Comparative analysis of three different health systems

Comparative analysis of three different health systems
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Introduction
The health care system concerns the institutions, services offered and institutional arrangements for treating and caring for the ill, as well as promoting health (Palmer & Short, 2010). Political, social, economic, technological as well as legal factors influence the health care systems of countries making them distinct and these factors influence how health policies are created. For instance, the Australian healthcare system has its unique features, but because of a strong British influence, it shares some similarities with the U.K. On the other hand, adoption of voluntary insurance systems was heavily influenced by the American system since 1953. Similarly, the use of tax funded health insurance arrangement is based on the Canadian Model adopted in 1975 under the Medibank scheme (Palmer & Short, 2010). On the political front, reformist organizations and the political structure determines policies adopted as with more partisan politics it is harder to achieve consensus because of ideological differences (Hussain & Rivers, 2010). This is a comparative analysis of the Australian, American and Canadian healthcare systems
Design and functioning of Australian healthcare system
Role of government
In the Australian context, the government plays a prominent role in the health sector especially though funding and making policies but there is less emphasis on provision of health services. Medicare is also covered by the government with the federal government offering funds and overseeing the national health insurance scheme as well as other health related benefits and health programs within territories (Maynard, 2005). At the same time the government plays a prominent role in regulating health services even in the private sector, and supervises subsidised services in the regions. Since 2011, the federal government has continued to play amore prominent role in healthcare provision through primary care and funding of public hospitals.
Federalism influences the financial arrangement and arrangements of healthcare organisations. There are two territories and six states under the Australian central government commonly referred as the federal, Commonwealth or Australian government, and there are over 800 local governments throughout Australia (Palmer & Short, 2010). The local governments have limited powers through restrictions imposed by the constitution, but roles may change depending on policies of the government in power. The Commonwealth government typically funds most projects and health arrangements, while states mainly direct service provisions.
The Canadian model is similar to the Australian healthcare system whereby the regionally administered public healthcare is a universal insurance coverage for public funded hospitals. Nonetheless, Canadian provinces and territories have responsibilities in delivering health services, and have authorities tasked with funding local services provision especially in the communities. Funding typically occurs when there is adherence to criteria set by the Canada Health Act. However, in the U.S. the government’s role is less prominent, whereby under Medicare people above 65 years are eligible and younger people with disabilities. Medicaid covers low income earners below 65 years, but under private insurance schemes cover a potion of the uninsured (Prieto, 2008). In Australia, the government’s role is most prominent, while in Canada territories have more flexibility in their health care systems, and America typically focuses on private healthcare system that is diverse and flexible. Nonetheless, accessibility of the Australian health care system at any level includes coverage even to remote areas, unlike American and Canadian models (Collier, 2013).
People covered
Medicare and the public health insurance scheme provide universal coverage under Australia’s health system for both citizens and permanent residents of the country, together with people having residency from countries in arrangement with Australia. Foreign students ought to register for health cover, while asylum seekers are partly covered in the Australian health system. Coverage is through private or public health care services, while the private health insurance system complements and supplements healthcare coverage in private hospitals. Under the private scheme people choose their own scheme covering either individuals or all family members, where the scheme typically offers relief for low- income earners, and high income earners shoulder more responsibilities.
In Canada, emphasis on universal health care coverage of citizens is similar to Australia’s healthcare. The Australian healthcare system is also closer to the Canadian because of government involvement in funding healthcare coverage; but Canada lays more emphasis on universal health care provision than both the Americans and Australians. As in Australia there are provisions of some services through provinces and territories to asylum seekers and illegal immigrants. Nonetheless, most Canadians opt out of the public funded health insurance programs, and hence are not eligible for service provision in the public programs. Even though, all the three countries give the option of private insurance coverage, this is more important in the U.S where the employer provided health insurance schemes are most prominent. In the U. S, the high cost of medical care and underfunding puts the underinsured in a precarious situation with out of pocket medical expenses.
Insurance Coverage
Medicare covers all the fees for public patients in Australian public hospitals, as the National Health Act of 1953 makes health are provision free for these patients. However, patients can choose private hospitals where there are subsidised healthcare services and ancillary services for inpatient care. In the case of outpatient care, the Australian government also offers subsidies, while in collaboration with the territorial governments there is provision of population health services to indigenous communities, veterans and rural areas (ABS, 2012). For cost sharing Medicare reimburses 75% of medical fee related services and 85 % for ambulatory services (My Dr, 2014). Physicians can directly charge bills to Medicare through bulk billing to recover cost of medical services, but there is no set limits for Doctor Fees.
In the U.S the range of services depends on the insurance package, and may involve inpatient, outpatient as well as physician services. Since both the Australian and Canadian health systems emphasise universal health coverage, they have broader health services under insurance programs, and in America the employer funded schemes are more restricted on services offered and medical services providers. Both the Australian and Canadian federal governments provide funds to the territories but services are typically provided by the territories with varying degrees of independence and medical benefits. In the three countries, the federal governments offer varying preventive services while in Canada and Australia the territories typically make purchasing decisions on medical supplies and equipment. Similarly, the American system places decisions on the medical services providers, but with less coordination at the state level as the decisions making process is decentralised.
Financing
According to the OECD- a (2013), the Australian government spent 8.9 % of the GDP on public health in 2010/2011, while in Canada it was 11.2 % and 17.7% in America. Funding to Medicare in Australia is through tax revenue and private means, but low income earners are given exemptions through reduced levy payments. The Australian government funds the biggest portion of healthcare expenditure, while the states and territories contribute less towards covering health care costs. On the other hand, private funding of health care typically accounts for dental services and medication not included in the pubic financing of the health system. The private insurance payment system is more flexible and covers private care in both private and public hospitals as well as ancillary services (Healy et al., 2006). There is also increased service delivery to out of hospital services through private insurance schemes.
Among the OECD countries, approximately 70% of health expenditures were funded by public means, with taxation being the main source of funding. Public financed healthcare in the U.S is almost 50% of the expenditure, and the main difference with both Canada and Australia is that it is through Medicare. The American Medicare combines government revenues, taxes and payroll while Medicaid is mainly tax funded and is set to expand following adoption of the Affordable Care Act. For Canada, public funding takes place at the territories through grant funding per capita. In the three countries, public funding seeks to improve health care coverage, but there are more restrictions when seeking medical services, as those seeking medical services have few choices on the type of services or choice of doctors
Organization and financing of healthcare services
In most cases, GPs in Australia are self employed similar to Canadian and American primary care health providers who are in private practice, but there are others employed in private agencies under contracts (Willis et al., 2012). Australian GPs also get paid fees for services provided under Medicare funding, and by meeting set benchmarks they can receive incentive payments in relation to health provision for chronically ill patients, using health Information Technology and teaching health students. Patients can consult any GP as they like or change at any time, while specialist doctors may decide not to offer services to new patients if they are under demanding schedules. For nurses, practice earnings play a vital role in funding nursing practice together with funds from Medicare benefits and incentive payments. In provision of out of hospital services, Australian patients can consult any specialists but GPs typically refer patients to specialists (Willis et al., 2012). While, both Australia and Canada rely on universal health coverage, the Australians use private financing and competition to improve accessibility than Canadians who rely on public funding (Collier, 2013).
The main differences
The health care systems are different in terms of the structure, funding, role of private insurance cost -sharing, primary care role and exemptions in payments. Furthermore, while three countries use English as their official language, both the Canadian and Australian model have more British influence because of close ties, while the American system has developed more independently. The most glaring difference is the role of the government in health care financing. In Australia, coordination and collaboration between the federal government and the states is a joint activity that finances healthcare services through Medicare. The Canadian health system relies on territories to administer public insurance programs through Medicare. The American public system spends more on health related matters unlike the other two countries, whereby Medicare and Medicaid only cover people qualifying for the set limits.
The role of private insurance is another feature that differentiates the healthcare systems, where in Australia the package covers 50% of private hospital costs, together with other non covered benefits. This contrasts with the Canadian model where the role of private health insurance covers approximately two- thirds of the non covered benefits. The American private health insurance system is the most diverse as it covers more than 50 % of the insurance cover, whereby the individual and employer based systems supplement the services of Medicare. There are also no caps on cost sharing in all the three systems, except that the Australian approach typically sets limits on the amount covered.
Comparative analytical framework
PerspectiveDomainKey IssueMain ConceptsEconomicThe economyEfficiencyDemand/ SupplyPoliticalPoliticsPolicy makingReform/stabilitySociologicalSocietyEquityDominance/ SubordinationEpidemiologicalDiseaseEffectivenessMorbidity/ mortality
Theoretical perspectives on human policy adapted from Palmer and Short
Duckett (2007) utilizes a system approach to evaluate Australia’s healthcare system and relies on an adapted framework from WHO (2000) in analysing health systems. Highlighting the framework Duckett looks into stewardship as one of the core components. On the other hand, Palmer and Short (2010) emphasize a multidisciplinary health policy analysis in addressing various complexities affecting healthcare. The authors furthe...