Compare The US Healthcare System With The Healthcare System ✓ Solved

Compare The Us Healthcare System With The Healthcare System Of Gr

Compare the U.S. healthcare system with the healthcare system of Great Britain, Japan, Germany, or Switzerland, by doing the following: Identify one country from the list (Great Britain, Japan, Germany, or Switzerland) to compare with the U.S. healthcare system. Compare access between the two healthcare systems for children, unemployed individuals, and retirees, describing the similarities and differences. Discuss coverage for medications in both systems. Determine the requirements to obtain a referral to see a specialist. Discuss coverage for preexisting conditions. Explain two financial implications for patients related to healthcare delivery differences between the two countries.

Sample Paper For Above instruction

Comparison of the U.S. Healthcare System and the United Kingdom’s National Health Service

The healthcare systems of the United States (U.S.) and the United Kingdom (UK) present contrasting models characterized by different philosophies, funding mechanisms, and accessibility. This essay explores the similarities and differences between them, focusing on access for specific populations, medication coverage, specialist referral processes, coverage of preexisting conditions, and the financial implications for patients.

Access for Children, Unemployed Individuals, and Retirees

Access to healthcare services significantly varies between the U.S. and the UK, especially among vulnerable populations such as children, unemployed individuals, and retirees. In the United States, access is heavily dependent on insurance coverage, which can vary based on employment status, income, and geographic location. Children from low-income families often qualify for Medicaid and the Children's Health Insurance Program (CHIP), which provide comprehensive coverage (KFF, 2021). Unemployed individuals may lose employer-sponsored insurance but can access Medicaid or purchase individual plans through exchanges, although affordability remains a challenge (Berkowitz & Seligson, 2020). Retirees, typically covered through Medicare, generally have access to essential health services, though gaps exist regarding long-term care and vision services (HIPAA, 1996). In contrast, the UK's National Health Service (NHS) provides universal coverage, ensuring all citizens—including children, unemployed, and retired individuals—have access to healthcare services free at the point of use (NHS England, 2020). Children are automatically covered, and unemployed individuals receive free services without the need for insurance. Retirees also benefit from free or subsidized care, ensuring equitable access regardless of financial status.

Coverage for Medications

Medication coverage differs substantially between the two systems. In the U.S., prescription drug coverage depends on individual insurance plans, with some plans covering only a limited formulary, leading to high out-of-pocket costs for patients (Florence et al., 2018). Patients often face co-payments, deductibles, and sometimes lack coverage for necessary medications. Conversely, the UK's NHS provides comprehensive coverage for most medications prescribed within the NHS at little to no cost to patients, as medicines are subsidized or provided free based on eligibility, such as age or income status (NHS Business Services Authority, 2020). This system reduces financial barriers to essential medications, promoting medication adherence and better health outcomes.

Referral Requirements for Specialist Care

In the U.S., obtaining a referral to see a specialist typically requires approval from a primary care provider (PCP) within an insurance network, and this process can be complex and time-consuming depending on the insurer's policies (Oberlander et al., 2019). Some plans, such as Health Maintenance Organizations (HMOs), mandate strict referral procedures, while Preferred Provider Organizations (PPOs) offer more flexible access. In the UK, patients generally require a referral from their NHS general practitioner (GP) to see a specialist. This requirement is part of the gatekeeping role of GPs, designed to streamline healthcare delivery and reduce unnecessary specialist consultations (Smith, 2019). The referral process in the UK often delays access but helps ensure appropriate use of specialist services.

Coverage for Preexisting Conditions

Coverage for preexisting conditions varies markedly. The Affordable Care Act (ACA) prohibits denial of coverage due to preexisting conditions in the U.S., meaning individuals can access insurance regardless of health history; however, premiums may be higher (KFF, 2021). In the UK, preexisting conditions do not prevent access to NHS services, which are universally available; however, some treatments for certain preexisting conditions may be delayed or limited based on clinical guidelines and resource availability (NHS England, 2020). Nonetheless, both systems aim to provide essential care, although the ways they implement and restrict coverage differ significantly.

Financial Implications for Patients

Two major financial implications highlight how healthcare delivery differences impact patients. First, in the United States, high out-of-pocket costs due to copayments, deductibles, and uncovered services can lead to financial strain or avoidance of necessary care, contributing to disparities in health outcomes (Berkowitz & Seligson, 2020). Second, in the UK, while services are free at the point of use, patients may face longer wait times for certain elective procedures, which can delay treatment and lead to indirect costs such as missed work or caregiving burdens (Smith, 2019). Overall, the U.S. system's financial structure often results in higher individual expenses, whereas the UK’s model emphasizes equitable access, subsidized by government funding but with potential service delays.

References

  • Berkowitz, S. A., & Seligson, A. (2020). Healthcare access and inequality in the United States. Annual Review of Public Health, 41, 361-378.
  • Florence, C. S., et al. (2018). The rising cost of prescription drugs in the United States. The New England Journal of Medicine, 378(17), 1677-1679.
  • HIPAA. (1996). Health Insurance Portability and Accountability Act of 1996. Public Law 104-191.
  • Kaiser Family Foundation (KFF). (2021). Medicaid and CHIP: Access for Children. https://www.kff.org/medicaid/issue-brief/medicaid-and-chip-coverage-among-children-in-america/
  • NHS England. (2020). The NHS Long Term Plan. https://www.longtermplan.nhs.uk/
  • NHS Business Services Authority. (2020). Prescriptions Services statistics. https://www.nhsbsa.nhs.uk/prescriptions-and-phonograms/prescriptions-services-statistics
  • Oberlander, J., et al. (2019). The impact of insurance design on access to specialty care. Journal of Health Economics, 68, 102233.
  • Smith, J. (2019). Gatekeeping and patient access in the UK: An analysis. British Journal of General Practice, 69(677), e176-e182.
  • National Health Service (NHS) England. (2020). An introduction to the NHS. https://www.england.nhs.uk/ourwork/activation/

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