Comparative Health Systems

Healthcare are all goods and services delivered which are designed to provide preventative, curative and palliative services/intervention directed towards individuals and populations.
A system is a framework by which one can analyze a group of objects working together to produce a common result.
A healthcare system is all the resources dedicated to providing healthcare services to populations, and/or Nations which include patient, providers, methods, treatments, institution organizations and buildings acting as an integrated unit.
Health systems evolved as a by product of world war II due to labor shortage, freeze on prices and wages(U.S.),need to rebuild from scratch(most of western Europe and Japan).
Healthcare systems emanated in the context of specific political, economic and cultural histories and, as a result, the ways they finance, organize and deliver care vary tremendously.
A typical healthcare system has separate components acting as an integrated whole often reaching functional equilibrium forming a closed system.
The components of a healthcare system are often grouped into categories viz; input, processing, output and feedback with each part having a functional and structural relationship to each other.
Many developing countries have introduced health sector reforms aimed at improving performance ranging across all functions of the health system but a framework for identification of the goals and objectives against which the outcomes can be judged has to be developed before a definition of health system performance can be quantified.
This framework can be constructed by developing, testing and revising models of cause and effect in health policy and prospecting policy transfer based on a few lessons learnt from international comparative research on health systems reforms.
Health system models for comparison among the Organization of Economic Cooperation and Development (OECD) countries comprising of 30 member states of the industrialized countries in the world are;
1 National Health Service (NHS)
2 National Health Insurance (NHI)
3 Mixed Funding, Mixed Coverage
Western European Nations and Japan developed the National Health Systems through Socialist Governments while the United States chose to provide subsidies instead to their healthcare system.
The U.S. method entails providing funding for hospitals as well as granting tax exempt status, training of health professionals through Government grant subsidy, employer –sponsored health insurance and in the 1960’s,Medicare and Medicaid.
The NHS (U.K.) seeks to nationalize healthcare including providers, facilities and services to ensure universal coverage using a single payer method with financing from income tax, general tax and general fund while using district budgets to control spending.
This means all the physicians work for NHS, coverage is universal with the hospitals owned and managed by the government.
The challenge with this system is inefficiencies, old infrastructure, waiting times and unequal distribution of resources among districts.
The Nationalization of Health insurance (NHI)practiced by Japan and France is more flexible with single or multiple payers but ensure universal coverage with employer and/or individual mandates while financing comes from employment taxes; social security with the existence of private and public hospitals/clinics.
Individuals buy coverage from government plan or private users, pay insurance premiums while the government provide subsidies for elderly, less privileged and those in small businesses.
The ensures frequent doctor visits, long hospital stays and insurance covers everyone but has the challenge of overuse of care, shortage of physicians in many specialties and rural areas, increasing cost and a rapidly aging population.
In the mixed funding and mixed coverage practiced in the U.S.A., funding is from private insurance, individuals and government and as such has multiple payers with no individual mandate and coverage is not universal.
In this method, there is no price control for the uninsured that pay approximately 200% incremental charges compared with the insured.
The flexibility of individual choice makes the method very expensive though exposes the populace to advanced technology with the insured having the privilege of choosing their own doctors and hospitals.
The challenges include inequality and discrepancy between the rich and poor in access to quality healthcare, increasing cost and a dysfunctional payment system.
The NHS is less expensive and may have acceptable outcomes, a comparative analysis of the US and the UK by the WHO in 2000 ranked the U.K. 9th and the US 17TH in the overall system performance.
France was rated first, Italy second and Spain third and according to the OECD comparative data study in 2006, the total health expenditure by the UK in 2004 was 8.3% of the GDP and 2,546 per capita while the US was 15.3% of the GDP and 6,102 per capita.
As at 2003, the life expectancy at birth was 78.5years for the UK and 77.5years for the US, this tells us that there are many factors that could play a role in this case though the US has a low tobacco consumption rate than the UK and spends a larger percentage of their GDP on health, the UK has a higher life expectancy at birth.
This shows that a better understanding of healthcare spending and delivery is paramount to a productive and effective healthcare system.



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