health care economics_us uk health systems

Running Head: A Comparative Analysis of the Organization and Structure of the United States

and United Kingdom Health Systems 1

Source: Stay Smart Stay Healthy RSS – SSSH

A Comparative Analysis of the Organization and Structure of the United States and United

Kingdom Health Systems

Annushree Patel

Newbury College




Contents

Executive Summary……………………………………………………………………………. 3

A Chronology of United States Health Care Reforms........................................................... 4-6

A Chronology of United Kingdom Health Care Reforms...................................................... 6-9

Foundation of a National Health Care System..................................................................... 9-10

The National Health Service..................................................................................... 10-11

Organization structure of United Kingdom

Overview of Organization and It’s Roles................................................................ 11-12

Clinical Commissioning Groups.............................................................................. 12-13

Health and Wellbeing Boards....................................................................................... 13

Regulation - Safeguarding People’s Interest

Monitor............................................................................................................................ 14

Healthwatch..................................................................................................................... 14

Other Ministries......................................................................................................... 14-15

Private Sector......................................................................................................................... 15-16

Organization of the United States Health Care System.......................................................... 16

Public Health Insurance............................................................................................ 17-19

Private Health Insurance

Employer Sponsored Insurance................................................................... 19-20

Private Non-group/Individual Market........................................................ 20-22

Conclusion……………………………………………………………………………………... 23

References…………………………………………………………………………………. 24-26




Executive Summary

The philosophies which underlie systems of medical organization are developed through

cultural, social, and political development. The fundamental premise of the American free

market system is that consumer welfare is maximized by open competition and consumer

sovereignty -- even when complex products and services such as health care are involved. The

structure and organization of the United States health care system comprises the ideal of

individual market. The agencies created within the health care system play an important role in

safeguarding the free market system from anticompetitive conduct, by bringing enforcement

actions.

The majority of the population in England consider it not a disgrace, but the most natural

thing in the world, when they fall ill, to demand and receive free treatment without delay. The

basis of the National Health Service was from the idea that health care should be available to the

public regardless of the income. The NHS remains a free health care system for citizens of the

United Kingdom; the NHS is the commissioning services in England.

Today, hospitals in both countries tend to follow national guidelines rather than their

own. Hospitals have begun to utilize best practices and have initiated programs to look events

associated with care. Centers of excellence are becoming prevalent in both the United States and

the United Kingdom. The UK utilized Academic Health Science Network and the Center of

Excellence is responsible for identifying and driving best in class services. Local commissioners

will have the responsibility at looking at the quality data in their area and setting goals for quality

improvement that addresses their specific gaps. The two countries advance towards achieving a

cost efficient, quality-based system that serves the interests of consumers.

A Chronology of United States Health Care Reforms




Health care in the United States is an evolution of the English “Poor Laws” where

Americans were taking care of individuals who had fallen ill (SSSH,1). Additionally, the Poor

Laws influenced the establishment of alms houses. Blockley Almshouse in Philadelphia was

constructed in 1732. It provided the first government-sponsored care of the poor in America, as it

offered an infirmary and hospital for the sick and insane, besides housing and feeding the

impoverished. The Blockley Almshouse became the foundation for the development of the

Philadelphia General Hospital. The earlier hospitals of the United States were referred to as the

“marine seaport hospitals.” The purpose of the marine seaport hospitals was twofold; first, take

care of the ill and second, to quarantine the ill to prevent the spread of diseases.

On July 16, 1798 John Adams signed into law the Act for the Relief of Sick and Disabled

Seamen, which established what is now the Public Health Service. Twenty cents were deducted

from monthly wages of each merchant seaman to build or rent hospitals and pay for the medical

care provided. The President of the United States authorized and nominated directors of the

marine hospitals in America. U.S. Marine Hospital in Chelsea, Massachusetts became the first

formal hospital in 1834.

Dr. John M. Woodworth was the first surgeon general in the United States and in 1871

was appointed Supervising Surgeon of the Marine Hospital Service. Some of the administrative

challenges that the marine supervisors faced were “who was covered?”, “who to collect tax

from?”, and “if contracts from providers were viable?”. Policies were interpreted locally; tax

collection was so uneven and insufficient to meet local health care costs. Such shortcoming in

funds contributed to the lack of health care in local communities.

Marine hospitals were the first form of national health system in the United States. At the

same time, the private sector was developing their own hospitals. Famous hospital include:




Pennsylvania Hospital of 1752, New York Hospital of 1790, and Massachusetts Hospital of 1821

(SSSH,1). Hospitals were only providing care to patients that required surgery and did not harbor

communicable diseases or unknown diseases. The Pension Act of 1776 was enacted to provide

soldiers and sailors with compensation for injuries that hinder working (PBS,1). The law granted

half pay for the length of the disability or life and became the first disability insurance in the

United States. In 1917, the War Insurance Act amendment provided medical services to veterans

with service-connected disabilities. The Sheppard-Towner Act enacted in 1921, provided grants

to states to develop health services for women and infant children. In 1929, the first Blue Cross

Plan was established, which was a significant development in health care delivery. The Social

Security Act was established in 1935 and national health insurance was not part of the act

(PBS,1). This act put into place Medicare and Medicaid.

World War I, as people were being enlisted for military services, they were still harboring

childhood diseases or lack of vaccinations. The purpose of the Sheppard-Towner Act was to

provide vaccination and take care of infants and mothers so we had a healthy population. These

laws created a demand for health care. The Hospital Survey and Construction Act was

established in 1946 and allotted money to communities and states to build hospitals, essentially

putting federal money into the private market to increase capacity in the private market

(SSSH,1). The Comprehensive Health Manpower Training Act of 1971 increased the enrollment

in schools of medicine, optometry, dentistry, veterinary medicine, and pharmacy (PBS,1). This

law helped train thousands of medical professionals in America. The cost of health care

continued to rise astronomically. Cost containment measures were focused on the Social Security

Act. In 1977, the Health Care Financing Administration (HCFA) was created to manage

Medicare and Medicaid separately from the Social Security Administration. This agency was




changed to Center for Medicare and Medicaid Services (CMS) in 2001. The United States

government continued to aid the most vulnerable population: young children through the State

Children’s Health Insurance Program (SCHIP) in 1997 (SSSH,1). This enabled states to extend

health coverage to uninsured children, safeguarding them from communicable diseases. Both

cost containment and access to health care for all Americans paved the way for the passage of

Affordable Care Act in 2010 (PBS,1). The law put into place comprehensive U.S. insurance

reforms.

In the early development of the United States, the government sponsored health insurance

covered the merchant marines and later spread to the most vulnerable populations in the United

States including the elderly, indigent, and war veterans through Medicare and Medicaid. The

principle perception that health care is a personal responsibility prevails in America where

parents are responsible for their children and children are responsible for their parent dating back

to the English Poor Laws. Concluding, the hallmark of American individualism prevails in the

American health care market.

A Chronology of United Kingdom Health Care Reforms

Before a centralized health system in the United Kingdom, there was a patchwork of

private, charity, and voluntary run hospitals. In 1911, the chancellor, Lloyd George, established a

system of National Health Insurance, keeping the Elizabethan Poor Laws of 1601 at heart

(Medical Facilities,1). Poor Laws created a system that administered poor relief at the local level

and was paid for by levying taxes. Similarly, the National Health Insurance offered benefits to

the contributor below a certain level of income. Insurance contributions were paid at a flat rate

shared equally by the employer and the employee. In return for their contributions, individuals




received cash benefits for sickness, accident and disability. Individuals also had the right to free,

but limited, care from a doctor on a local list and were entitled to hospital treatment for major

illnesses. In return, doctors received a capitation fee which provided a fixed income for their

services (Socialist Health Association, 1).

National Health Insurance was the largest health service provider in the early 20th

century (Medical Facilities, 1). By the 1930s, it had expanded its hospital provision, taking on

Poor Law hospitals. The Poor Law offered relief to the most impoverished Britons seeking

medical care. Lloyd George’s health system faced financial shortcomings rather quickly. The

two primary deficiencies were lack of access to hospital care and lack of access to health care for

family members. Seeking medical care during an illness posed high financial problems for

British families across the country.

Aneurin Bevan, architect of the National Health Care Service set out to create a single,

centralized British health care system that was not based on the insurance principle - entitlement

following financial contribution. The NHS was of crucial importance in establishing the post-

Second World War pattern of health service finance and provision in the United Kingdom. It

introduced the principle of collective responsibility by the state for a comprehensive health

service. The NHS received mixed views from privately practicing doctors that saw the

movement of a centralized, government controlled system as a socialist movement. The doctors

organized an offensive against the government; no doctors therefore no national health service.

Bevan negotiated with physicians and brought them under a single umbrella (Socialist Health

Association, 1).

On July 5th, 1948, Park Hospital in Manchester, Bevan unveiled the National Health

System. It was the biggest and most expensive social reform conceived by United Kingdom. The




NHS the first health system to offer free medical care to the entire population at the point of need

and was financed out of taxation (Medical Facilities, 1).

All over Britain people suffering from hernia, toothaches, ulcers, etc. flooded into

hospitals without fearing humiliation for not being able to afford treatment. For the first time,

hospitals, doctors, nurses, pharmacists, opticians and dentists are brought together under one

umbrella organization to provide medical service (Socialist Health Association, 1). The new

medical service remained totally free until 1951 when charges were imposed for prescriptions,

dental care, and spectacles. Charges of one shilling was introduced for prescriptions. Prescription

charges of one shilling was introduced and a flat rate of a pound for ordinary dental treatment

was also brought in on June 1, 1952 (Medical Facilities, 1). Universal access was a tremendous

step forward for women. The removal of fear of illness cannot be underestimated and, as a result,

the NHS was popular at its inception.

The NHS continued to face strong structural criticism throughout its early development.

In 1962, the medical profession criticized the separation of the NHS into three parts: hospitals,

general practice and local health authorities. They believed that a more unified national system

would work coherently to provide medical care. The Hospital Plan approves the development of

district general hospitals for population areas of about 125,000 people. Additionally, in 1967 the

Cogwheel Report considered the organization of doctors in hospitals and proposes specialty

groupings, to meet future health needs. It also highlights the efforts being made to reduce the

disadvantages of the three part NHS structure with hospitals, general practice and local health

authorities.

Critics of the NHS, including David Ennals, commissioned the Black Report in 1980 to

investigate the inequalities of health care in Britain (Socialist Health Association, 1). The report




aims to investigate the inequality of healthcare that still exists despite the foundation of the NHS.

There were distinctions between the social classes in the usage of medical services, infant

mortality rates and life expectancy. Poor people are still more likely to die earlier than rich ones;

the system favored one set of the British population over the other. The 1981 Census shows that

11 babies in every 1,000 die before the age of one. In 1900 this figure was 160 (Medical

Facilities, 1). Childhood survival has been revolutionized by vaccination programs, better

sanitation, and improved standards of living, resulting in better health of both mother and child.

The Community Care Act of 1990 was passed in order to provide localized and standard

care to all NHS patients (Socialist Health Association, 1). Health authorities managed their own

budgets and health care from hospitals and other health organizations. Individual organizations

became part of the NHS Trusts and provided standard of care to all its patients regardless of

wealth of the patient. The British health system continues to evolve to provide the utmost

medical care to its citizens. In 2000, NHS walk-in centers were introduced. These new health

facilities stay open offering convenient access, round-the-clock, 365 days a year (Medical

Facilities, 1).

Foundation of a National Health Care System

The philosophies which underlie systems of medical organization are developed through

social and political development. The majority of the population in England consider it not a

disgrace, but the most natural thing in the world, when they fall ill, to demand and receive free

treatment without delay. The British population believed that health care was a right. For

centuries, England has regarded it as a public responsibility to make provisions for the sick poor.

Poverty has been interpreted generously. These provisions were started by the Catholic Church

in England and gradually the hospitals were transferred to the government. Before 1948, a




majority of the cost of hospitals were endured by charitable bodies and the rest were covered by

the government (Socialist Health Organization, 1).

The charity organizations and the British government set out to provide service to the low

income public. The criterion was need of medical service not payment. The question of payment

was not raised until 1881 when British hospitals did not have a method of incorporating patients

that were paying out-of-pocket (Medical Facilities, 1). Free hospital care was made available to

the poor after the Poor Law was passed. England encouraged its medical professionals to provide

medical care for the poor.

The National Health Service

The National Health Service is the health care system that is responsible for coverage not

only in United Kingdom, but also in Northern Ireland, Wales, and Scotland. The NHS was

launched in 1948 and has grown to become the largest national health care system. The basis of

the NHS was from the idea that health care should be available to the public regardless of the

income. The NHS remains a free health care system for citizens of the United Kingdom (The

NHS in England, 1).

The NHS serves more than 53 million people and employs an estimated 1.7 million

people. There are approximately 39,780 general practitioners (GPs), 370,327 nurses, 18,687

ambulance staff, 105,711 health and community health service medical and dental staff, etc. The

giant health system serves one million patients every 36 hours (The NHS in England, 1).

Organization Structure of United Kingdom

Overview of Organization and It’s Roles




First, there are a series of groups and divisions (shown in Figure 1) with professional

responsibilities including: Clinical Commissioning Groups, Health and Wellbeing Boards,

Monitor, and Healthwatch.

Figure 1, Overall structure of the new NHS in England

Second, there is the Department of Health (DH), under the direction of the Secretary of State,

which has ultimate responsibility for the provision of a comprehensive health service in England

and ensures the whole system works together to respond to the priorities of communities and

meets the needs of patients. DH is responsible for strategic leadership of both the health and

social care responsible, including improving people’s health and wellbeing through its

stewardship of the adult social care, public health and NHS systems (The NHS in England, 1). .




Third, there is the office of NHS Commissioning Board (NHS England). The NHS

England’s main role is to improve health outcomes by commissioning care for people in

England. Additionally, it acts as a national leader for improving outcomes and driving up the

quality of care. Quality of care is insured by NHS England by overseeing the operation of

clinical commissioning groups, allocating resources to clinical commissioning groups, and

commissioning primary care and specialist services. As well as its headquarters, the NHS

England has four regional offices located around the country. These offices are responsible for

the regional implementation of national policies and, with this aim in mind, monitor the

performance of health authorities. They occupy an important position of accountability from the

local level to the center.

Clinical Commissioning Groups

Clinical Commissioning Groups (CCGs) have replaced Primary Care Trusts (PCTs),

which controlled 80% of the NHS budget (The NHS in England, 1). CCGs have taken on many

of the functions of PCTs and, in addition, some functions previously undertaken by the

Department of Health.

All GP practices belong now to a CCG and the groups also include other health

professionals, such as nurses. CCGs commission most services, including planned hospital care,

rehabilitative care, urgent and emergency care, most community health services, and mental

health and learning disability services.

Essentially, CCGs can commission any service provider that meets NHS standards and

costs. These can be NHS hospitals, social enterprises, charities, or private sector providers.

CCGs must be assured of the quality of services they commission, taking into account both

National Institute for Health and Care Excellence (NICE) guidelines and the Care Quality




Commission's (CQC) data about service providers. Both NHS England and CCGs have a duty to

involve their patients, health care providers, and the public in decisions about the services they

commission (The NHS in England, 1).

Health and Wellbeing Boards

The NHS established Health and Wellbeing Boards to act as a forum for local

commissioners across the NHS, social care, public health, and other services (The NHS in

England, 1). The boards are intended to increase democratic input into strategic decisions about

health and wellbeing services, strengthen working relationships between health and social care,

and encourage integrated commissioning of health and social care services. Boards strengthen

democratic legitimacy by involving democratically elected representatives and patient

representatives in commissioning decisions alongside commissioners across health and social

care. The Health and Wellbeing Boards also provide a forum for challenge, discussion, and the

involvement of local people. Health and Wellbeing Boards will have strategic influence over

commissioning decisions across health, public health, and social care. Ultimately, the boards will

help give communities a greater say in understanding and addressing their local health and social

care needs.

Regulation - Safeguarding People’s Interest

Monitor

Monitor is a regulatory agency of the NHS; its main role is to regulate all providers of

health and adult social care services by protecting and promoting the interest of patients (The

NHS in England, 1). Monitor aims to promote competition, regulate prices and ensure the

continuity of services for NHS foundation trusts. Competition is promoted by regulating the

provision of health care services to ensure it is effective, efficient and economic, and maintains




or improves the quality of services. Additionally, Monitor has an ongoing role in assessing NHS

trusts for foundation trust status, and for ensuring that foundation trusts are well-led, in terms of

both quality and finances.

Healthwatch

Healthwatch is another element of the regulatory system and functions as an independent

gathering (The NHS in England, 1). It represents the views of the public about health and social

care services in England. The public view of the health care system is based on both a national

and a local level by Healthwatch. Locally, Healthwatch will give patients and communities a

voice in decisions that affect them, reporting their views, experiences, and concerns to

Healthwatch England.

Other Ministries

Additional responsibilities of the NHS regulatory system is transferred to individual

professional regulatory bodies. These include:

● The General Medical Council which is responsible for protecting, promoting, and

maintaining the health and safety of the public by ensuring proper standards in the

practice of medicine (General Medical Council, 1)..

● The Nursing and Midwifery Council which is responsible for safeguarding the health

and wellbeing of the public. The Council sets standards of education, training, conduct,

and performance so that nurses and midwives can deliver high quality healthcare

consistently throughout their careers (Guidance On Professional Conduct, 5).

● The General Dental Council which is responsible for registering qualified dental

professionals, setting and enforcing standards of dental practice and conduct, protecting




the public from illegal practice, assuring the quality of dental education, and investigating

complaints (Council Member Appointments, 1).

● The Health and Care Professions Council develops and monitors strategy and policy

and consists of 20 members including the Chair.

Private Sector

In 1997, 12% of the British population was covered by private medical insurance. Today,

10% of the population choose medical coverage through a private market; one million operations

are performed privately every year (Doyle, 2). The private sector provides many services for the

NHS, such as 75% of acute medical and psychiatric care and long-term residential care for

people with learning disabilities. Private medical insurance is more common among older people

and those in living in wealthier parts of the country; 20% of the population in the outer London

metropolitan area are covered, but only 4% in the north of England (Doyle, 1). Private health

insurance is paid one-third by the individual and two-thirds by the employer (Doyle, 1). Britons

benefit economically from the collaboration of the NHS and the private market. The NHS is a

substantial supplier of private beds; there were an estimated 39% of dedicated pay beds in NHS

private units in 1997 (Doyle, 3). In spite of the commonality of new medical technologies in

private practice, collaboration between public and private health care sectors would serve the

United Kingdom better than continued isolation.

Organization of the United States Health Care System

The United States’ health care system comprises both private and public markets. Unlike

any other country in the world, the U.S. health system is dominated by the private market. In




2011, 55.1% of the population received private employer-sponsored insurance (ESI) (Chua, 2).

15.2% of the population were enrolled in public insurance programs like Medicare, and 16.5% of

the population were covered by Medicaid (Multack, 3). 15.7% of the population were uninsured

(Multack, 3). Elderly individuals aged 65 or over are uniformly enrolled in Medicare and

Medicaid.

Figure 2, Sources of Insurance Coverage, 2011

Public Health Insurance

Medicare is a Federal health insurance program that has provided coverage for

individuals age 65 and older since its establishment in 1965. The program also covers certain

people under age 65 with disabilities. Medicare is a single-payer program administered by the

government, which is a single entity performing the insurance function of reimbursement. In

2011, Medicare covered more than 15% of the population (Multack, 3). Medicare comprises four

individual components: Part A (Hospital Insurance), Part B (Supplementary Medical Insurance),

Part C (Medicare Advantage Program), and Part D (Voluntary Outpatient Prescription Drug

Benefit).




Part A covers a multitude of services from inpatient hospital to nursing facility services.

Inpatient hospital services cover up to 90 days per benefit period. Patients can also enjoy the

skilled nursing facility services for up to 100 days per benefit period following at least a three-

day inpatient hospital stay. Medicare part A allows homebound individuals home health care and

allows patient psychiatric care for up to 190 days for patients in need of psychiatric attention

(Multack, 2).

Part B is a supplementary medical insurance that covers the expenditures associated with

a hospital visit. Patients can utilize physicians’ services, including office visits, a one-time

physical examination for new beneficiaries, and a yearly wellness visit. Other supplementary

coverage includes medical equipment (wheelchairs, oxygen) and clinical laboratory access

(blood tests, x-rays screening tests) (Multack, 3).

Medicare Part C is the part of the Medicare policy that allows private health insurance

companies to provide Medicare benefits. Health Maintenance Organizations (HMOs) and

Preferred Providers Organizations (PPOs) are private health plans covered by the Medicare

Advantage plans (Multack, 3). HMOs and PPOs administer Medicare benefits. Part D of

Medicare is a voluntary program that subsidizes the cost of pharmaceutical drugs; Medicare Part

D provides insurance to cover the cost of drugs (Multack, 4).

Medicaid is the largest publicly financed program, providing health and long-term care

coverage for certain groups of low-income people throughout the United States since 1965.

Federal law identifies over 25 different eligibility categories, including children, pregnant

women, individuals with disabilities, and the elderly. In addition, individuals must also meet

income and asset requirements, as well as immigration and residency requirements. In 2011,

Medicaid covered 52.6 million people in the United States (Flowers, 2).




Medicaid is financed jointly by the states and Federal government through taxes. Every

dollar that a state spends on Medicaid is matched by the Federal government at least 100%. In

poorer states, the Federal government matches each dollar more than 100%. Overall, the Federal

government pays for 57% of Medicaid costs. In order to receive Federal matching funds, state

Medicaid programs are required to cover the services for mandatory populations including,

inpatient and outpatient hospital services, physician, midwife, and nurse practitioner services,

home health services for persons who qualify for nursing home care, pregnancy-related services,

laboratory and x-ray services, and some other services (Flowers, 3).

Other national public programs include the Veteran's Administration (VA) and

Children’s Health Insurance Program (CHIP). The Veteran’s Administration is a federally

administered program for military veterans. Services are administered in government-funded VA

hospitals or clinics; the VA is funded through taxpayer dollars. Disability benefits include

compensation or pension. VA can pay veterans monthly compensation if they are at least 10%

disabled as a result of military service (Chua, 2). Pension plans support wartime veterans who

have limited income or are over the age of 65.

CHIP provides health coverage to nearly 8 million children in families with incomes too

high to qualify for Medicaid, but unable to afford private coverage. Signed into law in 1997,

CHIP provides Federal matching funds to states to provide this coverage. Additionally, CHIP

shares similar administrative and financing structure to Medicaid’s. Mandatory services covered

through CHIP include inpatient/outpatient hospital services, home health services, physician

service, rural health clinic services, laboratory and x-ray services, and several others (Chua, 2).

Private Health Insurance




Employer Sponsored Insurance

Employer-sponsored insurance plays a central role in the financing of health care in the

U.S. In 2012, 162 million Americans had ESI, representing over 60 percent of the non-elderly

population. ESI dominates the private insurance market, accounting for 90 percent of the market

(Buchmueller,1). ESI not only is an important source of insurance coverage for workers and their

families, but also affects individuals' employment decisions; employers provide health insurance

as part of the benefits package for employees.

ESI coverage is strongly correlated with firm size, with 97 percent of firms with over 100

employees offering coverage vs. 40 percent of firms with fewer than 25 employees

(Buchmueller,1). Currently, the share of premiums paid by employers averages 85 percent for

individual coverage and 75 percent for family coverage. However, due to the rising cost of health

care, employee premiums skyrocketed between 2001 and 2011; the total premium for family-

based ESI coverage increased from $7,061 to $15,073 or 113%. Such premium increases have

outpaced the growth in workers’ earnings, which increased only 33 percent from 2001 to 2011

(Georgetown University, Employer Sponsored Insurance Coverage).

Figure 3




There are three key components associated with the success of ESI in America. First,

there are substantial economies of scale when purchasing insurance through a group. Second, the

problem of adverse selection -- sicker individuals being more likely to sign up for coverage -- is

reduced in an employer-sponsored group. Companies have an efficient way of risk pooling as

compared to an individual in the market. Third, the fact that health insurance premiums are not

subject to income taxation effectively reduces the price of insurance purchased through the

employer (Buchmueller,1).

Private Non-group/Individual Market

The individual market covers part of the population that is self-employed or retired. In

addition, it covers some people who are unable to obtain insurance through their employer. In

contrast to the employment-based insurance, the individual market allows health insurance

companies to deny people coverage based on pre-existing conditions.

Individuals pay an insurance premium out-of-pocket for coverage. Risk in the individual

market depends only on the health status of the individual, in contrast to the group market, in

which risk is spread out among multiple individuals. As such, low-risk, healthy patients will




have a low premium, whereas the opposite is true for high-risk, sick patients. although, on

average, non-group insurance premiums are lower than for ESI, enrollees pay 100% of the cost

because they cannot share that premium expense with an employer.

Nationwide, the average monthly premium per person in the non-group market in 2010

was $300.5 with an annual cost of $3606. For a family plan through the individual market, the

monthly and annual cost totaled around $591.83 and $7102 respectively (refer to Table 1).

Table 1, Average reported annual premiums for non-group health insurance

by coverage type and age, 2010

Despite the cost benefit associated with the individual market health insurance plans,

there are shortcomings. Insurance premiums in the non-group market may vary by age and health

status and may be less comprehensive than group plans purchased by employers. Under the

current system, applicants with health problems who are offered non-group coverage may be

charged a higher premium due to their medical history. Obtaining coverage in the individual

market can be difficult, particularly for those who are older or have had health problems. In

2008, 29% of individuals age 60 to 64 who applied for non-group insurance were denied

coverage based on their health status (Kaiser Family Foundation, 17-19).




Conclusion

The National Health Service of England provides universal health care that is free at

point of service; it is governed centrally and funded from taxes. The United States health care

system if funded by a patchwork of public and private insurance with large point-of-service fees

on many patients. Quality of care is one of the key focuses of both the British and American

health care system. Indeed, one of the stated goals, of both systems, is to enhance the quality and

safety standards of health and social services. Quality issues are addressed in a variety of

methods. There are a number of regulatory bodies in place which monitor and assess the quality

of health services provided by public and private providers. This involves regular, periodic

assessment of all providers, investigation of all individual issues that have been drawn to the

attention of regulatory body, and careful consideration in order to recommend the best methods.

of practice. Additionally, the two countries are seeking similar changes in their health care

systems including: better value for money from health care, medical professionals and health

care institutions to focus on quality and adopt value enhancing behaviors, and control the cost of

health care to the patient. The United Kingdom’s NHS can benefit from assessing the spending

growth required by the American system; a financial transparency within the system could serve

to enhance the NHS. On the other hand, U.S. needs to put into place accountable care

organizations, similar to NHS’s Monitor, that can bend the health care cost while improving

patient outcomes. Given that similar issues are being faced by the two countries, ideally the

process of restructuring can be accelerated by sharing lessons learned across health systems on

both sides of the Atlantic.




References

1. Buchmueller, T., & Monheit, A. (n.d.). Employer-Sponsored Health Insurance and

Health Reform. Employer-Sponsored Health Insurance and Health Reform. Retrieved

April 23, 2013, from http://www.nber.org/bah/2009no2/w14839.html

2. EMPLOYER-SPONSORED INSURANCE COVERAGE. (n.d.). Georgetown

University Health Policy Institute Center for Children and Families. Retrieved April

23, 2013, from http://ccf.georgetown.edu/facts-statistics/employer-sponsored-

insurance-coverage/

3. Jonas and Kovner's Health Care Delivery in the United States, Tenth Edition. (2012,

October). Kaiser Family Foundation. Retrieved April 23, 2013, from

http://www.kff.org/uninsured/upload/7451-08.pdf

4. Multack, Megan. "The Medicare Program: A Brief Overview." AARP. N.p., Mar.

2012. Web. 23 Apr. 2013.

5. How did healthcare come about in the United States? (2012). Stay Smart Stay Healthy

RSS. Retrieved April 22, 2013, from

http://www.staysmartstayhealthy.com/health_care_history_inthe_united_states

6. PBS. (n.d.). Retrieved April 22, 2013, from

http://www.pbs.org/healthcarecrisis/history.htm

7. Medical Facilities. (n.d.). :: History of Healthcare in the UK. Retrieved April 23,

2013, from http://www.londonmedicalcentre.co.uk/history-of-healthcare-in-the-

UK.html

8. History of healthcare. (n.d.). Socialist Health Association. Retrieved April 22, 2013,

from http://www.sochealth.co.uk/healthcare-generally/history-of-healthcare/

http://www.kff.org/uninsured/upload/7451-08.pdf

http://www.staysmartstayhealthy.com/health_care_history_inthe_united_states




9. The NHS in England. (2013, January 28). The Structure of the NHS in England.

Retrieved April 20, 2013, from

http://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhsstructure.aspx

10. Accounting for the cost of US health care: A new look at why Americans spend more

. (n.d.). McKinsey Global Institute. Retrieved March 13, 2013, from

http://s3.amazonaws.com/health_source_production/files/70/original/MGI_Accountin

g_for_cost_of_US_health_care_full_report.pdf?1358230311

11. Chang, J., Peysakhovich, F., Wang, W., & Zhu, J. (n.d.). The UK Health Care

System. Columbia.edu. Retrieved March 13, 2013, from

ce.columbia.edu/files/ce/pdf/actu/actu-uk.pdf

12. Ham, C. (2005, March 12). Money Can't Buy You Satisfaction. BMJ. Retrieved

March 14, 2013, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC554041/

13. Roe, A. M. (n.d.). A Comparative Analysis Of The UK And US Health Care Systems.

Upload & Share PowerPoint presentations and documents. Retrieved March 13,

2013, from http://www.slideshare.net/abbiemc/A-Comparative-Analysis-of-the-UK-

and-US-Health-Care-Systems

14. Murray, C. (n.d.). Ranging 37th - Measuring the Performance of the U.S. Health Care

System. The New England Journal of Medicine. Retrieved March 13, 2013, from

http://www.nejm.org/doi/full/10.1056/NEJMp0910064




15. Sandler, S., Paris, V., & Polton, D. (n.d.). Health Care Systems In Transition. Euro

Who. Retrieved March 13, 2013, from

http://www.euro.who.int/__data/assets/pdf_file/0009/80694/E83126.pdf

16. The structure of the NHS in England - NHS Choices. (2013, January 28). NHS

Choices - Your health, your choices. Retrieved March 14, 2013, from

http://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhsstructure.aspx

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