Health Insurance in the U.S and Other Countries

Introduction

There is the common perception among the Americans that irrespective of its coverage and cost management, their health care system is among the best in the world in terms of quality. In a 2009 study, Robert Berenson and Elizabeth Docteur found that 55 percent of Americans believed that they get better quality by seeking medical attention in the American health facilities than in any other country. Nevertheless, only 45 percent of the surveyed individuals believed that the American health care system was the best in the world. Upon deeper questioning, Berenson and Docteur noted that some of these respondents were dissatisfied by the manner in which the authorities handle the health insurance matter (Nolte & McKee, 2008).

Although the overwhelming majority of Americans support the government’s actions that aim at increasing the health care coverage, a recent study indicated that about 63 percent of the respondents worried that such a move would lower the quality of the healthcare provision. In this case, while the cost of accessing health care would be minimized, attempting to avail care to everyone is viewed by the majority of Americans as being counterproductive. Indeed, there have been poll reports that have indicated that as much as 81 percent of Americans would not support the system that assures medical cover to every citizen. As such, there have been disagreements as stakeholders attempt to come up with the most appropriate reform strategy while the government seeks to avail quality health care services to as many people as possible, and at an affordable cost (Lee & Mongan, 2009).

This paper elaborates how the quality and affordability of healthcare in America compares with the rest of the world. Precisely, the paper seeks to assess how the impact of the American health insurance on medical services compares with the rest of the world. By exploring the manner in which the American health insurance compares internationally, it becomes possible to address the fundamental concerns and attitudes that the stakeholders have with regard to the provision of medical service. For instance, if study indicates that the country’s health care system is the most applicable as per the prevailing situations, it will be possible to justify why the American authorities prefer to maintain the health insurance scheme as per its current standards (Nolte & McKee, 2008).

The paper begins by evaluating the constituents of a quality health care system in endeavor to establish the role that is played by the health insurance policy that a country adopts. Consequently, the study attempts to evaluate the evidence of disparity the American health insurance as compared to that of other countries. At this juncture, the study explicates how this impacts on the quality of services that medical facilities offer. Later sections evaluate how the American health insurance system influences on the prevalence of the challenges that the patients encounter as they seek access to health care facilities (Lee & Mongan, 2009).

The Elements of a Quality Health Care System

According to the American Institute of Medicine, health care quality is defined as the degree by which access to health services increases the probability of achieving the desired medical outcomes for the patients. For the health system to achieve quality provision of services, the level of proficiency of the staff members must be consistent with the current professional knowledge. Having quality services means acting right at the most appropriate time and in the best manner as possible. In this case, ensuring quality enhances the effectiveness of the health care system of a country (Institute of Medicine, 1990).

The term quality encompasses a range of positive or desirable attributes that the authorities of a country have put in place in endeavor to enhance the performance of their healthcare systems. Reviewing the medical provision frameworks of different countries facilitates the comparison of the manner in which the aforementioned attributes influence on the effectiveness of the healthcare systems under evaluation. Studies have indicated that the formulation of an effective health care system necessitates the evaluation of such parameters as acceptability, appropriateness, accessibility, competence, and care environment. Others include the availability of amenities that assure continuity, efficiency, governance, equity, responsiveness, timeliness, safety, and responsibility (Lee & Mongan, 2009).

The superiority of the American health care system has attributed, among other factors, to the insurance coverage that is promptly available and accessible to a significant portion of the society. Comparing the American health insurance statistics with those of other countries reveals a range of variations. For instance, there are countries that operate hybrid health insurance systems that incorporate the roles of the private as well as the public sector. However, in every country, there are varying degrees of cost sharing, such a situation that results into remarkable differences in terms of design of the insurance scheme, accessibility, as well as the associated cost burden on the part of the patient (Institute of Medicine, 1990).

In the United States of America, patients have always loathed the high medical expenses that they have to pay even when they happen to be insured. Many of them report that are to have spent a significant amount of time while filling insurance paperwork as well as resolving disputes over payments. In some unfortunate circumstances, there are those who have had the payment of a section of their medical bills denied (Institute of Medicine, 1990). On the same note, studies have indicated that the Germans spend as much time as the Americans do while filling insurance paperwork. Nevertheless, there may be appreciated the measures that have been put in place to safeguard the patients against the out-of-pocket expenditure. The Swiss have always been skeptical of the frameworks that have been instituted to protect the patients since they, just like a section of American patients, have been experiencing instances of out-of-pocket expenditure (Shi & Singh, 2011).

Insurance coverage has been a matter of concern for quite a long time as it has been viewed as one of the fundamental factors that influence on the financial stability for the sick people and their families. Many US citizens regard a comprehensive health reform as being the only strategy that can assure improvement in the accessibility of health care among the low income groups. However, this view has always been countered by criticism that over-emphasis on availability could lower the quality of care that health facilities offer. They argue that although accessibility ought to be encouraged, it should not be at the expense of quality as such a situation would disadvantage everyone across the board. Several observers believe that adequate research should be conducted in endeavor to gain insight with regard to how the designing of insurance coverage would affect quality (Institute of Medicine, 1990).

The American Health Insurance as Compared to Those of Other Nations

The paper evaluates the health systems of eight industrial nations while attempting to establish the basis for assessing how the American health insurance compares with the rest of the world. These nations have been carefully chosen so as to represent every region that has the same level of development as the United States. They include Canada, France, Germany, Japan, Norway, Sweden, the United Kingdom, and the United States. This section commences with an evaluation of the common funding models that are utilized in most of the countries (Lee & Mongan, 2009).

There are four common models of insurance funding. The models include the socialized health care, single payer’s insurance, universal insurance, and the private pay. In the socialized health care, the government retains the ownership and control of all the operations that relate to the delivery of healthcare. Therefore, the government owns the insurance program, and it facilitates the situation whereby payers are recognized singly. This is the case in such countries as the United Kingdom, Sweden, and Norway.

In Norway, health services are funded, majorly, through the taxation of salaries. Country’s health care system does not have a specified contribution fund, the situation which gives it the characteristics of a socialized health care system. In Norway, unlike most of the countries, the government avails much of the funding that is required in the health care system, and this includes the financing the health insurance system. The country operates a single and universal insurance program where everyone is guaranteed a basic level of support in case of involvement in an accident, illness, or any bodily defect (Institute of Medicine, 1990). The government-sponsored insurance program also supports the citizenry in case of pregnancy, birth of a child, disability, death of a relative, or loss of a breadwinner. Every working citizen who happens to be living in the country is required to contribute so that the government can cater for the aforementioned categories of people, as well as the aged and the unemployed ones. Norway’s insurance system derives much of its funding from payroll taxes that the government charges the workers (Shi & Singh, 2011).

The Swedish health care system bears some similarities with that of Norway. The authorities aim at availing health care services to all the citizens. It is for that reason that the system has been devolved into three levels so as to ensure that the service providers are as close as possible to the sick and needy members of the society. In this case, it has been organized on three distinct levels, namely, the national, regional, as well as the local level. The health care system in Sweden, just like in Norway, is funded through taxation. The arrangement has allowed both the county councils and the cities to exercise their right of charging proportional income taxes on the population that live within their jurisdictions. This is the case as a significant number of healthcare facilities are owned by the respective cities (Institute of Medicine, 1990).

The health care system in the United Kingdom has a socialized framework. It is such a single payer’s model that is commonly referred to as the National Health Service (NHS). The system is owned, financed, and operated publicly in endeavor to avail a universal health care as well as health insurance to every citizen of Great Britain. In that what is presumably comparable to the situation in Norway and Sweden, the British National Health Service is centrally controlled and funded through taxes that are charged on individuals’ incomes (Shi & Singh, 2011).

In the single payer’s insurance arrangement, the government retains the ownership of the health insurance scheme but not the entire healthcare service delivery system. Therefore, it concerns itself with matters relating to the regulation and issuing of policies to the interested parties without attempting to dominate in the health care system taken as a whole. Such an arrangement is predominantly utilized in Canada, the scenario that has created an environment where the private and public sectors specialize during the provision of health services in the country. In Canada, the provision of healthcare is managed separately in each of country’s three regions and ten provinces. In this case, while Canada has 13 separate single payers’ systems, they are all structured in the same manner. This means that, as to an observer, Canada has a single national plan for managing the provision of medical services. Currently, Canada has the reputation of having among the best health systems in the world. It sometimes is presumed to be superior to that of America (Shi & Singh, 2011).

Where the universal insurance arrangement has been instituted, government’s role is limited to mandating and regulating the insurance coverage. Nevertheless, it is not engaged in the provision of polices. Furthermore, government’s role in the ownership and operation of the health care delivery system is insignificant. The private sector is allowed room to engage in much of the operations relating to provision of health care services to the citizens. The model is commonly utilized in Japan, France, and Germany. These three countries have some of the most superior health care systems in the world, the situation which underscores the importance of eliminating challenges that the private sector faces in making its contribution towards the enhancement of the health sector. Much of the innovation has its basis in the private sector and, in this case, restraining private contributions may, actually, derail the efforts that are geared towards enhancing accessibility, affordability, and quality of health care in a country (McDavid et al., 2003).

The National Health Care program in France is the responsibility of country’s social security system. A significant portion of the program, i.e. 60 percent, is funded through workers’ salaries. The remainder comes from the indirect taxes that are imposed on tobacco and alcohol as well as host of other modest taxes.

In Germany, the government has mandated a universal insurance coverage which invites the participation of every citizen. The participation of the citizens may be in terms of an employer-sponsored sickness fund or the plan that incorporates private insurance enterprises. Majority of the insurance plans in Germany are funded by either employees or their employers. Various local governments step in to provide funding for the unemployed as well as those who belong to the low income category. Much of the insurance funding for the elderly and retirees has been the role of the national government, such a role that is quite limited as compared to other categories of insurance funding arrangements (Shi & Singh, 2011).

The national health insurance program in Japan is one of those that are complex in the world. It incorporates over 2,000 private insurers and 3,000 government units into a single system. The system is superior to many others in the world as it is able to pay for over 70 percent of the drug and medical costs that are incurred when individuals seek medical attention. The patients are required to pay just 30 percent of the bills. The insurance premiums are carefully calculated so as to facilitate their charging on a monthly per household-basis. The premiums are, actually, scaled as per individuals’ annual income (McDavid et al., 2003).

The last arrangement is commonly referred to as private pay. In this case, everyone pays for his or her own health care expenditure. This is usually the case in much of the developing world. In fact, studies have indicated that of 195 countries in the world, only about 35 utilize the other three models. In this case, over 80 percent of the entire population of the world has to foot their medical bills themselves.

The aforementioned cases indicate that most of the nations have a single and universally applicable health care financing system. This is the case irrespective of whether a nation utilizes a socialized health care, single payer, or universal insurance model. The United States of America utilizes the option that incorporates some of the aspects in every one of the aforementioned systems. For instance, those who choose to be remaining uninsured and those who fail to qualify for medical insurance have the option of utilizing a patient’s private pay model (McDavid et al, 2003). Since the recent healthcare reform laws did not require the implementation of a universal health care system, the option of being in a patient’s private pay model has been retained. Nevertheless, the government has instituted measures that are aimed at encouraging everyone to get ensured. For instance, those who opt to remain uninsured are charged a special tax as they as presumed to be causing a derailment to government’s efforts of ensuring the universal access to health care. The following section deals with some of the reforms that have been put in place in endeavor to enhance service delivery in the American health care system (Harrington & Crawford, 2004).

The Similarity of Medical Situation in the Eight OECD

The US health sector has been able to incorporate some of the aspects that are associated with the other OECD countries due to the similarities that these nations have. Although the American health sector has evolved independently, there are those similar challenges that each of the societies faces that impacted heavily in the manner in which their health systems are evolved. The similarities include the impact of age on individuals’ health, their health risks or statuses, care rationing, as well as the level of dissatisfaction that the citizens have with their health care systems (McDavid et al, 2003).

With regard to age, individuals in each of the eight nations experience deterioration of their physical health, the situation that ushers in other related challenges as declining fertility, weakening of the immune system, as well as loss of sight and hearing capacity. In this case, it becomes almost certain that as individuals advance in age, their requirements for medical attention increase. Thus, their medical bills increase proportionally thereby prompting the stakeholders to undertake measures that could mitigate the effect of age on health and financial stability of individuals. Since the effect of age in each of the OECD countries is almost similar, their medical and insurance systems have evolved in such a manner that bears similarities to each others’ (OECD, 2008).

In most of the eight OECD countries, the citizens are dissatisfied with the manner in which service delivery is accomplished. There is much complaining about the slowness that they experience even when their conditions happen to be critical. In this case, there are those who feel that their governments, apart from the measures they have taken to ensure insurance coverage for all, have been letting them down as they are not attended as they should be (Harrington & Crawford, 2004). The issue of health care has always been revisited in all these countries, especially, during the campaigning for political offices, since the citizens do not relent in demanding for quality medical services. Some of the stakeholders have been arguing that the challenge can only be solved by increasing the number of health care practitioners. Others insist that with proper management, even the current level of resources and personnel is adequate to avail the expected levels of service delivery (McDavid et al, 2003).

Similarities in Terms of Financial Situations

The health care system in each of the eight nations is funded through tax revenues. Over half of them make use of combination of payroll, general tax funds, and the consumption taxes while funding the health care expenses. These measures are undertaken in endeavor to enhance the universality of nations’ provision of medical services to their citizens as per their needs and expectations (Harrington & Crawford, 2004). As indicated earlier, there have been various reform strategies that have impacted on the collection of revenue that is aimed at funding the national health insurance policies. These measures are undertaken with the view of safeguarding the interests of the patients, and since the challenges that these societies face, bear similarities, the strategies of overcoming them are remarkably similar. It is for this reason that the authorities have instituted similar funding strategies (OECD, 2008).

With exception of America and Norway, the rest of the OECD countries have a relatively similar strategy in budgeting for their medical expenses. Nevertheless, all the eight countries have among the best funded health care systems in the world. In this case, they are all considered to be global leaders in terms of provision of health services. Being industrialized nations where the level of income is relatively high, the private insurance strategies in each of these nations have been fruitful. All these nations have utilized such strategies in endeavor to supplement their comprehensive national plans (Kovner et al., 2011).

The period between 2002 and 2007 saw a remarkable annual increase in the per capita health care expenditure in all the eight nations. This has been attributable, in part, to the increasing costs of securing supplies and professional services as well as to the rising costs of insurance. In America, the cost is set to rise, especially, after the Patient Protection and Affordable Care Act becomes fully operational. Although it is perceived that the act will facilitate universal coverage, at times the associated costs have been considered to be inhibitive. In fact, there have been several instances where stakeholders have sought to derail the implementation of such measures in order to avoid the associated costs (Kovner et al., 2011).