Different Models of Healthcare Systems
Different Models of Healthcare Systems Free Essay
Health care is one of the most important branches of human activity, and the work of this sector is controlled by government agencies in various countries. The provision of medical care, diagnosis, treatment, and prevention of various diseases require large financial costs due to the widespread introduction of various modern technologies in the practice of medical practitioners. Since health care costs are increasing significantly throughout the world, and the economy of only rich countries can afford to fully fund the activities of the medical infrastructure and pay for medical staff, problems arise in the availability of medical care to poor and needy populations. This problem arose in the United States of America, which required action from the government in the form of health care reform. In general, to evaluate the effectiveness of the US medical infrastructure, it is important to compare it with the models of healthcare delivery in other successful countries. Thus, the national health insurance in Canada, the national health system in the United Kingdom, and socialized health insurance in Germany will be compared with the healthcare system in the United States, taking into account the influence of the political factor on these systems.
The health care delivery system in the United States is funded from a variety of sources. The main players that provide payment for medical care of working citizens are private insurance companies that enter into contracts with employers. Thus, a person does not have the right to choose a service company since buying insurance individually is a real luxury that only wealthy people can afford. At the same time, the coverage of the insurance package provided by these companies includes the majority of common medical procedures and pays up to 80% of their cost. However, there is a problem with providing expensive medical care to socially unprotected populations, such as the elderly, the disabled, and the financially disadvantaged. The task of assisting such people was taken over by the US government. In 1966, the Medicare public health insurance program was launched for the provision of a range of basic medical services to people over 65 as well as people with disabilities, end-stage renal disease, and severe neurological diseases. A year earlier, Medicaid was launched to pay for a wider range of medical services to people below the poverty line. These programs have existed for a long time, but over the past two decades, medical expenses have begun to increase exponentially due to the development of modern technologies used in the treatment of mainly cardiovascular and oncological diseases. The proportion of elderly people has also increased significantly, which creates an additional tax burden on the working population of the United States because both programs are mainly financed by payroll taxes and the country’s treasury (Schoen, Doty, Robertson, & Collins, 2011). Because about 60% of the population had insurance from the employer in 2007, a little more than a quarter of the citizens used the state programs, and less than 10% had private insurance, a total of 84% of Americans had some kind of medical insurance (Kocher, Emanuel, & DeParle, 2010). However, about 47 million of the total population did not have any health insurance at all.
This situation forced the government to take action. Thus, in 2010, shortly after the election of President Barack Obama, the Affordable Care Act was signed and adopted by Congress. The law required a reform, which would take about 10 years and consist of the simplifying access to state insurance from Medicare and Medicaid and more stringent rules for the use of insurance by private companies, which could not refuse to issue a policy to already sick people (Rosenbaum, 2011). Special benefits are provided for employers in the field of small and medium-sized businesses while providing insurance for their employees. Resources for financing this reform were additional taxes from pharmaceutical companies and several other enterprises with large annual incomes exceeding hundreds of thousands of dollars. The implementation of this reform significantly improved the insurance coverage of the population, especially from socially vulnerable groups. Thus, by 2017, medical insurance provided by Medicaid and Medicare for projected to cover more than 58 and more than 74 million Americans respectively, which affected treatment outcomes, but significantly increased the cost of these programs (Kronick, 2017; Sommers, Gunja, Finegold, & Musco, 2015). The reform is regarded as ambiguous and has a large number of both supporters and opponents, but it is generally considered to be the main achievement of President Obama during his work as the President of the United States.
At the same time, it is very important to evaluate the experience of other countries with efficiently operating systems that provide affordable medical care to their citizens. Many countries have to use the services of private companies, although the main emphasis is still on public sector financing. Examples of such systems are national health insurance, national health system, and socialized health insurance.
The first option can be very clearly demonstrated by the example of Canada, where a special system has been created, which is funded by the state and provides insurance to the citizens of this country. This system is also informally called Medicare, which should not be confused with the American version. Many features are worth considering. First, due to the peculiarities of the administrative division of the country’s territory, Canada has ten provinces, and medical services are under the authority of these regional structures. At the same time, all of them are subject to national principles and are funded by both local and national budgets through taxes on the profit of large enterprises as well as taxes on sales and wages. All Canadian citizens can receive free medical care if necessary. In addition, socially vulnerable people in this country are provided with separate programs from local budgets that provide, in addition to basic services, a wide range of specialized services, such as dental and ophthalmologic medical care or the provision of expensive medicines (Schoen et al., 2010). In the US, there is disagreement on the part of various federal districts, because Medicaid does not provide an expanded range of services in some states even after the adoption of the Affordable Care Act (Sommers, Gunja, Finegold, & Musco, 2015). This is due to the heavy load on the economy of these regions, especially in the south-eastern part of the country. In general, Canada is a good example of a country that has been able to provide all its people with quality medical care.
The country in which the health sector is financed and fully controlled by the state is the United Kingdom. A special structure called the National Health Service, which is funded by state taxes was created in the UK to provide free medical care for all citizens of the country with an exception of several dental and ophthalmologic procedures. In addition, virtually all medical professionals are employed in this structure. This feature distinguishes medical practice in the United Kingdom from that in Canada, where most doctors have a private practice. A similar situation exists in the United States because most of the hospitals and doctors employed in them also belong to the private and not the public sector. Due to the peculiarities of the administrative division of the United Kingdom, four divisions of the National Health Service are distinguished in England, Wales, Scotland, and Northern Ireland. However, compared to the United States, this division is more conditional, since uniform rules apply throughout the country (Blumenthal & Dixon, 2012). Since the system is 99% paid from state taxes and covers virtually all areas of medical services, it ensures high satisfaction of the population with the availability and quality of medical services provided.
Germany is a good example of socialized health insurance. The main principle of this system is social equality, which consists in providing free medical care to every citizen of the country. The bottom line is that the insurance principle is used while working people pay taxes in half with the employer, and the socially unprotected and the unemployed receive insurance from the state. Such a system ensures the provision of quality medical care to all citizens in need, but at the same time it is extremely costly for the state and thus has undergone some reforms over the past decade (Grunow & Nuscheler, 2014). In particular, the system proposes the creation of such a regulatory structure as the state health fund, which will help ensure healthy competition between insurance companies, thus reducing costs without affecting the quality of services provided (Ridic, Gleason, & Ridic, 2012). In general, the principles of this system are difficult to extrapolate to those in the United States since the systems are working on different concepts but striving for the same goal – affordable medical care to all citizens of the country.
Politics plays one of the most important roles in shaping the structure of the health care system. This area is extremely socially important and concerns virtually every citizen of the country; therefore, it is a very good tool for various kinds of manipulations. This is especially clearly demonstrated by the reform in the United States, which is even informally called Obamacare and is considered one of the main achievements of the previous president, the representative of the Democrats. At the same time, one of the first cases of the newly elected President Donald Trump, the representative of the Republicans, one of the opponents of the reform, was the repeal of the law on health care reform, despite all the resources spent on it. One of the biblical principles of leadership during the presidency of Barack Obama was the commandment of Moses, which called for a close eye on petty criticism, in this case from the opponents, which resulted in a delay in signing the US state budget. Nevertheless, the President insisted on his principles and achieved his goals.
As for the influence of politicians in other countries, it is more interesting historically. For example, in Canada, Medicare has been functioning since 1967, which has proven its effectiveness and reliability. Nevertheless, the debate between the ruling forces and the liberals regarding federal contributions to the health care system continues to grow annually. In the United Kingdom, politics also played a role during the reform period. Although the system is fairly stable and does not require major changes at the moment, Teresa May is under pressure from politicians about the need to raise taxes to provide more adequate funding for the National Health Service due to the rising health care costs. In Germany, the system of social equality was established in the time of Otto von Bismarck, and although it has undergone several changes, the basic principles remained unchanged since then. At one time, the first chancellor succeeded based on the biblical principle spelled out by Barnabas eliminating the gaps in opinion and achieving the provision of medical care to all the citizens of his country.
Thus, the health systems of these countries are different but pursue the same goal, which is to provide quality and, most importantly, affordable medical care to all citizens. Different financing models demonstrate that a good result can be achieved using any method, and each country has chosen the appropriate development path. A significant role in the choice of the health care delivery model was played by the political situation in the countries and principles that were pursued by their leaders in various historical periods.