Healthcare Utilization And Finance Essay
Healthcare Utilization and Finance
The United States and the United Kingdom share historical and cultural ties, however in terms of healthcare, the two countries are markedly different but each could learn from the other in order to improve policy, systems and health care delivery. With this in the mind, the purpose of this paper is to compare access between the United States healthcare system and the British healthcare system for children, people who are unemployed and retired people. Further it will outline the requirements to get a referral to see a specialist in the two healthcare systems and discuss coverage for preexisting conditions in the two healthcare systems. The financial implications for the patient with regard to the healthcare delivery differences between the two countries are also discussed.United States vs. British Healthcare
Healthcare is provided to all permanent residence of the United Kingdom. Healthcare is paid for by general taxation (Blank & Burau, 2014). The majority of healthcare in England is provided by the National Health Service (NHS), which is a publicly funded healthcare system. Additionally, healthcare is also provided by private healthcare sector, which is obtained by private health insurance companies. The NHS also provides special services for children, those individuals who are unemployed and for children (Kirkpatrick, Bullinger, Lega, & Dent, (2013).
The United States spends more on healthcare than any other industrialized country in the world; however is the only one that does not provide universal healthcare (Blank & Burau, 2014). Unfortunately, the United States is also last in terms of access to healthcare, patient safety, coordination and efficiency. Further, the United States sets age and income requirements on public health care coverage (Medicaid and Medicare) whereas the United Kingdom provides public health care to all permanent residents.
The United States Department of Labor indicates unemployed individuals in the United States may be able to obtain health insurance at affordable rates through the Marketplace. Coverage plans are based on income and household size. They may also qualify for Medicaid of the Children’s Health Insurance Program (CHIP). The household size and income determine coverage eligibility and not employment status. The CHIP varies by state, but in some states pregnant women are eligible. Individuals with family incomes that are too high for Medicaid coverage but too low for affordable private insurance may also be eligible for the CHIP.
Retired individuals in the United States are eligible for Medicare if the individual or their spouse has been employed in a Medicare-covered workplace, if they are aged 65 years or older, and a citizen or permanent resident of the United States. Further, Medicare may cover individuals with specific disabilities even if they have not reached the age of 65. Organizations such as HIPAA, COBRA and ACA all provide methods in order to continue health insurance covered once an individual reaches retirement age. Additionally, the Employee Benefits security Administration (EBSA) is charged with enforcing the Employee Retirement Income Security Act of 1974( ERISA), which was enacted to provide the rights of individuals and their beneficiaries who have participated in health and retirement plans.
Requesting a specialist in the United Kingdom is done through the general practitioner and is based on need. The NHS referral service allows an individual to choose the hospital or clinic they would prefer to be treated as long as the general practitioner feels there is a need for such treatment (Ullmann, et al. 2013).
In the United States, the process of obtaining a specialist depends on the type of insurance coverage an individual has (Blank & Burau, 2014). For example, under a PPO plan, an individual can either to a primary care physician or specialist that is within the PPO network directly. If the individual has an HMO plan however the individual will have to be seen by the primary physician in order to obtain a referral only if the physician deems it necessary.
In the United States, the Obama Care program will cover healthcare costs even if the patient has a pre-existing condition (Blank & Burau, 2014). Before 2014, many insurance companies would not cover a pre-existing medical condition that started before the individual’s health coverage went into effect. The Patient Protection and Accordable Care Act prohibit these types of exclusions as of January 1, 2014. Likewise, in the United Kingdom, the NHS does not exclude coverage for individuals with pre-existing conditions.
In the United Kingdom, because healthcare is free, it does not typically cause personal financial issues (Blank & Burau, 2014). Costs for prescriptions and dental services are low enough that the majority of people can afford them and the majority is covered by the NHS. Unlike in the United States, individuals in the United Kingdom do not go bankrupt because they cannot pay their medical bills. Also, healthcare is not tied to employment therefore a person working for the government enjoys the same healthcare coverage as someone who is starting their own business (Blank & Burau, 2014). Taxes in the United States and the United Kingdom are generally similar. Typically, individuals with lower incomes would fare better in the United Kingdom, whereas individuals with higher incomes would fare better in the United States. Because the cost of living in the United Kingdom is higher than in the United States, individuals have less disposable income to use to pay for private healthcare.
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References Blank, R.H., & Burau V. (2014). Comparative health policy. (4th ed.) Palgrave Macmillan: Basingstoke. Kirkpatrick, I., Bullinger, B., Lega, F., & Dent, M. (2013). The translation of hospital management models in European health systems: A framework for comparison. British Journal of Management, 24, 48–61. Kuhlmann, E., Burau, V., Correia, T., Lewandowski, R., Lionis, C., Noordegraaf, M. Repullo, J. (2013). A manager in the mind of doctors: A comparison of new modes of control in European hospitals. BMC Health Serv Rec.13:46.