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U.S. & Norway Healthcare Systems
healthcare system has many advantages and disadvantages which are most revealing when compared to the other health care systems of the world. An analysis between the U.S. healthcare system and a government run healthcare system of Norway provides a deeper understanding of the similarities and differences in the two systems.
Almost every other developed nation in the world has some form of universal coverage which reduces this disparity in care. However, many of these systems are purportedly ridden with their own issues such as high cost and long waiting times. By comparing the U.S. system with the universal system like that of Norway, I can investigate the effectiveness of each in terms of the quality of care provided and the equality of distribution of that care.
A Comparison and Analysis of Healthcare Systems in the United States and Norway
A. United States
The healthcare system in the U.S. is made up of a combination of private insurance coverage based primarily on employment, along with public insurance coverage for the elderly (Medicare), the military, veterans, and for the poor and disabled (Medicaid, which varies greatly in its implementation across states) (University of Maine, 2001). The U.S. is the only country in the developed world, except for South Africa, that does not provide health care for all of its citizens (University of Maine, 2001).
The federal government continues to play a predominant role in the financing of health care, since Medicare pays for 56% of the elderly's health care bills and the nation's elderly population is growing as a share of the total population (Goldman & McGlynn, 2005).
The U.S. has the most expensive healthcare system in the world based upon two measures including health expenditure per capita ($4,178 per person) and total health expenditures as a percentage of the gross national product (GDP) (13.6% of GDP) (University of Maine, 2001). National health care spending in the U.S. has been rising steadily over the past 40 years (Goldman & McGlynn, 2005). In 1960, it accounted for slightly more than 5% of the total, but by 2002, health care spending was about 15% of GDP (Goldman & McGlynn, 2005). Much of this increase reflects that the U.S. is delivering more technologically advanced care in the hospital (Goldman & McGlynn, 2005). In 2002, 53 cents of every health care dollar was spent on hospital and physician services and people 65 and over spend about four times more than those under 65 (Goldman & McGlynn, 2005). A majority of health care dollars are spent on hospital care and physician services (Goldman & McGlynn, 2005).
The high cost of the U.S. healthcare system can be attributed to many factors including large administrative costs, the rising costs of medical technology and prescription drugs, and the increasing number of for profit health care providers (University of Maine, 2001). One of the most talked about factors involved in healthcare costs is the large number of uninsured Americans who often forego treatment until their health issues become severe (University of Maine, 2001). The aging U.S. population also contributes to increased healthcare costs (University of Maine, 2001).
In general, the costs of healthcare rise approximately exponentially with age (Goldman & McGlynn, 2005). This fact alone suggests that demographics, especially the baby boom generation, have, and will continue to have, profound effects on health care spending (Goldman & McGlynn, 2005).
The Institute of Medicine (IOM) has defined quality of care as a multidimensional concept including the underuse and overuse of services (Goldman & McGlynn, 2005). Underuse is when people do not get the care they need and overuse is when people do not need the care they receive (Goldman & McGlynn, 2005). Taken together, these two elements measure whether or not care is effective (Goldman & McGlynn, 2005). Care should be provided safely, in a timely manner, be patient centered, equitable and efficient (Goldman & McGlynn, 2005). When it isn't, patients experience a health care system unresponsive to patient needs and preferences and wasteful of resources (Goldman & McGlynn, 2005). RAND's national study of the U.S. healthcare system found deficits in the quality of care across all types of care: chronic, preventive, and acute (Goldman & McGlynn, 2005).
Norway has a universal, tax-funded, single payer National Insurance Scheme (NIS) (Johnsen, 2006). All Norwegian citizens, as well as anyone living or working in Norway, are covered under the NIS (Johnsen, 2006). The Norwegian government owns and operates a majority of the hospitals in the country, but there is a small private sector of the health system mainly concentrated in dental care and substance abuse treatment (Johnsen, 2006).
The NIS is funded by general tax revenues, but there is no earmarked tax for health care, which means that health care is just one large contributor to a tax burden that consumes 45% of GDP (Tanner, 2008). The government sets a global budget limiting overall health expenditures and capital investment which requires limiting and rationing of health services (Tanner, 2008). Norwegians can opt out of the government system and pay out-of-pocket for treatment in other countries, which many Norwegians choose to do because waiting lists for care are long (Tanner, 2008).
Benefits under the Norwegian health system are extensive and include inpatient and outpatient care, diagnostic services, specialist care, maternity services, preventive medicine, palliative care, and prescription drugs (Tanner, 2008). At public hospitals, there are no charges for stays or treatment, including drugs and the program also provides "sick pay" and disability benefits (Tanner, 2008). Hospital and nonhospital physicians generally are paid on a salaried basis, but some specialists can receive an annual grant and fee-for-service payments (Tanner, 2008). Reimbursement rates, however, are set by the government and the physician cannot charge higher rates than the centrally-set reimbursement rate (Tanner, 2008). Most other health care personnel are salaried government employees (Tanner, 2008).
The expansive health care system in Norway has experienced serious problems with long and growing waiting lists (Tanner, 2008). Out of a population of just 4.6 million, approximately 280,000 Norwegians are estimated to be waiting for care on any given day (Tanner, 2008). "Approximately 23% of all patients referred for hospital admission have to wait longer than three months for admission" (Tanner, 2008). Also, care can be denied if it is not deemed to be cost-effective (Tanner, 2008). Norway, like most European countries, faces challenges associated with an increasing number of elderly people (Johnsen, 2006).
Another significant issue in Norway is the effective distribution of care (Johnsen, 2006). While citizens are universally provided with the same insurance, the quality of treatment differs between the urban and rural populations (Johnsen, 2006). The average health outcomes of the Norwegian system are very good, but despite the coverage provided by the NIS, sources indicate that inequality is persistent in health outcomes (Johnsen, 2006).
Primary, secondary and long-term health care in Norway have been exposed to continuous change and some radical reforms, but the goals of solidarity and equality as a basis for welfare have remained basically unchanged (Johnsen, 2006). The national goals have been to improve the level of health for the population and to distribute health care according to needs (Johnsen, 2006).
C. Analysis of U.S. Healthcare System and Norway's National Insurance Scheme
The U.S. And Norwegian health care systems are drastically different in design, funding and function. The differences must be considered in light of the drastic difference in population size, geographic area and diversity of population between the two countries. The basic societal differences also dictate what each country's population will accept from government involvement. The U.S. has a market driven economy and therefore the healthcare system, for better or worse, is most available to those who can afford to pay for services. In contrast, Norway provides medical care to all of its citizens…[continue]
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