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National Health Service (NHS) vs. National Health Insurance (NHI)
All residents are automatically entitled to free public health care in a national health service. Healthcare is paid for and provided by the government, and the healthcare system is financed by taxation. Examples of national health services are the United Kingdom, New Zealand, and Spain (Columbia University, 2019).
NHS systems often depend on the government to coordinate the direct delivery of services and either directly employ providers or hire them as contractors. The funding for NHS systems comes from general revenue taxation, which includes various taxes, including income taxes. More significant resource redistribution from the wealthy to the poor is possible with the help of income taxes and general revenues. In NHI systems, governments set up social insurance plans that compensate suppliers of healthcare services rather than directly funding healthcare through government spending. Payroll taxes are often how NHI systems finance their health services. (Knickman & Elbel, 2019)
Similarly, all residents have universal health coverage in a national health insurance system. Healthcare is also paid for by government-run insurance. However, healthcare is provided by the public and private sectors. Nevertheless, the funding also comes from taxation. Examples of national health insurance systems are Canadian provinces and South Korea (Columbia University, 2019).
NHI and NHS vs. the Healthcare System in the United States
The US system differs significantly from NHS or NHI systems in that it incorporates significant portions of financing based on actuarial principles, whereby private insurance premiums are determined in relation to predicted risk, even after the Patient Protection and Affordable Care Act of 2010 (ACA) was passed. Most health care financing in the NHS and NHI systems is based on the ability to pay. Wealthier, younger, and healthier people end up footing a disproportionately large share of the bill when treatment is provided based on ability-to-pay standards. Neither an NHS nor an NHI system exist in the United States. The American healthcare system is based on a patchwork of public and commercial insurance with significant coverage gaps. It uses a social welfare system (Medicaid) for certain persons with low incomes, a social insurance system (Medicare) for the elderly and those with permanent impairments, and a private health insurance system based on employers for most salaried workers in the private and public sectors. The United States contains components of socialized medicine in addition to its public and private insurance plans, including the military health care system, the VHA system, and the Indian Health Service (IHS) for Native Americans and Alaskan Natives. (Knickman & Elbel, 2019)
The United States follows an out-of-pocket health system model. Unlike NHI and NHS, wherein the government pays for healthcare, the out-of-pocket health system is funded mainly by consumers (McAlister & Helton, 2021; Columbia University, 2019). Thus, not all residents are entitled to free public health care. Moreover, like NHI, healthcare in the United States is provided by public and private care providers (Columbia University, 2019).
The United States vs. Other Countries with Similar Capita Income
The United States has faster access to specialist care and better coordination between hospitals and other facilities than other countries with similar capita incomes (McAlister & Helton, 2021). Despite our desire to innovate and invest in the most advanced medical technologies, access to high-technology and essential primary care services is highly unequal compared to other OECD countries. The United States has the highest per capita spending on healthcare, the highest incomes paid to doctors and other members of the medical profession, and the highest average costs for hospitals, medical services, and drugs. (Knickman & Elbel, 2019)
The United States provides the highest compensation for physicians at US$218,173. However, healthcare spending in the country is substantially higher than in other wealthy outcomes. For example, it ranks 1 in total pharmaceutical spending at US$1,443 per capita. Nevertheless, the United States does not achieve better health outcomes. The health-adjusted life expectancy in the country is only 69.1 years, which falls below the international average (Papanicolas et al., 2018).
The enormous array of health insurance options we provide to our population, including the choice (following the ACA) to not purchase health insurance, even with a financial penalty, is another way the American health care system varies from wealthy OECD countries. Despite the emphasis on having a choice of insurer, many people can only get healthcare inside specific provider networks, outside of which the cost of services is frequently prohibitive. In developed OECD countries like England, Canada, and France, there is no similar issue. The issue in China is not an abundance of insurance options. Because a sizeable portion of the urban migrant population (about 250 million people) is often excluded from affordable health care coverage, the situation is significantly worse than in the United States. China’s issue with internal migrants is significant but not unexpected. For a system that spends only 5.5 percent of its GDP on health care and has only lately set the objective of providing universal coverage. (Knickman & Elbel, 2019) Workforce digital skills in the country are also subpar with many countries. It lags in 29th place in Coursera’s 2021 global digital skills rankings (Ezell, 2021).
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