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Running Head: US VS UK HEALTH CARE SYSTEM

United States Verse United Kingdom Health Care System

Sara Coy

California State University Channel Islands

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US VS UK HEALTH CARE SYSTEM
Abstract

Comparing the inefficient, extreme cost, and the underserved medical care in the United States

versus the government sponsored well managed health care system in the United Kingdom.

Multiple insurance plans, limited coverage and lack of understanding policies raises the question

if the US health care system is what it should be. Many US citizens cannot afford healthcare

coverage as much as the US tries to make healthcare insurance a possibility. There are still

people in the US without a healthcare plan. The enactment of the Affordable Care Act provided

healthcare insurance plans for many people who previously could not afford to pay is now being

threaten by the removal of tax credits. Improvement of specialty care and drugs are primary

drivers in the high cost of insurance plans. The US government sponsored plans are only

available to age based and limited low-income individuals. Continued rising cost makes it

difficult to afford healthcare in the US as the US plays a minor role in the funding of the

healthcare system.
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UNITED STATES VERSE UNITED KINGDOM HEALTH CARE SYETEM

This paper will compare the United States (US) health care system to the health care

system in the United Kingdom (UK). Each country delivers excellent medical care to its citizens

and each system is advance in contrast to other industrialized nations. Both countries offer

medical services to all its citizens in two different ways. The government in the UK pays for its

citizen to have medical services and in the US the citizens pay into an insurance plan to receive

medical care. This paper will argue and determine the UK has a more efficient, less costly, and

better health care system.

Type of Health Care System

The UK offers its citizens a government sponsored universal healthcare system, called

the National Healthcare Service or NHS. The NHS is one of the largest organizations in the

world, with a budget it over £48 billion (pounds), as it provides comprehensive and high-quality

medical services. On a typical day in the UK, a “million people visit their doctor, 130,000

citizens see a dentist and 33,000 people receive emergency care” (Stahr, 2001). Citizens of the

UK are entitled to healthcare, but also have the option to buy private health insurance. The UK’s

healthcare system is one of the most efficient in the world when comparing to other

industrialized countries (Chang, Peysakhovich, Wang, & Zhu, 2015).

The US does not have a universal health care system or universal health care coverage,

only recently did the US enact legislation mandating healthcare insurance coverage for most of

its citizens. The outcome of this mandate is the Affordable Care Act where health insurance

companies are to provide affordable plans to the people of the US. Individuals with income

between 100% and 400% of the federal poverty line would be eligible for advance premium tax

credits to subsidize the cost of a health insurance plan (“Affordable Care Act”, 2010).
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Requirements of the ACA are private insurance plans must follow, putting no annual or lifetime

limits on coverage, having no discriminating exclusions for preexisting conditions, allow

children to remain on their parent's health insurance up to age 26, provide limited fluctuations or

variances in price, and allow for limited out-of-pocket expenses (“Fact Sheet” 2016). Some

changes that will affect the ACA are: stopping government funding of premium tax credits and

cost-sharing reductions, expansion of association health plans and health reimbursement

arrangements in addition to repeal of the individual mandate (“Affordable Care Act”, 2010).

These changes are intended to reduce government and individual spending on health plans, but

some authors warn that overall spending on health care may not be reduced and that there may

be increased numbers of uninsured or inadequately insured people (Schreck, 218). However,

there are disparities in insurance coverages as the US has a plethora of insurance plans, ranging

from plans with minimum catastrophic coverage to plans with minim deductibles and higher

premiums that cover more than what the average person will use. In comparison to other

industrialized countries the U.S. health care system is unique and costly.

Finance

The United Kingdom provides public healthcare to all permanent residents,

approximately 58 million people. Healthcare coverage is free at the point of service and is paid

for by general taxation. In the UK 18% of what a citizen pays in income tax goes towards

healthcare. On average this amounts to 4.5% of a citizen’s annual income. As a nation the UK

healthcare cost amounts to 8.4% of its gross domestic product (Chang et al., 2015). The World

Health Organization states government funding covers 85% of healthcare expenditure in the UK

and the remaining 15% is covered by the private sector (Chang et al., 2015).
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According to the “Fact Sheet The U.S. Health Care System: An International

Perspective” “In 2014, 48% of U.S. health care spending came from private funds, 28% come

from households, and 20% come from private businesses, and the federal government accounted

for 28% of spending while state and local governments accounted for 17%” (2016). Most health

care is delivered privately regardless if its government or privately financed.

The percentage of GDP spent on healthcare in the US is more than any other nation. In

2016 the United States spent 17.9% of GDP on health care compared to the next highest

countries: Switzerland 12.4% of GDP and Sweden, Germany, France, and Japan were about 11%

of GDP (Schreck, 2018). Over the years, the amount of money spent on health care has increased

more than the overall economy has grown.

The NHS is complete funded through taxation, and covers healthcare for the majority of

the population. The UK manages the medical care cost of its residents without overwhelming the

economy. The system allocates funds to respective faculties and organizations who in turn make

decisions on the best use of the money. The US has two medical plans Medicaid and Medicare

that are only provided to low income individuals and the elderly. Over all the US play a small

role in the funding and support of healthcare.

Primary Care Providers and Roles

The UK has a universal registration platform where every resident provides their choice

in general practitioner (GP’s). The GP manages and coordinates all primary medical care needs

for each patient. Primary care and specialist care is almost entirely free at the point of delivery.

However there are prescription fees of £7.20 or $11.60 (US) per each item prescribed. In

addition there are fees for dental and optical care (Roland, Guthrie, & Thome, 2012).

Theoretically, the general practitioner plays a gatekeepers role during face to face consolations as
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he assesses a patients needs and determines the type of care. There is a difference between the

general practitioner and specialist in the UK. The specialist works with patients from a hospital

and performs follow-ups visits in a clinic. A GP will work with 4 – 6 other physicians in a group

practice and sees patients in a clinic making decisions to refer a patient to see a specialist

(Roland et al., 2012). Specialist care has grown and improved in the UK over the last 15 years

where 80% of patients are referred to a specialist within 4 weeks of diagnoses as compared to the

US where 88% of patients are referred (Roland et al., 2012).

In the US the role of the general practitioner is the same as the primary care doctor. Most

people with healthcare insurance have a primary doctor and like in the UK that doctor manages

the care of his patients and makes referrals to specialist when necessary. However, not all people

in the US have a primary care doctor and there is not a registration platform. Specialists in the

US are among the best in the world. Nevertheless treatment in the US is inequitable,

overspecialized, and neglects primary and preventive care. (Fact Sheet, 2016). The end result of

the US approach to health care is poorer health than other in other advance courtiers.

Insurance Plans

Although the UK publicly funds the health care system through taxation, it also has a

small private healthcare sector in which healthcare is acquired by private health insurance. This

type of insurance is usually provided to employees as a benefit from large companies (Gürsoy,

2015). The plan the NHS offers promises more power and information for patients, more

hospitals and beds, shorter wait times, in addition to access to more doctors and nurses.

In the US every person’s care is dependent on the type of insurance that individual pays

into. Typically, there are three types of insurance plans HMO, PPO, and fee-for-service. The

HMO plan is health care insurance that usually limits coverage to care from doctors who work
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for or contract with the HMO. It generally won't cover out-of-network care except in an

emergency. The HMO plan may require the individual to live or work in its service area to be

eligible for coverage. HMO’s often provide integrated care and focus on prevention and

wellness. A PPO is a health plan that contracts with medical providers, such as hospitals and

doctors, to create a network of participating providers. The individual out-of-pocket expense is

less if the individual uses providers that belong to the plan’s network, although the individual

does have the option to use doctors, hospitals, and providers outside of the network for an

additional cost. The traditional fee-for-service health insurance plan is the most expensive, but

offers the client the most flexibility in choosing health care providers (Finding Health Insurance,

2018). All three plans pay for emergency services and do not limit the service to in network

doctors or clinics. Although the US offers tax credits to its citizens to make insurance more

affordable, coverage among the insured is uneven leaving minorities, and the poor underserved.

It is estimated that two out of every five workers in the US do not have paid sick leave, making it

difficult to get medical attention. In addition, premiums of these plans have risen 61% from

2005 to 2015 (Finding Health Insurance, 2018).

Cost Inpatient/Outpatient

Outpatient care is less expensive than inpatient care since it does not require an overnight

stay in a facility, using less hospital or medical resources. Insurance plans pay for procedures

based on the type of services provided (Primary Care Physician, Specialist, Mental Health, etc.)

and outpatient surgery is one area that is specifically identified and describes [the] share of costs

should [a patient] need a procedure or operation that does not require an overnight stay at a

medical facility (Value Penguin, 2018). People who require inpatients care have more serious

conditions that require monitoring and care from medical staff including overnight stays for
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several days. The costs for inpatient care are considerably higher; as the patient uses up resources

and services at the medical facility, therefore, these costs get passed along to both the insurance

company and the policyholder.

The United States has the most advanced medical technology in the world, but it is very

expensive. Costs of health care is higher in the United States than in any other country and this

puts a strain on the overall economy. These higher costs are regarded by many as unsustainable.

A driver of increasing health care cost is new technologies and prescription drugs. Analysts

argue that the availability of more expensive state of the art medical technologies and drugs

increase health care spending because they generate demand for more intense, and costly

services even if not necessarily cost-effective (“Fact sheet”, 2018).

The United Kingdom’s healthcare system is quite successful for achieving the goals of

good health outcomes, risk protection, and public satisfaction. Based on the Commonwealth

Fund study of seven countries, looks at the areas of quality, efficiency, access to care, equity, and

healthy lives, the UK healthcare system is ranked high (see table 1). Primarily in categories of

quality of care, access to care, and efficiency.

In contrast to the other six other advanced countries, the US underperforms and scores

the lowest in most areas of health care. Additionally, the US is last in the categories of patient

safety, cost, efficiency, equity, and healthy lives. The US healthcare government plan sets age

and income requirements for Medicaid and Medicare, where the UK makes public healthcare

accessible to all UK residents and free when needed (see table 2). With that said, the US does

offer advantages over the UK when it comes to the private healthcare sector. On the other hand,

when it comes to cancer survival the US ranks 40% higher over the UK for men and women.
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The US also leads in the treatment of diabetes and in all other areas as shown in the Key Medical

statics graph.

Conclusion

Health care in the United Kingdom is managed and efficiently maintained by the

government. It is reasonably affordable to the citizens as it is paid for by the taxes they pay and

available to those who are in need of medical care. Being able to provide healthcare to all

residents it incredibly overwhelming but the UK has created a system that can be taken

advantaged by all its citizens. The healthcare system in the US is dependent on the ability to pay

into a healthcare policy and not all resident of the US has a healthcare plan. In addition, the

variety of policies and the restriction or limits placed upon the policyholder is not always equal

in the care given. Therefore, as the UK efficiently manages, controls costs and spending this

system exceeds the healthcare system in the US.

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Table 1 (Chang et al., 2015)
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Table 2 (Chang et al., 2015)
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References

Chang, J., Peysakhovich, F., Wang, W., & Zhu, J. (2015). The UK Health Care System.

In Columbia.edu. Retrieved November 30, 2018, from

http://assets.ce.columbia.edu/pdf/actu/actu-uk.pdf

Gürsoy, K. (2015). Analyzing The United Kingdom Healthcare System: Lensing On Cancer

Management In England. Sosyal Guvence Dergisi,(8), 119-143.

doi:10.21441/sguz.2015817919

Roland, M., Guthrie, B., & Thome, D. (2012). Primary Medical Care in the United Kingdom.

The Journal of the American Board of Family Medicine, 25(Suppl 1), S6-S11.

Schreck, R. I. (2018, July). Overview of Health Care Financing. Retrieved November 28, 2018,

from https://www.merckmanuals.com/home/fundamentals/financial-issues-in-health

-care/overview-of-health-care-financing

Stahr, H. (2001). Developing a culture of quality within the United Kingdom healthcare

system. International Journal of Health Care Quality Assurance, 14(4/5), 174-

180.

Affordable Care Act (ACA). (2010). Retrieved November 20, 2018, from

https://www.healthcare.gov/glossary/affordable-care-act/

Fact Sheet-The U.S. Health Care System: An International Perspective. (2016). Retrieved

November 30, 2018, from https://dpeaflcio.org/programs-publications/issue-fact

-sheets/the-u-s-health-care-system-an-international-perspective/

Finding Health Insurance. (2018). Retrieved November 30, 2018, from

https://www.usa.gov/finding-health-insurance
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Inpatient vs. Outpatient Care and Coverage. (2018, August 23). Retrieved November 30, 2018,

from https://www.valuepenguin.com/inpatient-vs-outpatient-care-and-health-

coverage