National Healthcare - Essay Example

Introduction Health care is recognized as one of the most fundamental needs of society and considered as one of the key criteria for evaluating quality of life and its sensitivity to a country’s financial and political issues also make it an often-debated concern. Modern health care systems are generally a competency of developed countries: the common objective is to provide availability and access to health care to ensure public safety and welfare with or through public and private health care service providers. Two of the countries that are often used as standards of comparison are the health systems of the United States and that of United Kingdom (Davis et al, 2007). The contrasting health systems also provide an opportunity to compare the pros and cons of providing universal health care, allowing free market behavior to dictate cost and price of services as well as the application and effectiveness of government intervention and controls. US Health Care System As the world’s leader in medical research and technology, there is a common and high expectation that the health care system in the US to be of the same standard or status. The US is the only member of the Organization for Economic Co-operation and Development (OECD), commonly establishing the standards for social and economic development that does not provide universal health care. However, there are a number of federal services that provide extensive protection of identified key sectors such as Medicare, Veterans’ Health Administration Services, State Children’s Health Insurance Program and TRICARE. Thus, the US government is not only a health service provider but also the country’s largest health insurer. At the same time, the US provides one of the largest networks of public hospitals and emergency health response systems in urban areas. Universal access to health care may vary between states and there has been some effort to establish a universal health care system (Montreal Economic Institute, 2005). The US health care system has a high reliance on the private sector not only to provide health care services but also in financing the actual health care systems services. City hospitals operate in cooperation with the private sector, particularly medical universities for staffing and research. Though majority of citizens’ health care needs are accessed through private medical practice and services, the cost of such services are often supported by public health insurance systems, primarily by Medicare. Health care in the country is based on an employment-based insurance model: companies pay health insurance premiums associated with individual employees who also pay a factor based on their employment and at the same time, business taxes are in part paid to support social services which include health(Speller et al, 2009). Currently, as part of efforts by the government to reform the US health care system to become more cost-efficient and affordable to small businesses, a government-sponsored group health insurance programs parallel to federal health care insurance systems utilized by government employees. Health care systems in the US are considered to be market driven wherein premiums paid are to mitigate health care costs. This reduces premiums required but requires the establishment of HSAs or Health Savings Accounts and HRAs or Health Reimbursement Arrangements to support the cost of standard medical expenses. In such a system, consumers have greater control over the health care system that they get at the same time motivating providers to be competitive in the services or coverage that they provide (Hussey et al, 2008). UK Health Care System The United Kingdom’s health care system is managed by the National Health Service (NHS), a collective term used to encompass health services in England, Wales, Northern Ireland and Scotland. It is a publicly funded healthcare system providing full line dental and medical in and out of hospital care. This service also is extended to prescriptions, rehabilitation, public education and training, as well as emergency response. Health care systems in the mentioned countries are all independent of each other though there is no discrimination as to where services are to be obtained. It is largely funded though taxes and other government social security funding sources or generally as National Insurance contributions. However, private health services have kept pace with the NHS. In contrast, these health services have been funded through private insurance (Barry et al, 2009). The UK NHS is also the largest health care employer, the 5th largest workforce globally. Even private practitioners generally contract their services with the NHS. In addition to medical personnel, the NHS also employs social service and public administration personnel, a function that is usually separate in other countries’ public services. Another unique role of the NHS is that it is actively and directly engaged in the education and training of doctors. Moreover, licensure requirements prescribe a two-year training programme with NHS institutions which ensures that non-NHS-school educated doctors are trained under NHS system. The NHS also regulates the price of prescriptions and medications by subsidizing the cost of pharmaceutical goods or through endorsed legislation to set price of prescriptions and medications. Residence is the primary criteria for the acquisition of services but some exceptions are made residents who reside outside the country primarily due to the nature or requirements of the their occupations such as in the case of government or military personnel. Dependents of individuals are also entitled to majority of the services but limitations are set based on the extent of care or service. There are also restrictions on the services that will be compensated through NHS: the general rule being that expenditures that go beyond the ordinary requirements of addressing the health issue or conditions will be borne by the individual. Since majority of research and development is within the NHS system, private health services are often only chosen for expediency, preference or specialized health needs (Hussey et al, 2008). Analysis and Comparison Comparing these two health care systems, key differences can be seen in the extent and control of access, the degree of government power and the mode of financing services. These differences are influenced by the political, social and economic policies of each country. At the same time, these policies in turn impact not only health care service markets but also social services, pharmaceutical prices and channels and perspectives on health and well-being (Arah et al, 2003). The UK health system provides universal health care including primary and non-critical care needs. In contrast, US health care systems are largely accessed thorough health insurance systems. In this model, health care is provided and managed by the state or the government. In the US model, health care can be accessed from either private, government or semi-private service providers whose services are compensated primarily through health insurance funds (Speller et al, 2009). Generally, except for cases where in the health care client can access health care via specialized care services like Medicaid or Medicare, Veterans’ Health Administration Services, State Children’s Health Insurance Program and TRICARE, the choice for extent of coverage is based on the individually chosen health insurance or reimbursement system acquired (Fiander et al, 2003). In terms of market freedom, US health care systems allow for greater freedom. It is clear that the government has a higher degree of control over health care systems in the UK. Not just involved in the management and delivery of health services, the UK NHS also prescribes professional requirements for medical personnel; they also directly impact professional regulation and practice. However it should be noted that the US has one of the most extensive public hospital systems and is considered to be the highest investor in medical research, training and technology (Arah et al, 2003). The contrast lies in the US model is that even in public hospitals, management is done by private consortiums. Beyond state and federal regulatory measures, medical professionals are free to practice their profession across states and practices regardless of whether they studies or served with government medical institutions. The other contrasting of two health care systems is in its method of financing. In the case of the US, health-related payments, do not directly fund health care services but rather directed towards a health care insurance system, the actual health services accessed through private health service providers or in government (Fiander et al, 2003). Financing in the UK health system comes directly from health contributions or payments: the government collects the funds through salaries and then uses the funds to finance health services regardless of employment status or actual contributions with residency status as the primary criteria (Barry et al, 2009). Conclusion Both health care systems have their advantages and disadvantages and both health care systems are moving towards the other in an effort to increase efficiency and effectiveness of services (Hussey et al, 2008). There is a call for a more universal health care system while there is a move from the UK government to set in place better criteria for service delivery to reduce the abuses of the universal health care system. The former is motivated by the need of, “…some sort of universal health care would ease the economic burdens on families and possibly add to economic stimulus.” (Teslik and Johnson, 2009). For the UK, the impression is that though there is universal health care available, the strain of maintaining such access is reaching critical levels because of diminishing social capacity to support such services. This leaves the system open to abuse and even diminishes the perceived value of such services (Weisz et al, 2008). Either health systems can benefit by adapting the other’s key competencies (Davis et al, 2007). It is not just a matter of choice: critics of the US health system say that though Americans are being given choice in health care, the exorbitant cost of health prevailing in the market leaves them no affordable option. In contrast, the UK residents feel that they are made to settle for services that are stretched thin and not commensurable for the amount they are being asked to contribute to finance the universal health care program (Cribb, 2008). However, there is also a realization that what works for the other may not be readily effective if adapted since the two countries also contrast in its social and political perspectives regarding health care. The key realization is that there is a need for government and private sector to reach and equitably bear the burden of providing quality health care to the public, particularly its vulnerable and marginalized members. References Arah, O. A., Klazinga, N. S., Delnoij, D. M. J., Ten Asbroek, A. H. A. and Custers, T. (2003). Conceptual frameworks for health systems performance: a quest for effectiveness, quality, and improvement. Int. J. Qual. Health Care, Oct 2003; 15: 377 - 398. Barry, M.M., Allegrante, J.P., Lamarre, M.C., Auld, M.E., Taub, A. (2009). The Galway Consensus Conference: international collaboration on the development of core competencies for health promotion and health education. Glob Health Promotion, Jun;16(2):5-11. Cribb, Alan (2008). Organizational Reform and Health-care Goods: Concerns about Marketization in the UK NHS. Journal of Medicine and Philosophy Advance, 33: 221-240. Davis, K., Schoen, C., Schoenbaum, S. C., Doty, M. M., Holmgren, A. L., Kriss, J. L. and Shea, K. K. (2007). Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care. New York: The Commonwealth Fund Fiander, Matthew, Burns, Tom, Mchugo, Gregory J. And Drake, Robert E. (2003). Assertive community treatment across the Atlantic: comparison of model fidelity in the UK and USA. The British Journal of Psychiatry, Mar 2003; 182: 248 - 254. Hussey, Peter, Anderson, Gerard, Berthelot, Jean-Marie, Feek, Colin, Kelley, Edward, Osborn, Robin, Raleigh, Veena and Epstein ,Arnold (2008). Trends in socioeconomic disparities in health care quality in four countries. Int. J. Qual. Health Care, Feb 2008; 20: 53 - 61. Montreal Economic Institute (2005). Two myths about the U.S. health care system. Retrieved on July 12, 2009 from http://www.iedm.org/uploaded/pdf/juin05_en.pdf. Speller, Viv, Smith, Becky J. and Lysoby, Linda (2009). Development and utilization of professional standards in health education and promotion: US and UK experiences. Global Health Promotion, Jun 2009; 16: 32 - 41. Teslik, Lee Hudson and Johnson, Toni (2009). Healthcare Costs and U.S. Competitiveness. Council on Foreign Relations. Retrieved on July 12, 2009 from http://www.cfr.org/publication/13325/ Weisz, Daniel, Gusmano, Michael K., Rodwin, Victor G. and Neuberg, Leland G. (2008). Population health and the health system: a comparative analysis of avoidable mortality in three nations and their world cities. Eur J Public Health, Apr 2008; 18: 166 - 172. Selected Annotated References Fiander, Matthew, Burns, Tom, Mchugo, Gregory J. And Drake, Robert E. (2003). Assertive community treatment across the Atlantic: comparison of model fidelity in the UK and USA. The British Journal of Psychiatry, Mar 2003; 182: 248 - 254. Proposes that differences between US-ACT (assertive community treatment) and UK-ACT may reflect failed model fidelity UK health systems that may be reflected in the health care systems of each country respectively. Thus, comparing the two health systems would require the development of first an understanding of socio-political issues that impact perceptions of health care participation. Hussey, Peter, Anderson, Gerard, Berthelot, Jean-Marie, Feek, Colin, Kelley, Edward, Osborn, Robin, Raleigh, Veena and Epstein ,Arnold (2008). Trends in socioeconomic disparities in health care quality in four countries. Int. J. Qual. Health Care, Feb 2008; 20: 53 - 61. The study has three main conclusions: that there are social and economic disparities in health care quality and status in Canada, England, New Zealand and the United States. Next, such disparities are long-term in nature. Third, that though there has been open recognition of such disparities, there is likely no universal solution to addressing such disparities. Montreal Economic Institute (2005). Two myths about the U.S. health care system. Retrieved on July 12, 2009 from http://www.iedm.org/uploaded/pdf/juin05_en.pdf. The study shows that the cost health care insurance in the US is the highest in the world and there is a need to mitigate their cost to widen access and coverage, In contrast to popular opinion attributing the failure of health care systems due to the high degree of privatization, the study cites the high degree of regulation of the industry and the action of insurance systems as the more critical concern. Speller, Viv, Smith, Becky J. and Lysoby, Linda (2009). Development and utilization of professional standards in health education and promotion: US and UK experiences. Global Health Promotion, Jun 2009; 16: 32 - 41. According to the researchers, the advancement of international competencies in health promotion needs to begin with the definition of a standardized health promotion terminology. This is to enhance the standards and competencies used to evaluate health care systems, creating a platform not only for comparison but also the adaptation of best practices between countries. Weisz, Daniel, Gusmano, Michael K., Rodwin, Victor G. and Neuberg, Leland G. (2008). Population health and the health system: a comparative analysis of avoidable mortality in three nations and their world cities. Eur J Public Health, Apr 2008; 18: 166 - 172. The researchers highlight the importance of social conditions to realize improvements in population health. One of the key factors of achieving such a goal is developing disease prevention and health care that directly enhance social determinants of health. Thus, as much as health care systems are dictated by social and political conditions, health care systems also create such differences across countries focused on by the study. Read More