The aim of this research paper is to discuss and compare health care systems in different countries and find out the best solution whether the dominance of public or private spending is optimal for the society; here the comparison between Canada, France and USA health care system will be appropriate. The United States is having many problems with the way the economy is today. The economy is at its worst, and the health care system is not any better. The United States has the most money spent per person on healthcare than in any other nation.
Even though health care in the United States is at its worst, the American people shouldn’t be spending as much money on it as they are currently paying. We should understand that health care should be considered a human right, rather than an economical benefit. However, there are two hundred countries in the World and many of them still lack an adequate health care system. First of all, let us define what health is. These can be two ways to define it: 1) Negative: the absence of disease 2) Positive: “a state of complete physical, mental and social well-being. (World Health Organization, 1946). Therefore we can outline two aims of health policy: to improve health and to reduce health inequalities. In terms of the first definition, the US health care system is efficient. In terms of the world-accepted definition, the second one, the US health care system is expensive and in many cases not efficient. Let us analyze the relation between costs and effectiveness in this system. First of all let us trace the development and progress of both health care systems.
The basis for current health care system was established after the World war II, when private doctors were serving most of the market. The traditional perception of health care as one of the paid services was and is still remaining the leading one. But it doesn’t give the poor, elderly and disabled people, who most often need the medical treatment, the possibility to receive this treatment. In 1965, however, the Congress introduced Medicare and Medicaid programs, which were tax-funded and offered medical help for those groups of society who were not able to afford to pay for medical care.
Naturally, this has caused the growth of health expenditures. In the 1970s the government was trying to stop the growth of spending on health care and offering different measures: price controlling and regulation of medical practice. These measures, however, didn’t work, as the doctors have been protecting their incomes. We can make a conclusion that the concurrence solely between GPs, private doctors etc. is not enough to maintain the balance of prices and provide the needs of consumers.
In 1980s a lot of insurance companies called “Health Management Organizations” (HMOs) emerged; they were not offering direct medical treatment, but were instead making contracts with private doctors and taking the insurance payment from citizens. This helped a little to reduce the growth of budget spending for medicine, but did not help to solve the problem in general, as they didn’t manage to perform a constructive structural change in health care system. The NHS services remained necessary for the less protected groups of society and their financing still was growing.
The policy of both presidential candidates in 1990s included the concept of “managed care”, which meant the further development of HMOs network and the participation of the employers in it. But statistics in the beginning of 2000s has shown us that not very many employers have accepted this offer, and those who were using “managed care”, were mostly big corporations. In 2002 Maxwell and Temin published a survey of more than 500 corporations in the US and it turned out that less than 10% of the employers offered “choice or fixed dollar contribution” [7, p. 9] to their workers. The reforms in 1990s years have been aimed to the reduction of budget costs involved into health care and stimulation of the concurrence between private doctors and NHS. In fact, they have contributed to the development of the private practice and GPs in the US and have strengthened their positions against those of the NHS workers. Currently, the health care system funding in the USA is one of the highest in the whole world, and the ratio between GDP and health care expenditures is likely to become even higher in coming years.
But there is a contradiction between these high costs and the effectiveness of the treatment provided by the system. The reasons of this phenomenon are different: starting from the bureaucracy and great administrative spending in the NHS system, the lack of regulation of private practicing doctors, ineffective management system of public medical treatment, the tradition of “waiting lists” etc. , ending with high tax rates and opacity of the NHS financing, and difference in NHS and GPs rates of earnings. from America’s Debate – Universal Health Care) The results of a public opinion poll have shown that still more people support the idea of Universal health care rather than the idea of private doctors’ system. Though on one hand, private practices and personal doctors are more convenient for those who want to get perfect and qualified medical services, and for those people who need to receive constant treatment, the majority is still consulting the doctors only in emergent cases and such people do not necessarily need personal doctors.
So we can make a conclusion, that together with the GPs and insurance companies, the NHS system is needed. Though on the other hand, it is clear that this system needs to be reformed; a lot of people are dissatisfied with the high tax rates and the fact that they do not actually know what their money are being used for.
The USA health care system is strongly funded but since the general system of prior treatment is not well-developed, people are tending to do directly to the specialist – this tendency is leading to the increase of number of hospitalization cases which could be prevented by the timely treatment and turning to the doctor. The evidence shows us that a lot of people in USA, who are uninsured, do not have enough money to turn to the appropriate specialist are unable to receive proper medical treatment.
In my opinion, the inefficiency of the health care system in the USA is depending on: 1) the lack of effective management in the NHS system; for example, in the last years statistics shows us that the administrative spending constituted about 25-30% of the whole health care financing; 2) the difference in earnings of the private doctors and those working in the NHS system: it has become rather difficult to attract qualified workers to the state system since they most probably can have higher profits in private sphere; 3) the lack of concurrence between the systems: in my opinion, they should both complement and compete with each other; only in this case the gap in growth of private doctors’ prices and the lack of effectiveness of HNS system can be eliminated; Question #1.
Now let us take into consideration the health care system in the UK. It represents the other scheme of governmental attitude and actions than in the USA: the UK health care system is based on the gate-keeping system. It means that people willing to receive medical treatment have to be first registered with the local GP, which gives the primary care. If the GP is unable to give the proper treatment, the patient is sent to public hospital and there receives the proper treatment. The priorities for the patients to receive medical care are defined by the waiting lists. On one hand, this system offers medical care for a bigger amount of people, than that of the USA.
On the other hand, the general quality of the treatment in it is relatively worse, because instead of turning to the proper specialist, the patient first of all has to visit the local GP which means the loss of time and money. And in addition to this, the bureaucratic formalities like waiting lists, registration etc. require a lot of time and effort. The health care system in the UK is primarily ruled by the government, and therefore has different problems than that in the US. The main of these problems are the following: 1) because of the absence of concurrence and publicly regulated salaries in the branch of health care, the doctors are in no need to improve their professional qualities, to work better and to provide new technologies, new treatments etc. ) instead of improving their work, the service providers are interested in keeping the budget allowance and stay on the same level of efficiency and productivity as earlier; 3) the system of performance indicators used in the UK to measure the qualification has proved to be not very effective because the specialists are interested rather in improving the indicators than the performance and specialization; 4) the doctors are not interested to use new technologies because they usually demand a lot of investments and do not guarantee the return on these investments; 5) the same problem that with the US health care system, but represented vise versa: the lack of concurrence between private doctors and national system; in my opinion, the concurrence between the two systems is absolutely important for establishing the balance between them, and between prices and quality of services on the health care market. The reforms of 1990s and 2003-2004 years were aimed to eliminate the main problems of public health care system.
Both reforms introduced by different governments were strengthening the role of GPs in the health care system and lowering the role of NHS; some analysts compare this reform with the “managed care” in the USA, but in my opinion, these reforms can hardly be compared, due to the different approach for health care regulation in UK and US. The reforms were not sufficient to solve all the problems related with budget financing and subsequent behavior of the service providers, but the increasing role of the GPs allowed to lower costs for the public system and enable them to offer more qualified treatment (which also contributed to the decrease of loading of the public services and also helped to reduce the costs). Question # 3. Let us compare the advantages and shortcomings of UK and the US health care systems. ————————————————-
UK: NHS health care is accessible to most people and therefore this system gives the possibility to improve health of the whole population; US: access to health care is only for those who are paying the insurance and/or the taxes, and therefore there are people that can’t receive necessary treatment; UK: people who can’t afford paying for medical treatment can still receive it and there is no need to take special measures to provide this; US: government has to take special measures for people that are uninsured or can’t pay for their medical treatment; UK: the general psychological effect of being cared of by the society exists; US: people are worried because there can be cases of not receiving medical care when needed; UK: it takes a long time and bureaucratic formalities to get access to a proper specialist; US: people can go directly to the specialist; UK: waiting lists and queues make the medical treatment worse and the resources are not spend effectively in this case; US: the market mechanism working in the health care sphere as well allows avoiding delays in receiving the treatment and allows using resources in an optimal way; UK: budget spending on health care is fixed on a certain level; US: budget financing the health care system is growing more and more with each year. In general, the specific treatments and professional health care services in the USA are much better than in the UK, but the probability of receiving medical care in emergent cases is much lower; and in general health insurance and health of the nation are more protected in the UK and in general, in countries where the public spending and governmental control over the health care system dominate over the private financing of this branch. The recent evidence shows us that such countries (UK, Italy etc. ) have higher health rate indexes despite the growing distrust of citizens to the national health care systems.
In my opinion, the introducing of the market forces into the relation between public and private sectors is the key solution to this problem: but the dominance of public regulation and financing over the private one has to remain in order to ensure the health of the whole nation. Throughout the World health, except the U. S. , care systems tend to follow general patterns. There are four basic models: Beveridge, Bismarck, the National health insurance, and the out-of-pocket. The Beveridge model named after the founder of British health care system William Beveridge. According to McCanne (2010), the majority of hospitals and clinics are owned by government. In this model the government is a sole payer, which controls the costs of medical expenses. Therefore, there is the tendency for low cost per capita.
The second model of health care named after a founder of European welfare Otto von Bismarck. The major principle of this system based on the insurance plans, which financed jointly by employers and employees. Moreover, the insurance plans are non-profit and cover everyone. The government tightly regulates and controls the health system, that allows to keep low medical costs. The third model is a the National health insurance model. It uses private sector of health providers, but payments come from a government based insurance, to which every citizen must pay. The National health insurance controls and keeps low prices for medical services, and tend to be cheaper and simpler administratively.
The last and most disorganized health system follows the out-of-pocket model. The major principle of that system based on the money and basically people with money can get the medical assistance, whereas poor get sicker or die. According to the World health report (2000) released by World Health Organization, France is the country that provides the best health care. The same report states, “The U. S. health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its performance. ” The question is, why equally strong, politically and economically, countries have such significant difference of health care performance?
Certainly, one of the major dissimilarity of the systems is the difference of health care models. The French health system rigorously follows only one, as most of European countries, the Bismarck’s model. At first glance it seems to be very similar to the American; both countries widely use an insurance system, where employers and employee are both responsible for an insurance payment. However, in contrast to USA, the biggest fundamental difference between the two systems is that the Bismarck-type health insurance plans have to cover everybody, and they do not make a profit. Opposite to France, the United States of America does not follow any of the models of health care.
American health care system have elements of all of the models. When it comes to treating veterans, it becomes a government owned and controlled system, as Beveridge model. For Medicare dependant Americans and population over the age of 65, our health care system uses the model of National Health Insurance, otherwise known as universal health system, which tends to be cheaper and simpler. The health care system of a working population, who gets insurance through the employer, is more aligned with the Bismarck model. Finally, for those fifteen percent of Americans, who do not have any health care insurance the current system becomes an Out-of-Pocket Model, which is primarily used in Third World countries.
Most of health care industries in the World, in order to be efficient, try to meet only three of the models, but very important basics: costs, quality and access. All those major elements of a health care system have a complex and often challenging nature; they often interlace with each other, what leads to a conglomerate of hard solvable health care issues. For example, the quality of care is tightly bounded to the cost of therapeutic and diagnostic procedures. Consequently, the high cost of health care puts access restrictions for certain populations. Therefore, one of the major health industry concerns is access to quality and affordable health care.
The French health care system combines universal coverage with a public–private mix of hospital and ambulatory care, higher levels of resources, and a higher volume of service provision than in the United States (Rodwin, 1993). According American Journal of Public Health 2009, France has a higher physicians’ density per population than USA. Moreover, there is a significant difference, of more than 50%, between physicians of general practice and more disparity in more specialized practices. It demonstrates that French health care is based on more generalized medicine, than the US, where high costly specialty medicine is common practice. France and the U. S. ace a crises of unprecedented scope. Both countries possess large and growing elderly populations that threaten to push the pace of health care price increases even higher than their already faster-than-inflation rates. (Dutton, 2011) However, France has wide access to comprehensive health services for a population that is, on average, older than that of the United States (Rodwin, 1993). France and the United States, relies on both private insurance and government insurance. In both countries, working populations generally receive their insurance through their employer. However, French health care is based on the National Health Insurance and there is no uninsured population.
French national insurance covers about 70 percent of the medical bills, the rest of the 30 percents is paid by private insurance companies, which are typically provided and paid by employer. Furthermore, contradictory to the common American opinion, that universal health care system does not allow one to choose doctors, hospitals and clinics, French people are not restricted in their choice of medical professionals and institutions, and they freely navigate themselves from doctor to doctor (Imai, Jacobzone, Lenain, 2000). In contrast to that, certain American HMOs allow their members to visit doctors strictly in their systems. The other tremendous distinction of the French health care system is that there is no discrimination of people with preexisting conditions.
Moreover, individuals with preexisting conditions have a priority and receive more coverage; patients with long-standing diseases, such as mental illness, cancer, diabetes, obtain 100 percent governmental support for all medical expenses, including surgeries, therapy and pharmaceutical agents (Imai et. al. , 2000). At a final point, most of American’s health budget oriented on the end of life diseases, which as a rule, heavily involve costly sophisticated technology and procedures that enormously brings operating cost up. At the same time USA still neglects major successful health care steps such as disease prevention and public health education. This perhaps explains, in spite of impressive achievements in the biomedical science and technology the US does not have a better health care performance.