National Healthcare System in the UK - Assignment Example

 National Healthcare System in UK Contents Literature Review 2 United Kingdom 3 United Stated of America 6 Research Methodology 8 Key Findings 8 Expenditure 8 Usage of Healthcare Services &Other Statistics 9 Conclusion 10 References 11 Introduction The strong bond between United States of America and United Kingdom is indeed an inspiration and there is no doubt that both countries have helped each other in difficult times but with many similarities certain aspects of both nations differ sharply. The two nations have witnessed different circumstances throughout their development and as a result their policies and provisions for their citizens differ from each other. In the same way, Healthcare program s in both countries are different from each other to a great extent with some advantages and disadvantages carried by both. The national healthcare system of United Kingdom is probably the most comprehensive and largest state run healthcare system in the world. It is funded by tax payments from the citizens providing equitable services to all. Its comprehensive nature and the fact that it is owned and managed by the government, sets it apart from other programs prevailing in developed countries. On the other hand the US healthcare system is the most complex with its ever changing in nature as it is partially funded by the government and partially by the employers and in some cases by the individual citizens themselves. In this paper the research seeks to investigate and compare the advantages and disadvantages of healthcare systems prevalent in both countries taking into consideration various elements that make a healthcare program effective. Literature Review In most of the western countries, healthcare sector forms a major part of national budget. According to an estimate, healthcare forms around 8% to 15% of the overall national expenditure which is higher than other sectors including agriculture, tourism, education etc (Walshe & Smith 2011). The ratio shows that almost 15% of the national population is employed in this sector or has a family member in this industry. National healthcare system usually grows with rest of the economical setup and elements like religious bodies, social care services, employee unions and city governments play a vital role in its development and operations. Users of healthcare system are connected to it through main hospitals, private clinics, social service providers, ambulance service etc (Walshe, 2003). United Kingdom UK is one of the most established economies in western part of the world and it has a healthcare system which is completely funded by government and has a healthcare provision extended all across the country. Unlike other economies in the same region, UK is the only economy that funds its healthcare expenses through general tax collected and the state completely owns this sector and services associated to it. If evaluated in international terms, UK healthcare system levies lowest burden on the consumer and is exceptionally low in cost. It has maintained its position as a lowest spender of healthcare expenditure since past four decades. Since the healthcare sector is state-owned, the controls over expenditure related to research and development, medical education, supplies and procurement and overall operations, are exceptionally strong making it the lowest spender in healthcare sector (Paton 2006). Where these attributes are considered as the strength of UK healthcare system, critics have demonstrated a concern that UK has been under-spending in this area as compared to other parts of the economy due to which overall standards of healthcare services are not meeting the expectations of its users. According to Walshe and Smith (2011), UK has a huge population and as compared to other countries in Europe, it is under-investing in healthcare sector whereas it is expected to invest around 12% of its GDP in this area. In comparison to UK healthcare system, USA has a rather complex structure. The main elements of USA healthcare system includes public services for elderly and the impoverished with private insurances which are either provided by the employers or paid by the individuals themselves. Where UK has its healthcare services extended to everyone, a major share of population in USA either have no or limited access to healthcare services. Although in USA, healthcare services are provided on universal coverage basis which includes all kind of services, UK has no fixed benefit structure. Various aspects of NHS such as clinical services, access to hospitals, general medication, and nursing with social care services are all funded by the state. In some cases, users are expected to make a minimal contribution such as dental care and for certain medication however elderly patients and impoverished are exempted under the policy framework. The same applies to those with near end-of-life health conditions and diseases. However, this does not give users of healthcare services to have access to all the facilities. Instead there are policies and procedures that determine the needs of the patients and then access to certain services is granted accordingly (Walshe & Smith, 2011). Since the healthcare system is state owned, therefore other departments of national government also provide necessary to this department. All the individuals registered under national statistics division are provided enrolled for healthcare services and are entitled to have access to general practitioners. These general practitioners act as the front end of UK’s NHS and allow further access to use of specialized services, hence other than emergency conditions, patients cannot use specialist services until unless their GPs provide references. Since the national healthcare services are mainly funded by state and users have minimum contribution in it, therefore state uses rationing mechanisms to control it which provides minimum independence to the user (Walshe 2003). Usually there are waiting lists on surgeries and specialist services to which users have access only after the referrals from GP and these lists are governed by first come-first served rule or on severity basis (Ducket 2005). According to statistic provided by OECD (2012), average user has to wait for around 2 weeks to use specialist and surgical services. After 1997, England, Wales, Scotland and Northern Ireland amended their healthcare sector and brought them under the jurisdiction of national institutions such as parliaments and assemblies whereas the earlier model was a close replica of England’s department of health which is now run by Whitehall of central government (Paton 2003) . Now, the practices in four parts of UK are slightly different as compared to each other (Walshe 2003). Since 1990s, there has been a constant improvement and transformation in NHS model due to contributions made by Conservatives and new labour government as a result of which a managerial structure was introduced similar to business model however state’s control was also strengthen to ensure that performance and expenditures remain supervised (Paton 2006; Luna 2006). It is important to note that most of the general public considers current healthcare system as one of the most effective outcomes of post-war government in UK. As a result of it, social values such as equality, compassion are inculcated to overall social model (Shapiro 2005). However with the rise of consumerism, public’s tolerance for slow procedures involving waiting and tolerating under-managed infrastructure appears to have decreased exponentially. As a result of high public expectations current government reforms appears to be focused on revamping the overall operations within NHS which not only expedites the service provision process but also alleviates the service level. This attempt for reengineering the overall healthcare model is also perceived as a threat to uniform service provision (Department of Health 2000). Another criticism includes its vertical chain of command model, due to its state owned nature little efforts have been made to reengineer the infrastructure whereas overreliance on bureaucratic directions leave less room for innovations and necessary interventions. Where tremendous growth took place in UK as a result of deregulation by Conservative party in the pursuit of managing public sectors effectively, increase in investment in NHS went up to three times in this era (Paton 2002; Paton 2006). In short, it can be said that present NHS model in UK is an outcome of reforms that took place during 1980 to 1990s. As a result of this transformation, a business-model involving more delegation and managerial authority with auditing controls was introduced which induced better accountability standards having direct impacts on overall performance (Segall 2000; Dusheiko, Hardman & Martin 2010). However, actual reason for overall growth in this sector took place after 1997 when regulating bodies were introduced for monitoring of national healthcare services along with private healthcare services providers (Walshe 2003). United Stated of America In comparison to UK model, US healthcare system is rather complex in nature. It is partly state-owned and has major part of population using private insurance services provided by employers and procured by individuals themselves. This leaves a significant portion of population deprived of access to healthcare services. The structure is immensely complex and shows constant transformation which makes it difficult for state or even national healthcare authorities to have a defined model (Walshe & Smith 2011). As compared to UK, USA spends three times per capita on healthcare services which is even higher than most of OECD members (Walshe 2003). Since the system is not uniform or clearly defined, therefore, medical coverage has a variable structure. Even if the insurance is provided by the employer which usually forms an integral part of remuneration structure, the users are provided with low-end access which makes them deprived of other parts of healthcare services such as OPD and OR . For elderly patients and impoverished earning a certain level of per capital income, government provides healthcare services including clinical care, hospital access, social care services etc. However, the level of services and overall infrastructure is still compromised. Individuals who are unable to procure insurance or do not fall in the bracket defined by government, they have to pay for clinical services and other medication from out of the pocket (Schmidt & Kreis 2009). Most of the people in this group are those who are employed without insurance and have exceptionally low income (which usually involve non-citizens of USA from different ethnic groups) (Walshe 2003). Although where employers provide insurance, the covered healthcare services vary in nature and are usually limited. Private insurances require a high contribution from the users and have a restricted nature with minimum healthcare services covered (Walshe & Smith 2011). Unlike UK where there are defined bodies responsible for healthcare services provision, USA model has a lot of bodies involved from public as well private sector. Secondly, non-profit organizations also form major part of healthcare sector. There are also profit-based organizations that have stakes in hospital networks. Philanthropic organizations form a major part of healthcare services in USA. However, state owns main responsibility for major healthcare plans like Federal Employees Health Benefits Program (FEHBP). Even the employment of healthcare practitioners is highly diversified. Some are self-employed or engaged with physician groups where they are contacted by hospitals and insurers whenever required. Same goes for healthcare organizations where some offer a wide range of integrated service and some are of specialized nature (Walshe & Smith 2011). Due to diversity in overall healthcare structure, it is argued that cost of per capita healthcare has increased due to inefficient management including tremendous wastage where most of the healthcare services are under-used. USA is known for its market-driven healthcare system, with high costs, technological advancement and complexity of distribution of healthcare services among general population, provided by state and general insurers. Research Methodology Research methodology used in this research paper is of exploratory nature. The reason for choosing this type of research methodology was obvious as it involves systematic analysis of a wide spread national healthcare system with involvement of public as well as private organizations or entities. Therefore, extraction of primary data was rather difficult and complex to analyze, hence secondary data and peer-reviewed literature is used for research purposes. Key Findings Expenditure According to data provided by OECD (2012), public expenditure by USA and UK in terms of total healthcare expenses as a percentage of GDP included 48.2% and 83.2% in the year 2010-11, whereas total expenditure on healthcare in USA and UK forms 17.6 and 9.6% of GDP in 2010. As far as general funding is concerned, UK healthcare model is state-owned and funded by general tax collections. A minimum contribution is made by users of healthcare services in the form of out-of-pocket expenditure, on the other hand, total health insurance related to public coverage in United States is 26.4% as compared to 100% coverage provided by United Kingdom’s NHS program. Only 4% of UK population has private healthcare insurance as an alternative, compared to 54.9% population of USA which does not include complete medical coverage (OECD, 2012). In UK, point of access to national healthcare services is similar for everyone where GPs act as the main source of interaction between system and the patient. For specialized services, referrals from GPs and rationing are the pre-requisites, which is not a norm in USA where point of contact vary greatly in terms of different organizational models and presence of public as well as private authorities (Walshe & Smith 2011). Where USA national care system has many governing bodies having authority over accreditation and overall operations of healthcare operations, four countries of UK have singular authorities which in turn, delegate their authorization i.e. England healthcare system is run by National health care department whereas Wales, Scotland and Northern Ireland have their assemblies as the governing bodies. . Usage of Healthcare Services &Other Statistics According to data provided by OECD (2012), there are more physicians present per 1000 capita of population in UK as compared to USA despite higher expenditure i.e. 2.7 physicians in UK compared to 2.4 in USA. Furthermore, life expectancy rate of males at the time of birth in UK and USA is 78.6 and 76.2 whereas similar rate in females is 82.6 and 81.1 respectively. Hospital beds present for 1000 density of population are 3.3 for UK and 3.1 for USA. Out of Pocket expenses per person on healthcare annually are USD 306 in United Kingdom as compared to USD 970 in United States. Average length of stay in hospitals for acute care is 6.6 and 5.4 days in UK and USA respectively. Conclusion Thorough analysis of United Kingdom and United States healthcare system helps us in reaching a conclusion that where UK NHS is criticized for its bureaucratic structure and vertical chain of command, which allows minimum improvement due to lack of innovation and also for lower standard of services due to rationing system where public expectations are getting higher due to increased level of income, it also shows minimum wastages and medical coverage of 100 percent population which reduces economic disparity and ensures that equal level of services as well as necessary healthcare is available to all of its citizens. On the other hand, USA has a vast healthcare expenditure which forms a significant part of its GDP but wastages and inefficiencies are clearly reflected in its model due to complex national healthcare set up due to the presence of multiple authorities. Also, a major part of population is actually deprived of necessary healthcare access. Hence, it can be concluded that UK national healthcare system does have a huge room for improvement as the present system needs to be expedited and overall infrastructure can be reengineered according to public expectations however the prevailing model is comparatively efficient as compared to other western economies and ensures accessibility to all the citizens irrespective of their income level. References Department of Health. 2000, ‘The NHS Plan: A Plan for Investment, A Plan for Reform’. London, Stationery Office. Ducket, ST 2005, ‘Private Care and Public Waiting’, Australian Health Review, vol. 29, no. 1. OECD Library 2012, ‘Health: Key tables from OECD’, Viewed 13 November 2012 < http://www.oecd-ilibrary.org/social-issues-migration-health/health-key-tables-from-oecd_20758480> Dusheiko, M, Hardman, G & Martin, S 2010, ‘Competition and inequality: evidence from the English national health service 1991-2001’, Journal of Public Administration Research and Theory, vol. 20. no. 3. Luna, J 2006. ‘Falling sick: Britain's national health service’. Harvard International Review. vol. 28, no. 2. Paton, C 2002, 'Cheques and Checks', in Powell, M (Ed), Evaluating New Labour's Welfare Reforms l, Policy Press. Paton, C 2003, ‘The State of the Healthcare State’, Cambridge, Judge Institute. Paton, C 2006, ‘The changing political economy of the NHS’, Public Finance and Management. vol. 6, no. 4. Schmidt, H & Kreis, J 2009, ‘Lessons from abroad’. The Hastings Center Report, vol. 39, no. 6. Segall, M 2000, ‘From co-operation to competition in national health systems - andback?: impact on professional ethics and quality of care’. International Journal of HealthPlanning and Management, vol. 15, no 1. Shapiro, J 2005, ‘Markets in health care: Taking a tiger by the tail?’, Australian Health Review. vol. 29, no. 4. Walshe, K 2003, ‘Regulating Healthcare: A Prescription for Improvement?’, Philadelphia: Open University Press. Walshe, K & Smith, J 2011, ‘Healthcare management’, Open University Press. Read More