Comparative Perspective of Welfare
Comparative Perspective of Welfare
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Cultures vary from country to country; so do people, their values, general traits and qualities. From these differences sprouted the variation of one place to another in the policies governing public matters such as education, health care, local government units, environment protection and business monitoring.
Countries draft their policies, which are subject to change through time and as deemed necessary by the government leaders and by the people as the stakeholders. There is the element of history which can be a given influence that cannot be questioned. Through it all, the resources available to the country for utilization in such concerns as the public welfare largely depend on the economic and financial conditions prevailing therein.
To study the policies of one country and to compare with those of another country involves going into the specifics of both countries. There can be no single sweeping generalization – neither “global forces [nor] trans-national economic retrenchment” – that will sufficiently explain the details behind the changes that have occurred. Authors John Clarke and Janet Newman have written regarding the recent phenomenon called “new public management”:
The effects of world recession were particularly felt in Britain because of the relative structural weakness of the British economy… But as Mishra and others have pointed out, the consequences of these conditions of crisis were not inevitable. Countries pursued different solutions to economic crises. These solutions – and even the definition of what the problem was – depended on specific national circumstances, and the policies, ideologies and politics of particular national governments - Comparative Perspective of Welfare introduction. (1997)
Indeed, each country is unique in terms of leadership in place, the form of government adopted and the people governed. Similarly, each country presents different situations, scenarios and complications – social, political, economic or geographical. Different systems and policies have, thus, been erected. There will remain to be differences for as long as no absolute rule regulates the conduct of affairs in countries according to what has been planned and agreed to by the same concerned or participating countries. While such uniformity among nations remains to be but a dream or an abstract goal of world leaders, the individual countries get on with their respective welfare systems.
Thus, concrete differences in the provisions of countries for the general welfare of their respective constituents undeniably exist. Countries have set up varying systems for public education, public safety, public health and others that are equally critical for the overall well-being of the people.
It would be easy for people in developed nations to think that they are enjoying the best possible packages for their basic needs as citizens of their countries. These people are likely to believe they are entitled to the best and are therefore accorded the best. This may be the case of the people of the United Kingdom (UK) or the United States of America (USA), and this research paper aims to prove such assumption right or wrong. For lack of awareness of what is going on right in the country and of how things are in other countries, anybody can stay blissfully ignorant of better welfare services that he could have been entitled to had he been a citizen of another country.
This paper also zeroes in on a particular welfare program – the public health system of the two subject countries – to further specify the categories that serve as bases of this written comparison.
(taken from an article by S. Schifferes, 2005)
It is surprising to see that the industrialized countries such as UK and USA have the highest incidence of poverty. The people living below the 60% of median income would be the same people who would most need the welfare programs that they can benefit from as citizens of their countries. (Schifferes, 2005)
All countries care for their poor, aged and unemployed at varying degrees. It greatly matters, though, whether or not the country has sufficient ammunition in terms of financial resources for battling the oppressors of its society members. “Britain created one of the earliest and most comprehensive welfare states when Labour adopted the Beveridge report in 1945. But it was never well-funded enough to eliminate poverty.” (Schifferes, 2005)
Britain’s failed bid to provide for its constituents the kind of life envisioned for them by leaders who pioneered the design of social welfare in the country is best manifested in the current affairs and condition of National Health Service (NHS), the country’s government-run organization for public health.
The biggest issue that has confronted the management of NHS is its dire need for additional funds for use in its operations. This issue has torn apart the doctors and their administrative superiors, the doctors and today’s government leaders, and the doctors and the principles they cling to as providers of cure for sickness and of medical attention. In fact, in a special report written by author Hannah Brown, consultant diabetologist Gordon Caldwell was angrily reacting to the order he received from his superior to deliberately delay for two months all consultations of patients with him as a way of balancing books – available funds versus actual costs. (2007; p. 1679). An account of the incident goes:
Caldwell recalled, “I couldn’t believe that I was being asked to behave in such an unethical manner. A doctor sitting with a worried patient would write a letter to me and if I had an empty appointment two weeks away I couldn’t see them because the trust wouldn’t pay for it.” (Brown; 2007; p. 1679)
In contrast to the evident inefficiency of the UK’s NHS system, patients in Germany generally do not have to wait for such a long time to be given proper medical attention and treatment. It has been said that there are no waiting lists for appointments with doctors in Germany. Public confidence in their system is, thus, high. The overall effect, unsurprisingly, is “a hugely expensive health care system.” (Hampson, 2005)
As further relayed by author Hampson in his paper written in 2005, the extent of public confidence in the system has been measured by a survey of Mossialos, 1997, cited in Green & Irvine, 2001, as follows:
Public Satisfaction with Health Care Systems, 1996
Very & fairly satisfied
Neither satisfied nor dissatisfied
Very & fair dissatisfied
And so it would seem, based on the tabulation provided, that Germany gets to have higher satisfactory ratings despite the higher costs of health services and amenities. It would be worth comparing the systems of UK with those of Germany for want of a comparison. Both countries are EU members, but they share very little similarities in terms of the public health systems installed for their respective citizenry.
UK’s dilemma has been aggravated by the abrupt increases in the numbers of single mothers and abandoned wives in the country, especially in the recent years. In fact, the scarcity of funds for adequately funding NHS has been worsened by the fact that there existed other welfare programs that as well needed to be set up. After all, the welfare services of the government ought to be more relevant to the present times and to be more responsive to the prevalent problems of the society. One example would be the Child Support Agency (CSA), which has evolved from troubles in the society that have become increasingly common only since the past years. This is the story of CSA:
By the time 1992 arrived it was clear that the issue of child support was becoming a prominent issue as it had developed into a huge expenditure burden for the government. During Thatcher’s era, the child support bill had trebled to 6.6 billion pounds, and thus was a massive and increasing tax burden for the country. (Bates, Hutchinson, Robertson, Wadsworth and Watson, 2002)
Funding sources and availability of health services, then, to this day remain to be challenges that UK is faced with. Meanwhile, the trend for improving the public health services of countries in Europe has been zeroing in on the modernization of health systems. Along with the upgrading of equipments and methods used in providing public health service, the education of the people with regards to their rights as health consumers empowers them to interact better with their doctors. Thus, the public as consumers have become knowledgeable on choices they have and their involvement as stakeholders in the health care system of the government. (Newman & Kuhlmann, 2007)
The European Union (EU), as it is now, can never implement uniformity of the public health structures of its member countries. As related in an article by Thomas Gerlinger and Hans-Jurgen Urban, the areas where EU has jurisdiction and the areas where it has none are as follows:
Due to [its] narrowly defined scope of action, the EU has explicit legislative powers in only a few spheres of preventive policy, the most important being workplace health and safe and various aspects of health-related consumer protection. In these areas the EU sets supranational minimum standards that the Member States must meet. By contrast, the authority to shape the health care system lies entirely with the Member States (Article 152, par. 5), which are thus individually responsible for [these three areas]: a) the type and extent of coverage afforded by the social security system in case of illness (i.e., financing of payments and scope of services); b) organization of the health care system, including institutional structures and the division of labor among the professional groups; and c) the decision on the distribution of authority over the regulation of the health care systems. (2007)
Thus, despite there being such thing as a convergence formalized by establishment of EU, “the wide range of health care systems persists with serious differences in the structure of medical services, funding and regulatory framework. (Blank and Burau, 2004)
While UK’s NHS is government-owned, Germany’s welfare system is a well-oiled network of private, for-profit organizations. Jack Hampson has written:
Under the pressure of the “new public management”, economic problems and a general EU trend towards (quasi)market regulated social services, more and more private (businesses) providers become part of the German welfare system. Special areas of profit interest: ambulant long-term care, senior citizens’ centres, hospitals, child and youth welfare services. (April 20, 2005)
Thus, while UK has NHS as its institution for ensuring the good health and safety of its people, the country’s leaders will have to continually push for the needed reforms for addressing the pressing problems that confront the institution in its daily operations. It will not be easy; great leaders like Margather Thatcher have already tried to make changes but have been unable to successfully see to the implementation of the changes that can help NHS get in better shape and fare better when compared to the equivalent public health institutions or systems of Sweden, France and Germany.
(taken from an article by S. Schifferes, 2005)
This research paper mainly focuses on the comparison between the public health systems of UK and Germany. This being the case, data have been gathered to tabulate the similarities and differences between the two subjects. The sources of information include textbooks, scholarly writings, news articles and selected websites.
Based on the tabulation, identified points of comparison will lead to appreciation of what the public health systems of both UK and Germany have as respective strengths and weaknesses and will on the whole bring in more attention to the issues at hand – the urgent matters to be acted on and resolved for continued advancement to take place.
The following are comparison points and figures derived from tables that form part of the article authored by Thomas Gerlinger and Hans-Jurgen Urban (2007):
(Data applies to 2003, except as indicated)
GDP (US$ PPP, per capita)
Total health expenditure (US$ PPP, per capita)
Total health expenditure
(% of GDP)
Total government social welfare spending (% of GDP) **
Unemployment benefits (% of average earnings received if out of work for 60 months) **
Practicing physicians per 1,000 inhabitants
(Data applies to 2003, except as indicated)
Practicing nurses per 1,000 inhabitants
Hospital beds per 1,000 inhabitants
Overall organization of services
As a national health service organization
Based on a health care insurance system
Provision of out-patient care
Exclusively by general practitioners
Free choice between general practitioners and specialists
Provision of specialized, in-patient care
Restricted to hospitals
Restricted to hospitals
Government and public authorities themselves more often make the rules, even with regard to specific problems.
Government’s role is usually limited to defining a regulatory framework, and the competencies for detailed regulation are delegated to corporate actors.
* pertains to the year 2002
** taken froma BBC News article by S. Schifferes
PPP purchasing power parity
Source: Organisation for Economic Cooperation and Development
“Britain’s NHS provides a universal service, although not the best-funded one, with particularly generous prescription drug coverage.” (Schifferes, 2005) This is seen to be true, based on the readings and figures provided by different authors.
One noted difference between the British and the German welfare systems lies in the general attitudes and outlook towards the poor and unemployed members of the society. Countries like UK upholds the “belief that people can better themselves through their own efforts, and may be poor because they do not try hard enough.” On the other hand, countries in Continental Europe like Germany view poverty “as either inevitable or as a result of social injustice. [Their welfare systems, thus,] bring together traditional religious charity and modern socialist thinking about reducing inequality.” (Schifferes, 2005) Thus, the 33% unemployment benefits that UK provides against the equivalent 67% of Germany.
Britain’s NHS has been a national health organization run by the government and to an extent, by the people as the stakeholders. However, it has proven to be not the best way to establish an efficient public health institution. For decades now, the British government has been trying in vain to accomplish the same. Now, UK leaders have been attempting to lead the private sector towards becoming active in attending to the health problems and needs of the society – just like how it is in countries like Germany, where public health is addressed by a health care insurance system that is governed by private corporations. Such change much just be the formula for turning things around at the NHS.
“Entitlement to proper medical services is a cornerstone of the welfare cultures in the industrially developed capitalist states and is seen almost as a kind of civil right ‘Health care matters… Being able to go to the doctor is one of the hallmarks of citizenship in most advanced industrial countries.” (Gerlinger and Urban, 2007).
These sentences are true and countries all over the world have ever been in their continued quest for the public welfare designs and systems that will truly help their citizenry. In comparing the welfare perspective and lookout of one country to another, one gets to see individual features of the entire packages, much like specific lines within an entire book. And yet, it is not as simple as identifying all the outstanding factors and features and then putting them all together for implementation in a given country. This research has shown that the intricacies of each country’s history, culture and people get into the picture and make changes – even the most necessary and beneficial ones – ever so hard to finally put into practice.
Blank, R.H. & Burau, V. (2004) Comparative Health Policy: An Introduction. In Comparative Health Policy (pp. 1-28). New York: Palgrave Macmillan.
Newman, J. & Kuhlmann, E. (2007) Consumers Enter the Political Stage? The Modernization of Health Care in Britain and Germany. Journal of European Social Policy, 16:99-111. SAGE Publications.
Clarke, J. & Newman, J. (1997). The Managerial State: Power, Politics and Ideology in the Remaking of Social Welfare. SAGE Publications.
Gerlinger, T. & Urban, H. (2007). From Heterogeneity to Harmonization? Recent Trends in European Health Policy. Cad. Saude Publica, Rio de Janeiro.
Schifferes, S. (August 4, 2005). Is the UK a Model Welfare State? BBC News Channel. http://news.bbc.co.uk/1/hi/business/4704081.stm
Bates, G.L., Hutchinson, D., Robertson, T.M., Wadsworth, A.P. and Watson, R.P.E. (2002) Identifiying the Cause of the Child Support Agency’s Problems: A Case of New Public Management Failure or an Issue of Inapt Accountability?
Brown, H. (2007) Tony Blair’s Legacy for the UK’s National Health Service. www.thelancet.com. Volume 369; May 19, 2007.
Hampson, J. (April 20, 2005). Social Policy in Germany: A Comparative View. University of Central Lancashire.