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Introduction

According to a US post, Americans have had a harder time than other residents of several other countries getting after-hours appointments with a primary care physician without going to an emergency room. The study by Health Affairs journal, found out that the US lags behind several other countries in health care matters despite spending more on medical care than any other country in the world. The comparison was made in regard to such factors like cost of health care, access to care and quality of care offered (Lee, C. 2006). This paper will discuss the health system of three other countries; the UK, Netherlands and Germany and why and how their health system is considered superior to that of the USA.

Health care system in the UK

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How is the delivery system organized?

General practitioners are the first point of contact with patients. Most GPs are paid by primary care trusts (PCTs) through such combination as salary, capitation and fee-for-services. Private GPs set their own fees and are not reimbursed by the government through the public system.

Access

Services covered for publicly funded coverage" the NHS covers preventive services, impatient and outpatient care, general practitioner services, dental care mental care, rehabilitation, impatient and out patient drugs , learning disability and rehabilitation service. For cost sharing; there are some few arrangements for publicly covered services with about 88 percent of prescriptions exempt from charges. Safety nets are where most are met from the public purse.

The National Health Service (NHS) ensures focuses on quality care. According to health objective in 2007, it is meant to enhance the quality and safety of health and social care services. Quality issues are addressed by such bodies like regulatory bodies which monitor the quality of services provided by the public and private providers. Efficiency has also been a key focus by the NHS and it seeks to improve by high level efficiency targets, benchmarking institute for innovation and improvement which supports the development of better and more efficient ways of providing health care through such bodies.   

The costs are controlled by the government, it sets the budget for NHS on a three year cycle and to control utilization and costs and setting a capped overall budget for PTs. The PCTs and NHS are expected to achieve a financial balance each year and the centralized system tends to lower overhead costs.

Sources of health care finance

For NHS, the NHS accounts for 86 percent of the total health care expenditure mainly funded by taxation (76%), National Insurance Contributions (19%) 5% user charges. The NHS receives also income from fees and other charges levied to private patients. For private health insurance, a mix of profit and not-for-profit provide services of comfort and privacy than NHS. They cover 12% of the population and accounted for 1% of the total expenditure in 2004.

Health care system in Germany

Sources of health care financing

The health system is financed through various means including;

Public financed scheme; the SCI is a scheme operated by more than 200 competing health insurance funds as regulated by the law. The SCI is funded by compulsory contributions based on wages. E.g. in 2008, the average insured employer contributed almost 8 percent of the gross wage while the pension firm adds another 7 percent. The government pays for the unemployed so called "Hartz IV.    

Private health insurance (PHI); the PHI covers those who are excluded from SHI as from the high earners, those who are refunded by their employer. These people pay a risk related premium assessed on a number of factors. But the PHI is regulated by the government and from 2009, private insurers covering substitutive cover, were required to take part in a risk adjustment scheme. In 2005, PHI accounted for 90.1 percent total health care expenditure in Germany. 

Access- who is covered

The SHI is a public social health insurance and is compulsory for people earning €48,000 per year including dependants who are included in the insurance. This covers around three quarters of the population. For those who earn more than €48,000 per year, they are not required to be covered unless they wish so but they can purchase private health insurance or can be theoretically be insured.

Quality and efficiency  

To ensure quality care, a number of measures are put into place. Structural quality is addressed as a requirement to have quality management system for all the providers, all the physician as well as health technology assessment for drugs and procedures. There are minimum requirements that were introduced for a number of procedures. Process and outcome quality is also ensured through mandatory reporting system for all hospitals.  

To improve efficiency, a set of measures have been instituted. All drugs for example have been subjected to reference price since 2004. The cost effective of drugs have been evaluated to add pressure on pharmaceutical prices. Hospitals are reimbursed through DRG for each patient and this puts pressure on les efficient hospitals.   

How is the delivery system organized?

General practitioners have no formal gatekeeper function although in 2004 they were required to offer their members the option which provides a bonus for following the gate keeping rules.  Hospitals in the country are mainly non-profit; both public and private. The private for profit though has been growing mainly through take-overs and senior doctors can treat patients for service-for-fee although doctors are not allowed to treat patients.

Healthcare system in Netherlands

Access

Since 2006, all residents or those who pay tax in Netherlands are required by law to purchase insurance coverage which is statutory although provided private health insurers and regulated under private law. Asylum seekers are covered by the government and some other mechanisms put in place to reimburse health care costs. The scheme covers services, cost sharing and safety nets in which children are exempt from cost sharing.

Quality

Quality of healthcare is ensured through legislation regarding professional performance, health technologies, and patient rights. There is a national inspectorate for health whose mandate is to monitor activities. But mechanisms to ensure quality in the care are usually provided by individuals who are involved in registration for specialists.

The main approach to improving efficiency is under the competition between the insurers and the central steering on performance and transparency. The health technology assessment enhances value for money by informing the public of their rights.   

Sources of health care finance

The country has a statutory health insurance system (ZWV) financed by premiums paid by the insurer and income related contributions. The income related contributions are set at 6.5 percent of the first €30,000 of annual taxable income. For those without employers, the contributions are made at 4.4 percent. The government pays for premiums of children till the age of 18. In 2005, sources of finance accounted for 65.7 percent of total expenditure and this figure rose to 78 percent in 2007.

Private health insurance was though abolished in 2006. Most of the population now purchases a mixture of contemporary and supplementary private health insurance from the statutory health providers.   

Conclusion

The US health care system has been under attack from different quarters both in and outside the country as being very expensive despite not covering all its citizens. The paper has tried to highlight three different countries' health care systems and thus showcase how the US case can be improved to provide not only affordable care to all but also cover all its citizens. The study has covered the U, Netherlands and Germany as examples.

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