Aveneu Park, Starling, Australia

A cost of such access and how

Healthcare System is a program involving a network of agencies, organizations,
and institutions that exists to maintain the general health of the population
while minimizing the financial burden of medical expenses. The type of health
care provided in a particular Healthcare System depends on the public health services
needed based on research efforts, available services from the parties involved,
and the coverage of such services. Each country is responsible for establishing
a Healthcare system which may follow one of the following four models; The
Beveridge model, The Bismarck model, The National Health Insurance Model, and
The Out-of-Pocket model (Physicians for a National Health Program, 2010). The purpose of this
paper is to investigate health care from a global standpoint, specifically how
international healthcare systems compare to the healthcare system implemented
in the United States.

            An article from the Commonwealth
Fund uses the data provided by the Organization for Economic Cooperation and
Development (OECD), the European Observatory on Health Systems and Policies,
and the World Health Organization (WHO) to prepare an evaluation of global healthcare
spending (Schneider, Sarnak, Squires, Shah, & Doty, 2017). Each country’s
healthcare system was ranked based on evaluation of the system’s care process,
access to health care, administrative efficiency, equity, and health care
outcomes. Care process was used to assess the general health care provided to
the population. The four subdomains of the care process assessment included
evaluation of ways illness is prevented (i.e. screenings and vaccinations), the
endeavor to provide safe healthcare experiences, the timeliness of healthcare
provision, and the patient-centeredness of care (Schneider, Sarnak, Squires, Shah, & Doty, 2017). The access
component represents how available and reasonable the health care system is. Using
the access component, the cost of such access and how swiftly the access is
made available to the patient from the health care facilities, such as
hospitals and urgency care, was evaluated (Schneider, Sarnak, Squires, Shah, & Doty, 2017). Administrative
efficiency is a component used to assess the details concerning administration
of the health care system as a whole and its providers. It defines and measures
the patient’s hindrances to care, as well as various aspects of healthcare documentation
from the providers (Schneider, Sarnak, Squires, Shah, & Doty, 2017). Equity is the
analysis of “fairness” between lower- and higher-income earning populations in
the target country (Schneider, Sarnak, Squires, Shah, & Doty, 2017). Fairness is
calculated based on whether the individual is earning an income above or below
the median income of the country. The difference between the mean income status
of those populations are calculated and the corresponding value represents the
size of the income gap (equity) prevalent in that country. The outcomes of the country’s
healthcare system are assessed by way of the Healthcare Outcomes component (Schneider, Sarnak, Squires, Shah, & Doty, 2017). Such outcomes
reflect health outcomes in general, preventive health outcomes, and health
outcomes of a specific disease.

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            Of the elements used to evaluate the
health care systems in each country, the access dimension is of most importance,
in my opinion. Without proper access to the health care services provided by
the health system, the other dimensions become irrelevant because it’s impossible
to evaluate the effectiveness of a system that no one has access to. The
healthcare system in the Netherlands currently has the best performance and
ranking in this dimension (Schneider, Sarnak, Squires, Shah, & Doty, 2017). The high ranking is
due to their model of health care outlined in The Health Insurance Act by Dutch
legislation in 2006 (P.M.M. van de Ven & Schut, 2008). This act effectively
increases access to care by making the access mandatory and affordable through
tax contributions. The plan ensures that individuals are covered through their
employers for their contributions to the tax collector. The lowest ranking
country in the access dimension is the United States (Schneider, Sarnak, Squires, Shah, & Doty, 2017). Before 2012, a
large number of Americans were under- or uninsured due to the cost of health
care. The U.S. has just begun to make strides to improve this by implementation
of the Affordable Care Act (ACA) which requires U.S. citizens to get health insurance
and for employers to pay a portion of their earnings on healthcare (Schneider, Sarnak, Squires, Shah, & Doty, 2017).

            The Patient Protection and
Affordable Care Act (PPACA), more commonly known as the Affordable Care Act (ACA)
or Obamacare, is a health reform law passed in 2010 with three goals; provision
of affordable health insurance, expansion of Medicaid, and lower costs of
health care (Schneider, Sarnak, Squires, Shah, & Doty, 2017). Obamacare includes
many reform components, two of which are prevention of coverage denial by insurance
companies due to pre-existing medical conditions and requirement of insurance
companies to spend 80-85% of their income on health care (Zwelling & Kantarjian, 2014). The prevention of
coverage denial by insurance companies will increase the general access to
health care for citizens who need it regardless of their medical history and
maintain the coverage agreed upon regardless of short-term illnesses. Requiring
insurance companies to spend the majority of their revenue on health care will
increase the affordability of health care improving access of the healthcare
system as well. Together these two components have the potential to improve the
quality of the healthcare system, but at the expense of the healthcare network.

The reason behind coverage denials and regulations is to ensure that insurance
companies are able to cover health care costs of an individual without huge
risks to the company (Cordner, 2015). The ACA requiring
that insurance company coverage regulation be based on four factors alone (type
of plan, location, age, and tobacco use) puts huge pressures on insurance
companies to make policy changes to accommodate coverage for individuals they
would usually deny (Cordner, 2015).  This accommodation may include the increase of
premium required to cover these “high-risk” individuals incurring challenges
for not only individual consumers but also employers who are required to
provide health insurance for their employees. This, in addition to consequences
involved with the requirement to spend 80-85% of revenue on health care
mandated by the ACA, may ultimately result in insurance companies withdrawing
participation in ACA Healthcare plans because it is more of a financial burden
than expected and desired. Should this happen, the amount of companies involved
and, subsequently, the available health care services could be reduced
substantially. These outcomes are predicated upon the agreement and compliance of
the insurance companies with this new law.

in the United States has much room for improvement, and Obamacare (PPACA) just
may be the way to improve. The PPACA will potentially shift the financial
burden of medical expenses from the patients to the businesses and employers
creating a more appealing healthcare program for those in need. Consequently,
this shift requires more adjustments to the law to reduce the financial stress
on parties involved in the healthcare network. Personally, I can appreciate the
goals and efforts of the PPACA given its potential improvement of the “big
picture” regarding the Healthcare system in the U.S., but I can also understand
the potential controversy of business owners and companies not feeling as
though it is their responsibility to finance an individual’s health insurance
especially given the requirement to comply in ways that negatively affect their


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