1. In most of the countries discussed, does universal coverage provide the gold standard of care? 2. Does rationing occur in these countries? If so, how is it different from rationing in the United States? 3. Do revenues used to pay for health care tend to come from a single source or are they derived from many different sources? 4. What steps do these countries take to ensure that payments required of individuals do not become a barrier to access? 5. What other patterns of similarities and differences do you notice? 6. To what extent do you think the crafting of the ACA relied on experiences in other countries? Can you think of examples of policies or countries that may have been influential?

In most of the countries discussed, does universal coverage provide the gold standard of care? 

Paraphrasing World Health Organization,”Universal health coverage is defined as ensuring that all people have access to needed health services (including prevention, promotion, treatment, rehabilitation and palliation) of sufficient quality to be effective while also ensuring that the use of these services does not expose the user the financial hardship. Universal health coverage has therefore become a major goal for health reform in many countries” (“Health Systems: Universal“, n.d.).

“Universal Health plan, all would be covered by public health insurance, regardless of income, age, or employment status; provides all citizens with basic services, including hospital, physician care and long term care plus system would be fully regulated by the government” (Cicconi & Strug, 1999).

Gold Standard term used to describe a method or procedure that is widely recognized as the best available

The point of universal coverage is to provide the gold standard of care for all, further going by WHO, universal coverage is supposed to embody Equity of access, Quality of service and Financial-Risk protection; this however has not been the absolute case in the industrialized nations with universal coverage. Despite the fact that the World Health Report on health systems financing in 2010 provide framework and support for universal health coverage amongst nations without universal coverage and improvement of those with existing universal coverage. Some of thees nations with universal health coverage from before 2010 like Australia, Britain, Canada, Germany are discussed in the case.

As for Equity: Australia- has fewer access problems compared to others under review. Britain- decentralization of responsibility, eradicate discovered differences in treatments and outcome among different geographic areas, regional health authorities, and fund-holders, Germany- everyone is entitled and even double covered either through community or organizations, Japan- no claims of universality, but provisions are made for majority with better outcomes than most countries. “Premiums are pooled, and each insurer receives the same premium per enrollee in an attempt motivate efficiency improvements”-Germany (McLaughlin & McLaughlin, 2015).

As for Financial-Risk protection: Australia- financial-risk is reduced for the general populace and even those that do complementary insurance with private. Germany- there is cover created specifically for the unemployed, it is well regulated despite the recent growing presence of private insurance. In my opinion, the “optional” gift in the Japanese system leaves those unable to fulfill, open to whatever cultural ramifications, there are to not obliging in such a traditional society as Japan. There is a constant pooling of risk and premiums, across nations.

As for Quality of Service: Australia- issues with prescription payment, higher doctor to population ratio than the US. Britain- there have been incentives for physicians towards improving the quality of care offered “In 2004, the NHS adopted a pay-for-performance system for family physicians that involved 146 quality performance measures” (McLaughlin & McLaughlin); Britain also increased funding and successfully reduced queues and wait times.

Worthy to note that according to  McLaughlin & McLaughlin “employment-based health insurance is the core of Japan’s health system, and it continues to produce the one of best health outcomes of any of the systems mentioned” in the case, despite claim old equipments.

Reference

Cicconi L. & Strug , K. (1999). Universal Health Care In The U.S..Poverty & Prejudice: Social Security at the Crossroads. Retrieved from http://web.stanford.edu/class/e297c/poverty_prejudice/soc_sec/universal.htm

Health Systems: Universal health coverage (n.d.) Retrieved from http://www.who.int/healthsystems/universal_health_coverage/en/

Horton, R. & Das, P. (2014). Universal health coverage: not why, what, or when but how? Retrieved from https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61742-6/fulltext

McLaughlin, C.P.& McLaughlin, C.D. (2015). Health Policy Analysis: An Interdisciplinary Approach. Jones and Bartlett. 2nd ed. Pp 82

Does rationing occur in these countries? If so, how is it different from rationing in the United States?

Yes rationing does occur in these countries.

In the U.S. rationing occurs by insurance status, employers’ cutbacks, inadequate safety nets, limited access given by insurances, high and unaffordable costs etcetera . “The costs of health insurance and care have reached more than 25,000 a year for a typical family of four insured by an average employer-sponsored PPO (4), having doubled over the last ten years, clearly a huge burden when we consider that the median household income is now about 53,000” (Geyman, 2016).

In the case of the countries mentioned in this case, rationing is done through staggered non-life threatening procedures, reduced wait times/queues (Japan). While in Britain it is done based on the severity of the healthcare-need not ability to pay and overseen by National Institute for Health and Care Excellence (NICE). In Canada, through delays in elective services, rather than ability to pay and relative reduction in lengths of hospital stays. The other nations are similar in this rationing, that is holding off for varied lengths of time for treatment of non-acute conditions.

Even with the rationing, it is clear the U.S. government wants to preserve life, but there is a “seemingly inverse relationship between health care expenditures and the access to necessary services in the U.S. health care system” (Baribault & Cloyd, 1999) and this endures as U.S. remains the highest spender per person in the world.

Reference

Baribaukt, M. & Cloyd, C. (). Health Care Systems: Three International Comparisons. Poverty & Prejudice: Social Security at the Crossroads. Stanford University.Retrieved from https://web.stanford.edu/class/e297c/poverty_prejudice/soc_sec/health.htm

Geyman. J., (2016). Does The U.S. Ration Health Care? Huffington Post. Retrieved from https://www.huffingtonpost.com/john-geyman/does-the-u-s-ration-healt_b_11296230.html

McLaughlin, C.P.& McLaughlin, C.D. (2015). Health Policy Analysis: An Interdisciplinary Approach. Jones and Bartlett. 2nd ed. Pp 79-89

Do revenues used to pay for health care tend to come from a single source or are they derived from many different sources?

Revenues come from various sources, the most constant amongst the countries has been the government and usually the government sources it from taxes,

Canada’s universal coverage is financed through payroll, VAT and income taxes, so does Japan. In most cases it is a combination of both public and private (co-payments with healthcare recipient, employers, Insurance companies, retirement funds, unions etcetera. (McLaughlin & McLaughlin, 2015).

In countries with universal healthcare coverage, there are no uninsured persons unlike the countries without universal healthcare coverage. Though these two categories have their share of underinsured people.

The extrapolation is that the countries all have relatively different funding mechanisms, the various governments’ focus is less about how healthcare is funded and more on who has access to healthcare especially the ones with universal coverage. (Munro, 2013)

Reference

McLaughlin, C.P.& McLaughlin, C.D. (2015). Health Policy Analysis: An Interdisciplinary Approach. Jones and Bartlett. 2nd ed. Pp 79-87

Munro. D., (2013). Universal Coverage Is Not "Single Payer" Healthcare. Forbes. Retrieved from https://www.forbes.com/sites/danmunro/2013/12/08/universal-coverage-is-not-single-payer-healthcare/#6532a03536ee

What steps do these countries take to ensure that payments required of individuals do not become a barrier to access?

Japan- the employment based insurance premiums are according the income of the household(s) and even retirees are covered; but those not covered with the employment based insurance, are covered by community plans and payment is hinged to patient satisfaction, also more procedures-lower fees.

Germany- unemployment insurance and retirement fund covers the premiums for the unemployed and retirees respectively.

Australia- increased the taxation used for funding health and made it accessible to all. Subsidizes longterm care of seniors. Also government provided incentives to encourage private insurance who cover half the population and who in turn provide relatively good packages to the people.

Britain- British National Health Service provides mandatory healthcare service for all its citizens.

Canada- growth in per capita spending by the government has picked up and there is slight improvement in health outcome post 1971.

U.S.- demography-specific coverage, selective healthcare insurance for members of the public who belong to certain groups for example Medicaid for young and very low income earners and Medicare for the elderly. This is supposed to target those in most need of support.

The template of the universal healthcare coverage is to be all-encompassing  so as avoid barrier to access of anyone and everyone.

Reference

McLaughlin, C.P.& McLaughlin, C.D. (2015). Health Policy Analysis: An Interdisciplinary Approach. Jones and Bartlett. 2nd ed. Pp 335

What other patterns of similarities and differences do you notice?

Payment system for healthcare vary per country, be it single payer or multiple payer or multi-layered payments. It could be government, private, not-for-profit, religious bodies etcetera.

Wait times also differ across the world, this is the length of time it takes to see a doctor. “In both the United States and countries with other types of health insurance plans, it's usually possible to make an appointment with your primary care physician within a day or two, if the need is pressing” (Cain, n.d.)..

Taxation as a common/similar source of income for government which in turn funds the public health insurance be it partly or in full, both with universal and selective insurance coverage.

Incentivizing providers towards higher quality of care through gains, rewards etcetera. Encouraging insurers through rebate and such to further increase ease of entry/access. Big risk pools balance insurance payments, premiums paid by all reduce risks of loss and cost. Remuneration: “The British experiment with pay-for-performance was sufficiently successful that Epstein (2006) argued that its time has come for the United States. One might also see it as a way to boost the incomes of primary care” (McLaughlin & McLaughlin, 2015). Replacement and cross functional duties, roles of healthcare professionals are often expanded to further accommodate needs and reduce shortages.

Countries vary in physician to population ratios, with some having more than others.

Whatever the similarities and differences between healthcare systems in various cultures and the way they are run, it is clear, there are borrowed and initiated ideas across the globe for example Germany under Bismark started a version of the universal healthcare coverage we know today.

Eligibility: for citizens, residents and even illegal aliens access and cost of healthcare vary. in nations with universal all citizens are insured (public), some from birth, while those with citizenship may vary, a common factor in many countries is that they are all taxed, citizens and non citizens alike.

Healthcare expense and cost vary all over the globe for whoever is paying, be it consumer or third party, it is quite high in the U.S.

The U.S. gives the patient and provider option to choose who they accept, making it optional in the case of non-existing relationships and certain parameters.

Access to facilities, hospitals, laboratory really differ especially with rural communities in underdeveloped countries of the world.

A number of countries have established global hospital budgets or capitation budgets for hospitals, often administered through local authorities or trusts”(McLaughlin & McLaughlin, 2015).

Level of regulations and regulatory power through enforcement and adherence differ in many countries, nations with corruption governments find it harder to enforce rules or protect population from abuse sometimes.

Agents, these include consumers, insurers, health plans, funds, sponsors, providers to mention a few. (Ellis et al, 2014).

The OECD found that in 2013, the U.S. spent $8,713 per person or 16.4 percent of its GDP on health care—far higher than the OECD average of 8.9 percent per person (Dorning, 2016).

Reference

Cain, J. (n.d.). U.S. Health Care vs Health Care Systems in Other Countries. Retrieved from https://usinsuranceagents.com/us-health-care-compared-other-countries

Dorning, J. (2016). The U.S. Health Care System: An International Perspective. The Department for Professional Employees. Retrieved from http://dpeaflcio.org/programs-publications/issue-fact-sheets/the-u-s-health-care-system-an-international-perspective/

Ellis, R. P., Chen, T. & Luscombe, C.E. (2014). Comparisons of Health Insurance Systems in Developed Countries. Department of Economics, Boston University. Retrieved from http://www.bu.edu/law/files/2016/01/EllisPaper.pdf

McLaughlin, C.P.& McLaughlin, C.D. (2015). Health Policy Analysis: An Interdisciplinary Approach. Jones and Bartlett. 2nd ed. Pp 87

To what extent do you think the crafting of the ACA relied on experiences in other countries? Can you think of examples of policies or countries that may have been influential?

Not by much, it was mostly a review of policies from decades ago for example Medicare of 1965, , plus court imposed adjustments that evolved into The Affordable Care Act of 2010. Be it “universal coverage or a legal right to care, Europe covers both bases. Nearly every European nation has signed and ratified the European Social Charter. That treaty’s section on health care, casts healthcare as a right” (Greenberg, 2015).

Most governments for decades find ways to ensure regulatory supervision of insurance providers, protections of privately insured and maximization of the private insurance reach and/or number of people covered; the ACA is no different “Private insurance plans were required to offer minimum packages of benefits that would be determined by the federal government” also predominant is that “finance health care overhaul, several new fees and taxes would be levied by government”. (Levy, n.d.)

There are things about the act that is unique to the U.S. “Access to the federal high-risk pool for the uninsured with pre-existing conditions” (“History and Timeline”, 2018) is more protective of the insured and prevents rejection insurers, while Australia’s “Lifetime Health Cover program” shores up the insurer more than the insured, allowing for rejection under the guise of “ensuring” early enrollment.

Reference

Greenberg, J. (2015). Bernie Sanders: U.S. 'Only Major Country' That Doesn't Guarantee Right To HealthCare. Retrieved from http://www.politifact.com/truth-o-meter/statements/2015/jun/29/bernie-s/bernie-sanders-us-only-major-country-doesnt-guaran/

History and Timeline of the Affordable Care Act (ACA) (2018). Retrieved from  https://resources.ehealthinsurance.com/affordable-care-act/history-timeline-affordable-care-act-aca

Levy, M. (n.d.). Patient Protection and Affordable Care. Retrieved from https://www.britannica.com/topic/Patient-Protection-and-Affordable-Care-Act

McLaughlin, C.P.& McLaughlin, C.D. (2015). Health Policy Analysis: An Interdisciplinary Approach. Jones and Bartlett. 2nd ed. Pp 83