There are many philosophies shaping healthcare services around the world, and this article glances at some prominent examples. This may help understand why different countries experience healthcare differently
Healthcare in the USA
The USA does not have a universal, free healthcare program, unlike most other developed countries. Instead, in line with the free-market-virtue mindset, most Americans are served by a mix of publicly and privately funded programs and healthcare systems.
Most hospitals and clinics are privately owned, with about 60% being non-profits, and another fifth being for-profit facilities. Coverage by federal and state programs is partial, and most insured Americans have employment-based private insurance.
Group plans funded by the employer cover about 150 million Americans
Private Insurance
These include health maintenance organizations (HMOs), which are networks of providers. Insured patients see a primary care physician (PCP), whose refers them to a specialist if necessary.
A more popular option is to use preferred provider organizations (PPOs), which allow patients to see external providers, choose their PCPs, and see a specialist without a PCP referral provided the former is willing.
These are now used by over 55% of insured employees, compared to 25% in HMOs or point-of-service (POS) plans.
With POS plans, patients must have a PCP in the provider network, but can go out of the network for a fee.
Federal insurance
The Indian Health Services and Veteran Health Administration provide care for Native Americans and military veterans, respectively. The Military Health System, operated by the Department of Defense, provides paid care to serving military personnel.
Publicly funded insurance
Public spending accounts for at least half of all healthcare expenditure, while third-party payers pay only 27%.
About a third of the population is covered by three publicly funded programs – Medicare, for people above 65 years and some disabled people, Medicaid, for those living in poverty. and the Children’s Health Insurance programs, which cover children from families that are not eligible for Medicaid, at above 300 percent of the Federal Poverty Level (FPL).
The ACA act of 2010 (“Obamacare’), which was enacted in 2010, revamped health insurance. It created health insurance marketplaces, which cover about 17 million Americans. However, these plans are often small, exclusive, and restricted in provider choice.
At the same time, the expansion of Medicaid under the ACA act has possibly saved many lives at less than $900,000 per life saved, vs $7.6 million under other public insurance plans.
The good and the bad
Among 11 high-income countries, the US healthcare system is the most expensive, with 17% of the GDP being spent on healthcare in 2018. Many American health indicators far surpass world standards.
Its rate of specialized scans (computerized tomography – CT – and MRI) – are among the highest in the world, at double the OECD average. So is its utilization of hip replacements, influenza vaccines, and breast cancer screenings.
However, among developed countries, the American system is among the least accessible, efficient and equitable. The number of physicians, and rate of physician visits, is among the lowest. Ethnic and disadvantaged social groups suffer massive inequalities.
About 14% of Americans (over 27 million) were uninsured against illness at the end of 2018, causing an estimated 60,000 avoidable deaths. High medical costs have led to bankruptcy for a fourth of senior citizens, says an earlier study.
Preventable and lifestyle conditions such as obesity, hypertension and diabetes are rampant: this indicates poor access to primary care and primary prevention of disease, compared to its peers.
Meanwhile, US suicide rates are highest among all members of the Organization for Economic Co-operation and Development (OECD).
Overall, the US healthcare system allows providers to inflate prices and expensive services, but poorly compensates essential services such as primary care and behavioral advice. It also draws healthcare services away from rural and poor communities.
Nonetheless, the US leads in medical innovation, boasting many of the world’s leading hospitals. For those who can pay, it provides high-quality care.
COVID-19 response
Even though the US healthcare system serves 4% of the world’s population, a quarter of global COVID-19 cases and a fifth of global COVID-19 deaths occurred here. The reasons are not primarily related to the healthcare system, however.
Rather, they include a disjointed, reluctant and often contradictory public health response to the pandemic, driven by political apathy toward the virus threat.
There is no central command and control for healthcare in the country: this obstructs infection spread control
The UK healthcare system covers the whole population via the National Health System (NHS), which is 79% publicly financed from taxes, and operated by the Department of Health. About 20% is paid for by national insurance, and private patients and copayments make up the rest.
NHS England supervises and funds local Clinical Commissioning Groups. These provide comprehensive care, including preventive screening programs and vaccinations, inpatient and outpatient care in hospitals, maternity care, mental health care and palliative care.
Like the USA, the UK has public, private profit and nonprofit hospitals. The first type is operated as hospital trusts or foundation trusts, in three tiers: community hospitals, district hospitals, and regional-level hospitals. Dedicated hospitals offer specialized treatment.
General practitioners (GPs) offer primary care to locals through their practices. Many such practices are overtaxed: one alternative is registration-free walk-in centers. GPs refer patients as necessary for secondary care.
All residents of England, as well as anyone with a European Health Insurance Card, are entitled to NHS care: primary care is mostly free. Others receive emergency or infection-selective treatment.
Patients in the NHS can choose a hospital and specialist. Currently, 12% of the population also opts for private health insurance, mainly to avoid the waiting period for elective care, to have a choice of specialists, and better facilities.
Private hospitals typically offer specialized treatments, such as bariatric surgery, and do not offer trauma care, emergency services or intensive care.
The UK spends about a tenth of its GDP on healthcare, with almost 80% being spent on the NHS.
Unlike the American healthcare system, the NHS’s administrative spending is only 16% of healthcare costs.
Health 