benefits.

Finland, Population: 5,259,250

Life expectancy is 82 years for women and 75 years for men. There are 307 residents for each doctor. About 18.9% of health care is funded directly by households and 76.6% by taxation.

France, Population: 65,102,719

The French healthcare system was ranked first worldwide by the World Health Organization in 1997 and then again in 2000. Care is generally free for people affected by chronic diseases (Affections de longues durées) such as cancer, AIDS or Cystic Fibrosis.

Germany, Population: 81,471,834

Germany has the world's oldest universal healthcare system, dating back to Otto von Bismarck's Social legislation in 1883. Currently, the population is covered by a basic health insurance plan provided by statute. According to the World Health Organization, Germany's healthcare system was 77% government-funded and 23% privately funded as of 2005. In 2005, Germany spent 11% of its GDP on health care.

Greece, Population: 10,760,062

The health care system in Greece is managed and controlled by the state. The main aim was to facilitate equal distribution of healthcare facilities. The government spends 5% of its GDP on the healthcare system

Hungary, Population: 9,976,062

The free-market shift initiated after the end of the communist rule twenty years ago put a strain on the largely centralized, wholly tax-funded public health system, which required far-reaching reforms. These resulted in the creation of the National Healthcare Fund in 1993. The OEP, predominantly based on a social insurance system, is the public organization currently controlling the management of health care in Hungary.

Ireland, Population: 4,670,976

The public health care system of Ireland is governed by the Health Act 2004, which established a new body to be responsible for providing health and personal social services to everyone living in Ireland - the Health Service Executive. The new National Health Service came into being officially on 1 January 2005; however, the new structures are currently in the process of being established as the reform program continues. In addition to the public sector, there is also a large private healthcare market.

Italy, Population 61,016,804

Italy has had a public healthcare system since 1978. Healthcare spending in Italy accounted for more than 9.0% of the national GDP in 2008, slightly above the OECD countries' average of 8.9%. However, Italy ranks as having the world's 2nd best healthcare system, and the world's 3rd best healthcare performance.

Latvia, Population: 2,204,708

The Latvian healthcare system is a universal program, largely funded through government taxation. It is among the lowest-ranked healthcare systems in Europe, due to excessive waiting times for treatment, insufficient access to the latest medicines, and other factors. There were 59 hospitals in Latvia in 2009, down from 94 in 2007 and 121 in 2006. The average life expectancy at birth is 72.7 years, the second lowest in the European Union.

Lithuania, Population: 3,535,547

Lithuania Health care is adapted with all the needed facilities for an individual and sufficient funds are there for the free medical care of an individual. Lithuanian Health care system is in a much better condition with respect to any other developed nation.

Luxembourg, Population: 503,302

Luxembourg has an extremely high standard of compulsory state-funded healthcare. Medical staff are extremely well trained and free and subsidized healthcare is available to all citizens and registered long-term residents. Private healthcare is also available in the country. All citizens have the right to choose their doctor, specialist and hospital. Luxembourg’s Union of Sickness Funds oversees the health service in Luxembourg. All citizens are entitled by law to equal access to healthcare.

Malta, Population: 408,333

Malta has a long history of providing publicly funded health care. The first hospital recorded in the country was already functioning by 1372. Today, Malta has both a public healthcare system, known as the government healthcare service, where healthcare is free at the point of delivery, and a private healthcare system. Malta has a strong general practitioner-delivered primary care base and the public hospitals provide secondary and tertiary care. The Maltese Ministry of Health advises foreign residents to take out private medical insurance.

Netherland, Population: 16,847,007

Healthcare in the Netherlands is financed by a dual system that came into effect in January 2006. Long-term treatments, especially those that involve semi-permanent hospitalization, and also disability costs such as wheelchairs, are covered by state-controlled mandatory insurance.

Poland, Population: 38,441,588

Poland's healthcare system is based on an all-inclusive insurance system. State-subsidized healthcare is available to all Polish citizens who are covered by this general health insurance program. However, it is not compulsory to be treated in a state-run hospital as a number of private medical complexes do exist nationwide.

All medical service providers and hospitals in Poland are subordinate to the Polish Ministry of Health, which provides oversight and scrutiny of general medical practice as well as being responsible for the day-to-day administration of the healthcare system. In addition to these roles, the ministry is also tasked with the maintenance of standards of hygiene and patient care.

Portugal, Population: 10,760,305

The Portuguese health system is characterized by three coexisting systems: the National Health Service (NHS), special social health insurance schemes for certain professions (health subsystems), and voluntary private health insurance. The NHS provides universal coverage. In addition, about 25% of the population is covered by the health subsystems, 10% by private insurance schemes, and another 7% by mutual funds.

Romania, Population: 21,904,551

Health care in Romania is generally poor by European standards, and access is limited in certain rural areas. In 2001 health expenditures were equal to 6.5 percent of gross domestic product. In 2005 there were 1.9 physicians and 7.4 hospital beds per 1,000 people. The state-owned healthcare system was a target of the campaign to decentralize state services that began in 2006. The system has been funded by the National Health Care Insurance Fund, to which employers and employees make mandatory contributions. Private health insurance has developed slowly. Because of low public funding, about 36 percent of the population’s healthcare spending is out-of-pocket. Bribes frequently are paid to gain improved treatment.

Slovakia, population: 5,477,038

Slovakia has an average to the poor standard of compulsory state-funded healthcare and many hospitals are in debt. State healthcare is available on equal terms to all citizens and registered long-term residents. Private healthcare is also available in the country, although it is little used. The Ministry of Health oversees the health service. The Office for the Supervision of Healthcare supervises the five health insurance companies and the healthcare establishments and controls what is offered as part of the basic healthcare package, known as ‘the solidarity package.’

Slovenia, Population: 2,000,092

The Health Insurance Institute of Slovenia (the Institute) was founded on March 1, 1992, according to the Law on health care and health insurance, after declaring independence from Yugoslavia. The Institute conducts its business as a public institute, bound by statute to provide compulsory health insurance. In the field of compulsory health insurance, the Institute's principal task is to provide effective collection (mobilization) and distribution (allocation) of public funds, in order to ensure the insured persons’ quality rights arising from the said funds.

Spain, Population: 46,754,784

Spain's single-payer health care system is ranked seventh best in the world by the World Health Organization. The system offers universal coverage as a constitutionally guaranteed right and no out-of-pocket expenses aside from prescription drugs. Patients do complain, however, about the long wait to see specialists and undergo certain procedures.

Sweden, Population: 9,088,728

Healthcare in Sweden is similar in quality to other developed nations. Sweden ranks in the top five countries with respect to low infant mortality. It also ranks high in life expectancy and safe drinking water. A person seeking care first contacts a clinic for a doctor's appointment, and may then be referred to a specialist by the clinic physician, who may, in turn, recommend either in-patient or out-patient treatment, or an elective care option. Health care is governed by the 21-land sting of Sweden and is mainly funded by taxes, with nominal fees for patients.

Wales, Population: 3,017,441

NHS Wales was originally formed as part of the public health system for England and Wales created by the National Health Service Act 1946 with powers over the NHS in Wales coming under the Secretary of State for Wales in 1969. Responsibility for NHS Wales was passed to the Welsh Government under devolution in 1999 and has since then been the responsibility of the Welsh Minister for Health and Social Services.

Norway, Population: 4,691,849

Norway has an excellent standard of compulsory state-funded healthcare. Medical staff are extremely well trained and healthcare in the country is available to all citizens and registered long-term residents. Private healthcare is also available. The Ministry of Health determines healthcare policy and oversees the state system. Healthcare policy is executed by five health regions and municipalities

Canada, Population: 34,030,589

Healthcare in Canada is delivered through a publicly-funded healthcare system, which is mostly free at the point of use and has most services provided by private entities. It is guided by the provisions of the Canada Health Act. The government assures the quality of care through federal standards. The government does not participate in day-to-day care or collect any information about an individual's health, which remains confidential between a person and his or her physician. Canada's provincially-based Medicare systems are cost-effective partly because of their administrative simplicity. In each province, each doctor handles the insurance claim against the provincial insurer. There is no need for the person who accesses health care to be involved in billing and reclaiming. Private insurance is only a minimal part of the overall healthcare system. Competitive practices such as advertising are kept to a minimum, thus maximizing the percentage of revenues that go directly toward care. In general, costs are paid through funding from income taxes, although British Columbia is the only province to impose a fixed monthly premium which is waived or reduced for those on low incomes. There are no deductibles on basic health care and co-pays are extremely low or non-existent

Australia, Population: 21,766,711

Total expenditure on health (including private sector spending) is around 9.8 percent of GDP. Australia introduced universal health care in 1975. Known as Medicare it is now nominally funded by an income tax surcharge known as the Medicare levy, currently set at 1.5 per cent. The states manage hospitals and attached outpatient services, while the Commonwealth funds the Pharmaceutical Benefits Scheme (reducing the costs of medicines) and general practice.

New Zealand, Population: 4,290,347

Healthcare system of New Zealand has undergone significant changes throughout the past several decades. From an essentially fully public system in the early 20th century, reforms have introduced market and health insurance elements primarily in the last three decades, creating a mixed public-private system for delivering healthcare.

USA, Population: 313,232,044

The U.S. healthcare system far outspends any other nation, measured in both per capita spending and percentage of GDP. The World Health Organization ranked the U.S. health care system in 2000 as first in responsiveness, but 37th in overall performance. The United States is a leader in medical innovation. In 2004, the nonindustrial sector spent three times as much as Europe per capita on biomedical research.

Unlike in all other developed countries, healthcare coverage in the United States is not universal. In 2004, private insurance paid for 36% of personal health expenditures, private out-of-pocket payments covered 15%, and federal, state, and local governments paid for 44%. In 2005, 46.6 million Americans, 15.9% of the population, were uninsured, 5.4 million more than in 2001. The main cause of this rise is the drop in the number of Americans with employer-sponsored health insurance. The subject of uninsured and underinsured Americans is a major political issue. A 2009 study estimated that lack of insurance is associated with nearly 45,000 deaths a year. In 2006, Massachusetts became the first state to mandate universal health insurance. Federal legislation passed in early 2010 will create a near-universal health insurance system around the country by 2014.

Importance EHR

Essential medical information will be different for each person. Although it may not seem relevant, knowledge of even the smallest medical detail could potentially save a life.

Medical problems: A complete list of all current and past medical problems. This should include chronic diseases such as diabetes, asthma, emphysema, high blood pressure, high cholesterol, cancers, etc.
Medical and surgical history: List any illnesses, hospitalizations, or operations you have had. This list should be comprehensive and should include a history of strokes, ulcers, sexually transmitted diseases, serious infections, major or minor operations, and mental health disorders.
Childbirth: Women should add a history of childbirth, including miscarriages, abortions, and caesarean sections as well as natural births.
Current medications: Have a comprehensive list of any medication you are currently taking, how much you take (dosage), and how often you take it. Medicines such as blood thinners, water pills, blood pressure pills, and anti-seizure treatments can all influence how you are treated during emergencies. Many medications have important interactions with one another. Doctors need this information to avoid potentially dangerous reactions. Included with this medication list should be any herbal, alternative, or over-the-counter medications you take because all of these can have potentially important effects on your treatment, also any tobacco or recreational drug use and alcohol.
Allergies to medicines: Equally important is a list of all medical allergies. Some people have very serious allergies to common medications. It is essential for doctors to know this information when treating people. When known, the precise type of allergic reaction should be listed. Did you start itching after taking the medication? Did you develop a rash? Or did you have trouble breathing? In addition to allergies to medications (rash, itch, swelling around the mouth generalized swelling, breathing difficulty, shock), also list intolerances (such as nausea, vomiting, abdominal pain, headache, etc.).
Family medical history: Women should add a history of childbirth, including miscarriages, abortions, and caesarean sections as well as natural births.
Phone numbers: It is important to list not only family members to contact in case of emergencies but also any doctors, therapists, or other healthcare professionals you see. Each of these professionals can provide valuable information and can be very helpful during emergencies.

Why People Should Have EHR

Here's a relevant scenario: In a busy emergency department, an unconscious man is brought in by ambulance. The paramedics found him on the street, unresponsive but alive, with no obvious signs of what might be wrong. And no one in the hospital knows anything about him/her. This scene is all too common in today's hospitals, where patients often arrive with no medical information. The doctor's job in these cases is very difficult. The doctor must try to treat someone for an unknown medical problem with no knowledge of that person's medical history.

Has he had a heart attack in the past? And is he having another? Has he accidentally overdosed on one of his medications? Furthermore, once his problem is diagnosed, the doctors are faced with not knowing the safest way to treat him. Is he allergic to medicines that, if given, could make him worse instead of better? Does he have medical problems that would make certain treatments dangerous?

With no family in the emergency department, how do the doctors contact the patient's family and friends to tell them he/she is there? Patients often arrive at hospitals without any information about their medical problems. This presents a difficult and potentially dangerous situation. Although the tests and medicines doctors have are very powerful, they can also be unsafe if used on the wrong person. Knowledge of your medical problems can effectively prevent giving you the wrong medication or performing a risky test. Additionally, many of these tests are time-consuming and can delay important treatments. With medical information, it can allow doctors to save time and provide care more efficiently.

Finally, beyond the need to provide immediate care is the importance of contacting family, friends, and physicians. Not only can these people provide important information, but they also can offer much-needed emotional and decision-making support for you. Having the ability to contact families early in your care can help simplify very complicated situations.

Emergency medical care can be life-saving, but is often filled with difficult and expensive decisions that must be made rapidly. Maintaining your own records is one of the best ways for you to take an active role in your own health care and ensure that you receive rapid, effective, and safe treatment in both emergency and routine medical situations.