The Comparison and Contrast between the Health Care System in the United Kingdom and That in the United States
|School||Southwestern University of Finance and Economics|
|Keywords||Health Care System the U.K. the U.S. Fairness Efficiency|
Health care reform is known as a great problem of the world. All the countries in the world are doing their best to establish health care systems which are suitable to their own circumstances. During the recent years, health care reforms have never been stopped. The United States is a nation that advocates freedom. Thus its health care system is dominated by the market. However, in March 2010, Obama signed the new health bill to begin the health care reforms emphasizing the government’s intervention. The United Kingdom is the first welfare country in the world, so its health care system is lead by the government. But in January 2011, Cameron introduced Health and Social Care Bill 2011 into Parliament planning to reform the British health care system focusing on undermining the government’s invention. Then the conclusion can be drawn that though the UK and the US are developed countries and have built relatively complete health care systems, reforms are still needed owing to the existing drawbacks. Therefore, the author will compare the health care system of the UK and that of the US to analyze the performance and the outcome of the two health care systems from the aspects of fairness and efficiency, and try to propose feasible suggest on the establishment of the health care system in China.The body of thesis goes as follows.The first part is the Introduction. This chapter describes the research background and significance, provides literature review on health care system and states the research methods and structure of this thesis. The author maintains that it is critical to build a fair and effective health care system from the theoretical and practical perspectives. Countries, as their historical, political, social and cultural backgrounds vary, have established different health care system models. Government plays an indispensable role in the establishment of health care system. The extent to which government participates in the establishment exerts dramatic impact on the fairness and efficiency of the health care system. From the perspective of government’s intervention, the health care system in the United Kingdom with the National Health Service (NHS) as the main body and the health care system in the United States with commercial health insurance as the main body represent the two extremes. Specificity of these two models determines the performance and reforms of the health care system in the UK and that in the US.Chapter One provides the theoretical basis for the establishment of health care system by governments. Resorting to the theories of antipoverty, information asymmetry and externality, this chapter elaborates the necessity of establishing health care system by governments. The author holds that poor people tend to be poor due to illness or illness again, so governments need to provide medical assistance for the poor, and invest human capital to help the poor get rid of the "poverty trap" by standing on their own feet. Asymmetric information in the health care market triggers "adverse selection" which affects the health insurance coverage. Thus government’s mandatory measures are needed to assure health insurance coverage. Since most medical services have externalities, leading to the insufficiency in supply and consumption of medical services, government involvement is essential to guarantee the supply.Chapter Two depicts the transition of the health care system in the United Kingdom. This chapter describes the composition of the British health care system, including the government’s NHS, medical assistance and private health insurance, and gives a detailed description of the organization and the contents of reforms that have ever taken place. The author supposes that the stipulation that the government should raise funds in the form of taxes and provide virtually free medical services to all residents helps realizing the full coverage of health care. Thus, there is no need to provide a lot of medical care for the poor. Under the guidance of the new public management theories, the British government had the health administrative organizations and public hospitals reformed and realized the separation between health care purchasers the identity of them as health care provider. Later on, the British government tried other measures, for example, streamlining government organs to reduce management costs, constantly changing buyers to better represent consumer demand, continually stimulating competition among providers to improve supply efficiency.Chapter Three introduces the evolution of the health care system in the United States. This chapter describes the composition of the health care system in the U.S., including Medicare, Medicaid and CHIP. Commercial health insurance is operated in free market conditions due to the existence of "adverse selection" in health insurance market, so many low-income and poor elderly are excluded from the commercial health insurance. Therefore, the government carries out medical relief and health insurance for vulnerable populations. In addition, there have been excessive medical needs, leading to rising medical costs, due to the "moral hazard" and third-party payment system in medical insurance market. To solve the problem, the United States applies a "managed care" model, such as HMO, PPO and POS in the hope that medical costs and health insurance money increases can be controlled by limiting the hospitalizing freedom of consumers.Chapter Four compares the operating results of British and American health care systems. This chapter uses a large number of indicators and data to compare levels of health spending, equity and efficiency of the health care systems of the two countries. The comparison suggests that the overall size of health expenditure and that per capita of the US medical insurance system exceeds those of the UK and pressure on government health spending budget in US is heavier than that in the United Kingdom. Britain’s NHS financed by collecting taxes reflects strong fairness. Medical services are accessible for the whole residents and can be provided according to the patient’s condition. With the commercial health insurance system as the main body, financing fairness of the health care system in the United States is not as good as that of NHS. Moreover the system in the US doesn’t achieve universal coverage for the residents, and medical services patients receive largely vary. Health care market in the United States is quiet flexible, making the U.S. better in the efficiency of providing services to individuals. However, the macro-efficiency is not as good as that of the UK.Chapter Five summaries the aspects of British and American health care systems that worth learning from and gives some suggestions accordingly. The author maintains that it is necessary to establish a unified health care system to improve the level of financing. China can draw lesson from commercial health insurance from the UK and the US to develop its commercial health insurance. It can also learn from Medicare to develop its medical assistance system. China especially the government should invest more funds to improve the fairness of health care system, expand the acquirable medical service, allocate medical resources more properly by gatekeeper, carry out reforms in public hospitals, encourage the building of private nonprofit hospitals, and inspire the competition in medical service market to improve the efficiency.On the basis of existing research findings and achievements, the present thesis conducts continuity, in-depth research on the health care system and makes the following innovative exploration. (1) A new perspective. Former domestic researches on the international medical insurance systems models often divide the medical insurance systems by the different funding methods of medical insurance. This article makes comparison and contrast of the fairness and efficiency between medical insurance systems from the perspective of intervention intensity and selects two extremes for the purpose of comparison and contrast. (2) Substantial argument on the effect of the policy. Previous analysis described in rough language while this article lists a large number of indicators and data closely related to the evaluation of medical insurance systems for the purpose of demonstrating the operating results of such systems. (3) Collection of newly published research findings and data. Previous researches on British and American medical insurance system are based on data published before 2005. This article has collected latest data dated after 2007.There are also some deficiencies, including:a. The contrast between the analysis objects is gradually decreased. British and American health care systems are respectively government-led and market-driven classics; but with the development of society, the United Kingdom introduces market mechanisms into the health care system, while the United States strengthens government intervention the health care system. Therefore, due to the continuing reform, the relevant data cannot sufficiently demonstrate the operation effect of government’s intervention on the health care system.b. Certain data have been missed. Because of the missing data, the analysis fails to fully explain the impact of government-led and market-oriented models on health care systems.