Healthcare in the England versus the US
A healthcare system is defined as, the of combination of resources, their organization, financing and management aimed at resulting in the delivery of health services to a population (Roemer, 1991). Healthcare systems can further be defined as the sum total of activities whose primary concern is to promote, restore and maintain health (World Health Organization, 2000). In addition, the comparison of health systems has increasingly become commonplace and most of these comparisons are based on national health care comparisons of OECD member countries, measures as a fraction of their Gross Domestic Product (GDP) or on a per capita basis (Annell & Willis).
Debate on the Comparison of Health Care Systems
According to the Economist (2014) the Common Wealth Fund’s assessment of health care systems has often been faulted. While this system lays emphasis on value for money, accessibility of healthcare, quality of healthcare and equity as the leading criteria for inter-country country healthcare systems comparisons, there are many people who disagree with this method. The major points of debate revolve around people differing on what should be waiting. The general consensus is that while the National Health Service(NHS) methods used in countries like Spain and New Zealand offer cost-efficient care other expensive health care systems like that of the U.S offer great preventative health care that is highly innovative and patient centres.
In addition, different bodies employ different measurement parameters with a ranking by Bloomberg health ranking Singapore, Hong Kong and Japan as having the best performing healthcare systems. It has also been claimed that the criticism levelled against the American healthcare system is unwarranted as it dwells on the expense and overlooks feats such as the no harm to patients model in Seattle’s Virginia Mason Hospital than many hospital worldwide
now seek to emulate.
Comparison Between England Versus United States HealthCare
According to (Docteur & Berenson, 2009) in order to make a informed assessment about the quality of healthcare offered in one system versus another, it is imperative to look at a wide range of indicators. This is the preferred method because healthcare encompasses a wide range of activities and therefore using a single measure may prove to be an unreliable indicator.
Efficiency of Care
In the comparison context, efficiency of health care refers to the relationship between the inputs into a healthcare system versus the outputs/products of that system. According to OECD Health Data (2013) , the average length of stay in hospitals is shorter in the UK compared to other OECD member states including the U.S. It was also revealed in the health data findings, that the UK spends less on pharmaceuticals and generally more on generic medicines and that it also spends less resources in terms of staff and beds compared to its peers. According to ( Davis, 2014) a survey between 11 industrialized countries on measures such as efficiency, access to care, equity and health system quality, revealed that the U.S health care system is the most expensive and the least effective. The research findings revealed that on average the U.S spent $8,508 per person compared to $3,406 spent per person in the UK in the year 2011.
The US healthcare system is more lucrative compared to that of the UK. The pronounced anathema towards the establishment of a national health insurance policy/ program is also a matter that continues to plague the US. This process also seems to have been abetted politically and the payer and provider model is the main mode of operation within the U.S healthcare system. According to data from the Common Wealth Fund in 2014, the labour tax and spend model along which the NHS is modelled led health spending to increase to a record 9.3% but this was less than Germany whose spending amounted to 10.7%and the U.S which was at 15%. The report further showed that not only was the UK model more cost more effective but it also was instrumental in the saving of lives. For instance data released by the Commonwealth Fund revealed that adult deaths in the UK reduced by about 3,951 each year and this figures were remarkably better than those of other European OECD states. The report further suggested that the NHS had created a situation in which UK healthcare system has been reducing annual deaths by 162,000 since 1980.
Differences in Life Expectancy
According to (Jarman, 2013) the mortality rates were higher in English hospitals than they were in U.S hospitals. This conclusion was reached after analysing data collected using the Hospital Standardized Mortality Rate (HSMR) Index. According to Jarman, comparison over a ten year period revealed that: In the year 2004, there were 22.5% more deaths in English NHS hospitals than there were in the U.S. The HSMR indexes were 58% higher than they were in the overall best performing country, the U.S. In 2012, the mortality rates seem to have somewhat decline by a patient admitted in a British NHS hospital, was 45% more likely to die than if they were admitted in a U.S hospital.
The comparison in mortality rate of persons aged 65 and over revealed that elderly people suffering from pneumonia were 5 times more likely to die in English hospitals than American ones. In the case of elderly people with septicaemia (blood infection) death was twice as likely to occur in a UK hospital as in a U.S hospital.
The advanced state of technology that is synonymous with the U.S. health care system is its greatest strength. For instance, premature babies born in U.S hospitals have a relatively higher chance of survival because of the advance state of technology available. The life expectancy of elderly persons above 80 is higher when compared to that of their counterparts in the UK and other OECD member states. In terms of pharmaceutical innovations and clinical expertise, the U.S is better compared to the U.K and all this results in products that save, extend and improve the quality of lives.
Physicians Per Person
The OECD Health Data Findings (2013), revealed that in the UK there are about 8.2 nurses per 1000 people and 2.8 doctors per 1000 people. This number is significantly higher compared to the U.S which has 1.2 primary care physicians per 1000 people.
Equity of Access To Care
The UK predominantly utilizes the National Health Service (NHS) which is a type of insurance program.. In this type of program medical services are delivered via government salaried physicians in public owned hospitals and clinics that are mainly operated and financed by governments through tax payments. In 2014, the Common Wealth ranked the NHS system mainly utilised in UK, Spain and New Zealand as the first and most effective compared to other systems. The same report indicates that out-of-pocket expenses in the UK were significantly low compared to other OECD countries. A report by the Department for Professional Employees (2014), prohibitive cost is the number one problem suggested by Americans in regard to their health care system. The same report suggested that 58% of physicians acknowledge the fact that Americans have trouble affording health care. The US healthcare system and its attendant costs, has made many people remain uninsured and in 2012 this figure stood at 48 million uninsured Americans.
Out-of-pocket expenses also proved to be significantly higher in the U.S compared to the U.K with costs averaging $17,943 for all medically bankrupt families.
The NHS guidelines propose that 95% of patients should be seen within 4hours of visiting a hospital or health facility. The waiting times in UK hospitals are thus shorter compared to waiting times in American hospitals. As reported by the Business Insider, the waiting times in the US are much longer and this could be attributed to the few number of physicians in relation to the target population.
Care for Chronic Conditions
Studies in the U.S have revealed that there are significant gaps between the care that U.S patients with chronic illnesses receive in relation to recommendations for the achievement of optimal health outcomes (Crosson et.al 2009). The American health care payment system is generally premised on a fee-for-service (FFS) structure, that is generally gears towards rewarding healthcare personnel for the number of services provided but fewer incentives are generally offered for high quality health care and this has been identifies as a key contributor to the gulf between what is achievable and what is actually delivered by the health care system in the US.
According to (Crosson et al 2009), a comparison study between the UK and US on Chronic Illnesses and the quality of care provided, revealed that most UK practices used Electronic Media Registers for all practices while in the U.S EMRs were only used for nine procedures. The study, following the assessment of all processes of care and intermediate outcomes related to chronic illnesses, revealed that the variability of practice rates in the UK was lower compared to the US. The study, in using a hierarchical odds model established that after the adjustment of patient level confounders such as (gender and age) processes of care ,measures achieved were higher in UK practices compared to U.S practices when it came to patients with CAD or Diabetes .
Both the U.K and the U.S healthcare systems have their fair share of strengths and weaknesses. The UK system is generally cost effective and offers less out of pocket expenses, compared to the American system. Another notable distinction this paper established is that the American system is concerned with quantitative healthcare as opposed to qualitative healthcare. The major focus in the US system is on fee for service charges and this breeds a culture in which physicians are more concerned with making profits than in the quality of health care provided. Another key departure point is in the number of uninsured Americans which is at about 40 million. This is a significant portion of the entire U.S population and this could be attributed to the lack of a national healthcare plan leaving many Americans at the hands of private companies whose insurance fees are often prohibitive and inaccessible to many. This system also leads to the incurrence of a lot of out of pocket expenses for the patient.
The stakeholders in the American healthcare system should prioritize the formulation and implementation of a national healthcare program as this will greatly subsidize the cost of healthcare and offer much needed relief to many Americans who remain uninsured and unable to access quality healthcare due to prohibitive costs. As studies mentioned earlier proved, the use of electronic registers should also be included in more processes in the US healthcare system like they are utilized in the UK system. One of the major drawbacks recognized in the UK healthcare system is the lack of innovation and technological advancement compared to the US. Relevant stakeholders and especially the government should prioritize hospital funding in relation to upgraded technology and improved innovation. This means allotting more money to the field of medical research to match the clinical expertise of other OECD countries such as the U.S. Both systems should also try and employ more adaptive systems of thinking as opposed to mechanical systems.
Comparisons have historically proven to be more useful if they analyse the expenditure vis a vis the number of resources available. Conventional comparisons of expenditure alone offer flawed results. Comparisons such as those of health care systems are important as they provide knowledge and insights that can be useful in long term planning and management of the future. These comparison studies should not be used as a basis of chest thumping and grandstanding, but rather they should stimulate intellectual ware fare geared towards healthcare improvement and strengthening of existing healthcare frameworks.
Annell, A., & Willis, M. (2000). International Comparison of Health Care Systems Using Resource Profiles. Bulletin Of The World Health Organization, 78(6).
Crosson, J. (2009). A Comparison of Chronic Illnesses Care Quality in US and UK Family Edwards, J. (2016). What it’s like when you’re an American using Britain’s NHS. Business Insider.
Docteur, E., & Borenson, R. (2009). How Does The Quality of U.S Healthcare Compare Interationally?. Urban Institute.
Retrieved 17 April 2016, from http://www.businessinsider.com/an-american-uses-britain-nhs-2015-1 Medicine Practices Prior to Pay-For-Performance Initiatives. Oxford Journals.
http://www.economist.com/news/international/21595474-improve-health-care-governments- need-use-right-data-need-know. (2016). Retrieved 17 April 2016
Roemer (1991). National Health Systems of the World, Vol. 1: The Countries. New