tonight on "worldfus" -- >> on this special edition of "worldfocus," the health of nations. as the u.s. overhauls its health care system, how are other countries insuring their citizens? in chile, how fast you get treated depends on what ails you and how likely you are to be cured. while in brazil, the emphasis is on providing medical care for the poor. we'll travel to singapore where health care is funded by an unusual savings plan. and then from canada, something strikingly different. where are all the billing people? from the different perspectives of reporters and analysts from around the globe, this is "worldfocus." major support has been provided by -- rosalind p. walter and the peter g. peterson foundation, dedicated to

promoting fiscal responsibility and addressing key economic challenges facing america's future. and additional funding is provided by the following supporters -- good evening. i'm martin savidge. thank you for joining us. i'll be with you until the middle of next week.with its hi overhaul, the united states joins most other developed countries in moving toward universal coverage. over the next two nights we're going to look at health care around the world. while universal coverage is a subject of ferocious debate in the u.s., most other developed countries have a long history of it. we'll look at some of them tonight in a series we call "the health of nations" starting with a report filed by "worldfocus" special correspondent edie magnus from chile. >> reporter: a public hospital in santiago. the waiting room at emergency is jammed. there are 42 people in line to

receive chemotherapy, and possibly the busiest place in the building is here, the office of complaints. but in chile, they're not just talking about improving health care. they're acting on it. with universal coverage, no one goes uninsured here. but as in many developing countries wait times for certain procedures can be long and huge gaps in health outcomes were detected between haves and have-nots. so the government launched health care reform. but unlike the u.s. where the conversation has focused on coverage and costs, chile chose to tackle certain conditions which by the numbers affected the most people everywhere. they literally came up with a list. >> it's a list. you can go to the website of the minister of health. you can go to the guarantee system and then you will see the list. >> reporter: dr. sandoval headed the committee that created the health reform effort known here

as plan ewinge. the list contains conditions which the government pledged to treat with timely quality medical care no matter who you are. your coverage for these conditions is guaranteed as a matter of law. the list is determined by how dangerous the condition is to the population and the feasibility of cure if it's tackled quickly. >> we didn't put the money first and then we decide what to do. it was clearly the opposite. we decide what to do and how to put the money in the thing we wanted to do. we have still gaps between social class and income education groups but are trying to reduce it. >> reporter: plan auge includes such things as diabetes, heart attacks, depression and palliative care at the end of life. studies have found more than 3 million chileans mostly from its public insurance system have used plan auge. still, the cost/benefit approach does lead to some interesting choices. prostate, breast and cervical

cancer are on the list. pancreatic cancer is not. >> we got the rate is very low in some cancers. and they -- in other cancers, you can have -- >> reporter: so if you develop pancreatic cancer, you can still get treatment, but not on the fast track as a plan auge patient. what's the youngest baby you have here? how old? >> 24 weeks. >> reporter: one chilean neonatologist says overall the plan has increased the quality of medical care. do you regard plan aug he had as an improvement? >> yes. >> reporter: can you describe why? >> because the patient some years ago have to wait for some treatment. now you have some protocol. >> reporter: but here in the hospital neonatal unit, we met patricia fuentes concha whose son was born with a host problems. >> translator: he has problems

feeding. he doesn't increase his weight. he throws up. >> reporter: how old is he now? >> translator: 3 months. >> reporter: she tells us that her first child born 15 years earlier had this same condition and lived only a year and a half. as the infant's plight is rare, this is not an auge case. so when he leaves the hospital, she'll be in the regular public system. no fast track guaranteed care for this little boy. >> translator: she's scared. >> reporter: scared of what? >> translator: the same thing will happen as happened with my first. >> reporter: a seller at a street fair tells us she had appendicitis and was treated as a plan auge patient. she still feels she waited too long, but she was incredulous that the u.s. doesn't have guarantees of good medical treatment for every citizen written into its laws. >> translator: you would think a country so much bigger than

chile, so much more developed and advanced, you would think you could give people that right. >> the trick is really to find out how you spend on the things that are worth spending on. >> reporter: "newsweek" columnist robert samuelsson is watching the health care reform debate unfold in the u.s. as americans struggle with the competing priorities of covering the uninsured, keeping their physicians and controlling costs. >> we have not been willing to face these choices. and as a result, costs are out of control and to some extent we limit care for people. we kind of juggle these balls and we've got a system that's basically not working. >> reporter: chile's health reform did generate rebellion from some doctors. plan auge patients must receive very specific protocols or treatment regimens that are established by the state in accordance with medical experts. are you restricting in some way doctors' abilities to decide the best course of treatment for their patients?

>> sure. it's good. >> reporter: it's good? >> it's good. >> reporter: why is it good? >> because -- >> reporter: he says health reform in the u.s. must inevitably turn its attention from focusing on costs to focusing on goals. >> the health reform concerned the health. but do the concern the health -- the health outcomes? until the moment you will see which kind of health we have and what do we want to think, and then they put the money and the institution behind the objectivity. otherwise, you will discuss money. and money is another distraction. >> reporter: for "worldfocus," this is edie magnus in santiago, chile.

now staying in south america, we turn to brazil, a vast country of almost 200 million people where the focus is on providing medical care for the poor. edie magnus traveled there for a this next report on brazil's health care system. >> reporter: this unassuming medical clinic is on the front lines of health care delivery in braz brazil. located in villa canoas, a slum, in rio de janeiro, it serves some 600 families from the surrounding community. a member of the health team, some of whom live in the slum as a condition of working here, shows us around. >> translator: our vaccine campaign is done in this room. >> reporter: we move by the messages posted on the wall. warnings about the dangers of smoking and denges fever. the focus is not just lifestyle but prevention. >> translator: here is the doctor's room and she's currently seeing a patient. >> reporter: the young woman

being treated today is joanna. she's 17. >> translator: i decided to come because i had a strange pain and i got worried. they gave me the medication i needed and i was treated very well. >> reporter: and just as important -- did she have to pay for this visit? >> translator: no, i didn't have to pay. >> reporter: health care in brazil is a right. that's the law. and the state must pay for it. and so in this country of nearly 200 million people, there are no uninsured. and the array of free medical services extends from vaccinations to organ transplants to more recently sex change operations. since brazil made this vast array of services a constitutional right 20 years ago, many indicators of the nation's health have improved such as infant mortality and life expectancy. and while some wealthier brazilians opt out for private

care, today three-quarters of the population relies on the public system. >> i think any society has to provide basic health care for its members and especially those who are the most vulnerable. >> reporter: dr. daniel becker is an expert in health care policy and helped create the national program that provides free primary health care here. he says brazil's focus has been to deliver health care to those who need it most -- the poor, who make up some 60% ofbrazil's. >> i think this has been done to a certain extent not with the quality that we should have done it but we could have done it. but in many ways, in a pretty revolutionary and noveltive way. >> reporter: he's talking about the 25,000 community health care teams all across brazil like the one in villa canoas. physicians are paid up to three times more to work in the poorest, often most dangerous areas. it is personal and proactive.

they reach out even before the patients come in. >> translator: we try to always get into their homes. >> reporter: barbara gomez, 24, is what's called a community health agent. she lives in villa canoas and her job is to knock on as many doors as she can. >> translator: our work is to register all the residents. that way we can follow them. those who have hypertension, diabetes, those who are pregnant. we work in health promotion. it's not just about addressing the problem. >> reporter: in downtown rio, we stumbled on a storefront setup offering free vaccinations against measles, mumps and rubella. a woman in line was shocked to hear from me that shots in the states aren't always free. but offering so much to so many has put a strain on the system. >> everything is given and everything is a right of everyone, and everything is free.

so it is impossible, basically, doing that. >> reporter: with the current focus on primary care, it often battles for resources with brazil's hospitals. and the result, the hospitals often come up short. a recent study by the world bank called most of brazil's hospitals substandard and said that many deliver inefficient, poor quality care. >> the hospitals are a very serious problem. >> reporter: are there long waits for complex procedures? >> absolutely. yeah. very long waits and sometimes very bad quality. >> reporter: isn't this an inevitable consequence when you try to be all things to all people? >> no, no. because we have to have a social responsibility regarding health. ideally, you have to provide optimal health care to everyone. of course, at some point, the system will find its limitations, because you cannot do everything for everyone at any time. >> reporter: becker says brazilians still prefer their

system with all its flaws to that of the u.s. where so many people have no guaranteed access to care at all. >> i think this is really sad. a society which is so rich, to leave people out of the system because they're poor is -- it's pathetic. >> reporter: brazil is a good f the highs and lows of universal health care. i'm edie magnus reporting for "worldfocus" in rio de janeiro, brazil. now we're going to take you to asia, to singapore. according to the world health organization, singapore's universal health care system is one of the best in the world. how do they do it? well, the 4 million people there are required to save a portion of each paycheck, which then goes into an interest-bearing savings account used to pay future medical bills.

daljit dhaliwal went to singapore to take a look. >> for you because of your heart problems this is quite a risky procedure. >> okay, i understand. >> reporter: when this swiss national who lives abroad learned he needed heart surgery, he didn't go home for the operation. he went to singapore. the asian city state of 4 million where everyone has access to health care is famously healthy. >> singapore surpasses the united states in most measures when you look at the health of society. >> reporter: life expectancy in singapore is 82 years, compared to 78 in the united states. and singapore is achieving that success in a cost-effective way. the u.s. spends nearly 17% of its gross domestic product on health care. by contrast singapore spends only 12%, yet its health system is widely regarded to be one of the best in the world. so how does singapore do it?

american dan snyder worked in u.s. health care before taking over a hospital group in singapore. he says the singapore system works through a combination of quality care and a compulsory national savings program called medisave. >> throughout your working career and life, you're paying into a fund. that fund then grows in value over time. and then you use those resources to pay for health care. >> reporter: between 6% and 8% of every singaporean's salary is automatically deducted with medisave with employers also paying a smaller amount into those same individual accounts. while the government heavily subsidizes health care through taxation, patients are expected to make hefty co-payments, some as high as 20% for medical services. >> so there's a bit more responsibility on the part of the patient to understand and be accountable for their selection for health care. >> reporter: singapore's system emphasizes personal responsibility. because it's your money, the

thinking goes, you'll spend it wisely. and providers are less likely to perform unnecessary procedures when patients, not insurance companies, are paying the bills. >> the first question the mechanic will ask you is if you are insured. if he knows you're insured, he'll do a lot more things then. than what is necessary. in medical circles we call it overservicing. >> repter: it's consumer-driven health care that encourages hard work and clean living. >>so my medisave is mine. you are lazy, you work less, your medisave is small. i work more, i earn more, my medisave is large. i keep myself healthy. i hardly use it. i don't go to hospital. my medisave helps. i smoke, i drink, i'm obese, i don't exercise, my medisave gets depleted.

>> reporter: but medisave funds are largely restricted to hospital costs and can't be used for outpatient services like those provided by this doctor. he runs a small clinic just outside the city where his patients must pay cash. about $20 for this visit. this person is here for a persistent headache. but a bigger headache he says is his mother's medical bills. she worked off the books for a street merchant and never paid into medisave so he's paying out of his own account for her dialysis, about $250 a week. now he worries about depleting his own health care savings. it's a common complaint. >> talk to anybody in singapore. everybody is worried. and you ask them if you would have an operation or any major -- do you think you have enough? most of them will not be able to answer with confidence, yes, i have enough. >> reporter: and though

supplementary health insurance is available, it's not a popular alternative. the government does provide a safety net for those who haven't saved but some say the poor are less well served by the system. but because of the compulsory saving scheme, the concept of millions uninsured doesn't exist in singapore. >> where hospitals are open to all, rich or poor, and we heavily subsidize them. so we have less of that kind of a problem than you face in the states. and precisely because of that, we are beginning to see some american patients. >> reporter: a hysterectomy in the u.s. costs $20,000 on average. in singapore, it's $7,000. a hip replacement in the u.s. costs $43,000 compared to $12,000 in singapore. a heart bypass, $127,000 compared to $22,500 in singapore.

>> for 170 million americans, health care is delivered through private insurance companies such as united health care, aetna, others. 30% of health care premium that's paid to that company goes to administrative, overhead costs or administrative processing costs or the pocket of the company. >> reporter: could the singapore model work in the united states? >> i hesitate to say yes to that because health care is so politicized. there are now so many interest groups, it makes your reform even more challenging. >> the united states needs a national health plan. there are too many ceos of health care insurance companies that are making hundreds of millions of dollars delivering insurance when those dollars, in my opinion, could be better spent providing help to the population. >> reporter: i'm daljit dhaliwal for "worldfocus" reporting from singapore.

during the health care debate here, president obama talked a great deal about how much money is being spent on paperwork and other administrative costs attached to medical care. hundreds of billions of dollars, which he said could be redirected to the care itself. those savings are already being realized in canada, where basic health care is universal and in most parts of that country free, with remarkably little administrative work involved. edie magnus went to montreal to take a look at how canada's system works. >> reporter: it is morning in the cardiology department at the royal vic hospital, part of the magill university health center in montreal, canada. this doctor is preparing to operate on his 47-year-old patient. >> she's going to be undergoing

coronary angiogram to assess the patency of her coronary vessels. are they open, are they blocked. >> reporter: there's a can tell you about heart, about his patients, about the state of cardiac care today. but there's one thing he doesn't know and doesn't need to know -- what it will cost to fix her. >> everybody who comes in, they show their medicare card and all their services are free, from beginning to end. >> reporter: marilyn caplow is an administrative director at the magill university hospital. the administration of health care in canada is surprisingly simple even for the most complicated cases. >> we're not negotiating with insurers. we're not negotiating the value of different procedures with insurers. we're not paying a lot of people to make certain that everybody moves through the system as quickly as possible. >> reporter: of course health care anyone can have is health care everyone must line up for. and by now, the long waits for certain high-end tests and procedures in canada are well known. but consider this.

the royal vic is part of a six-hospital chain that sees nearly 700,000 patients every year. they do 34,000 surgeries. they deliver 3,000 babies. so how much manpower does it take to run the billing for all of this? here's the patient billing department all in one room. it's pretty quiet here. what would an equivalent hospital in the united states take to run administratively? >> you'd be talking 800, 900 people just for the billing. >> reporter: what are 800, 900 people doing? >> with each different managed contract, you have different rates. you have different things that need preauthorization and not depending on the contract. you haggle over every bill. you submit the bill. the insurer rejects it. you haggle. and it may take 90 days to settle one bill.

they don't have that in canada. >> reporter: rinehart is an economist at the university who has written extensively about u.s. medical care. while he does not advocate for canada's completely nationalized system, rinehart says canada could teach us a thing or two on how to save on so-called nonmedical costs, costs which he estimates accounts for 20 to 25 cents of every health care dollar we spend. as much as $450 billion annually. >> if you go out there, sure, they may have to wait for some mri image or for some heart procedure. but overall, the system produces very good health outcomes. so if you were to diagnose it like a physician, you'd give that system an "a" and you'd have a hard time giving more than a "b" to ours. >> reporter: so how do they run things? each hospital in canada gets a global budget, a set amount,

which is all they have to spend for the year. they don't price things like bandages or drugs or even overnight stays individually. administrator caplow admits there are sometimes problems. >> the frustrating part, i'll start with that -- is that the budgets do not always reflect growing numbers, growing complexities of patients, different procedures. so you could have a huge influx of some new kind of disease that we have to treat, but the budgets are not adjusted accordingly. >> reporter: still, she says the budgets overall are based on good patient care. and the hospitals don't spend a dime trying to lure new people in the door with the latest, greatest treatments. >> the more patients we have, the more endangered our budgets are. so we don't really go out and wildly advertise that we want more patients, because, in fact, that's more demand on our budget. for us, our business is health care.

and i think for the united states, health care is business. >> reporter: economist rinehart has estimated that if the u.s. cut administrative costs and ran its books more like canada, it could save enough money to fund universal health care for every american citizen. if true, that would give all of us something canadians take for granted about their medical coverage -- peace of mind, which they might tell you is priceless. this is edie magnus reporting for "worldfocus" in montreal, canada. that is "worldfocus" for this monday evening. a reminder you can find much more news and analysis on the web at worldfocus.org. i'm martin savidge in new york. as always, thank you very much for joining us. we hope to see you back here again tomorrow and any time on the wen. until then, have a good night. -- captions by vitac -- -- captions by vitac -- www.vitac.com

major support for "worldfocus" has been lind p. walter and the peter g. peterson foundation, dedicated to promoting fiscal responsibility and addressing key economic challenges facing america's future. and additional funding is provided by the following supporters --