Comparative Analysis of the UK Healthcare System and France Healthcare System: Lessons for the UK - Term Paper Example

 Comparative Analysis of UK Healthcare System and France Healthcare System: Lessons for UK Introduction A global perspective of healthcare systems suggests that there are two broad categories of healthcare funding. These include public-funded system and a mixed system of public-private funding as stated by Glennerster (2009, p.14). Either way, healthcare systems are anchored on strong policies that holistically cover all matters pertaining to healthcare and general welfare of the population. The aim is to provide quality healthcare in a standardized manner that is affordable and accessible to all member of the community. Milton Roemer first explained this underlying principle when he argued that an increase in the hospital bed density is likely to result in increased hospital bed occupancy. With these in mind, this paper presents a comparative analysis of the public-funded system of UK and the public-private mixed system of France. Besides, the paper examines various issues relating to sustainability and cost implications for the two systems in line with Roemer’s Law and the famous analogy of ‘tragedy of the commons’. Thus, the paper culminates with a succinct conclusion as to which system provides much flexible options and const-effective healthcare without compromising the quality of service delivery. Healthcare System in the UK The structural design of the UK National Health Service takes place in a manner that guarantees equitable distribution of healthcare resources. The structure allows coordinated management and monitoring to ensure professional diligence at all levels (Mossialos et al 2011, p.53). In line with service provision, the government through the NHS controls a massive 80% of the healthcare share. The other 20% is provided by private healthcare plans especially in cases relating to specific care such as dentistry and other medical practices that require specialized attention (Glennerster 2009, p.56). It is through this approach that the UK has scaled the heights of excellence in healthcare services delivery. Specifically, the UK health care system emphasizes that healthcare is an essential component in promoting the universal human rights. Where the system discriminates people on grounds of financial ability or social class, there is high likelihood that majority will miss out the basic primary healthcare. In addition, healthcare economists argue that the cost of poor health in a country is more expensive than the cost of integrated of healthcare funding (Azizi et al 2012, p.84). It is on such understanding that the UK government is determined to keep improving its policies to fund universal healthcare for all its citizens. The UK system receives funds through contributions from employers that accounts for 83.4% of the entire healthcare expenditure. This covers a comprehensive package for primary health care, prevention campaigns, rehabilitation services and mental healthcare as asserted by Glennerster Ashcroft (2011). The remaining 16.6% is augments by individuals through health insurance schemes or out-of-pocket expenditures on medical related services. According to Magnussen et al (2009, p.31), healthcare funding pool in the UK comprises general government taxations, NHIS and individual-based health insurance plan. The government obtains about 65% of its revenues from income taxes and other forms of tax such as corporate and VAT taxes. On the other hand, the National Insurance Scheme NHIS requires all employers to contribute about 13% of weekly income earned above £84. Employee contributes 11% for the first lot of income earned between £84 and £645 on a weekly rating. They are also required to submit an additional 1% for earnings above £645 UK (Commonwealth Fund 2010). Those who are self-employed also have a part to play. Their earnings are on a yearly basis from which they surrender 8% of profits not exceed earnings £33,540 and 1% of net profits above the nominal £33,540. In addition to a flat rate of £2.1 per week for all self-employed persons, most people in the UK as ascertained by Ashcroft (2011) deem the yearly rates affordable. Out these contributions, the government directly apportions about 22% to the NHS and another 20% to the NHIS. The rest is plunged in the general taxation revenue (Glennerster 2010, p.48). This is a typical case of the tragedy of the commons. The population is bound to comply with the dynamics of this system without having sufficient options to decide on the preferred service provider or how much to pay spend on one’s healthcare service needs. While the services might be good, additional enrolment of NHS subscribers will probably outweigh available resources in public hospital facility, resulting in potential deterioration of service quality as argued by De Young and Kaplan (2012, p.5). In UK, about 87% of NHS allocations go to public hospitals and other community healthcare services such as health campaigns and mass vaccination. The remaining 13% is distributed between general family health services and administrative services (Gapenski & Pink 2007; Simonet 2010, p.473). The allocation criterion takes into account all factors such as age variations, unique challenges that might affect the cost of service provision as well as any other significant additional needs all in all the 10 territories. On a different note, the support of health insurance plan helps individual members to recover costs of medication incurred in accordance with the policy specifications. This plan covers only about 11.4% of the entire population estimated at 63,047,162 (CIA Factbook 2012a). The rest of the UK population is comfortable and satisfied with the healthcare services offered in public hospital under NHS or primary healthcare trust. These services are readily accessible to the community. In context of the famous Roemer’s Law, healthcare facilities in UK are well equipped with hospital bed capacity of 3.4/1000 population. Nonetheless, the quality of service delivery might drop is the government does not get other sustainable ways of funding other than total dependence on contributions and general taxation (Azizi et al 2012). Healthcare System in France First, healthcare system in France depends on a balance approach to public-private funding. According to Lundy and Finder (2009, p.7), the French system implies a compulsory healthcare coverage for all resident citizens through its NHIS. This scheme provides about 99.5% of all healthcare needs to the public. At the same time, over 80% of all French residents have adopted an additional cover through private health insurance plans that are recognized and supported by the government. Secondly, the French system takes into account the challenges facing low-income families and other special groups such as cancer patients or nursing mothers. As such, this healthcare system provide free services to low income earners based on a mean-tested rational of public fund allocations as provided under the CMU (Couverture Maladie Universelle) program. Likewise, special groups are entitled to cost exemptions for both general and specialized healthcare obatinable from public or private hospitals depending on individual preferences (Rodwin 2003, p.32; Schmid et al 2010, p.447). As part of the cost-sharing model deployed by France, the government maximizes revenues from tobacco and alcoholic substances whose consumption directly leads to ill health and subsequent increase in healthcare burden. It is from these taxes that the government is able to fund public healthcare through coinsurance and copayment approach (Steffen 2010, p.358). With this arrangement, private practitioners can bill the cost to NHIS to reimburse expenditures within the coinsured limit and the client would top up any extra expenses above the set limit. Recent reforms brought about various changes in the French healthcare. For instance, coinsurance payments are now limited to 20% for in-patient services. This portion supplements the cost of hospital services with additional €16 copayment paid for every additional day in hospital but not exceeding 30 days of hospital care (Brunner 2009, p.2). Besides, outpatient services are funded by a predetermined 30% coinsurance with a supplement of €1 for consultation services not exceeding the annual upper limit of €50. Where the case demands extensive medical attention beyond the prescribed NHIS rate, the patient is required to augment the cost by up to €91. This amount of copayment depends on the severity and type of intervention required as discussed by Bodenheim and Grumbach (2009). In terms of cost exemptions, the French healthcare system exempts almost 10% of the population from coinsurance liability (Chevreul et al 2010, p.51). These include patients diagnosed with chronic ailments such as HIV/AIDS, diabetes, chronic mental disorders, cancers and high blood pressure among others. Expensive surgical operations and other disability medication exceeding 6 months are also exempted from coinsurance as reported by Lundy and Finder (2009, p.8). Other exemptions allowed by the healthcare system of France relate to cases of sexual abuse, maternal-child healthcare and medical care for the elderly above 65 years. People with permanent disability and war veterans are also exempted from cost sharing expenditures as observed by Simonet (2010, p.477). In cases where family income fall short of €18,766 per annum, the family may apply for a renewable exempt cover provided under the CMU Complementary program introduced in 2008. Otherwise, the cost of healthcare system of France accounts for a meager 3.5% of its GDP (Commonwealth Fund 2010; CIA Factbook 2012b). Issues in Healthcare Finance Comparative analysis of the two healthcare systems presents a number of issues of economic importance. First, public-private funding instituted by France has resulted in emergence of more hospitals including private and not-for-profit healthcare institutions. With an average bed density of 7.1/1000 population, the French hospitals operate at about 79% in line with Roemer’s Law (Heggenhougen et al 2009, p.61). On one hand, the emergence of more hospitals is a good thing since it increases accessibility to quality healthcare towards achieving the goal of universal healthcare. On the contrary, the cost-sharing model of France is an essential factor of controlling waste and overutilization of medical resources. This is practically applicable since the patient is bound to pay for any unallowable costs above the set limits of coinsurance. Patients can choose nay type of treatment they wish any doctor they would like to visit, but for every decision, there are significant cost implications as established by Bodenheimer (2005, p.849). As a result, the community including patients and hospital staffs are keen to avoid unnecessary out-of-pocket expenses and unwarranted bed occupancy even it the country has sufficient bed density per 1000 population. Since the government cannot afford to supply all the type of technologically advanced medical equipment in all healthcare levels, it is prudent to outsource such technology from private practitioners. Specialists are better placed to install specific medical machinery in their private clinic to serve the best interest of their clients. Coupled with legal implications for professional negligence, all practitioners especially in private domain are very diligent in their work and professional practice that might not abound in most public facilities. As such, the idea is highly achievable in a hybrid system of public-private mixed system where competition and accountability defines the level of survival and growth (De Young & Kaplan 2012). Strategies for reducing cost of poor quality Healthcare According to Brailsford et al (2012, p.4), contemporary healthcare systems should always aim at providing high quality services at minimal cost. When the quality of healthcare is high, a significant proportion of the population will be healthy thus reducing the burden on hospital and other medical resources. This is a synergistic concept of reducing long-term healthcare cost as argued by Gapenski and Pink (2007, p.114). The second viable approach to cost reduction was proposed by Irvine (2007, p.12). This requires an inclusive structure that allows a wide variety of options that brings more service providers and different funding sources. For that reason, it is advisable to have a mixed system that offloads the extra cost burden from general taxation to individual healthcare consumers. The concept relies on setting a definite funding limit as seen in France (Simonet 2010, p.482). This will force consumers to seek additional funding from personal health insurance or out-of-pocket copayments for any extra costs incurred above the set coinsurance limit. The third option is entrenched in behaviour change advocacies. Personal behaviours such as smoking and poor health seeking practices can result in ill health including cancer and compromised immunity. It is therefore advisable to institute policy measures that will promote positive behaviour change and desirable health seeking behaviour. For instance, the government can impose high taxes on tobacco and alcoholic products to discourage smoking and drinking. Funds collected from such taxes can be channelled to support healthcare systems as witnessed in France and Switzerland (Bodenheimer & Fernandez 2005, p.28). Conclusion With the increasing cost of healthcare, ‘the tragedy of the commons’ suggests that every healthcare system should regulate the level of resource consumption and accessibility (De Young & Kaplan 2012). This will instil some element of behavioural discipline among stakeholders in the healthcare system. Healthcare managers will be careful not to exhaust hospital supplies and consumers will be aware that excess consumption of available healthcare resources would result in creased taxation and household expenditures on health budgets. 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