Healthcare in the US vs Healthcare in the UK France and India

Comparing the U.S. Health Care System to Other Countries
The US health care system compares favorably to some other countries in terms of long-term costs but unfavorably to others in terms of quality of care. However, statistics about costs can be misleading because there are administrative costs and long-term care costs; there are also tax payer costs in countries like the UK and Japan, where health care has been nationalized. So household expenses may seem high in the US but in the UK they are also high if one takes into consideration how much they are taxed to pay for universal coverage. This paper will compare the health care systems of the US, UK, Japan, France and India to see how they well they stack up.
Coverage
Coverage in the US is both private and public. The government provides coverage for individuals through Medicare and Medicaid if they meet an age or income threshold. France is a mix of both public and private coverage but skews mainly towards public care with a universal system recently put in place. In India, it is primarily private, with only 20% of coverage coming from the government—so the opposite of in France (WHO, 2018).
In the UK, coverage is public, but individuals can pay out of pocket for private, home care. In Japan, it is the same situation with universal coverage and private coverage being an option.
Funding
In the US, funding comes from taxpayers who support Medicare and Medicaid, ut it also comes from private insurers, who are funded by individuals or by companies that incentivize employees by offering them health benefits—i.e., health insurance plans. In the UK, funding comes completely from taxpayers as in Japan, while in France it is mixed as in the US, and in India it is primarily from individuals with some government funding coming from taxpayers (WHO, 2018).
Costs
Costs can be divided into administrative and long-term care costs. The US has the highest administrative costs of care and the highest per person care (Peter G. Peterson Foundation, 2019). However, in terms of long-term care costs, the US is among the lowest of developed nations, as Graph 1 below shows.. Long-term care costs are 8x higher in Japan per person, and 7.5x higher in the UK and France. India’s healthcare costs are very low in Western terms, but this is relative because for Indians, many of whom are impoverished by Western standards, healthcare costs are not cheap.
Graph 1. Healthcare costs of US compared to other countries (Peter G. Peterson Foundation, 2019).
Providers
In the UK, even though care is nationalized, individuals can still shop around among providers. This is also the case in the US, though selection may not be as high as it used to be due to consolidations and mergers of firms. In Japan and France, there are similar options, and this is the case in India as well. France is very competitive, and more like the US (Carroll & Frakt, 2017).
Integration
Integrated care is available in the US, the UK, France, Japan and India. There are no real obstacles to integrated care in any country, other than the usual barriers of cost and access. In the US, a tenth of the population is without any coverage at all, which makes integration a problem for the underprivileged—and the same is true in India. In the UK and Japan, integration is interwoven into the single-payer, universal care system. In France, it is a mix, similar to the US (WHO, 2018).
Markets
The US has a mixed market system that consists of both private and public sources for cost. Public sources (government spending) accounts for 45% of health care costs and the rest are private (CMS, 2010). In Japan care is mostly provided by public institutions, though private facilities provide about a third of the care services in the Japanese market. Private care is also available in the UK and in France. The market in India is a mix of public and private institutions.
Analysis
Analysis in the US is generally quite high as there are significant measures in place to monitor performance, multiple outlets for research, considerable emphasis placed on implementing evidence-based practice, and a substantial health care education discipline that promotes continuing education. France, the UK and Japan are all similar, with India trailing the pack but increasing its commitment to analysis and implementation of best practice standards (Sawyer & McDermott, 2019).
Supply
Access to care is considered a significant issue in the US because the market is mixed. The Affordable Care Act was meant to improve supply and get 20 million more people signed up for government subsidized plans or for private insurance. Access to care remains an issue, however, because of the fact that in many states Advanced Practice Registered Nurses are still obliged to practice under the supervision of doctors, even though they have been trained and certified to be able to practice independently. This creates a situation in which supply is constrained by outdated laws (IOM, 2010; O’Brien, 2003). In the UK, France and Japan, supply is available but because of the single-payer system that ensures care for everyone, delays are inevitable and obtaining care through the public system can cause long waits (Carroll & Frakt, 2017). In India, supply is found in urban areas but is greatly reduced in rural regions.
Satisfaction
The US ranks on the low side of the scale in terms of patient satisfaction with health care, while Japan, England and France rank higher (Peter G. Peterson Foundation, 2019). India ranks lowest among the countries in terms of patient satisfaction due to the fact that India is still somewhat of a developing nation and its standards are not as high as in the Western or developed nations. Graph 2 below shows, however, the extent to which satisfaction is low among US health care patients.
Graph 2. Patient satisfaction in terms of status and quality (Peter G. Peterson Foundation, 2019).
Role of the Government
The role of the government in the US is focused primarily on regulation but also on subsidization of health care. The Affordable Care Act placed specific requirements on health care providers that obliges them to provide preventive care for patients if they expect to receive subsidies from the government (Lau, Adams, Park, Boscardin & Irwin, 2014). The role of the government in the UK, Japan and France is more pronounced in terms of creating a healthcare system that is totally overseen by the government in terms of funding and regulating care. However, in all three private institutions are still able to exist outside the structure of the government system. In India, the government regulates the healthcare system entirely (WHO, 2018).
System Strengths
The strengths of the US system are that it allows for competition in the market place and for individuals to choose their own providers and care plans. Regulations are tight in the US, which is another reason for high administrative costs, but providers are also among the most educated in the world. In the UK, France and Japan, similar strengths can be seen, as each system supports the professional development of healthcare providers, focuses on regulation, safety standards, and improving access to care. In India, the healthcare system is less robust because of the inconsistency of the national government to monitor and regulate healthcare throughout the diverse country, which was not united until the British made it so and now is less so (WHO, 2018).
System Weaknesses
The main system weakness is that administrative costs are so high in the US system that it often deters people from seeking care if they have a bad coverage plan or no coverage. Health care is too expensive across the board for low-income families to pay for it out of pocket—but if they are above the poverty threshold they cannot obtain government subsidized care. This represents a further complication because they are still too poor to afford care but do not meet the government’s definition of poverty (WHO, 2018). In England and Japan, the main weakness is the wait time for care as the universal care system can create long delays particularly for specialized services via the public system—which is why many turn to private care practice as an added expense if they can afford it; there care is much more quickly obtained and accessible. In France, it is a similar situation and in India the main weakness is the lack of development, the lack of integration and the lack of professional grade support networks.
References
Carroll, A. & Frakt, A. (2017). Best health care system. Retrieved from https://www.nytimes.com/interactive/2017/09/18/upshot/best-health-care-system-country-bracket.html
CMS. (2010). Annual statistics. Retrieved from https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/downloads/proj2008.pdf
IOM. (2010). The future of nursing. Retrieved from http://nacns.org/wp-content/uploads/2016/11/5-IOM-Report.pdf
Lau, J. S., Adams, S. H., Park, M. J., Boscardin, W. J., & Irwin, C. E. (2014). Improvement in preventive care of young adults after the Affordable Care Act: the Affordable Care Act is helping. JAMA pediatrics, 168(12), 1101-1106.
O’Brien, J. (2003). How nurse practitioners obtained provider status: Lessons for pharmacists. American Journal of Health-System Pharmacy, 60(22), 2301-2307.
Peter G. Peterson Foundation. (2019). US healthcare compared. Retrieved from https://www.pgpf.org/blog/2019/07/how-does-the-us-healthcare-system-compare-to-other-countries
Sawyer, B. & McDermott, D. (2019). Quality of care compared. Retrieved from https://www.healthsystemtracker.org/chart-collection/quality-u-s-healthcare-system-compare-countries/#item-start
WHO. (2018). Health report. Retrieved from https://www.who.int/whr/2000/media_centre/press_release/en/