Comparative Analysis of Health Care Systems - Case Study Example

Comparative Analysis of Health Care Systems Name of student Institution affiliation Course title Name of instructor Date of submission Comparative Analysis of Health Care Systems Every state or nation of the world has in one way or the other a health care system in function. Such systems help achieve goals of maintaining a healthy people in the nation, administering treatment to the sick and to protect people and their families from the financial burden of medical bills. Different countries in the world have put in place different ways and strategies to enable them meet these goals of health care system. While these systems are representative of the common health care delivery, a country may have an alternative health care system within its population that helps her achieve the health care reforms. Despite the variations in different part of the world, health care systems generally follow four major systems. These systems include entrepreneurial, welfare-oriented, comprehensive and socialist. Of these four health care systems this paper takes a comparative analysis of entrepreneurial, welfare-oriented and comprehensive systems. The paper compares and contrasts the design and functioning of the three systems, explains why they are different from one another, evaluates the systems using the comparative analytical framework and finally evaluates the reform proposals for each of the three systems. Design and Functioning of the Systems Entrepreneurial Health Care System This system is also known as an Out-of-pocket model. It is designed to provide medical services depending on the financial ability of the patient. The basic rule for this system is that the rich get medical services while the poor live with the sickness or die. This system is common in the United States even though it has several systems in place for different groups of people. There are different sources of health insurance. Private companies provide private health insurance from the monthly fee paid to the companies by the subscribers. They are therefore responsible for paying the doctor and settling the hospital costs of the subscriber in case of sickness. In the United States, the government also provides health insurance to cater for medical care in case of illness. However, this is not universal as it is in other states where every citizen is covered. A majority of the population in the United States is covered by the insurance plans which pay most of the medical costs (Iglehart, 1992). The health care facilities are mainly privately owned and the doctors are individually paid for the services offered. The health care delivery in this system follows a fee for service model and without the fee; a patient may not receive the necessary medical service (Mahar, 2006). The private hospitals are all profit generating institutions and therefore consider payment for the services offered. The patient is obliged to pay the doctor directly for the services offered. The patients have the opportunity to choose the doctors to attend to them and the doctors have freedom to choose who to serve and which part of the state to work. The market incentives obtained from the medical services go into developing the health care services in the nation. This health care system is more dependent on the ability of the patient to meet the health care costs through employer or individual insurance thereby making health care to be an insurable risk. It is found in countries like United States, Indonesia and Philippines among other states. Work-oriented Health Care System This system is also known as the Bismarck model. The design of this health care system is aimed at making medical services universal and compulsory to all citizens which is achieved through employer purchased insurance. It is also designed to regulate the expenditure of health care services. It uses a social insurance system which is financed by both employers and the employees through deductions from the payroll. The health insurance plan in this system covers everybody in the country and is not aimed at making any profits unlike the United States insurance plans. For example, in Netherlands, all the hospitals are non profit therefore they are subjected to receive an annual income from the private insurers and the sickness funds contributed to by the employers and employees (Kirkman-Liff, 1991). Health care facilities privately owned in countries with this type of health care system. The doctors are usually family doctors who get their pay on a free-on-service basis. In Japan, the patients are also free to choose among the hospitals and the health care providers who are compensated by a uniform rate and method which is negotiated by the national council consisting of providers, insurers and the citizens. This makes this system to offer equitable access to health care services and controlled medical costs and expenditures. In this system, health care service is considered as a social right for each and every citizen of the country in which it is in effect. This system is found in Germany, Netherlands, Japan, Switzerland, Belgium and France among others. Comprehensive Health Care System Comprehensive health care system is also known as Beveridge model or single payer system since the government is solely responsible for the compensation of the health workers. This system is designed to provide a universal, comprehensive and accessible health care to all citizens. The design also controls costs of administration and medical care. The health care service provision is not discriminative on the basis of age, income level and health status meaning every citizen has access to medical services. The health care services coverage is universal and therefore all citizens are covered. The government is the one responsible for the provision and funding of the health care. This is done through tax payments. For example, in Canada, the provinces manage their own health care services through taxes and subscriber premiums. However, the national government also provides additional funds through grants and transfer funds generated from corporate and personal income tax (Iglehart, 1990) In this system, most of the health care facilities like hospitals are owned by the government. The doctors are also government employees even though some are private doctors. The private doctors are also compensated by the government for their services. In the United Kingdom, patients are not issued with a doctor’s bill. The cost per capita of this system is low because the governments which is solely responsible for the provision of the health care services is able to control the medical service costs and what the doctors are able to do. Doctors’ pay is determined through negotiations between the association of doctors and the government. The health institutions are independent, non profit generating and are managed by boards of trustees. The government’s sole responsibility of providing health care services to its citizens makes this system makes health care to be considered as a social service by the countries that practice it. Among the countries that use this health care system are Canada, Great Britain, New Zealand and Sri Lanka. What Makes the Three Systems Different? There is a significant difference between the three health care systems. These differences can be traced from historical, political systems, Historical factors in some of the nations of the world made them to adopt certain health care systems. For instance, due to World War II, Japan through its new constitution adopted a universal health coverage which made health care to be a social right for every citizen. Other states such as Canada have strong legal rights that that make them set laws that are considerate and all inclusive such as a universal health care system that ensures all citizens have a right to medical care. On the other hand, in the United States, the policy makers view universal health care as an infringement into an individual’s constitutional right. They therefore offer individual citizens to choose the kind of health care service they require. This is the reason why there is a significant difference between the health care system between United States and that of other nations in the world. Unlike other countries like Canada and Germany whose goal is to ensure the whole population has access to health care, the United States emphasizes on pluralism, free choice and an individual’s responsibility. The political system in the nations is also an important factor to consider when looking at the differences among the health care systems used in different countries. Unitary states like Netherlands and New Zealand are able to collect tax towards collective responsibility such as used in funding health care services in those nations. The federal governments have stronger tax base which can be utilized in funding medical care for all citizens. On the contrary, United States Federal Government has no such opportunity since the people are not willing to pay taxes which are to be used to finance health care for all citizens in the United States. Some countries like Great Britain have smaller geographical areas which make it easier for them to reach almost every citizen by health care services while larger states like the United States, Canada and Australia may find it difficult to use a single system of a universal health care provision. This is the reason why Australia has to use moth comprehensive and Entrepreneurial systems in administering health care to her citizens while United States has a conglomeration of health care systems aimed at meeting the medical needs of her citizens. Another factor that makes the health care systems adopted by different countries of the world to be different is the cultural differences. Some cultures are more concerned about whole while others are only concerned about an individual. The Americans are more individual centred and therefore only concerned about the individual that make them be reluctant to pay collectively contribute towards providing health care to all citizens. Americans therefore have no humanitarian feelings and reasoning (Campbell, 1982) about other people making the minority groups to be marginalised. This is contrary to what is seen in other states where people collectively contribute towards meeting the medical expenses of one another in the whole country irrespective of their financial status. Evaluation of the Health Systems To compare the health care systems, they have to be evaluated against one another. The mode of evaluation uses a comparative analytical framework is used. This framework analyses the equity, efficiency and effectiveness of the health systems. Equity Equity encompasses distribution and fairness of the health care services and costs. According to Aday et al. (1998) equity in health care is concerned with the disparities and fairness in the health care provision and in the effectiveness of the procedures used in addressing these issues. It also takes into account the right of a community to health care and wellbeing. There are several social injustices and barriers that prevent some special groups of people such as the disadvantaged, disabled and minority groups in the society. These barriers must be removed in order to ensure equity in health care delivery to all people without any form of discrimination. This will ensure that there is fairness in the distribution of health care (Donaldson and Gerard, 1993). In the countries like United States where entrepreneurial health care system is in effect equity seems to be compromised. Many people are denied opportunity to access medical care because of the high costs of premiums that prohibit them from getting the insurance cover. This is discriminatory since only the rich are able to pay such high premiums and consequently receive good health care as opposed to the poor and other minority groups. On the other hand, countries that have moth work-oriented and comprehensive health care systems tend to do better in ensuring equal access to health care by all citizens since the governments provides universal medical cover that is all inclusive meaning every citizen in such countries irrespective of social status is able to access medical care at all times anywhere in the country. Entrepreneurial health care system health care resources are unevenly distributed throughout the country. For example, in the United States, there is unequal distribution of physicians with majority being in states where people are rich and able to pay for high medical fees. Furthermore, the Medicaid that is instituted by the federal government in order to include the elderly, the extremely poor and children is only found in some states and not all. This cannot compare with the other states like Germany and Canada where every part of the country has physicians who are paid by the government and equal rate and therefore are equally distributed all over the country to meet the medical needs of every citizen. Efficiency In health care, efficiency focuses on the improvement of health provision and the available inputs needed to produce the services. Efficiency has two parts with one being allocative and the other productive (Aday et al., 1998). Allocative efficiency ensures that health is maximized given input constrain while production efficiency ensures services are produced at minimum costs. Work-oriented and comprehensive health care systems are often faced with challenges of resources like fewer hospital beds and deficits in managing the health program. Despite these constraints, these systems still ensure that patients receive the necessary health care. On the contrary, entrepreneurial health care system may not face any much constraint in health care delivery since the private health institutions use the profits to ensure that they improve their health facilities and services to meet the health needs of the patients. The health care delivery in the entrepreneurial system has to be maximized irrespective of the availability of resources since a patient pays for the services. Health systems where the government has full control of the health care prevision, the costs of health care services are regulated and therefore maintained to be as low as possible to avoid entrenching into the economy. The doctors are also compensated for their services by the government and so are obliged to provide the services at government set rates which ensure that they are efficient in their production of the services. Entrepreneurial systems that are profit oriented always aim at maximizing profits making their health services to be provided at relatively higher costs. The services are delivered in relation to the amount of money a patient has meaning the rich are able to get better and faster services while the poor are not able to get better health care due to inability to meet the high costs. This compromises production efficiency. Effectiveness Effectiveness is the extent to which a goal or a particular outcome is achieved. According to health care, effectiveness may be considered to relate to the improvement in the status of people with the health care provision. Effectiveness of health care services takes into account reduction in mortality and morbidity rates due to certain interventions. To compare the effectiveness of these three health care systems, the 2009 data is used. From the data, the United States had a total expenditure of $2, 324; Canada had $1,683 while Netherlands had $1,135. In the United States 11.8% of the Gross Domestic Product went to personal health compared to Canada’s 8.75 and Netherlands 8.35 (Schieber, Poullier, and Greenwald, 2010). United States has a higher GDP compared to other countries with different health care systems and so is likely to have a higher expenditure in health care. Another way of comparing the effectiveness in the three health care systems is by use of the data on infant mortality, life expectancy and perinatal mortality. In the United States, the life expectancy at birth for men and women are 71.5 years and 78.3 years respectively compared to Canada’s 73 and 79.7 years for men and women in that order, and Netherlands’ 73.3 and 79.9 years for men and women respectively. The data available on infant mortality is 10%, 7.2% and 6.8% in United States, Canada and Netherlands respectively. Another better measure of the effectiveness of the health systems is the parinatal mortality which measures the deaths within the first fist week of birth. Perinatal mortality stands at 9.75 in the United States, followed by Canada at 7.6% and Netherlands at 9.2% (Schieber, Poullier and Greenwald, 2010). These comparisons show that better health care is not measured in terms of the amount of expenditure on the health care. United States with its entrepreneurial health system spends a lot on health care yet the mortality rate remains high and the life expectancy is very low as compared to other countries such as Canada and Netherlands with comprehensive and work-oriented health care systems. Proposals for Reforms in the Health Systems In the United States, a recent proposal has been made by president Obama in order to provide health care to all people in America while gradually reducing the costs. The introduction of ‘Obama Care’ is likely to ensure equitable distribution of health care resources and services throughout the country (Houlton, 2012). It will also increase the effectiveness and efficiency in health care delivery because many people who are not able to afford the high costs of medication may now be able to enjoy these services thereby reducing the death rates and increasing the health status of the citizens. Canada which has over the ages provided comprehensive and universal health care to her citizens has been facing some challenges in the recent past due to changing trends in health, emergence of chronic diseases. These challenges calls for the development of the capacity to help respond to the changes in the needs of the Canadian citizens. The latest reform in the health system in Canada focuses on delivery of primary health care which emphasizes on preventing illness, managing chronic diseases and hastening the integration of the comprehensive health care services (CIHI, 2010). Another reform that is being proposed is the e-health technology which is aimed at increasing sustainability and efficiency in the delivery of health care services. The proposed reforms in the Netherlands health care system is the Universal Mandatory Health Insurance for all citizens. All citizens are to pay a tax that is channeled to the Risk Equalization Fund (Helderman, 2005). This proposed reform is aimed at improving the quality of the health care while lowering its cost. This reform will go into improving the efficiency of the health care system in the country. References Aday, L. A., Begley, C. E., Lairson, D.R. and Slater. H. (1998). Introduction to health services research and policy analysis in Evaluating the Healthcare System: Effectiveness, Efficiency, and Equity, 2nd ed. Chicago: Health Administration Press. Campbell, R. (1982). The Economics and Politics of Health. Carolina: University off North Carolins Press, 1982. Canadian Institute for Health Information. (2010). Health Care Reforms in Canada. Ottawa: The Institute. Donaldson, C. and Gerard, K. (1993). Economics of Health Care Financing: The Visible Hand. Houndmills: Macmillan. Helderman, J.K. (2005). Market-Oriented Health Care Reforms and Policy Learning in the Netherlands.  Journal of Health Politics, Policy and Law, 30(1), 189–209. Houlton, S. (2012). Debating Obamacare. Chemistry and Industry 76: 23. Igiehart, J. K. (1990). Canada's Health Care System Faces its Problems. New England Journal of Medicine, 322, 562-568. Iglehart, J. K. (1992). The American Health Care System: Private Insurance. New England Journal of Medicine, 326, 1715-1720. Kirkman-Liff, B. L. (1991). Health Insurance Values and Implementation in the Netherlands and the Federal Republic of Germany. Journal of the AmericanMedical Society, 265: 24-25. Mahar, M. (2006). Money-Driven Medicine: The Real Reason Health Care Costs So Much. New York: Harper Collins. Schieber, G. J., Poullier, J. P. and Greenwald, L. M. (2010). Health Care Systems in Twenty-Four Countries. Health Affairs. 10: 22-38. Read More