Comparative Analysis of Three Different Health Systems - Case Study Example

Comparative Analysis of Three Different Health Systems Comparative Analysis of Three Different Health Systems Introduction Healthcare system refers to the organisation of the institutions, individuals and resources in providing healthcare services to meet health needs in the specific population. The models may not be the same in different countries, but all models have a means of funding, reliable information and trained workforce. Development of policies in different states continues in ensuring that the country population have the best healthcare system that can take of the medical problems. Australia is not left behind with debate on ways to fund the prevention of the illness in the society. Country economic status plays a great role in determining the type of healthcare system that is applicable. Both the government and private sectors play important roles in determining and ensuring healthcare system become effective. Private sectors play a vital role when the population of the country is large. Most developed and industrialised countries have advanced systems that can cater for the larger part of their population. This difference is due to allocation of resources (Al-sharqi, 2012). There are different kinds of healthcare models that have differing characteristics. The models include Beveridge, Bismarck, National Health Insurance (NHI) and out-of-pocket models. Out-of-pocket model is common in underdeveloped countries and parts of China. Countries choose to implement different models of the healthcare system that best suit the population. However, there are countries like USA that has all the four models in their healthcare systems. In this article, we will consider the healthcare systems in Australia, Germany (Bismarck) and Great Britain (Beveridge model and others). The discussion will show how these healthcare system models work in countries while highlighting some of their disadvantages. Besides, the article will highlight some of the similarities in the healthcare systems in these countries with basis on the population sizes, religion and politics. Design and function of the healthcare system Germany The German healthcare system uses the Bismarck model where citizen are required to have insurance.The introduction of most of the reforms in the healthcare system in Germany took place in 2004 (Paloyo, 2014). The insurance schemes are in two models that are a health insurance scheme and private insurance health sector (Finkenstädt & Niehaus, 2015). Anybody earning less than €49500 per year fall in the HSI and those earning above €49500 can join the private insurance sector. However, there is no possibility of reversing back to HSI after joining private insurance sector, so most people remain in HSI. The founding principles of this health insurance scheme include corporatism, solidarity and subsidiarity. Each of the principles implies how the scheme should run in catering for the population. Solidarity implies that the government has man obligation of ensuring universal access to the health care system to those who cannot afford private health insurance. In this system, the insurance funds come from both employers and employees in the deduction from their payroll. Solidarity in the social partnership is evident in the equal contribution by both employer and employee to the insurance fund. In 2009, it became compulsory for German citizens and those staying for a long period in Germany to have insurance. The federal joint committee usually has the last word on who benefits from HSI on the categories in the benefits package. Coverage of long-term care is in the different scheme provided by the same carrier. The contribution is from both the employer and the employee with those without children paying more. There is also limit to a maximum amount depending on the care required. Unemployed individuals may also access the sickness fund through contribution or social fund known as Soziolamt for those who never worked. In Germany, there is sharing of healthcare responsibility along different levels that include the state, civil society organisations and the federal government. Physicians that are specialists and carry out ambulatory practices are members of the regional association that are also financial intermediaries and negotiate for contracts. The system has professional chambers that operate at the state lever but controlled centrally and are under continuous pressure for quality assurance. The majority of both public and private sector facilities are not profit. There are three types of hospitals in Germany depending on ownership that include non-profit private, for-profit private and public owned hospitals. Community hospitals have affiliation to the religion that is either protestant or catholic and partially receive funding from German church tax. Great Britain Great Britain uses the Beveridge model from William Beveridge, who designed Britain’s National Health Service. Other countries that have the same model or its variation as Great Britain are Spain, Cuba, New Zealand, most of Scandinavia and Hong Kong. Of all these countries, Cuba shows the highest application of Beveridge model. In this model, health care funding comes from the government from taxpayers’ money like funding (Gaffney, 2014). In Great Britain, a large number but not all clinics ownership is with the government. Through the system, patients never pay bills directly to the doctor for services. Some of the doctors are employees but even those who are not employed by the government also collect payments from the government. This system allows the government to ensure low costs on health services as they control what doctors do or charge. Hence, the healthcare system is in ownership and operates under government. The health care system in England has been in the transition to make the services better than in the previous times. The changes do not affect the patient’s ability to access free health services, but most change the running of the system. The National Health Service in England has the principle that health services should be accessible to all without any discrimination. NHS plays a great role in the prevention of illness other than previous focus on diagnosis and treatments. NHS England provides the support and ensures that the resources provide the best care for patients. In the new system, the clinical commissioning groups that include nurses, doctors and other healthcare professionals buy the services for their patients from service providers. Buying of the services takes place after proper planning in providing quality services. Health and wellbeing boards advocates for the rights of local communities and patients in receiving quality services. The new system in England provides more devolution of power giving both the patients and community opportunity to have more influence on the healthcare system. The department of health has the duty of ensuring people get quality services that increase life expectancy (UK, 2013). Besides, the department has the mandate to set budget and account for the system efficiency. The secretary of state has a major role in overseeing that the system work together in achieving the objective of providing quality health services to all. The system allows great freedom to the clinical commissioning group in planning and provision of services while the regulators ensure protection of the patients and community interest. Australia Australian healthcare system is complex hence mostly referred as the web (AIHW, 2014). It has both the public and private sectors participating in the provision of health services. There are even insurance services supported by the government while others are from the private sector. The government funding from insurance cover varies and sometimes require the patients to add their money in case funding is not 100%. This kind of complex system is inevitable when dealing with an individual from different backgrounds with varied needs. Most of the patients in Australia only visit the pharmacist or general practitioner when they are sick. The pharmacist and GP are part of the great network in the health system in Australia. Part of the network is the governance and support system that enable the delivery of quality services. The work involves all levels of government in planning and delivery of services. Public health services are available at the territory, state, local and Australian government. Public hospitals receive their funding from the territory, state and Australian governments, but management is through state and territory governments. These government levels also provide funding for different types of health-related programs including medical research and funds for health infrastructure. The funding for the health services is high with an estimation of 9.5% in the financial year 2011-12. The funding from Australian government includes universal public health care insurance scheme known as Medicare introduced in 1984 (Hajizadeh, Connelly & Butler, 2014). Contribution of 1.5% comes from the income of individuals while Australian government contribute the rest to Medicare. The insurance scheme has the aim of making services to health professionals cheaper. Medicare consists of three parts revolving around medical, hospital and pharmaceutical. The scheme aims at giving citizens access to adequate and affordable healthcare. There is also private insurance under a different provision. The private sector mainly includes private pharmacies, private medical practices and private hospitals. Almost 50% of the population purchase private insurance cover (PR, 2015). They receive their licences and registrations from the state and territory governments. NRAS formed from state and territory governments ensure that only qualified personnel provide healthcare services and facilitate mobility of the workforce. The healthcare system coordination remains the responsibility of Australian health ministers. These ministers are from the Commonwealth, state and territory each having jurisdiction in their areas (Dwyer & Eagar, 2008). Collectively, these ministers are called standing council of health with the common goal of overseeing implementation of the COAG’s reforms in health. The Australian government handles ensuring safety and quality of pharmaceutical products and appliances. Differences in the healthcare systems The political history of Germany plays a great deal in the choice of the model the country uses in the healthcare system. Germany uses Bismarck model from Otto von Bismarck due to the idea of unification of the Germans (Kulesher & Forrestal, 2014). This model has a basis in the political setup where the society needs to be united. The model survived many periods until the reunification Germany after World War II (PNHP, 2015). The model guaranteed unification through the principle of solidarity. This model is quite different from others like that used in Australia where there is a need for each to pay their insurance and top up required money when there is a need. In Germany, the insurance company usually takes care of all the bills. The model symbolises what most citizens in Germany will support while taking care of one another. No other healthcare system model has its basis on the principle similar to Bismarck model. The model also has unique characteristics that may not be the same as those used in other countries. Any individual must become a member of sickness fund that ensure coverage of all people. Most of the countries’ healthcare systems lack the part where individuals becoming part of sickness fund is mandatory. Payments to insurance in terms of salaries’ percentage ensure low earners pay the least amounts and those earning more pay higher amounts. It has simplified administration system that is easy to understand. One of the traits is the presence of non-profit and community hospitals that ensure wellbeing of the society. Also, classification of the physician as mandatory members of the regional association is unique to German healthcare system. Beveridge method used in Britain had the influence of equality in the health care system in being accessible to all. The idea is to consider health services important to the security of the money come from the taxes and not insurance contribution. The model gained usage after the soldier from world war needed medical care hence it from political influence. Great Britain has unique administration system that ensures the patients and community have a voice in the healthcare system. The main control of the health care system is through the health department, but power is more devolved to lower ranks. The system ensures the improvement of services continuously through the suggestion of patients and community that may lack in systems. The system also allows the government to control practices of health professionals uniquely through salaries. The system also allows the government to control the practices of medical practitioners. The idea of commissioning group requesting for payment from the providers instead of patients is unique to the system. The system allows planning before provision of health services that is also vital for the planning the prevention of illness. The system has led to great improvement in the healthcare system through budgeting for disease prevention. The reforms in 2009 allow undertaking of the NHS work out of the ITSC by private sectors (Whitaker, 2015). The Australian system is different from the German and Britain system. It has a slight similarity to German through the presence of insurance system. However, the coverage of the insurance is quite different from that in German. In Australia, there is the possibility of using personal money to top up where the insurance fails to pay. The German insurance system pays for all medical coverage without money from the pocket if the medical condition is under the benefits package. The possibility of payment also makes it different from the healthcare system used in Britain where patients do pay healthcare personnel directly. The type of health care system in Australia fit the country due to its economic status. Most of the individuals have the ability to pay for personal medical cover. The country has high life standards and quality education system. This reason explains why there are the possibilities of adding out of pocket money to cover a medical bill that insurance do not cover. Furthermore, the government subsidises close to 30% for those who buy private health insurance. Subsidising for the private insurance buyers is not common among many health care systems. The basis of the difference in the healthcare systems depends on the experience in politics, society and the economy of the country. Countries like Australia can do well with their kind of health system due low poverty levels. The administration system in Great Britain makes their system very successful in providing services to the people. The need for solidarity spirit in Germany makes the Bismarck model more acceptable. The German system is efficient in ensuring all individuals pay for the sickness fund and have access to healthcare services. The coverage from the sickness funds ensures equity and fairness in accessing health services. The availability of non-profit services from both public and private sectors in Germany ensure that services are cost-effective. Control of the cost is also through revision of expenditure in different areas. Creation of the Disease Management Programs in 2002 enables the sickness funds to take care of those who are having a chronic illness. This step has improved equality in accessing the health care services among individuals with such diseases. The Federal Joint Committee created in 2004 increases the compliance and efficacy. The quality of the services comes from the quality of the management through carrying out the obligation of educating the physician and testing the technology for drugs and procedures. Furthermore, hospitals get feedback from the patients and there are mandatory quality reports annually for all acute care hospitals. The system using National Health Service in Great Britain ensures accessibility of healthcare system to all patients. It does not depend on only those who pay for insurance or have money to receive healthcare services. The system has made the health services become a vital part of the society that the government fully funds. The system is effective in using funds with the approximate expenditure of $3405 per person annually. Besides, getting funds from the insurance systems has higher costs of operation than obtaining it through taxation. The only challenge is appropriate budgeting for the services to deliver. The quality improvement remains the responsibility of all working in NHS (NHS, 2013). The system in Great Britain has high quality with aims to prevent illness rather than just treating them. The patients and community have a chance through decentralised power in contributing to improve the quality of the services. The ability of patients contributions in improving the quality standards ensure there is an improvement in the quality of services each time. The department of health oversees that the efficiency of the system and ensure patients receive quality services. Australia has managed to maintain equitably and efficiency healthcare services through the policies. The ability is evident in the rise of expenditure towards health services over time. The policies balance between free market and efficiency in the system. The department of health and ageing collects revenue and provide subsidies that in turn ensure equity in accessing healthcare services. Decentralisation through states allows the state governments to become autonomous administers of health services. The government funding of those who take private insurance through the contribution of around 30% make the system more efficient in balancing the private and public sectors investments. At the same time, the government has Medicare that has universal safety for all citizens. The balancing of the private and public sector in Australia ensures maintenance in quality of services provided by both parties. Balancing the numbers of individuals in both sectors ensure that the public nor the private sector are not overwhelmed to maintain the quality standard of the services. Balance is mainly through subsidising the payment to the private insurance hence ensuring that some individuals get treatment from the private sector. The inability to balance between private and public sector has made most of the quality of health service in many countries to become worse. Reforms The German health care system needs reforms in the supply system so as not to have oversupply or undersupply. The quality of the services should not be left only to the management. German also faces a challenge in the provision of wrong incentives. Another area that needs reforms is the separation of the inpatient and outpatient care (Clarke & Bidgood, 2012). The outpatient and inpatient care need flexible care integration and management of the diseases. Undersupply occurring in the rural areas requires innovative approaches in the healthcare system. Coupling of the result and the payment will solve the problem of wrong incentives. Besides, the cost sharing may not be effective in enabling equity in Germany (Gericke, Dehn, Wismar & Busse, 2009). Most of the reforms in the Great Britain healthcare system took place in 2013. The reforms aim to solve the increasing changes and demands (Bickerstaffe, 2013). The commissioning group also became mandated in planning and buying services for the customers. However, the challenge remains in the appropriate budgeting for the services. There should also be extra amount to the care for emergency problems and prevention of illness. Part of the reform in the Australian health systems includes universal accessibility, equity and balance in the private and public sectors (AHCRA, 2008). Implementations of most of these reforms are already in place. The result is an improvement in the healthcare service efficiency and quality. The areas that needed reforms undermine the ability of the government to deliver the best services to the citizens. The main challenge for Australia is having an adequate number of healthcare service personnel to provide required services. The challenge is evident in the public sector due to workforce moving to the private sector (Richardson, 2010). Conclusion In the article, it is clear that different factors contribute the success of certain kind of healthcare system in a country. These factors range from social setting, politics to the economic status of the country. Each system has a unique characteristic that separates it from the rest. Each is facing challenges with German system has a problem dealing with inpatient and outpatient care. Great Britain faces the problem of proper planning and budgeting for the services. 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