Universal Healthcare vs. American Healthcare System

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The Universal Health (UH) plays a critical role in ensuring all persons have access to required health services comprising palliation, rehabilitation, treatment, promotion as well as prevention. These services need to be of adequate quality to be effective whilst also making sure that the services do not expose users to financial challenges (Light, 2003). The coverage of universal health has become the main goal for health reforms in several nations and a priority objective of the World Health Organization. It is called universal care because all citizens of a specific country are guaranteed access to healthcare (Sen, 2015). It is commonly planned around offering either all citizens or just the residents who are unable to afford quality health services on their own, with either means to acquire them or health services, the end result being to enhance health services (Martin, et al. 2018)

Many systems of universal healthcare are funded by the government, while others are based on the residents buying private health insurance. There are three critical dimensions that can help to determine universal healthcare: what kind of services are covered, who is covered and the total amount of the cover. It is defined by WHO as a circumstance where residents are able to access health services devoid of incurring financial challenges (Light, 2003). In this case, universal healthcare is the most powerful idea that public health is supposed to offer because it combines services and delivers them in an integrated and comprehensive manner. The main goal of UH is to help in creating a protection system that offers equal opportunity for persons to enjoy quality healthcare. 

Through this, the government can extend access to healthcare as extensively as possible and set minimum standards. UHC is usually executed through taxation, regulation and legislation. Operationally, UHC is a legislature provision for universal health insurance and more than ninety percent coverage for prepayment health insurance and skill birth attendance that assures service coverage with legal guarantees (Martin, et al. 2018). According to that standard, only 58 nations have managed to achieve UHC and almost all come from Organization for Economic Cooperation and Development (OECD) countries, and most developed countries with a small number of developing nations (Martin, et al. 2018)

To overcome the monetary problem of the whole populace during sickness devoid of quality of health service and discrimination, the United Nations stressed the necessity to attain universal healthcare in the sustainable development goals (SDG) in health (Light, 2003). universal healthcare does not only contribute to financial and population protection coverage and health service but similarly pointedly increase life expectancy and decrease adult death. This challenging objective to attain health coverage worldwide, countrywide as well as sub-nationally is a demanding task because of numerous challenges in policy, health care systems, as well as the political-economic atmosphere (Martin, et al. 2018).

The US is one of the developed nations that does not embrace universal healthcare.  However, its health delivery system has specified components like Medicaid, Medicare and the Department of Veterans Affairs that offer universal healthcare to particular populaces (Sen, 2015)

The USA Health Care Overview

The US healthcare is provided by several different firms. Healthcare amenities are principally owned and managed by private sector businesses. More than 50 percent of public hospitals in the USA are non-profit where 21 percent are for-profit and 21 percent are owned by the government. The WHO reported in the year 2014 that the US spent around 9,403 on healthcare per capita (Sheet, 2016). The coverage of healthcare is offered through joint public health coverage and private health insurance like Medicaid and Medicare. The USA doesn’t have a UHC program, unlike some of the other developed countries. 

In the year 2013, 64 of health expenditure was paid American government and financed through programs like Medicaid, Medicare, the health administration and children health insurance program (Sheet, 2016). Citizens aged 65 years and below acquired insurance through their family membership by buying insurance cover on their own or getting assistance from the government or based on income for public sector workers which is mainly offered by the government in its employers’ role (Kumar, Ghildayal & Shah, 2011)

The American healthcare system is exceptional amongst the established nations. America has a heterogeneous health system and recently enacted laws authorizing healthcare coverage for nearly all people.  Instead of operating a multi-plier universal health insurance fund, health insurance system, single-payer national insurance system or national health system. The American healthcare system is best labelled as a hybrid system (Azar, Mnuchin & Acosta, 2018).  In the year 2014, 48 percent of American healthcare expenditure came from private funds, with 20 percent coming from private business and 28 percent coming from households. The national government funded the 28 percent on the other hand local and state governments spent 17 percent. A larger percentage of healthcare even if publicly funded, is delivered privately (Kumar, Ghildayal & Shah, 2011)

Around 61 percent of coverage is related to employment, mainly because of the cost savings related to group programs that can be bought through an employer. Companies and their employers voluntarily pay for the insurance programs. Instead of buying an insurance policy from outside parties’ employee and employer premiums at some point fund an international insurance program (Sheet, 2016). The completely self-insured company presumed all the risks for its workers’ health care expenses. A partly self-insured company limits the risks it presumes by buying stop-loss insurance coverage, that safeguards it from incurring expenses over a specified amount. In both cases, the company normally contract with a third party to manage the insurance plan (Jonas, Goldsteen & Goldsteen, 2007)

The modern health insurance program that permits an unlimited choice of doctors or nurses and payment on a cash basis for services currently covers 30 percent and below of all workers. Even those plans offer some kind of utilization management plan (for example concurrent review, preadmission certification as well as mandatory second views for surgery) (Azar, Mnuchin & Acosta, 2018). Old style plans are different depending on medicinal services which are covered and the deductible and co-payment amounts. Instead of enrolling the workers in the conventional and old insurance programs, many companies now prefer managed care health insurance programs (Rosen, 2004). Managed care firms are systems that incorporate the funding together with the delivery of proper healthcare services covered by significant financial incentives, utilization review, formal programs for continuing quality assurance and direct criteria for the selection of doctors and nurses. 

Types of Universal Health Care Plans

There are 5 main UHC models which include national health insurance, mandatory insurance, and single-payer, compulsory insurance and community-based insurance. The nations usually combine UHC with other health systems to introduce competition. These options can improve care, expand choice and lower expenses (Hwang, et al. 2013). People can as well opt for effective services with supplementary private insurance. The US provides dissimilar models for populaces like low-income persons, veterans and the elderly. 

Single-Payer Model- In a single-payer model, the government offers free healthcare services paid for with revenues from taxes. Those who provide such services are government employees meaning the services are government-owned. Each citizen has similar access to care. This is termed the Beveridge Paradigm (Hwang, et al. 2013). When the government offers healthcare, they work to make sure that hospitals together with healthcare practitioners offer quality care at an affordable cost. They should gather and assess data. They can as well use their buying power to leverage doctors and nurses (Lu & Hsiao, 2003). The UK is among the nations that have embraced the single-payer model; other nations consist of Cuba, New Zealand and Spain. The US provides provide this to military officers and veterans. 

Social Health Insurance Model – Nations that use the model of social health insurance necessitates everybody to purchase an insurance cover, typically through their companies. The levies go directly into a government-managed health insurance trust that covers everybody. Private hospitals, as well as healthcare providers, offer services (Light, 2003). The government plays a key role in controlling the prices of health insurance. The government similarly has the authority to control the prices of private providers. Some of the countries that developed this kind of system include Germany, France, Switzerland, Belgium and Japan (Light, 2003). The American Obamacare system similarly needs insurance, however, there are numerous exceptions. It is similarly the same because it offers subsidies to health insurance firms for low-income enrollees. 

National Health Insurance – This model of national health insurance uses public health insurance to pay for private practice care. Each individual pays into the nationwide insurance program. Administrative expenses are lower for the reason that there is a single insurance firm. In such a situation, the national government has more power to force down medical expenses. Some of the countries that use this model consist of South Korea, Taiwan and Canada. The American Tricare, Medicaid as well Medicare systems similarly use this model. 

Compulsory insurance – This is normally enforced through rules and regulations necessitating the citizens to buy insurance, however, at some point, the government helps to provide that insurance. At some point, there might be a choice of private or public funds offering a standard service or at some point just a single public fund. In some European nations where UHC and private insurance coexist, the challenge of negative selection is overcome by using a riskier pool of compensation to equalize some of the risks between the finances (Hwang, et al. 2013). Therefore, the fund with the principally young and healthy populace is supposed to pay in the compensation pool and a finance kitty with older citizens and less healthy populace would get finances from the pool (Light, 2003). In the process, illness funds compete on prices and there is no benefit if removing persons with high risks due to the fact that they are paid for by risk-accustomed tax payment. Finances are not permitted to choose and pick their policyholders or repudiate coverage, however, they compete majorly on service and prices (Martin, et al. 2018). In some nations, the level of basic coverage is set by the national government and cannot be modified. 

A community-based healthcare insurance plan is private insurance that covers only limited aspects. Members of a particular community decide to pay collective healthcare funds that they are able to draw from if they need treatment. the contributions are not related to risks and are normally a high level of community participation in managing these programs. 

Types of the USA Managed Care

The US has two types of managed care firms: preferred provider organizations (PPO) and health maintenance organizations (HMO). Around 70 workers are presently enrolled in managed care firms.  Health maintenance firms is a delivery system that combines the producer and insurer functions. Health insurance firms are considered to be pre-paid and offer wide-ranging services to all those who have enrolled. A preferred provider organization is a 3rd-party payer which offers financial spurs like low out–of–pocket fees, to all those who have enrolled who obtain health care from a stipulated list of hospitals and healthcare providers (Kumar, Ghildayal & Shah, 2011). It is similarly a prepaid kind of managed-care firm that syndicates the producer as well as insurer functions.

Apart from private healthcare insurance around 26 percent of Americans are covered by public healthcare insurance. The main categories of public healthcare insurance, both of which started in the year 1966 are Medicaid and Medicare (Andersen, Rice & Kominski, 2002). Medicare is considered to be a homogeneous national public healthcare insurance plan for disabled and aged people. Managed by the national government, Medicare is the biggest insurer in the nation covering around 13 percent of the populace (Sheet, 2016). In the year 2018, Medicare Trustees Report indicate that Medicare-covered around 59.9 million individuals. That figure was more than 52 million persons aged 65 years and above and 8 million young persons (Andersen, Rice & Kominski, 2002)

The Medicare Trustee report similarly indicates that Medicare insures around 50 percent of healthcare expenses as compared to those who registered. Medicare has been divided into 4 different parts: the first part deals with skilled nursing (only after being officially recruited to the hospital for 3 days) hospital (inpatient, officially admitted only), as well as hospital services (Sheet, 2016). The second part covers outpatient services comprising outpatient hospice charges, some doctors and nurses’ services whereas inpatient at the hospice, most provider offices visits even if the office is “in a hospital”, and most jobs managed by the prescription medicines (Kumar, Ghildayal & Shah, 2011). The third category is an alternative termed as Medicate Advantage or managed Medicare that permits patients to choose health programs with at least similar service coverage. Part D covers mostly self-administered prescribed medicines.

The second category of public health insurance plan, Medicaid offers coverage for many American citizens comprising disabled people, elderly adults, pregnant women, children and low-income adults. Medicaid is managed by countries, according to national requisites. The insurance is financed jointly by the federal and state government. The national government offers the state governments with specified percentage of corresponding finds ranging from 50 to 77 percent, depending on per capita profits in the government (Azar, Mnuchin & Acosta, 2018). Medicaid covers differ from one state to the other because states have created dissimilar requisites for eligibility. People who are disabled, blind, elderly or members of families with dependent kids are supposed to be covered by Medicaid for all the states to get national funds (Jonas, Goldsteen & Goldsteen, 2007). In addition, even though the national government excites a certain basic package of healthcare benefits for example nursing homes, physician and hospital services, some countries are more liberal as compared to others. Because of that, people in some states are able to get more substantial benefits packages under Medicaid as compared to others. In addition, Medicaid is the only program that funds long-standing nursing homestay and it covers roughly 12 percent of the whole populace.

There is also a category of people who are not insured. Around 16 percent of the US citizens is approximated to lack health insurance coverage. This does not denote such people live without health insurance services. A large percentage of uninsured persons get healthcare services through local health plans, public hospitals and clinics, or private providers that fund care through shifting expenses and contributions to other payers (Sheet, 2016). However, lacking healthcare insurance cover can cause those who are not insured to face significant financial insecurity and hardship. Those who are not insured regularly find themselves in the emergency rooms of the hospices after it is very late for proper therapeutic treatment. 

Positive UHC Externalities

The positive externalities of UHC include the following: it decreases the total healthcare expenses where the government is able to control the prices through regulation and negotiation. It decreases administrative expenses where health care practitioners only deal with a single governmental agency (Amadeo, 2018). For instance, American healthcare practitioners spend around 4 times as much as the Canadian government deal with insurance firms. UHC compels healthcare practitioners and hospitals to offer the same standard services at lower expenses (Amadeo, 2018).  Based on this, in a competitive atmosphere such as the US, doctors and nurses should similarly focus on proceeds. They achieve this by giving new technology. They pay doctors more and offer expensive services. They attempt to compete by targeting rich people. 

In addition, UHC plays a key role in creating a healthy workforce: researches indicate that preventive care decreases the necessity for unaffordable emergency usages. Without access to precautionary care, around 46 percent of patients in the emergency room went due to the fact that they did not have a place to go (Amadeo, 2018). They utilized rooms for emergencies as their principal care doctor. Such inequality in healthcare is the reason why medical care costs keep on increasing. 

Early childhood care help to prevent future societal expenses. These consist of health issues, welfare dependency and crime. Health education educates families on various ways how to prevent chronic illness and how to make healthy lifestyle choices (Light, 2003). Also, the governments have the authority to impose taxes and laws to guide the populace towards healthier choices. Laws make unhealthy choices like drug abuse illegal (Light, 2003). As such, sin taxes on alcohol and cigarettes make them expensive. 

Positive Externalities about American Healthcare System

The established and modern state of technology is one of the greatest of the American healthcare system. Premature offspring for instance have higher chances of surviving if born in the USA due to modern technology. A comparatively high rate of pregnancy after 80 years is the other mirror of the modernized and established state of healthcare technology in America (Andersen, Rice & Kominski, 2002). Persons who are above 80 years of age in the US tend to live longer as compared to their counterparts in many other nations due to the fact that profusion of progressive and innovative medical technology (Zimlichman, et al. 2013). Similarly, the US continues to be the world’s best leader in the pharmaceutical invention. These products improve and extend and save the quality of life. 

Those who have the cash to pay for a premium health insurance package, they have exceptional Medicare whenever they have health challenges. Hospitals in the US have contemporary medical equipment as well as highly qualified healthcare providers. Surgeons and doctors are supposed to go through extensive subsequently training and speciality. This permits them to effectually treat the oddest conditions (Jonas, Goldsteen & Goldsteen, 2007). In the US, it is easier to get the ideal mental health services in the globe given the fact that the patients can pay them. Because of the high expenses of medicinal care under a direct-fee system, hospices are able to afford modern technologies that can assist individuals to battle many several life-threatening sicknesses (Jonas, Goldsteen & Goldsteen, 2007)

There are several dissimilar Medicare alternatives accessible that the patients can pick from according to their preferences or the daily lives they lead.  For example, there are exceptional Medicare advantage programs for individuals who travel regularly or who need extra benefits such as prescribed drug coverage (Jonas, Goldsteen & Goldsteen, 2007). Registering for the Medicare Advantage plan allow the original coverage to continue being payable through Medicare. 

Negative UHC Externalities

In spite of the up surged domestic funding for health and despite the burden of evidence about the effect of up surged expenditure on economic and health productivity, nations continue to under-invest in healthcare (Light, 2003). Not only do donor funds, but domestic finances, as well as out-of-pocket expenditures, are also considered to be insufficient, the gap between high-income and low-income nations in public expenditures on healthcare as the percentage of gross domestic product is essentially growing. There is also a big gap in the quality coverage (Amadeo, 2018). Additionally, many countries that nominally offer UHC have inequality problems as well as serious access problems. They are similarly unable to exploit numerous opportunities for enhancing outcomes. 

The negative externalities include the following: people who are healthy pay medical expenses for others. Chronic illness takes around 90 percent of healthcare expenses. Those considered to be very sick of the populace create around 50 per cent of the entire healthcare expenses, whilst those in good health condition only create 3 percent of the total expenses (Amadeo, 2018). Individuals have lesser monetary incentive to remain to be healthy, without a copay, individuals may overuse the doctor’s services and emergency rooms (Sen, 2015)

There are more delays on processes that are considered elective. The government agencies concentrate on offering emergency and basic healthcare. Also, health care practitioners might decrease care to reduce expenses if they are not well compensated by cost-cutting governments: for instance, doctors Medicare payment cuts shall compel them to close several internal blood testing laboratories (Light, 2003). In addition, healthcare expenses tend to overwhelm the budgets of the government. For instance, most Canadian provinces expend about 40 percent of their budgets on healthcare. The government might similarly regulate or restrict those services with a low possibility of success. This consists of medicines for expensive end-of-life and rare conditions (Light, 2003). In America, patients’ care in the past 6 years of life makes up to 4th of the Medicare budget

Negative Externalities about American Healthcare System

Unfortunately, the American healthcare system is similarly coupled with different weaknesses. Its visible weakness is demonstrated by the fact that around 42 million persons do not lack health insurance. Those who do not have health insurance plans have the problem of accessing problems and subjects a people’s proceeds to the whims of health status. The incapability to positively regulate expenses is the other major weakness of the American health care system. The advancement of health care expenses continues unabated, even though the pace has decelerated recently regularly because of the effect of managed–care firms (Zimlichman, et al. 2013). Whether managed care is likely to reduce the progress of healthcare expenses remains uncertain. Eradicating the weaknesses whilst upholding the strengths is considered to be a problem encountered by some plans for changing the American healthcare system. 

Health-care services are expensive– the main challenge that Americans have with the present healthcare paradigm is that medicinal services are considered to be extremely expensive. Those who are not insured or do not have insurance pay their medical expenses out of pocket. This means the uninsured people have limited healthcare services they are able to access. It is upsetting that healthcare debt is causing America to become bankrupt. Also, standard medical cover is not sufficient to offer treatments for some illnesses and medical processes.  

Ways to Improve Universal Healthcare Cover

There are some changes required to attain effectual promotion of private investment; leveraging of voluntary and private expenditure on health services with the public sector for better-incorporated care as well as the closing of quality and funding gaps that are meaningful for UHC (Lu & Hsiao, 2003). They are described as follows: Change from paying for the services to paying for results. Nations at all levels of income have already expressed their desire to execute “value-based care” through regulatory and payment reforms. Worldwide communities like OECD, WEF among other organizations support this change (McClellan & Scherdel, 2019). Yet, many nations still organize healthcare and pay for services and providers, not around the results that matter to persons. For all the US attempts to shift to value-based care, many payments are still based on the capacity of services offered (Sen, 2015). The SDG target linked to access to healthcare still concentrates on coverage of major services, not whether other inventive services are of high quality in practice for every person covered to attain SDG populace health goals (McClellan & Scherdel, 2019). However, there is currently a perfect comprehending of the changes and capacities that are aimed at reinforcing value based-care towards results-based funding plans.

Build capacity for sharing and capturing data and trace results to encourage their usage.  The capability to exchange and capture key social and health data to the community and personal risks, patient experience, treatment and outcomes results in better choices by patients and is the basis for rewarding firms and monitoring results that enhance health (McClellan & Scherdel, 2019). Thus, success in value-based care improvement needs outspreading data collection as well as measurement capacity to local populaces and measures that are able to assist in evaluating providers. With proper privacy securities, private firms knowledgeable in getting, cleaning, regulating, as well as sharing important business and consumer data—like service satisfaction and utilization— will assist the governments to build required capacity (Hwang, et al. 2013).

Leverage and scale effectual value-based care paradigms through supports and grants. Income-based supports and grants will enable populations and individuals to take part in value-based care frameworks. Health care firms that are entitled to get such subsidies will be selected as the first pilot with limited populaces or smaller changes from old-style funding. The primary condition is that populations and individuals must be paid based on accountability for results and other terms for helping the change to value-based care. In some of the nations where a rising middle class is gradually purchasing individual care, partly public grants for value-based care paradigms will help direct private investments toward value instead of fee-for-service paradigms (Lu & Hsiao, 2003). Higher subsidies for the poor populations will assist them to take part in similar care systems. Those subsidies will similarly play a key role in unifying private and public expenditure in supporting innovative care paradigms as well as assisting to drive the private venture to scale and develop key models which have demonstrated evidence of enhancing health results. The main objective is to influence and control the funds that rich people spend on themselves to finance inventive capacity which is likely to benefit the entire populace, instead of pushing private investment toward distinct, frequently ineffective systems of care.

Ways to Improve USA Healthcare Cover

The government should focus on upsurging expenditure on primary care. Greater investment in primary care will lead to reduced health care expenses as well as better health results. The health sector ought to stress the upsurge in American health care spent on primary care from the current one which ranges between 4–6 per cent to the 15–25 per cent that many high-functioning as well as lower expenses the health systems are expending on primary care (Andersen, Rice & Kominski, 2002).

Healthcare providers need readily available and transparent information on cost and quality to change the value equation. As such, the healthcare system is supposed to work collaboratively with researchers to gather broadly report on cost and quality metrics for all patients they treat (Jonas, Goldsteen & Goldsteen, 2007). These quality metrics must focus on processes and outcome measures. Hospitalists should seek out some of the metrics that really matter to patients, like attaining functional status. 

Those in charge of health must stop concentrating on the sick-care approach to care that is comprehensive and preventive. Also, healthcare leaders ought to upsurge family physicians as a speciality. More family doctors are required to upsurge preventive and comprehensive healthcare specifically in hospital settings and short areas (Kumar, Ghildayal & Shah, 2011). To succeed, the health care sector should support the upsurge of family medical residency spots of medicinal learners. 

References

Amadeo, K. (2018). Universal Health Care in Different Countries, Pros and Cons of Each. The Balance.

Azar, A., Mnuchin, S., & Acosta, A. (2018). Reforming America’s healthcare system through choice and competition.

Hwang, S. W., Chambers, C., Chiu, S., Katic, M., Kiss, A., Redelmeier, D. A., & Levinson, W. (2013). A comprehensive assessment of health care utilization among homeless adults under a system of universal health insurance. American journal of public health103(S2), S294-S301.

Jonas, S., Goldsteen, R. L., & Goldsteen, K. (2007). An introduction to the US health care system. Springer Publishing Company.

Kumar, S., Ghildayal, N. S., & Shah, R. N. (2011). Examining quality and efficiency of the US healthcare system. International journal of health care quality assurance.

Light, D. W. (2003). Universal health care: lessons from the British experience. American journal of public health93(1), 25-30.

Lu, J. F. R., & Hsiao, W. C. (2003). Does universal health insurance make health care unaffordable? Lessons from Taiwan. Health Affairs22(3), 77-88.

Martin, D., Miller, A. P., Quesnel-Vallée, A., Caron, N. R., Vissandjée, B., & Marchildon, G. P. (2018). Canada’s universal health-care system: achieving its potential. The Lancet391(10131), 1718-1735.

Ridic, G., Gleason, S., & Ridic, O. (2012). Comparisons of health care systems in the United States, Germany and Canada. Material socio-medica24(2), 112.

Rosen, H. S. (2004). Public finance. In The encyclopedia of public choice (pp. 252-262). Springer, Boston, MA.

Sen, A. (2015). Universal Health Care. Harvard Public Health Review5, 1-8.

Zimlichman, E., Henderson, D., Tamir, O., Franz, C., Song, P., Yamin, C. K., … & Bates, D. W. (2013). Healthcare-associated infections: a meta-analysis of costs and financial impact on the US health care system. JAMA internal medicine173(22), 2039-2046.

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