Download Analysis of foreign healthcare systems

Running head: ANALYSIS OF FOREING HEALTHCARE SYSTEMS
ANALYSIS OF FOREING HEALTHCARE SYSTEMS
by
Sonia Donaires
Applied Research Project Paper Submitted in Partial Fulfillment Of the Requirements
For the Degree of Master in Public Health MPH 500
Concordia University Nebraska
Dr. Hollie Pavlica
March 11, 2015
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ANALYSIS OF FOREING HEALTHCARE SYSTEMS
Introduction
This is a study of the Healthcare system of the United States in comparison with the
three types of Healthcare system adopted for developed countries. The purpose of this study is
to identify different characteristics of different healthcare systems from other countries that can
be useful and applicable to the healthcare system of the United States. I will also describe the
prices of low premium and deductible in the Health Insurance Marketplace of the government
for an average income and a minimum wage of the State of Texas. Finally, I will provide some
recommendations about the changes that can be made in the healthcare system of the United
States.
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ANALYSIS OF FOREING HEALTHCARE SYSTEMS
Analysis of Foreign Healthcare Systems
The healthcare system around the world has three different types of healthcare financing
systems. First, it is called the “national health insurance system that is publicly financed and the
medical care is provided by private practitioners” (Teitelbaum & Wilensky, 2013, p. 64).
Canada is an example of the National Health Insurance System. This healthcare system is
characterized by a universal coverage of all citizens, without regarding their age, income or
physical condition. All residents get medical care free of chargers. The federal government
subsidized: prescription drugs, public health, health research, and provide health services
special population such as, veterans and indigenous people. Canada's 10 provinces has their
own autonomy to pay coverage for their population. Additional funds come from public taxation.
The federal government pays 70% of medical expenditures from the tax revenue, Private
insurance pays a 12%, patients pay 15% and other sources 3% (Teitelbaum & Wilensky, 2013).

Quality of care- the federal funded Canadian Patient Safety Institute implements
strategies to improve medical care. However, one of the problems that need to improve
is the administrative efficiency and service quality.

Accessibility of care - is unsatisfactory, because the wait time is longer for patients in
need of medical care.

Affordability of care - all citizens in Canada are covered and they have access to medical
care free of charge.

Private options - there are private insurance that covers goods and services such a
dental, vision, OTC drugs, alternative medicine. (Schabloski, A. K., 2008)
Second, it is called ”a national health system which is publicly financed and where care is
provided by government employees or contractors” (Teitelbaum & Wilensky, 2013, 64).
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ANALYSIS OF FOREING HEALTHCARE SYSTEMS
Great Britain is an example of this type of health service finance. Britain’s healthcare system
is considered as a universal coverage. The National Health Service (NHS) provides full
coverage for all residents in United Kingdom. The primary care focuses in mental health care,
acute care, and ambulance services (Schabloski, 2008).
This system is financed primarily by public taxation and social security contributions. The
federal contribution which is the National Health Service (NHS) provides with 81.5%, the
national insurance contributes with 12.2%, patient contribution is 2.1%, other sources 1.2%, and
private funds of 14.6% total health expenditures (Schabloski, 2008).

Quality of care - The local health care and social service agencies, ensure that the
needs of the community would be covered. They monitor hospitals care and are
responsible of the quality of care.

Accessibility of care - because this is a universal health care system, all population has
access to medical care.

Affordability of care - is available to all residents. Patients contribute with the only 2.1%
of the health expenditures.

Private options - only 10% of population have private insurance and most of them are
high-income levels or better socioeconomic status (Teitelbaum & Wilensky, 2013)
Third, it is called “socialized insurance system that is financed through mandatory
contributions by employers and employees and in which care is delivered by private
practitioners" (Teitelbaum & Wilensky, 2013, p.64).
The healthcare system of Germany is a Social Health Insurance System (SHIS). SHIS
provides services such as, impatient services, outpatient services, medications, rehabilitation
therapy, and dental benefits. The government regulates the SHIS sickness funds. Based in this
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ANALYSIS OF FOREING HEALTHCARE SYSTEMS
model, the individual pay a solidarity tax and health insurance premium to the sickness funds.
Under this model, the contribution come from the employers and employees in equally parts.
Employers contribute with 7.6% and employees contribute with 6.6%. Premium subsidies are
from people with income lower than $60,000 per year, retired, students, disabled, homeless and
unemployed (Schabloski, 2008).

Accessibility of care - population in poverty and low income has access to medical care
through SHIS. If the patient is not able to pay their premium, the welfare system covers
the cost.

Affordability of care - population that earn less than $60,000 per year need to enroll in
SHIS or get medical insurance from private insurances

Private options - are for those that have higher and stable income. These people have
the option to buy private insurance to supplement to the SHIS funds (Schabloski, 2008).
Health Care System of Japan
Japan’s healthcare system is a model of social insurance or collects the universal Public
Health Insurance System (PHIS). Services covered by this system in Japan are: hospital care,
ambulatory care, mental healthcare, approved prescription drugs, home care, physiotherapy,
and most dental care. The PHIS is financed by the contributions of public taxation and private
insurance. Consumer’s Premiums is based on age, income and disease status. Premiums can
vary from 6 to 9.5% of monthly income and copayments range from 10-30% (Schabloski, 2008).

Quality of care is focus in primary care and there are not wait time. Patients can have
access to the medical services anytime.
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ANALYSIS OF FOREING HEALTHCARE SYSTEMS

Accessibility of care - medical insurance is a requirement by the government. Medical
insurance are obtained through their employers or the community- based insurer. The
government provide healthcare to the poor.

Affordability of care - all population in Japan is covered. It is not necessary to make
appointment to go to the doctor. The access to medical care is anytime with low
copayments. All insurers pay the copayment of 30% for services. Providers are not
allowed to charge extra fees.

Private options - purchases of private medical insurance are for cash benefits and cost
sharing (Schabloski, 2008).
Contributions of the United States’ Healthcare System to the World
Indicators that evaluate the effectiveness of a healthcare system of a country are based on
quality and access. Focusing on indicators to evaluate only quality care are: medical research,
life expectancy, infant mortality and mortality amenable to healthcare. In the healthcare system
of US, the quality of medical research is the indicator in which US excels in comparison with
outcomes of other healthcare systems. Some outcomes that improved the healthcare system of
the U.S. are:

Cardiac deaths decreased by two-thirds over the past 50 years.

Childhood leukemia has increase in treatment and cure

Medicine and physiology were awarded with the Nobel Prizes to more Americans in
comparison with researchers all over the world.

US companies make 8 of the 10 top-selling medical drugs in the world.
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ANALYSIS OF FOREING HEALTHCARE SYSTEMS

The survival rates in relation to breast, colon and prostate cancer are higher in
comparison with the world (Irvine, 2002).
The large amount of money expend has benefited the population in terms of research and
innovation and contributed with a lot of knowledge to the world.
What country could we learn the most from?
First of all, there is not a perfect health care system. Every health care system around
the world has advantages and disadvantages. The two countries that may help to learn
something and can be applicable to the healthcare system of US can be Canada and
Netherland.
Canada has a capitalist economy similar that US. Some characteristic that can be useful
to the US is the Canada’s universal coverage. The provincial government pays the costs of the
plan as the only source, reason for which, the administrative costs are lower. Also the federal
government provides additional funds to the health expenditures. Doctors are paid according to
fees that are determined by negotiations between the provincial government and an association
of doctor. (Baribault & Cloyd, 1999)
The Netherlands is socially administered. There are three funding: the sickness funds
that come from the employers, employees, retirement funds, and unemployment funds. Private
health insurance is conditioned to the age and sex. Employees that buy insurance receive
contribution from their employer. The Exceptional Medical Expenses Act are designed for longterm care, maternal and child health care service, these are supported by the government and
mandatory contributions of the employers. (Baribault & Cloyd, 1999)
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ANALYSIS OF FOREING HEALTHCARE SYSTEMS
Canada and the Netherlands’s expenditures are less than the USA health care system.
The point is that these countries showed that is not necessary expend large amount of money to
have a quality of health care system.
Identify a few key changes that would need to be made in the US in order to mimic an
existing system
Accessibility to medical care is one of the key changes that the healthcare system of the
US should consider. The federal government should make provision for those who are at high
risk of not being able to have insurance such as: children, young adults elderly, and homeless.
Those are the major problems in today’s healthcare system. The access for all population in US
to medical care requires an affordable medical insurance and subsidy by the federal
government.
Medical insurance would be another key changes that US’s healthcare system should
review. The idea for these reforms in the healthcare system is that private insurance companies
be willing to be monitored by the federal government. Some main points that would be beneficial
in these changes are:

Private insurance companies will be willing to offer standard benefits for all insured, such
as: general practitioners, hospitals, maternity care, lab tests and medicines. Other
services not provided can come from additional private insurance.

The consumer should pay same flat premium to their insurer.

People with lower income should have the federal subsidy to make affordable the
standard premium. (Admin, 2009)
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ANALYSIS OF FOREING HEALTHCARE SYSTEMS
Consider the principles of autonomy, capitalism, and individualism that characterize the
American people and describe how those changes would fit/or not fit with changes
needed to adopt another country’s healthcare system.
Autonomy is the “personal rule of the self that is free from both controlling interferences
by others and from personal limitations that prevent meaningful choice” (Pantilat, 2008).
Capitalism is an economic and political system that USA adopted. Under capitalism the
State gives the right that private owners control the trade and industry (Pettinger, 2013). This
group of capitalism tends to monopolize the goods and services with the only purpose to gain
profit.
The best definition that suit in this study for individualism is “ a doctrine holding that the
interests of the individual should take precedent over the interests of the state or social group”
(www.thefreedictionary.com)
The definitions of the three principle above mentioned are principle of the “political
culture” that are parte of the strong beliefs of American people (The American Democracy, 2008
p.6). These principles are the reason for which this country was built. Every reform proposed
that goes against these principles are debated and carefully studied by the different political
parties. The principle of Individualism states that every “American should take responsibility for
themselves” (the America Democracy p.6) i.e., that the government give them “the chance to
succeed in their own welfare” (The America Democracy p.9). I think, these are the cause for
what is difficult to make reforms into the system. The health reform of the Affordable Care Act is
the beginning for changes in the healthcare system of US in the following years.
Based on your discussion of autonomy, capitalism, and individualism, identify any
barriers to successful healthcare reform that may or may not exist in our society. If none
exist, state that and explain your answer.
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ANALYSIS OF FOREING HEALTHCARE SYSTEMS
One of the obstacles that the healthcare system in the US has, is capitalism. As I
mentioned before, the healthcare system of the US is not a unified system. Multiple payers and
providers finance it, this is the cause for which is difficult to make reforms in the healthcare
system. On the other hand, if there are disparities in the healthcare system of the US, it is
because of the capitalist economy. Besides, these groups that monopolized the goods and
services protect their own profit without considering the necessity of the population. Another
group to mention is the interest groups. Even though, those groups work in benefit of people
and have strong influence in relation to propose decisions to members of the congress; they
determine policies and laws that not only benefit the population, but they also protect their own
interests.
Description of a plan in the Health Insurance Marketplace (HIM)
This review is according the Healthcare.gov. This is a description of the lowest premium
plan in the HIM. The premiums, deductibles, and copayments of an average income between
$40,000 to $50,000 is:

Blue Cross-and Blue Shield of Texas – Blue Advantage Bronze HMO SM 006.

Estimated Monthly Premium $269.

Estimated Deductible of $12700

Estimated Out-of Pocket: Maximum of $12,700.

Primary doctor, Specialist doctor, and emergency room care, generic drugs: No charge
after deductible
The lowest deductible for the plan above mentioned is:
Assurance Health – Assurant Health Platinum Plan 002.
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ANALYSIS OF FOREING HEALTHCARE SYSTEMS

Estimated Monthly Premium $1025.

Estimated Deductible $0.

Estimated Out-of-Pocket Maximum $4,000.

Copayments/Coinsurance:

Primary doctor and specialist doctor: $25

Emergency room care: $100 Copay before deductible/ 25% Coinsurance after
deductible.

Generic drugs: $10 (Healthcare.gov,
The low premium is $269 monthly, in the Health Insurance Marketplace is less than the
coverage of my employer offered. Also, the highest premium of $1025 is less than my employer
offer. There is a difference of $260 that I am paying in comparison with the Health Insurance
Marketplace.
The minimum wage in Texas us $13,920 yearly. An individual with this income probably is
not eligible for help paying for coverage and the minor may be eligible for Medicaid and /or
CHIP in Texas
What is the lowest premium plan?
Blue Cross-and Blue Shield of Texas – Blue Advantage Bronze HMO SM 006.

Estimated Monthly Premium $250

Estimated Deductible $6,000

Estimated Out-or-Pocket Maximum $6000

Copayments/coinsurance: Primary doctor, specialist doctor, emergency room care, and
generic drugs: No charge after deductible.
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ANALYSIS OF FOREING HEALTHCARE SYSTEMS
What is the lowest deductible plan?
Assurant Health – Assurant Health Platinum Plan 002

Estimated Monthly Premium $ 781

Estimate Deductible $0

Estimated Out-of-Pocket Maximum $ 2,000

Copayment/ Coinsurance: Primary doctor and specialist doctor: $25

Emergency room care: $100

Copay before deductible/25%

Coinsurance after deductible

Generic drugs: $10
Are you surprised by anything you learned while on healthcare.gov?
I think, in the Health Insurance Marketplace is more affordable than to get covered
through my employer. But, the deductible is higher ($12,000). You cannot see a doctor until you
paid $6000 out of pocket. This is very inconvenient for all people that live with an average
income. If I understand well you are not covered until finish paying the deductible. Besides,
every year you need to renew your contract with your insurer. The insurer can raise the
premium and you keep paying the deductible and you still are not covered to get medical care.
Thinking about the minimum wage earner you found a plan for, even with insurance, do
you think healthcare is now affordable for him/her? With the expenses related to the
copays/deductibles, do you believe he/she could go to the doctor regularly with a
chronic illness (diabetes, congestive heart failure, COPD? What about food poisoning?
Appendicitis? The flu?
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ANALYSIS OF FOREING HEALTHCARE SYSTEMS
Health insurance in the US is difficult and very complex to understand. The beneficiaries
of the Affordable Care Act (ACA) are those that have an income below poverty, to be eligible the
income should be less than $28,725 for an individual and for a family of three $48,000.
Population with an income higher of $28,725 and $48,000 is affected by the ACA policy.
Medicaid, Medicare and federal subsidies is only for people that are eligible (low income or in
poverty). The minimum wage in Texas is $13,920 and of course this income is below poverty,
therefore, they have the benefits that the federal government provide such as eligibility for
Medicaid, Medicare, CHIP for children, very low copayments and available subsidies. But, what
about the population with an average income? Even though, they are insured still have the
difficult to face higher costs of medical care and might face bankruptcy. The minimum wage in
Texas does not give you assurance to get medical care because the deductible and out-of
pocket money are higher.
With that in mind, is the ACA accomplishing its goal of bringing healthcare to the
uninsured?
The Reform of the Affordable Care Act main focus is to make affordable medical
insurance to the millions of people uninsured based in their age, income and physical condition.
Some accomplishments that reach their goal are:

I assume that in the following years we will see that the healthcare spending gone down.

Million of people with income below poverty, handicaps, mental retarded, and homeless
have access to medical care through Medicaid and Medicare

Purchasing a private insurance is more affordable for people with an average income
(high deductible is not helping to get fully coverage and have access to medical care
easily)
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ANALYSIS OF FOREING HEALTHCARE SYSTEMS
In Conclusion, the healthcare system of the Unites Sates is not a Unified system. There are
multiple providers and payers that financed this system, this is one of the reasons for which the
model of the system in the US is complicated and difficult to provide medical care to all
residents of the US. Even though, the Affordable Care Act expands the medical care for those
that have low income and poverty, still the disparities will continue. The ACA benefit these parts
of the population but impact over people that live with an average income and rising taxes for
those that have higher incomes. A universal healthcare system would be a suitable for all
residents of US and will eliminate the several disparities in the healthcare system of US.
Recommendations

The healthcare system of United State should be revised and consider the possibilities
adopt a Universal Healthcare system

The affordable Care Act needs to focus not just in people of income below poverty, also
need to find the way to subsidized people insured and underinsured and help them to
avoid bankruptcy.

The Health Insurance Marketplace should be monitored by the federal government and
establish standard premiums and deductibles for people with average income.

Services of the providers should have a standard fee and provide the basic primary care
free of charge.

Taxes should be raised to those businesses that impact directly with the public health
such as, fast food restaurants, tobacco and alcohol businesses, juices and sodas
businesses, etc.
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ANALYSIS OF FOREING HEALTHCARE SYSTEMS
References
Admin, (2009, October 6). Comparing International Health Care Systems. Retrieved from
http://www.pbs.org/newshour/updates/health-july-dec09-insurance_10-06/
Baribault, M., Cloyd, C. (1999). Health Care Systems: Three International Comparisons.
Retrieved from
https://web.stanford.edu/class/e297c/poverty_prejudice/soc_sec/health.htm
Healthcare.gov, (2015). Health Plans. Retrieved from https://www.healthcare.gov/see-
plans/76059/results/?county=48251
individualism. (n.d.) Random House Kernerman Webster’s College Dictionary. (2010). Retrieved
March 11 2015 from http://www.thefreedictionary.com/individualism
Irvine, B. (2002). Health care Systems: The USA. Retrieved from
http://www.civitas.org.uk/nhs/download/USABrief.pdf
Pantilat S. (2008). Fast Facts: Autonomy vs. Beneficence. UCSF School of Medicine. Retrieved
from http://missinglink.ucsf.edu/lm/ethics/Content%20Pages/fast_fact_auton_bene.htm
Pettingers, T., (2013, March 20) Pros and Cons of Capitalism. Retrieved from
http://www.economicshelp.org/blog/5002/economics/pros-and-cons-of-capitalism/
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ANALYSIS OF FOREING HEALTHCARE SYSTEMS
Schabloski, A. K., (2008). Health Care Systems Around the World. Retrieved from
http://www.itup.org/Reports/Fresh%20Thinking/Health_Care_Systems_Around_World.p
df
Teitelbaum, J.B. & Wilensky, S. E. (2013). Essentials of Health Policy and Law, (2nd Edition),
Burlington, MA: Jones and Bartlett. Chapter 4
The American Democracy, (n.d.). The American Heritage: Seeking a More Perfect Union.
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pdf
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