Government sponsored health centers and emergency response

Governmental healthcare centers concentrate on providing primary care to individuals and to control and manage the spread of infectious diseases and to manage natural disasters (Christian et al., 2008). However, in the public domain, health care differs from one country to another. This can be specifically applied in developed nations, where social, economic and political factors are most likely to influence public health policies and centers and their accessibility and availability (Christian et al., 2008). This research proposal concentrates on presenting an overview and detailed background of health centers in English-speaking countries. The countries selected are Australia, Canada, the United Kingdom and the United States.

Chapter One:

Introduction

Governmental health care centers concentrate on the provision of primary care to individuals and on controlling and managing the spread of infectious diseases and managing responses to natural disasters (Christian et al., 2008). However, in the public domain, health care differs -- sometimes dramatically -- from one country to another. This can be specifically analyzed in developed nations where social, economic and political factors are most likely to influence public health policies and centers and their accessibility, availability and quality (Christian et al., 2008). Therefore, this study concentrated on presenting an overview and detailed background of health centers in English-speaking countries. The countries selected were Australia, Canada, United Kingdom and United States. These four countries have their own public health policies and have installed several governmental health centers in order to provide primary care to individuals and to effectively manage disasters and epidemic outbreaks. In terms of availability, accessibility and quality of care provided in these centers vary from one nation to another and this study therefore analyzed these differences. Furthermore, emergency preparedness plans, natural disaster management plans, performance, funding and demographic data were also analyzed in order to understand the respective efficiency and effectiveness of these health care centers.

Research Objectives

The objective of this study was to analyze and review the health care centers that are sponsored at the national level in different English-speaking countries to evaluate their respective effectiveness in responding to emergencies. The countries selected were the United States of America, the United Kingdom, Canada and Australia. This study concentrates on presenting a detailed and comprehensive history on the health centers that have been sponsored by the government. Furthermore, an assessment concerning how these centers effectively manage disasters and respond to emergencies as well as their effectiveness and efficiency is provided in order to better understand how they respond to the needs of their communities. Preparedness plans and emergency plans from the wide-ranging governmental health centers in countries are also analyzed and compared. Based on the analysis, the salient effectiveness and flaws of these plans are outlined, followed by an assessment concerning opportunities for improving emergency responsiveness in these national health care systems.

Research Questions

This study was guided by the following questions:

1. What are health centers?

2. How governmental health centers contribute towards providing universal healthcare to citizens in Australia, Canada, United Kingdom and United States?

3. To what extent have governmental healthcare centers contributed towards universal health in respective countries in terms of accessibility, availability and quality?

4. To what extent have governmental sponsored health centers been successful in managing and responding to emergencies and natural disasters?

5. To what extent have governmental sponsored health centers been successful in introducing emergency plans and disaster management plans to effectively manage disasters?

6. What emergency and disaster management plans have been incorporated by different health centers in United States, United Kingdom, Canada and Australia?

7. What are the strengths and weaknesses of these plans?

8. How successful are these plans in managing disasters in their respective countries?

9. How politics influence governmental health centers?

10. What is link between demographic need and the accessibility of health centers?

11. What is the relationship between quality, availability and accessibility of health centers?

Background to the Study

Health Care Systems in Australia

Of the 18 developed nations in the world, Australia is ranked fourth with respect to health status, after Japan, Switzerland, and France (O'Donnnell, 2005). This health status is supported by commonly used outcome measures for quality of care such as life expectancy (Comparing the U.S. And Canadian health care systems, 2013). By contrast, the United States is ranked dead last (O'Donnell, 2005). According to the Australia Commonwealth Fund (2013), "Most health services are financed and regulated by the federal government, although the states and territories have responsibility for public hospital care" (The health care system and health policy in Australia, para. 2).

In addition, approximately 50% of Australians are provided with additional government-subsidized health care coverage through their employers that covers private hospital stays (The health care system and health policy in Australia, 2013). In addition, the Australian Commonwealth Fund also reports that, "Current policy goals include developing a new management structure for public hospitals around local area networks, increasing the federal government's contribution to public hospitals, introducing performance reporting, and strengthening primary care" (The health care system and health policy in Australia, 2013, para. 3).

The national health care system in Australia has been criticized for using an ethno-specific delivery model that fails to provide the cross-cultural competence needed for the country's marginalized populations, most especially Indigenous and migrant people. For instance, according to Renzaho (2008), "The demographic profile of the Australian population indicates that Australia is a rich and complex multicultural society with more than six million migrants resettling in Australia since 1945" (p. 223). The research to date indicates that about one-third of all Australians have a culturally and linguistically diverse ancestry; nearly one-quarter (23%) were born outside of Australia and another 15% of the population speaks a language besides English at home (Renzaho, 2008).

Clearly, in a country of 22 million people, these percentages represent a substantial number of Australian citizens who may require specialized interventions by virtue of their linguistic and cultural differences. Moreover, the highly mobile nature of some other segments of Australian society make responding to the health care needs of these citizens especially challenging (Renzaho, 2008). According to Renzaho, "The challenge for health and welfare agencies is to provide a system of services to respond to the needs of diverse communities and individuals regardless of their backgrounds. However, resources are scarce and not all needs can be met" (p. 224).

Complicating matters even further is the fact that in an effort to optimize the available health care resources, government programs are designed to be "one size fits all" and there has been little progress in implementing culturally sensitive and appropriate interventions for some segments of the Australian population (Renzaho, 2080). In this regard, Renzaho emphasizes that, "For small marginal ethnic groups, an ethno-specific response becomes arguably unjustifiable" (p. 224). Nevertheless, because health care resources are by definition scarce, there will likely remain a paucity of informed interventions available for these marginalized populations in the foreseeable future. As Renzaho points out, "Although the ethno-specific model of service delivery is long recognized as more viable for larger ethnic communities, small communities are left with fewer options where there are no alternative models of service delivery" (p. 224). Taken together, Australia's national health care system is modern and comprehensive, but there are some areas that require improvement in order to improve accessibility and availability of these services for mobile and Indigenous segments of society.

Health Care Systems in Canada

The current Canadian Medicare model is the result of a half a century of health care administration experience -- and a good deal of negotiation. According to Romanow and Marchildon (2003), the first effort of the Canadian public health care system was implemented in 1947 in Saskatchewan; this initiative was mirrored and amplified in British Columbia and Alberta. In 1957, following the passage of the Hospital Insurance and Diagnostic Services Act by the national government together with the provision of federal cost-sharing transfers, the Saskatchewan model of universal public hospital insurance was formally adopted by all Canadian provinces and territories by 1961 (Romanow & Marchildon, 2003).

The next stage in the development of universal health care in Canada was another initiative by Saskatchewan in 1962 to provide public health insurance for primary medical care services provided outside of hospitals (Romanow & Marchildon, 2003). Following a review of other health care models, including Alberta's targeted subsidy approach, the Saskatchewan model was recommended by the Royal Commission on Health Services ("the Hall Commission") for nationwide implementation to the federal government in 1962 (Romanow & Marchildon, 2003). Although the Saskatchewan-based initiative ultimately required another 50:50 cost-sharing offer by the national government as well as several years of wrangling over details, universal Medicare was implemented by all Canadian provinces and territories by 1972 (Romanow & Marchildon, 2003).

In Canada's case, though, "universal" does not necessarily means what the term is generally understood to mean. For instance, according to Romanow and Marchildon (2003), the national parliament passed the Canada Health Act (CHA) in 1984 which restricted billing practices for medical services provided outside hospitals which had grown to ponderous levels. A concomitant consequence of this law was to "entrenched the hospital and physician-centered model of Medicare by limiting insured health services covered by the five governing principles of the Act -- public administration, universality, accessibility, portability, and comprehensiveness -to medically necessary hospital and physician services" (Romanow & Marchildon, 2003, p. 284). With respect to accessibility in particular, Romanow and Marchildon emphasize that the vagaries of the CHA with respect to the delivery of health care services has created a privileged system in some territories and provinces. In this regard, these researchers report that, "Although the CHA has never blocked the provinces from providing a broader range of services under their respective health plans, it has meant that both hospital services and primary care physician services are historically privileged" (Romanow & Marchildon, 2003, p. 284).

The fact that Canada has universal health care but also has issues with respect to the availability of health care services suggests that Canadian health care consumers are not receiving the same level of diagnostic and evaluation as their counterparts in the United States, despite outperforming them on the life expectancy rating for quality of care. In this regard, the National Bureau of Economic Research reports that:

Canada provides universal access to health care for its citizens, while nearly one in five non-elderly Americans is uninsured. Canada spends far less of its GDP on health care (10.4%, versus 16% in the U.S.) yet performs better than the U.S. On two commonly cited health outcome measures, the infant mortality rate and life expectancy. (Comparing the U.S. And Canadian health care systems, 2013, para. 2)

Health Care Systems in the United Kingdom

In the United Kingdom, the National Health Service (NHS) operates and manages a nationwide system of hospital services through NHS trusts that ensure hospitals deliver high-quality health care services and that the resources allocated to these facilities is used effectively. The NHS trusts are also tasked with developing appropriate hospital development strategies (About NHS hospital services, 2013). All medical services are provided for free at NHS hospitals except for emergency care (About NHS hospital services, 2013). In addition, according to Lynch (2012), in the United Kingdom, "Community health centers have long provided an excellent model of multidisciplinary care that the private practice of medicine would do well to emulate" (p. 5).

Accessibility to health care services is regarded as generally good, but there are some regional differences (Lynch, 2012). Moreover, there are lengthy waiting times for some services and specialists (in some cases, up to 18 weeks or even longer) (About NHS hospital services, 2013). According to the National Health Service, "The NHS Constitution says you have the right to access certain services commissioned by NHS bodies within maximum waiting times. Where this is not possible and you ask for this, the NHS will take all reasonable steps to offer you a range of suitable alternative providers" (NHS waiting times, 2013, para. 2). These commitments are legally codified by NHS England and Clinical Commissioning Groups (CCGs) in the responsibilities and standing rules regulations published in 2012 (NHS waiting times, 2013).

Health Care Systems in the United States

Health centers that are funded by the federal government in the United States include those defined in Section 330 of the Public Health Service Act as follows:

1. Community Health Centers, Section 330 (e);

2. Migrant Health Center, Section 330 (g); and,

3. Health Care for the Homeless, Section 330 (h).

In addition, the federal government maintains the country's largest system of health care facilities in the Department of Veterans Affairs Health Services Administration, with tertiary health care facilities located in each state as well as hundreds of outpatient clinics and Vet Centers across the country. Eligibility for these health care services, though, is restricted to veterans of the armed services and in a few restricted cases, their family members.

In the United States, the majority of state and local authorities initiate managed care contracts with privately managed health organizations and health maintenance organizations (McDaniel & Spiegelman, 2006). Accessibility to these health care facilities, though, is carefully controlled and is not automatic (McDaniel & Speigelman, 2006). According to McDaniel and Spiegelman (2006), "Several organizational procedures are employed to manage access to care, or gate-keeping, and counties, states, and private payers adopt them either singly or in combination" (p. 276).

Although eligibility for access to public health care facilities in the United States is rigorously controlled, the administration of policies and programs, and therefore accessibility, may differ from state to state (McDaniel & Spiegelman, 2006). Generally speaking, McDaniel and Spiegelman report that, "Gatekeeping typically establishes a single point of entry or other control over access to the treatment system and may include elements such as telephone or in-person administration of a precertification screening tool, the application of medical necessity criteria, and triage to treatment or other programs" (p. 276).

Some general indication of the respective availability, accessibility and quality of health care services provided or supported by the governments of Australia, Canada, the United Kingdom and the United States can be discerned from the numbers of hospitals beds that are available (availability), the physician/patient ratio (accessibility) and the life expectancy at birth rates (quality of health care services) which are set forth in Table 1 below and depicted graphically in the figures that follow.

Table 1

Comparison of Australia, Canada, UK and U.S. For Availability, Accessibility and Quality of Health Care Services

Category

Australia

Canada

United Kingdom

United States

Availability (beds per 1,000 pop.)

3.82

3.2

3.3

3

Accessibility (physicians per 1,000 pop.)

2.99

1.91

2.74

2.67

Quality of Care (life expectancy at birth)*

81.98

81.57

80.29

78.62

Source: CIA world factbook (2013) at https://www.cia.gov/library/publications/the-world-factbook/geos/

* Life expectancy at birth is a commonly used indicator of quality of care (Comparing the U.S. And Canadian health care systems, 2013)

The respective ratings for health care availability for Australia, Canada, the UK and the U.S. are depicted graphically in Figure 1 below.

Figure 1. Respective Ratings for Health Care Availability: Australia, Canada, UK and U.S.

The respective ratings for health care accessibility for Australia, Canada, the UK and the U.S. are depicted graphically in Figure 2 below.

Figure 2. Respective Ratings for Health Care Accessibility: Australia, Canada, UK and U.S.

Finally, the respective ratings for quality of health care for Australia, Canada, the UK and the U.S. are depicted graphically in Figure 3 below

Figure 3. Respective Ratings for Quality of Health Care: Australia, Canada, UK and U.S.

Importance of the Study

Organization of the Study

This study used a five-chapter format to achieve the above-stated research objectives. Chapter one of the study introduced the issues of interest, including a statement of the problem, the objectives of the study, as well as the background of the study including a brief review of the respective health care systems used in Australia, Canada, the United Kingdom and the United States. Chapter two of the study provides a review of the relevant and peer-reviewed literature concerning the health care systems in these four countries and how accessibility, availability and quality of care affect emergency responses. Chapter three describes more fully the study's methodology, including a description of the study approach as well as the data-gathering method and the database of study consulted. The penultimate chapter provides an analysis of the data collected during the research process and final chapter presents a summary of the research and important findings concerning the status of the nationally sponsored health care services in Australia, Canada, the United Kingdom and the United States.

Chapter Two:

Literature Review

In recent times, the increase in population, shortage of land and rapid urbanization in developed countries such as Australia, Canada, United Kingdom and United States have increased the population of areas, which are most likely to experience natural disasters that would have negative consequences on health of the entire community (Public Safety Canada, 2013). In the last few decades, the outburst of natural disasters and epidemic outbreaks have increased significantly and have contributed towards social and economic damages as well as claiming lives of millions of people all over the world. Natural disasters such as Hurricane Katrina, U.S. flu epidemic, Whooping Cough Epidemic in United Kingdom and Canada, are some of the disasters that have clearly demonstrated that even developed countries are prone to these disasters and therefore, it is necessary to address these problems in order to maintain the health and welfare of citizens (Public Safety Canada, 2013).