Comparison of Healthcare Systems in Great Britain and the United States, Thesis of Business Accounting

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RUNNING HEAD: Organizational Systems Task 3 1 Organizational Systems and Quality Leadership SAT 1 - Task 3 1A. Identify a Country I will be comparing the healthcare system of Great Britain to the healthcare system of The United States.

2. Compare Access for children, the unemployed and the retired Great Britain health care consists of a universal healthcare system called the British National Health System, or NHS (Light, 2003, p. 25). This system allows for most all healthcare services to be free at the time of services, with coverages paid for by the government. Differences in obtaining services and access to care depending on age and employment status is minimal by international standards (Light, 2003, p. 25). Children are covered at birth for all routine as well as emergent or disease care (Light, 2003, p. 25). Great Britain has a Child Health Promotion Program which specifically address issues and the health of infants from neonatal care through 5 years of life (Grosios, 2010, p. 531). Immunization programs are offered from infancy to adulthood free of charge (Grosios, 2010, p. 531). All citizens within Great Britain are covered by the NHS, and can obtain healthcare at any time regardless of employment status. Even the unemployed and the homeless can obtain the same health coverage as a working citizen (Light, 2003, p. 25).

The retired are also able to obtain coverage and care under the NHS. An option for privatized additional health care coverage is also an option for those in Great Britain. According to Light (2003), “The British system has always had a private sector which is often obtained as additional coverages for retirees for those who want quicker or more luxurious elective care. This sector’s clinical quality is no better and may be worse” (p. 27). About 11.5 percent of British adults take out private health insurance policies, but this does not typically relate to better care or coverages (Light, 2003, p. 27). The United States (US) healthcare system consists of an open free market system of private insurance paid for by consumers as well as government sponsored healthcare which is paid with taxpayer dollars. According to De Lew (1992), “The US spends more on healthcare than any other nation” (p. 151). Visits typically have a set cost to the consumer in the form of a copay or deductible, in addition to a monthly premium cost. Certain requirements must be met in order to qualify for a US government funded healthcare such as a low income, disability or age. Approximately 74% of the US population has private insurance funded through themselves and/or their employer (De Lew, 1992, p. 151). Children within the US are typically covered under their parent’s private healthcare coverages. Those children of parents without coverage qualify for coverage under the federal healthcare plan called Medicaid. Medicaid covers preventive, acute, and long-term care services for approximately 10 percent of the population, which includes children (De Lew, 1992, p. 151). Medicaid is jointly financed by Federal and State governments (De Lew, 1992, p. 151). The unemployed within the US qualify for federal and state sponsored coverages under Medicaid if they meet certain income level thresholds within their household. Coverages and care may not be as available to consumers for specialists, and certain private providers are not

required to accept this form of payment. Acute care hospitals are required to care for Medicaid patients. The elderly are covered by a program similar to Medicaid that is called Medicare. This same coverage is applied to those with disabilities. Medicare is the largest health care insurer in the United States (De Lew, 1992, p. 151). Most specialists who specialize in diseases and comorbidities related to the elderly take this coverage, and all acute care hospitals are required to accept this as a form of payment for services. 2a. Medication coverages According to the NHS website, British citizens are offered full prescription coverages at no cost to them if they meet the following requirements; are 60 or over, are under 16, are 16 to 18 and in full-time education, are pregnant or have had a baby in the previous 12 months and have a valid maternity exemption certificate, have a specified medical condition, have a continuing physical disability, hold a war pension exemption certificate and the prescription is for your accepted disability or are under inpatient care. If the patient does not meet any of these requirements the patient must pay for the prescription out of pocket. Both private health insurance companies within the US and Medicare and Medicaid typically have what is called a formulary, with a list of preferred drugs and brands of drugs to be used for certain conditions. The patient must typically complete a trial of the preferred medication before approval and coverage for a different medication will be paid for by the insurance company. Some insurances require a deductible to be met, in which the patient pays a certain amount out of pocket prior to the insurance covering any costs. 2b. Requirements to see specialists

According to the NHS website, the NHS will cover all costs incurred during specialist visits, and the specialist may be seen after the patient’s primary care provider refers the patient as such. Within the US, the requirements to see specialists are determined by the specific insurance policy held by the patient. Some private insurance plans require the patient to seek a referral by the patient’s primary care provider, while others do not require such referral and the patient is able to seek specialist treatment as they see fit. Those with Medicaid and Medicare are also eligible to seek treatment by specialists, but it is the responsibility of the patient to ensure the providers are approved to accept Medicaid and Medicare payments. 2c. Coverages for preexisting conditions Patients who have preexisting conditions within Great Britain are treated the same as those without preexisting conditions according to the NHS website. They are covered from birth throughout their healthcare journey, regardless of chronic conditions or needs. Preexisting conditions within the US is no longer an issue since the passing of the Affordable Care Act. This legislature banned private healthcare from denying coverages for patients suffering from chronic medical conditions. Medicaid and Medicare have the same acceptance of all qualifying patients regardless of health history.

3. Two financial implications for patients regarding healthcare The first financial implication is the willingness to seek care when needed related to the cost of private healthcare for patients in the US. “According to a 2016 Gallup survey, 27% of individuals in the United States identified affordability as the country’s most urgent health problem” (Emanuel, 2017). While the overall cost of privatized healthcare has plateaued since

the inception of the Affordable Care Act, the average affordability index percentage for families in the US has more than doubled in the last 10 years (Emanuel, 2017). This increase in percentage of income that is spent on healthcare has a direct impact on the financial stability of American families. Rising deductibles and co-pays have a lasting impact on how willing a patient is to seek care in the case of an illness or emergency. Patients routinely worry about what a visit to a provider or hospital will cost, what will be covered, and how much they will have to pay out of pocket (Emanuel, 2017). The US healthcare system lacks in transparency on costs of medical treatments and unfortunately has a “treat now, bill later” policy. The Second financial implication is related to the NHS style of universal healthcare. In this universal healthcare coverage layout there is what seems to be a constant struggle to maintain quality healthcare for individuals due to financial strains felt by the healthcare organizations and providers. This is evidenced by countless stories of poor care, failing infrastructures and questionably unsafe care received by patients in hospital wards throughout Great Britain. The high acuity and number of patients is a struggle to maintain within the NHS system, which will likely just worsen as healthcare products and resources increase in price leading to a struggle to provide quality patient centered care with Great Britain.

Resources De Lew, N., Greenberg, G., & Kinchen, K. (1992). A layman's guide to the U.S. health care system. Health care financing review , 14 (1), 151–169. Emanuel EJ, Glickman A, Johnson D. Measuring the Burden of Health Care Costs on US Families: The Affordability Index. JAMA. 2017;318(19):1863–1864. doi:10.1001/jama.2017. Grosios, K., Gahan, P. B., & Burbidge, J. (2010). Overview of healthcare in the UK. The EPMA journal , 1 (4), 529–534. https://doi.org/10.1007/s13167-010-0050- Light D. W. (2003). Universal health care: lessons from the British experience. American journal of public health , 93 (1), 25–30. https://doi.org/10.2105/ajph.93.1. (n.d.). Retrieved October 28, 2020, from https://www.nhs.uk/using-the-nhs/help-with-health- costs/get-help-with-prescription-costs/