Question

How might you compare and contrast the organization of the healthcare systems of the United States, Germany, and the United Kingdom?

Answer 1

Healthcare systems of Germany

The German healthcare system is a dual public-private system that dates back to the 1880s, making it the oldest in Europe. Today its doctors, specialists, and facilities make it one of the very best healthcare systems in the world.Healthcare in Germany is funded by statutory contributions, ensuring free healthcare for all. In addition, you can also take out private health insurance (Private Krankenversicherung or PKV) to replace or top up state cover (gesetzliche Krankenkasse or GKV).The Federal Ministry of Health is responsible for developing health policy in Germany. The sector is regulated by the Joint Federal Committee.Germany ranked 12th on the 2018 Euro Health Consumer Index. It has been praised for the level of choice given to customers in terms of treatment. However, it was criticized for having a low number of specialist hospitals, therefore this affected its score on quality.Germany is one of the biggest spenders on healthcare in Europe. It spends 11.1% of annual GDP on healthcare expenditure. Only Switzerland and France spend more in terms of GDP percentage. German healthcare spending works out at just over €4,000 per inhabitant each year.Under the German healthcare system, you are free to choose your own doctor. Many speak at least basic English. Some doctors only treat private patients, therefore if you have state insurance, make sure to check beforehand otherwise you will have to pay for treatment.Practice hours are usually from 8am-1pm and from 3pm-6pm from Monday to Friday; many close on a Wednesday afternoon. Few practices are open on Saturdays and only emergency services operate on Sundays.Some doctors have an ‘open door’ policy where you can just turn up at the surgery; however you may have a long wait. You will need a referral from your GP to see many specialist doctors, although some specialists take direct bookings.

Hospitals are called Krankenhäuser. There are three main types:

1.Public hospitals (Öffentliche Krankenhäuser) which are run by the local and regional authorities;

2.Voluntary, non-profit making hospitals (Frei gemeinnützige Krankenhäuser) run by churches or organisations run by the German Red Cross;

3.Private hospitals (Privatkrankenhäuser)

Outpatient care in Germany is generally provided by doctors and specialists from individual or joint practices. You will also find many medical centers, both public and private, where various different health professionals operate. These can include GPs, medical specialists, physiotherapists, psychotherapists, and nurses.

The health care system in Germany is based on four basic principles:

1.Compulsory insurance: Everyone must have statutory health insurance ("gesetzliche Krankenversicherung" – GKV) provided that their gross earnings are under a fixed limit ("Versicherungspflichtgrenze"). Anyone who earns more than that can choose to have private insurance ("private Krankenversicherung" – PKV).

2.Funding through insurance premiums: Health care is financed mostly from the premiums paid by insured employees and their employers. Tax revenue surpluses also contribute. To give you an idea of what this means: State-funded health care systems like those in Great Britain or Sweden draw on tax revenue. In market-oriented systems such as that in the United States, many people have to carry the costs of treatment and loss of earnings due to illness themselves, or have to get private health insurance.

3.Principle of solidarity: In the German health care system, statutory health insurance members jointly carry the individual risks of the costs of medical care in the event of illness. Everyone covered by statutory insurance has an equal right to medical care and continued payment of wages when ill – regardless of their income and premium level. The premiums are based on income. This means that the rich can help the poor, and the healthy can help the ill. However, these premiums are only calculated based on a percentage scale up to a certain income level ("Beitragsbemessungsgrenze"). Anyone earning more than this amount pays the same maximum premium.

4.Principle of self-governance: While the German state sets the conditions for medical care, the further organization and financing of individual medical services is the responsibility of the self-governing bodies within the health care system. These are made up of members representing doctors and dentists, psychotherapists, hospitals, insurers and the insured people. The Federal Joint Committee ("Gemeinsamer Bundesausschuss" or G-BA – please also see below: “Structure and institutions of the health care system”) is the highest entity of self-governance within the statutory health insurance system.

Healthcare systems of United States

It provided many distinct organizations. Health care facilities are largely owned and operated by private sector businesses. 58% of community hospitals in the United States are non-profit, 21% are government owned, and 21% are for-profit.

Although there are several different types of coverage and states often have their own health insurance regulations, there are some aspects of the system that are similar throughout the U.S. Hospitals, clinics, doctors’ offices and other health care facilities are owned by a variety of private and public entities. Health insurance providers are generally separate companies from these and deal with a wide range of different healthcare providers.Patients pay monthly health insurance fees to ensure that they will be covered when they need to go to the doctor, clinic or hospital. Insurance providers cover thousands of patients, so they are able to negotiate with health care providers for reduced fees and then pay for services. The Medicare or Medicaid insurance works the same way but on a bigger scale. Because they need to be able to negotiate, insurance providers generally have a network of doctors that they have agreements with, and patients are covered for visits to doctors within that network but may not be covered, or fully covered, for visits to doctors out of their network. Insurance providers will usually cover services considered necessary by doctors, but often will not cover services which are considered “elective.” Insurance companies aim to keep their costs down while still covering necessary health care.The US government does fund two kinds of health plans though: Medicare and Medicaid. They are especially designed for the elderly, disabled, poor, and young.However, many Americans have their healthcare paid for by their employer. It's often included as a fringe benefit in job packages.But some aren't as lucky. According to the US Census Bureau, in 2007 almost 46 million people in America didn't have health insurance.It's thought the figure's rising as the country copes with a recession and many continue to lose their jobs.A recent study published in the American Journal of Medicine says the biggest reason for bankruptcy is medical debt.

The Affordable Care Act (ACA), enacted in 2010, established “shared responsibility” between the government, employers, and individuals for ensuring that all Americans have access to affordable and good-quality health insurance. However, health coverage remains fragmented, with numerous private and public sources, as well as wide gaps in insured rates across the U.S. population. The Centers for Medicare and Medicaid Services (CMS) administers Medicare, a federal program for adults 65 and older and some people with disabilities, and works in partnership with state governments to administer both Medicaid and the Children’s Health Insurance Program (CHIP), a conglomeration of federal–state programs for certain low-income populations.Private insurance is regulated mostly at the state level. In 2014, state and federally administered health insurance marketplaces were established to provide additional access to private insurance coverage, with income-based premium subsidies for low- and middle-income people. In addition, states were given the option of participating in a federally subsidized expansion of Medicaid eligibility.

Healthcare systems of United Kingdom

Its a devolved matter, with England, Northern Ireland, Scotland and Wales each having their own systems of publicly funded healthcare, funded by and accountable to separate governments and parliaments, together with smaller private sector and voluntary provision. As a result of each country having different policies and priorities, a variety of differences now exist between these systems. Most healthcare in England is provided by the National Health Service (NHS), England's publicly funded healthcare system. Social care services are a shared responsibility between the local NHS and the local government’s Directors of Social Services, and falls under the guidance of the Department of Health. Similarly most healthcare in Scotland and Wales are provided by NHS Scotland and NHS Wales, respectively. The majority of healthcare in Northern Ireland is provided by Health and Social Care in Northern Ireland, which is still often referred to as "NHS" for convenience. The actual delivery of health care services is managed by ten Strategic Health Authorities and, below this, locally accountable trusts and other bodies. Healthcare in the United Kingdom is publicly funded, generally paid for by taxation. However, the UK also has a private healthcare sector, in which healthcare is acquired by means of private health insurance. This is typically funded as part of an employer funded healthcare scheme or is paid directly by the customer. Private healthcare has continued to exist, paid for largely by private insurance. Most health insurance products are distributed by the National Health Service (NHS); only a very small sector is distributed by private insurance companies.

Overall the health, as well as ideological and organisational challenges that the UK Healthcare system is facing are not dissimilar to those faced by many national healthcare systems across the world. Life expectancy has been steadily increasing across the world with ensuing increases in chronic diseases such as cancer and neurological disorders. Negative environment and lifestyle influences have created a pandemic in obesity and associated conditions such as diabetes and cardiovascular disease. In the UK, coronary heart disease, cancer, renal disease, mental health services for adults and diabetes cover around 16% of total National Health Service (NHS) expenditure, 12% of morbidity and between 40% and 70% of mortality . Across Western societies, health inequalities are disturbingly increasing, with minority and ethnic groups experiencing most serious illnesses, premature death and disability. The House of Commons Health Committee warns that whilst the health of all groups in England is improving, over the last 10 years health inequalities between the social classes have widened—the gap has increased by 4% for men, and by 11% for women—due to the fact that the health of the rich is improving much quicker than that of the poor . The focus and practice of healthcare services is being transformed from traditionally offering treatment and supportive or palliative care to increasingly dealing with the management of chronic disease and rehabilitation regimes, and offering disease prevention and health promotion interventions. Pay-for-performance, changes in regulation together with cost-effectiveness and pay for medicines issues are becoming a critical factor in new interventions reaching clinical practice .Preventive medicine is solidly established within the UK Healthcare System, and predictive and personalised approaches are increasingly becoming so. Implementation of PPPM interventions may be the solution but also the cause of the health and healthcare challenges and dilemmas that health systems such as the NHS are facing . The efficient introduction of PPPM requires scientific understanding of disease and health, and technological advancement, together with comprehensive strategies, evidence-based health policies and appropriate regulation. Critically, education of healthcare professionals, patients and the public is also paramount. There is little doubt however that harnessing PPPM appropriately can help the NHS achieve its vision of delivering healthcare outcomes that will be among the best in the world.

In a study that compares 7 industrialized countries, UK was ranked 2nd, while the US consistently underperformed in most areas of health care relative to other countries. The US healthcare system is the most costly in the world. Of the countries studied, it was the only one that did not have a universal health insurance system. The US is last in terms of access, patient safety, coordination, efficiency, and equity. The US has the highest healthcare spending in the world. Of the 15% of GDP the US spends on healthcare annually (that’s about $2.2 trillion dollars), around 50% is spent by the government (around $1.1 trillion). By contrast, the UK spends only around 8% of its GDP on healthcare. The UK National Health Service cares for 58 million people (100% of the population of England), where the US’s public healthcare currently covers about 83 million (around 28% of the US population). Also, US healthcare sets age and income requirements (Medicaid or Medicare) on public healthcare coverage, whereas UK made public health care accessible to all UK permanent residents by making it free at the point of need. The US does hold certain advantages over UK when it comes to the private healthcare sector. For instance, the UK rates 40% higher than the UK in percentage of men and women who survived a cancer five years after diagnosis. The US also ranks higher in percentage of patients diagnosed with diabetes who received treatment within six months. The number of US patients who received timely treatment for diabetes was more than 6 times that of the UK, and twice that of Canada. Similarly, the percentage of US seniors who received hip replacements within 6 months of diagnosis of need is more than 6 times that of UK and twice that of Canada. Finally, the percentage of seniors (Age 65+) with low-income who say they are in “excellent health” in US was far and away greater than that of any other nation.