It seems that debate over the complexities and faults of the U.S. healthcare system has been recurrent ever since the creation of the Affordable Care Act (ACA) of 2010. This initiative, also known as Obamacare, was made with the purpose of increasing the amount of people with healthcare coverage and reduce the price of health insurance for both the patients and the US government. By late 2016, more than two years after the Act had gone into full effect, “the rate of Americans without health insurance decreased to 10.9%” (https://www.medicalbillingandcoding.org/health-insurance-guide/affordable-care-act/). During the ACA’s implementation, it was estimated that the ACA would reduce the country deficit by $100 billion dollars over a span of ten years. Now, almost 10 years after its inception, many Americans see the ACA (also known as Obamacare) as a healthcare reform with many flaws. While the ACA initially seemed a step towards universal healthcare, the rules and exceptions surrounding it deny that.
A universal healthcare model is a type of healthcare available to all members of a country in which its services are paid for by the government which in turn gets its funds for healthcare through taxes. The Affordable Care Act has many exceptions, in relation to its set task, to be deemed a type of universal healthcare coverage. Those exceptions are not without due cause, as they were established to help low-income individuals (not just families) continue to have health insurance. This includes a Medicaid/CHIP expansion, which is meant to cover the coverage costs for those under the age of 65 who earn at or below the Federal Poverty Level. Since then, this expansion has been made a choice for states in the US, with some states choosing not to adopt this expansion and offer different programs instead. Other rules of the ACA include subsidized coverage, no denial of coverage from policy-holders due to any pre-existing conditions and essential benefits, including services that are available across all coverage plans.
Although the ACA has managed to complete its desired outcomes, the overall opinion believes that it has not greatly impacted their healthcare coverage and that service quality has not greatly changed. To help understand the dissatisfaction many U.S. citizens have with the ACA, it is crucial to answer these four questions:
- How do people choose a healthcare system in developed countries?
- How is the quality of worldwide healthcare systems determined?
- How does the U.S. healthcare system compare to that of other developed countries?
- How should the U.S. change its policies to improve its healthcare system, if needed, and what healthcare option is best for the country?
This literature review will help explain how healthcare systems are chosen and the ranking of the U.S. healthcare system amongst the World. After exploring the questions concerning this literature review, an outcome will be established in relation to how the U.S. can change its healthcare system in order to improve quality, benefactor satisfaction, and global ranking amongst the rest of the World.
How do people choose a healthcare system in developed countries?
Healthcare is usually chosen by factors such as the services provided, how payments will be made, the accessibility, and the general health requirements of a specific location. Most developed countries follow a universal healthcare model. A universal healthcare model is healthcare that is run by the federal government with direct payments through taxes. It has its benefits and consequences but, in general consensus many think universal healthcare is very beneficial for its users. England, for example, has a form of universal healthcare in which the government both pays for and provides medical services. This is known as socialized medicine.
Another advantage of universal healthcare is that the government can impose regulations that obstruct unhealthy behaviors. An example of this is “sin taxes” on cigarettes and alcohol.
Universal healthcare also has some disadvantages. Due to healthcare being paid for through taxes, many times people pay higher prices for others’ illnesses. Kimberly Amadeo (2019) states that “the sickest 5 percent of people bring about 50 percent of total healthcare costs.” There is also the danger of healthcare costs limiting the budget of the government for other programs. Canada, for example, uses 40 percent of its budget on healthcare, giving less money for programs on education and infrastructure. Not only that, with universal healthcare, most doctors do not get paid as much for their services which might lead to an ineffectiveness in their treatment of patients. Amadeo states that the U.S. has kept a high standard of saving lives, as during the last six years of one’s life, half of the people go to the emergency room, a third goes through intensive care and a fifth goes through surgery.
How is the quality of worldwide healthcare systems determined?
Before going any further, it should be mentioned that no country has the same standards for determining the quality of a healthcare system. Hanefeld, Jackson, and Bibanova (2017), on an article from the World Health Organization, expand on six variables that measure and rank the quality of the multiple healthcare policies of different countries. The first variable would be the clinical quality of said healthcare program. The second variable would be the experience of the user throughout a designated period. Third would be the process of the quality, being a combination of the first two variables. Fourth would be the responsiveness, labeled by Hanefeld and Co. (2017) as the expectations the benefactor has of their treatment. Fifth is related to the relationship between the services available and government management. The final variable shows how socioeconomic levels affect healthcare quality.
Clinical quality measures the quality of services given by providers, whether it is the government or an insurance provider. Factors in this area include the quality of services and medications available depending on the illness being faced. The second variable is more involved in the opinion a benefactor has towards his or her healthcare availabilities. Perception of the benefactor includes what they think of their treatment such as waiting times, appointment availability, and the overall perception of the doctor’s treatment. To summarize, this variable is based more on how the benefactor feels towards their treatment and availabilities based on their healthcare options.
The third variable is a continuation of the previous measurements, as they explain the long-term effects of healthcare and how the user will adapt, whether it includes changing healthcare programs and whether their program is sufficient for them to maintain their healthcare programs. This can be affected by the previous prescriptions given to the user and whether it was sufficient or deemed ineffective. The fourth variable, responsiveness, is affected by how the healthcare provider adapts to the needs and recommendations of their users. This variable in particular explains the reasons behind a person maintaining their healthcare provider or changing providers (doctors, insurance, etc.).
The fifth variable, upstream factors, relates to how government management affects healthcare providers and quality. For example, countries that have high involvement in the implementation of healthcare policies, such as the U.S. and the U.K., show higher degrees of quality unlike others. The sixth and final variable shows the availability of healthcare depending on one’s socioeconomic levels. While some people may have relatively easy access to healthcare living in a developed country, others may have difficult access to healthcare seeing as they live in a developing country, still in the first stages of obtaining adequate care.
References
- Amadeo, K. (2019, March 12). Why America Is the Only Rich Country Without Universal Health Care. Retrieved from https://www.thebalance.com/universal-health-care-4156211
- Carroll, A. E., & Frakt, A. (2017, September 18). The Best Health Care System in the World: Which One Would You Pick? Retrieved from https://www.nytimes.com/interactive/2017/09/18/upshot/best-health-care-system-country-bracket.html
- Hanefeld, J., Powell-Jackson, T., & Bilabanova, D. (2017, September 04). Understanding and measuring quality of care: Dealing with complexity. Retrieved from https://www.who.int/bulletin/volumes/95/5/16-179309/en/
- Jasso, L.D. (2019, April 8) US Healthcare Compared to the World (n.d.). Understanding the Affordable Care Act. Retrieved from https://www.medicalbillingandcoding.org/health-insurance-guide/affordable-care-act/
- Ranking Best Health Care Systems in the World by Country. (n.d.). Retrieved from https://www.internationalinsurance.com/health/systems/
