Healthcare Systems of Offering Effectiveness - Article Example

Student’s name) (Course code+name) (Professor’s name) (University name) Table of Contents Неаlth Саrе Dеlivеry аnd Rеfоrm 0 0 1.0.Abstract 2 2.0.Introduction 2 3.0.Comparing and contrasting the design and functioning 3 5.0.Reasons why the health care systems are different in design and functioning 7 6.0.Comparative evaluation of the three systems 9 7.0.Proposals for reform in the three systems 11 8.0.Conclusion 14 9.0.References 15 List of figure Figure 1: Exhibit 1: Supply and Utilisation of Doctors and Hospitals in Select OECD Countries (2013) 9 1.0. Abstract Certainly, what is dreamed of by citizens is a health care system that is integrally connected with them and such supports their specific needs and where possible, quality, effectiveness and efficiency is determined by the knowledge of the diverse consumers. Regardless of the health care system a country puts in place, citizens have one ambition; social dimensions of the health care must attend to their needs systematically so that even people with disability can be supported by virtuous systems. It is for these reasons that health care system remains a contested concept the report carries comparative analysis of the healthcare systems in Australia, United Kingdom and Canada. The underlying reason beghind the comparison is to establish factors that determine operations of these systems as well as establisihng how effectiveness, equality and effeciency is modelled and integrated in these systems. 2.0. Introduction Looking at health care systems across different countries, one thing cuts across; attempts to establish a system that is able to give a seamless treatment or diagnostic and ongoing support care to its citizens. A close look at the structures of health care systems as presented by Scott et al. (2006) there is a significant difference in these systems when it comes to the low and high income earners and between the employed and unempl0yed. These disparities are issues are no longer seen as intractable with scholars such as Wellstood et al. (2006). The appropriate criterion of judging the extent of reform needed on health care systems according to Gerdtham & Lothgren (2001) is to measure its functionalities based on equity, quality, acceptability and efficiency. This argument further conceptualises the fact that health care system is multifaceted term and even underscores a suggestion by Dominika (2012) that health care systems are ‘randomised’ and influenced by factors such as norms, values and aspirations the country is having towards the systems. This is a suggestion that a country and aspirations of the people influence how these systems should be run if not operate. However, there are general parameters that a healthcare system should be operated on. These are effectiveness, efficiency and equity but such need to be facilitated by the government. It is for this reason that scholars such as Wendt, Frisina and Rothgang (2009) have seen healthcare systems as collective and social responsibility---a statement contrary to some argument that healthcare systems should be viewed as a commodity that should be sold and bought and its operation dictated by market forces (Bhat, 2005). 3.0. Comparing and contrasting the design and functioning The question for equity has been a major issue in health care systems within United Kingdom, Australia and Canada (Canada 2010; Wang 2012). This being contentious issue, a comparison and contrasts of the design and functioning of health systems in these countries require clear understanding of high efficiency, equity and effectiveness which is also embedded in those systems. Starting from this point, one comparison existing in the design and functioning of the health systems in Australia, United Kingdom and Canada is that the systems are people and family centred---something that Wen et al. (2008) equates different economic statuses of citizens. As Deber and Thompson (2014) argue, the direction of health care systems should always be shaped around specific health needs of citizens, communities and families. Australia has free inpatient care in all public hospital---a design and functionality which is also recognized under the National Health Act 1953 (Australian Institute of Health and Welfare, 2011). In such cases, there are medical subsidies for this programme. The health care systems have been shaped around specific health needs of citizens, communities and families by availing cost-sharing services. For instance, Medicare has been designed to reimburse about 85 percent to 100 percent of its fees schedule for ambulatory services (Australian Institute of Health and Welfare, 2012). This is exactly the case in United Kingdom. First, the activity of health services is done through the National Health Service (NHS). Secondly, coverage in United Kingdom is universal through NHS---something that supports Beveridge model. Additionally, UK health care systems have availed cost-sharing arrangement which currently stands at £7.85 (US$12.62) for every prescription for outpatients (NHS Information Centre, 2012a). Just like Australia and UK, report by NHS Information Centre (2012a) shows that all provinces and territories in Canada have been designed to offer health care services to all citizens. To offer these services the functioning is done through federal financial contributions which also operate under the Canada Health Transfer Black Grants (NHS Information Centre, 2012b). Though researches such as Nuffield Trust (2013) agrees that is a relative term, the systems as described above are all concerned with improving healthcare efficiency. Secondly, the systems in the three countries attempt to uphold value for money. It is apparent that resources available to support health care systems are finite. Based on Wilson et al. (2002 model of measures, these systems are run as efficiently as possible thus designed to respond to future challenges. For the case of Australia, delivering value for money has been designed by making responsible institutions to be flexible in staffing, financing and providing necessary infrastructures. In 2012 and 2013 Extended Medicare Safety Net provided additional infrastructure and financing to the neediest systems to ensure that patients get values for their money (Australian Institute of Health and Welfare, 2012). Conversely, in 2009 alone Australia dedicated 9.2 percent of its GDP on health care systems (OECD 2012). This is what Deber and Thompson (2014) terms as allocative efficiency where “…resources are allocated across sectors in a way that maximizes societal welfare, including dedicating the “right” level of resources to health care.” Comparing this with the systems United Kingdom, England spent about 9.7 percent of its GDP on health care systems therefore showing commitment as far value for money is concerned. From these statistics, Healy (2011) perception of health system giving value for money is conceptualized. Canadian health systems are designed to give value for money through Canada Health Act including but not limited to diagnostic access, universal coverage for medically necessary hospital and physician services (Medicare) (Canada Health Infoway, 2013). Wilson et al. (2004) explains that though Canada Health Infoway gives equity narrow perspective with regard to health care systems, these countries are concerned with service for all and equal access to the service itself in terms of health care per se and/or the costs and benefits of health care services. Contrariwise, the health care systems in these countries show some differences. In his research, Stephen (2008) as cited in Marchildon (2013a) doubts these systems and wonders whether it is a reform, repair or replace. This is one area that Australian health systems differ significantly with UK’s and Canada’s. Secondly, there is difference how health services are organized and financed. In Australia, most general practitioners (GPs) work in multi-provider practices and are self-employed (Marchildon, 2013a). It is the responsibility of Royal Australian College of General Practitioners (RACGP) to set standards of practice for these GPs and so is the UK case where latest report by NHS Information Centre (2013) shows that most GPs are contracted by a national contract and get their payment using a mixture of capitation. On a different note, GPs in Canada operate on fee-for-service (FFS) basis (World Health Organization 2014). To underscore this statement, FFS accounted for 76percent of payments to family medical attention in Ontario in 2012, compared to 35percent in United Kingdom during the same period (Canadian Institute for Health Information, 2012a). Another contrast with regard to these systems is the role the government plays to ensure their functionalities and design. For the case of Canada, while the provision of health care is almost private, federal government co-finances territorial/provincial health insurance programmes (Canadian Institute for Health Information, 2012a). Based on functionality, the government through Canada Health Act has the mandate of setting pan-Canadian standards physician services, hospital and diagnostic tools. Unlike Canadian government, in Australia the government solely finances the health care systems (Laing and Buisson 2013)). However, basing on National Health Reform Agreement that was endorsed by Council of Australian Governments in 2011, the mandate of government in designing and monitoring functioning of the health now include monitoring and regulating all community based health care systems and hospitals. In United Kingdom though National Health Service (NHS) regulates how health care systems should be designed and function, general policy and health care legislations rest with the parliament (Marchildon, 2013b). 5.0. Reasons why the health care systems are different in design and functioning Reasons for these differences are pegged on pursuit for equity, efficiency, effectiveness, quality, and acceptability. For instance as noted that there was National Health Reform Agreement that was endorsed by Council of Australian Governments in 2011, this reform agenda differs significantly in its operations, designs and functionalities vis-à-vis that of United Kingdom and Canada. The main reason for this is what Laing and Buisson (2013) describes as “a system that is available to all not ability to pay” (p. 34). Therefore Australian health systems are designed to function in such a manner that element of inequalities and inefficiencies. As Department of Health (2010a) notes, “equity assesses whether the benefits and burdens of medical care are fairly distributed” (p.1). This is what Australia is prioritising on thus dictating how unique their will design and function their health care systems. While the above is the case in Australia, systems in Canada prioritise on shared responsibility and it is the reason why the systems’ funding is shared by different organs of government (Young 1999). These kinds of shared responsibilities enable stakeholders to identify performance measures which in turn form basis for comparative evaluation of these systems. This vision is reflected in Woodley’s comparative analysis of the health care systems where he sought to solve health care problems by comparing Canada’s systems with other countries such as Australia (Woodley, 2007as cited in Office of Fair Trading, 2011). To be specific, Canada has been forced to operate different design and functionality of the system so as to accommodate services such as support tax credits for medical expenses which are done through Medical Expense Tax Credit. United Kingdom systems on the other hand are driven by efficiency and that is why their designs and functioning are different from those from Australia and Canada. Making United Kingdom health systems efficient means bringing all resources together to ensure people access needed services. It is actually due to this that Social Care Act 2012 has been in force to ensure restructuring of the health system. Basically, efficiency in relationship to health systems in United Kingdom has different understanding of efficiency. Lastly, in Canada, the provision of health care is almost private with federal government co-financing with other sectors. Contrariwise, Australian government solely finances the health care systems. The reason for this difference is the vision the government has with regard to health care systems in future. For instance Australia has a vision of achieving comprehensive health care services by 2026. Under this vision, the country is aspiring to have a health care system that is integrally linked to social support and community and in so doing, the quality and efficiency is determined by the needs and knowledge of the diverse range of Australian community. This vision makes it difficult for Canada and Australia to have the same frameworks, design and functionalities of their systems. Additionally, introduction of Clinical Commissioning Groups (CCGs) and Care Quality Commission that are coordinated by National Health Service shows that United Kingdom health care systems have some connectivity across community support and health systems (Figueras 2005). In fact, research and development funding that aims to improve health care systems are driven by specific interests of community rather than future vested interests. These ideological and perspective differences make these systems to have difference in their design and functioning. 6.0. Comparative evaluation of the three systems For the purpose of comparative evaluation of the three systems already identified above, health care systems (HCS) is going to be understood from the perspective of Freeman who defines HCS as the actors, institutions or relationships that maintain or produce the health of its citizens (Freeman, 2000 as cited in Office of Fair Trading, 2011). Secondly, the comparative evaluation of the three systems will be based on the effectiveness efficiency and equity. Basically the baselines for comparatively evaluating these systems are on social insurance systems and market values. Beginning with the latter, United Kingdom continues to outspend all the other two systems with their GDP allocation ranked the highest according to report by Nuffield Trust (2013), this is where the effectiveness comes in. The percentage as earlier quoted even doubles Organization for Economic Cooperation and Development (OECD) median of $2,995. Australia and Canada then follows with in that order. Based on equity, Canada records the lowest physicians and physician visits compared to Australia and United Kingdom. In 2008 for instance, Australia had 6.4 doctor consultations per capita while United Kingdom and Canada registering 5.9 and 5.7 respectively (NHS Information Centre, 2012a). The exhibit 1 below can further show the trend in other selected OECD countries. Figure 1: Exhibit 1: Supply and Utilisation of Doctors and Hospitals in Select OECD Countries (2013) a: (2012) b: (2011) f: Data not available Source: Marchildon (2013a) On a similar breadth, there is relatively lower hospital admission rates in Australian compared to the other two systems thus compromising the effectiveness. Despite the enormous infrastructures, the rates of stays in Australian health care systems are shorter but with higher spending for every discharge this tend to compromise effectiveness in comparison to United Kingdom. The exhibit 1 above shows this data comparatively to the other two systems. Another critical analysis with regard to the three systems is the hospital admissions for chronic conditions. Australia has the highest hospital admissions rates between 2008 and 2012 regarding chronic conditions (Australian Institute of Health and Welfare, 2012). In 2010 for instance cases of asthma were 110 per 100,000 populations while United Kingdom and Canada having 98 and 87 cases respectively per 100,000 populations (Nuffield Trust, 2013). Though Canada topped in cases of obstructive pulmonary disease, Australia was still leading in cases of diabetes and congestive heart failures. In terms of effectiveness, Canada is ranked highly. In terms of financing health care systems in the three systems, Australia has segmented their systems into publicly financed health care and privately financed ones with public health care getting majority of its finances from general tax revenue. On the other hand, privately financed health care are further segmented with about 30% of finances coming from pockets, Insurance schemes taking about 40% and the rest lies with government incentives. This is the same case with Canada where public health care are funded through general taxation and private health care systems getting much of their share from out of pocket services and insurance deals. In United Kingdom, government allocates about 9.7% of the country’s GDP to NHS to finance public health systems with most of United Kingdom citizens relying heavily on over-the-counter drugs as far as private health care systems are concerned. 7.0. Proposals for reform in the three systems Beginning with the needed proposal for reforms in health care systems in United Kingdom, little has been done with regard to reform agendas that were touching on health care systems. For instance, the legislation that attempted to overhaul and restructure NHS is a good example of blunders that needs reforms. At the moment, English NHS has been designed to cover Acute Trusts (ATs), Primary Care Trusts (PCTs) and Strategic Health Authorities (SHAs). With these structures in place, Laing and Buisson (2013) notes that PCTs manages over 80% of the total health budget allocated. This is the problem with health systems and such allocation cannot be justified owing to the fact that ATs run several hospitals in the country and SHAs do regional cooperation and oversight management in the country. Such unfair resource distribution is the main reason why protesters took to the street to campaign against the decision of the government on Health and Social Care Bill. Therefore there must be equitable allocation of these resources across the three sectors. Additionally, in doing this, first the systems should be organized into consortia as NHS Information Centre (2012a) suggests. The consortia should therefore be allowed to take over the administrative, financial and strategic roles with regard to ensuring effectiveness and equitable service deliveries. Just like any other country, United Kingdom is recovering from the recession with national debt reaching £1 trillion (Office of Fair Trading, 2011). This has made the government to raise VAT and NHS is not exempted. Nigel Edwards, policy director at NHS Confederation has showed reservations with this step. This is the area that needs to be addressed if efficiency, equity, effectiveness and quality health care service delivery has to be enhanced. In Australia and Canada the VAT on health care systems or materials related to the same are relatively low compared to the case of United Kingdom. Additionally, already, there is a newly created health care system that runs parallel with existing ones in United Kingdom. This creates duplication and double running of the costs. Therefore instead of raising VAT these kinds of services needs to be scrapped off. Despite strong health care systems in terms of efficiency, effectiveness and equity, more needs to be done with the systems especially if Australia must achieve the desired goals by 2026. Therefore evaluation of proposal for the reform of Australian health systems must be based on the issues discussed earlier. First, this study has already noted that Australian health care systems are focused to offer equitable services especially to the indigenous community who cannot pay for any other services. This therefore calls for reform in the outpatient services the systems has been designed to offer. Though scholars such as Stephen (2008) have noted that there is need for the introduction of ambulatory emergency services for outpatient cases, this is not enough owing to the structure of the system and the growing demand for health care services. What is required is assigning responsibility to one level of government which in turn promotes efficiency. At the moment, Australia is facing a situation where there is cost shifting in the sense that a given service as provided by same clinician is reimbursed differently basing on the location of service (Wilson & Rosenberg 2004). Looking at the Australian Health Care Agreement, the anomaly is even more with regard to such cases in United Kingdom and Canada as there are restrictions to hospital billing depending on physical location and whether the said services existed before 1st July 1998. This questions the aspect of equity in terms of service deliveries. This state is not even helped when one considers the parlous state under which indigenous health exist. Unless there is ratification on how outpatient services are done, coordination or continuity of equitable health care services will continue to be inhibited by the currently existing Commonwealth-state division on how responsibility should be handled. In relationship, research conducted by Healy (2011) has revealed that there exist strong relationship between health status of an Australian and the economic status. On the one hand, this statistics shows that though the government is committed to ensuring universal access to medical facilities, national health insurance scheme and Medicare is not efficient and has not been designed to meet needs for all Australians, regardless of the economic status. Therefore to address this issue, National Health Reform Agreement that was endorsed by Council of Australian Governments should be revisited so that the role of government should be streamlined and strengthen with regard to the funding and governance of all public and private health care. With the case of Canada, there are systems that enhance equality, efficiency and effectiveness where the government establishes a design to enable all providers be paid by the government at rates that have been predetermined. Healy (2011) has also documented that access to quality health care services are effectively monitored and managed. In light of these initiatives, the questions that many are still asking are why there are health care tourism to United Kingdom and Untied States especially in the last 10 years. The answer to these questions is because the systems have not been reformed to meet specific challenges that emerge. In fact, this problem started immediately after Canada Health Act (1984) where the main interest of the Federal government was to preserve a popular national programme but ignoring responsibility for its implementations. What is therefore needed in awake of all these issues is to strengthen prevention and wellness. This is why Gray made a suggestion that with current states of affair in Canada, stakeholders lack evidence to back the "orthodox" theory that federal institutions in the country are responsible for the rise of weak conservative government (Wang 2012). 8.0. Conclusion From the assessment above, healthcare systems of offering effectiveness, equality and efficiency is vulnerable if providers will convince the public that these systems are failing. Therefore this report finds that interests of providers should not be made coincident with those of consumers. Additionally, policies such as Acts reviewed should be driven consumer acceptability. The report has assessed three systems based on their effectiveness, efficiency and equity in terms of service delivery. However, different governments have unique structures of operationalizing these systems and so are United Kingdom, Canada and Australia. While systems in Canada for instance have funds through insurance services, UK and Australia rely on taxes and subsidies. However, these systems, from the analysis, have different approaches of operation but with one common aim; achieving effectiveness, efficiency and equity. 9.0. References Australian Institute of Health and Welfare (2012). Health expenditure Australia 2010–11. Health and welfare expenditure series no. 47. Cat. no. HWE 56. Canberra: AIHW. Australian Institute of Health and Welfare (2012). Residential aged care in Australia 2010–11: a statistical over­view. Aged care statistics series no. 36. Cat. no. AGE 68. Canberra: AIHW. Australian Institute of Health and Welfare (2011). Australia’s Welfare 2011. Canberra: AIHW. 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