What is the Health care System?            

According to the World Bank Strategy for HNP Results, a “system” is the arrangement of parts and their interconnections to come together for a particular purpose (von Bertalanffy, 1968). A Health system is a system that focuses on improving the health of people.

Roemer (1991) said health is defined as “the combination of resources, organization, financing, and management that culminate in the delivery of health services to the population.

According to the World Health Organization (2000), the health system is defined as “all activities whose primary purpose is to promote, restore, and maintain health.” In recent times, the definition of the “purpose” of a health system has been extended to include the prevention of household poverty as a result of illness.

The definitions above show that a health care system in recent times, serve medical, social and economic purposes. Therefore, the health system of a country should satisfy the purposes of a health system to a certain degree for it to be effective.

A Comparative Analysis of the Health Care System of 3 Countries; France, United Kingdom, United States of America

In this essay, we would take a critical look at the health systems of three countries, France, the United Kingdom, and the United States of America.

This essay aims to analyze the various health systems used by each country carefully and discuss what can be learned and adopted from the other countries’ systems to improve that of the U.S health care system.

 

The Government Role in Health care financing and delivery

France

In France, the provision of healthcare is seen as a national responsibility. The national strategy of health in France is defined by the Ministry of Social Affairs, Health and Women’s Rights. However, to further help control expenditures and increase effectiveness, the state has been increasingly involved in controlling health expenditures funded by Statutory Health Insurance (SHI) (Nay et al., 2016).

The French health care system is an abstraction of the National Health Insurance (NHI), which provides health care coverage to all legal residents. French NHI is an example of public, private health care financing, and social security combined with a public-private mix in the provision of health care services (Victor, 2018).

Healthcare planning and regulation are carried out among the states, SHI, and Healthcare representatives. The agreed conditions of these negotiations are then passed by the parliament into laws (Isabelle, 2020).

Also, the central government is responsible for allocating health care budgets among various sectors like hospitals, mental health, ambulatory care and services for disabled citizens, and hospitals among different regions.

For effectiveness, the ministry is represented in each region by the regional health agencies. The regional health agencies are responsible for managing population health and health care; these include disease prevention and health delivery, public health, and social care.

The general council is responsible for the health and social care for the elderly and disabled people.

United Kingdom

The United Kingdom uses the National Health service system of health care to cater to its citizens (Victor, 2018). According to the Health Act (2006), it is the legal duty of the Secretary of State to promote a comprehensive health program that ensures that care is provided free of charge separate from the services that already have charges in place.

It is the responsibility of the parliament, the Department of Health, and the Secretary of state to handle health legislation and general policy in the UK (Ruth and Sandeepa, 2020).

National Health Service (NHS), according to the NHS constitution, provides the right to access to care without discrimination, and within certain time limits for some categories such as emergency and planned hospital care as long as the person is eligible for NHS (Ruth and Sandeepa 2, 2020).

It is the job of the Department of Health to provide general oversee for the overall health system, but the NHS handles the day-to-day responsibilities.

The NHS UK is responsible for the NHS budget, commissioning groups, and ensures that the goals set by the Secretary of State in an annual mandate are met; these include both efficiency and health goals.

The local government authorities are responsible for holding on to the budgets for public health.

United States of America

The U.S health care system is not a national health service, a single-payer national health insurance system, or a multi-payer universal health insurance fund system, instead, it can be described as a hybrid system. (The U.S Health care, 2016).

Among advanced individualized countries, the U.S health care system is quite different. The U.S does not have a system that offers health coverage to every citizen and does not have a uniform health system. It was not until recently in 2010 that health care coverage was mandated for almost every resident of the United States. (The U.S Health care, 2016).

The Affordable Care Act (ACA) was enacted in 2010, and it established a shared responsibility between the government, employers, and individuals to ensure that all Americans have access to affordable and good-quality health insurance. The health coverage, however, is not a complete and straightforward one as there are numerous public and private sources, as well as a wide difference in the insured rates across the U.S population (The U.S health care system, 2020).

The Centers for Medicare and Medicaid Services (CMS) help to administer Medicare which is a federal program that offers some form of health coverage to citizens who are 65 years old and over. CMS also provides people with disabilities with some form of coverage. CMS works with the state government to administer both Medicaid and the Children’s Health Insurance Program (CHIP), which is a combination of state programs for members of the population with low income (The U.S health care system, 2020).

The state is responsible for regulating private health insurance. In 2014, the Health insurance market place which Is operated by the state and the federal government was created to provide better access to private insurance coverage. The health insurance marketplace helps to provide income-based premium subsidies for low and middle-income citizens.

Health Insurance Coverage by various Health Systems

France

Total health expenditure in 2014 was 12 percent of the GDP (USD 310 billion) and 76.6% of this expenditure was publicly financed.

Coverage is provided to every resident of France by noncompetitive SHI. Health coverage is universal and made compulsory for every resident of France as of January 2016. Citizens can decide to opt-out of SHI in rare cases like an individual being employed by a foreign company (Isabelle, 2020).

There is no documentation for immigrants who have applied for residence, and for visitors who are from another country in the European Union, they are covered by an EU insurance card.

Non-EU visitors can be covered in case of an emergency only.

Note: People with low income are entitled to free or state-sponsored VHI, free vision care, and free dental care. 10 percent of the total population falls under this category (Isabelle, 2020).

United Kingdom

In 2014, 9.9 percent of the GDP was spent on health care, 79.5 percent of this expenditure was spent on NHS (public expenditure) (The NHS Constitution, 2015).

Health coverage in the UK is universal. For born citizens of the UK, they are automatically entitled to NHS care, it is largely free at the point of use. Nonresidents with a European Health Insurance card are also entitled to be covered by NHS care. However, non-European visitors and undocumented immigrants are only covered in case of an emergency or the treatment of an infectious disease (Ruth and Sandeepa, 2020).

Note: some people are exempted from the copayments of prescription drugs, and they include children aged 15 and under, and those aged 16 to 18 enrolled full-time in school; people who are aged 60 or older; citizens with low income; pregnant women and that put to bed within the past 12 months; and people suffering from cancer, certain long-term conditions, or certain disabilities. Also, patients that require a large amount of prescription medicine are allowed to buy prepayment certificates that cost GBP29.10 (USD42.00) for three months and GBP104.00 (USD150.00) for a year. Those with the prepayment certificate will incur no further billings for the duration of the certificate, regardless of how much more prescription medication they need (Ruth and Sandeepa, 2020).

United States of America

In 2015, 67.2 percent of the residents of the U.S received health insurance coverage with the help of private voluntary health insurance (VHI), while 14.6 percent received insurance directly, about 55.7 percent obtained their insurance through their employer. The public health programs cover about 37.1 percent of the residents (The U.S health care system, 2020).

In 2016, as many as 27.3 million individuals remain uninsured, and this represents about 8.6 percent of the population at the time; however, it was lower than 9.1 million people that were uninsured in 2015.

The coverage in the U.S is often overlapping as in 2015, as many as 10 million Americans were eligible for both Medicare and Medicaid services at the same time (dual eligible). In some states, CHIP is an extension of Medicaid, while in others, it is operated as a separate program. CHIP covered up to 8.1 million children in low-income families in 2015 (The U.S health care system, 2020).

As for undocumented immigrants, they are generally not eligible to be covered by any public health program, and it is estimated that up to 2/3 of undocumented immigrants are uninsured. Hospitals that are funded by Medicare (which is a majority) are legally obligated to provide the care required to stabilize any patient in the case of an emergency, and some states even allow undocumented immigrants to received emergency care under Medicaid beyond stabilization.

In some states, undocumented children and women receive health coverage too.

Similarities of the Health Care Systems of France, the United Kingdom, and the United States of America

The health care system practiced in France and the United Kingdom is similar in the aspect of coverage as both try to ensure that almost every resident in the country is covered. They use a system that ensures that the government helps to fund most of the health care costs of their citizens at the point of use.

The French health care system also bears some similarities to that of the United States. France and the United States use health care systems that rely on both private insurance and government-funded insurance. Also, in both countries, an employer provides a large portion of private insurance (Essays, UK, French Health Care System, 2018).

 

Differences between the Health Care Systems of France, the United Kingdom, and the United States of America

The biggest difference and advantage that the United StateS health care system has over the United Kingdom is its rapid response system. There is a shorter waiting list for those covered by private health insurance in America than there is in the United Kingdom. Also, the United States’ health care system promotes a wider pool of health insurance providers to choose from than the UK and France that relies more on a public system.

France according to World Health Organization has the best health care system in the world because of its provision of universal coverage, responsive health care providers, flexible choice system, and the general health of its population (Essays, UK, French Health Care System, 2018).

Ways in Which Various Health Systems of Countries are Affected by Social, Economic, Cultural, and Political Environments.

In the United States of America, one of the ways the health care system was affected by the political and social environment was the enactment of the Patient Protection and Affordable Care Act of 2010 also known as ACA by President Obama. It was in the effort of President Obama to reform the health care system in America to ensure that more citizens of America had access to affordable care that the ACA was formed. However, the Trump administration has been pushing to remove this policy completely in 2020.

The British NHS was formed based on the principle of the British Minister for Health in 1952 when he said, “he essence of a satisfactory health service is that the rich and the poor are treated alike, that poverty is not a disability and wealth is not advantaged” (A comparison between the French, 2015). However, the rise in the price of health care with technological and pharmaceutical advancements has made the NHS in the UK more convoluted.

The French policymakers assume the British NHS system is a less realistic system when compared to the French NHS system. French policymakers believe the British NHS requires too much rationing and insufficient choice to the residents of the UK. The French policymakers also consider the U.S health subsystem to be socially irresponsible due to a large number of uninsured citizens (Victor, 2018).

What can be Adopted and learned from other countries’ health systems to improve the U.S health care system?  

1. France’s Flexibility in access to Physician: Under the French NHI system, patients are allowed the freedom to consult any general practitioner, specialist or hospital of their choosing. There is, therefore, no restricting network of health care providers and hence, no concept of out-of-network surcharges. In 2016, a soft gatekeeping system was imposed by the French policymakers, requiring residents to sign up with a primary care doctor. However, it is still easy and requires only a slightly higher co-insurance payment to have direct access to a specialist in the absence of a referral (Dourgnon and Naiditch, 2010).

With the implementation of a system like this in the U.S, residents will have more options when it comes to the kind of health care provider they can see. It would also reduce the cost of co-insurance for residents and therefore, allow more people to have access to proper health care.

2. The General coverage Nature of UK and France: UK and France, operates a public health care system that allows a majority of their population to have access to proper health care. In the US, most of the health care system is privately operated and therefore very expensive. Even though policies like the ACA 2010 have helped to improve the number of people covered under America’s Health Insurance Plan, the private nature of America’s health care system, still makes it relatively expensive and not so affordable.

To allow more access to health care services, the government can extend the eligibility for Medicaid and Medicare to members of the population that were once ineligible. However, a system has to be developed to ensure that the public sector can be properly funded to allow proper services.