Compare the U.S. healthcare system with the healthcare system of Great Britain, Japan, Germany, or Switzerland, by doing the following:
Identify one country from the following list whose healthcare system you will compare to the U.S. healthcare system: Great Britain, Japan, Germany, or Switzerland.
The healthcare system of Great Britain has been chosen for this assignment as it is perhaps one of the most comprehensive and well-known healthcare systems on the global scale. The National Health Service, or NHS, is a universal healthcare system that provides free at the point of access healthcare for everyone in the entire country (Bevan & Hood, 2006). The U.K. is interesting because it spends around half the amount of money per person on healthcare that the United States does and yet has a longer life expectancy and exceeds the U.S. on another of other standard measures of health (Bevan & Hood, 2006). Great Britain has been chosen here because it is a country that is close to the United States in many cultural aspects and therefore makes a good comparison in the area of interest, that is the provision of healthcare and the results that universal healthcare can have on improving the lives of a population.
Compare access between the two healthcare systems for children, people who are unemployed, and for people who are retired.
Every single person in Great Britain gets access to free healthcare, whether they are children, unemployed or retired (Schoen et al., 2006). This happens regardless of how much the individual has paid in tax during their lifetime, and is also unrelated to any health insurance that they may have. There are some small charges for medications, but these charges are set at a fixed price and are only payable by those who without an income (Schoen et al., 2006). Dentistry is also included in the NHS and again, there are some small charges that are set at a fixed rate that are only payable by people with an income (Swayne et al., 2012). Emergency care is all provided for free, including ambulance fees, which means that people do not have to be worried about covering the costs of emergency and unplanned care. There are some problems with the NHS, such as a lack of beds and a lack of funding, but as a whole the system runs smoothly and cuts down on a significant number of costs (compared to the United States) by not being required to employ staff to sort through insurance paperwork (Swayne et al., 2012).
Discuss coverage for medications in the two healthcare systems.
As explained above, there is a flat fee for medications in the U.K. that is only payable if the individual is earning money. Students, children, retired people and the unemployed do not have to pay this fee. Contraception is also universally free within the NHS, and medications for chronic conditions like asthma can be reduced in price by purchasing a pre-paid number of prescriptions (Swayne et al., 2012). In the United States, medication prices are set by the pharmaceutical company and thus can vary dependent on these rates, rather than the actual value of the medication. The date of the patent on the medication, for example, has an effect on the cost of a medication, rather than the utility to the patient (Schoen et al., 2009). Some patients are able to get free prescriptions through insurance systems (including governmental insurance) but this is not necessarily guaranteed.
Determine the requirements to get a referral to see a specialist in the two healthcare systems.
Within the NHS, referral to a specialist is perhaps a slightly more complex procedure than in the United States. The individual must first visit a general physician (or go to the emergency room) who will make a preliminary diagnosis and make recommendations for further care. This may include a referral to a specialist, who will then take on the case and liaise with the GP who will continue to provide ongoing care to the patient (Schoen et al., 2009). This collaborative effort means that information is communicated more easily between practitioners, something which runs less smoothly in the U.S. healthcare service. Mehrotra, Forrest & Lin (2011) suggest that there are a number of issues in the specialty-referral process that stem from the fact that patients have more choice in the U.S. and therefore may not see the same specialist throughout their care, or even the same primary provider.
Discuss coverage for preexisting conditions in the two healthcare systems.
The British NHS provides for all preexisting conditions as with emergency care. As noted above, the cost of prescriptions can be greatly reduced if individuals buy a yearly prescription which can save them money if they have a preexisting condition (Swayne et al., 2012). As the NHS is a provider of care at the point of service, it does not discriminate between preexisting conditions and new ones, and individuals can even make elective choices about their ongoing care, despite the fact that there are waiting lists for some of these services (Swayne et al., 2012). Preexisting conditions are far more complex in the United States. Many insurance providers will not cover preexisting conditions if they are known to the patient, and policies will be invalidated if the individual has not noted this condition on their application (Swayne et al., 2012). With healthcare reforms made by President Obama, insurers now have to make allowances for preexisting conditions and cover all patients regardless of their current health status (Swayne et al., 2012). Despite this, many of the policies provided by employers, for example, will not cover this and patients may have to take out additional insurance in order to ensure that they have full coverage.
Explain two financial implications for the patient with regard to the healthcare delivery differences between the two countries.
Evidently, the fact that the healthcare systems between the two countries are so different has a significant effect on the finances of the individual. There are no medical bills in the United Kingdom, which means that one implication is that no-one will ever go bankrupt from co-pays or insurance policy excess clauses (Swayne et al., 2012). This means that people can feel secure in their access to healthcare and do not need to save money for emergency medical care, which is something that cannot be said of the system in the U.S. The NHS acts more as a safety net, which could cause some people to be more reckless with their health, but there is no indication of this being a problem within the U.K. or any other country with socialized medicine (Swayne et al., 2012).
Another financial implication is on the macro scale, and refers to the hospitals and providers themselves. In the U.K., providers compete with each other for survival rather than to increase profit (Swayne et al., 2012). They are somewhat competing for government contracts which in turn leads to more money, but this is spent on equipment, bills and staffing. In contrast, additional staff members must be present in U.S. hospitals to deal with the competitive capitalist structure. These individuals need to ensure that patients are coming in and are paying their bills, which increases the cost to the hospital. Additional staff are also needed to deal with insurance paperwork, which again increases the overall cost of staffing for the hospital and makes the cost of treatments to the patient higher overall.
- Bevan, G., & Hood, C. (2006). What’s measured is what matters: targets and gaming in the English public health care system. Public Administration, 84(3), 517–538.
- Mehrotra, A., Forrest, C. B., & Lin, C. Y. (2011). Dropping the Baton: Specialty Referrals in the United States. The Milbank Quarterly, 89(1), 39–68. http://doi.org/10.1111/j.1468-0009.2011.00619.x
- Schoen, C., Osborn, R., How, S. K., Doty, M. M., & Peugh, J. (2009). In chronic condition: experiences of patients with complex health care needs, in eight countries, 2008. Health Affairs, 28(1), w1–w16.
- Schoen, C., Osborn, R., Huynh, P. T., Doty, M., Peugh, J., & Zapert, K. (2006). On the front lines of care: primary care doctors’ office systems, experiences, and views in seven countries. Health Affairs, 25(6), w555–w571.
- Swayne, L. E., Duncan, W. J., & Ginter, P. M. (2012). Strategic management of health care organizations. John Wiley & Sons. Retrieved from https://books.google.ca/