|
The purpose of universal health care is to
deliver health services to large populations at little or no
cost. Canada, the UK and Australia have witnessed the advent
of a universal healthcare system in the 20th Century. The United
States remains the exception, being the only country in the developed
world that does not offer universal access to medical services. Maintaining
a universal or near universal health care system holds many challenges
in the new millennium.
The following profiles outline
healthcare coverage in Australia, Canada, the UK and the
US, identifying the
benefits and the issues of each unique system. Australia
Australia’s Department of Health and Ageing seeks to provide better health
for all Australians through a world-class health system. A mix of public and
private sector providers deliver health services, with the quality of health
provided high in both areas.
Australia is unique in that the government encourages private as well
as public health care institutions. The Australian Government believes
that strong private sector involvement in health services provision and
financing is essential to the viability of the Australian health system.
For this reason the Government provides a 30 per cent subsidy to individuals
who acquire private health insurance and has introduced additional arrangements
to foster lifelong participation in private health insurance.
Public hospitals include hospitals established by governments and hospitals
originally established by religious or charitable bodies but now are directly
funded by the government. Most acute care beds and emergency outpatient
clinics are in public hospitals. Large urban public hospitals provide most
of the more complex types of hospital care such as intensive care, major
surgery, organ transplants, renal dialysis and specialist outpatient clinics.
Private hospitals are owned either by profit or not-for-profit organizations
such as large corporate operators, religious operators and private
health insurance funds. In the past, private hospitals tended
to provide less
complex non-emergency care, such as simple elective surgery. However,
some private hospitals are increasingly providing complex, high
technology services.
The majority of doctors in Australia are self-employed. A small proportion
consists of salaried employees of Commonwealth, State or local governments.
Salaried specialist doctors in public hospitals often have rights to treat
some patients in these hospitals as private patients, charging fees to
those patients and usually contributing some of their fee income to the
hospital. Other doctors may contract their services with public hospitals
to provide medical services.
Recently, there have been innovative solutions to health issues arising
out of Australia’s unique history and needs:
· the Royal Flying Doctor Service which delivers care to remote
areas by aircraft
· the Aboriginal and Torres Strait Islander peoples community controlled
health services which aim to meet the special needs of Indigenous Australians;
and
· Regional Health Services: community identified priorities for Health
and Ageing services in rural and remote areas are met through a flexible mix
of Commonwealth and state funded services.
Canada
All Canadians enjoy a universal health care system. Any person living in Canada
is eligible for health care, including doctor visits, maternity care, and diagnostic
services such as x-rays and laboratory services. Monthly fees are $54 for one
person, $96 for a family of two, $108 for a family of three or more. Those
who live below the poverty line ($24,000 annually) are eligible for premium
assistance, which is an annual fee of $23.00.
Medical services not included in regular coverage are: cosmetic surgery,
dental services, and eye examinations. Surgeries are wait listed and patients
can check out provincial health websites to see median waitlists for surgery.
Those who have a higher income and wish to jump the line can have access
to surgery and special procedures at private clinics and hospitals. For
example, an ultrasound for one leg that carries with it a waiting time
of 6 weeks can be booked within a day at a private clinic for $846.00.
In September 2004, the federal and provincial governments signed a 10-year
health funding agreement. This agreement means that the government has
committed to inform Canadians on improvements to wait times. The agreement
provides long-term stable funding to help improve patient care, reduce
wait times and to build a sustainable health care system.
The advent of privatization in Canada has threatened a world-renowned
health care system, yet privatization has evolved out of a need for reduced
waiting times. The number of surgeries has increased by 40% in the last
15 years due in part to better technology but also because of Canada’s
aging population. Seniors today are more active and therefore require more
maintenance surgeries such as cataract surgery, heart, knee and hip surgery.
United Kingdom
Established 56 years ago, the UK’s National Health System
(NHS) remains the largest government health organization in Europe.
In February of this year, the Labour government announced a $250
billion U.S. investment in the National Health Service (NHS).
The strategy gradually increases the average funding per person
from $1,685 U.S. in 2002 to $2,579 USD by 2008.
Funding will address: developing plans for improving health services
in local areas, making sure local health services are of a high
quality and are performing well, reducing wait times for surgery,
increasing the capacity of local health services so they can provide
more services, and making sure national priorities - programs
for improving cancer services, for example - are integrated into
local health service plans.
Shifting the Balance of Power is the name for the program
of changes reforming the way the NHS works. The aim is to design
a service centred around patients to offer them more choices.
The main feature
of the change has been to give locally-based Primary Care Trusts
(PCTs) the role of running the NHS and improving health in their
areas. This also means creating new Strategic Health Authorities
which cover larger areas and have a more strategic role in health-care
policy.
A unique feature in the UK system is Health Care Navigator,
a telephone help line service launched in May last year. This
service enables subscribers
to make informed decisions about their medical conditions with
the help of an online nurse before seeking private care in their
community.
United states
Universal health care coverage does not exist in the US. Anyone who wants insurance
has to pay for it. Citizens buy insurance from private insurance companies
to protect themselves in case of illness or accidents, with private companies
such as the American Public Life Insurance Company offering a wide range of
coverage and options. Insurance coverage can range from $50.00 to $250.00 per
month. Basic coverage ($50.00-100.00 USD monthly for one family) includes visits
to a doctor and hospitalization but there are limitations: there is no coverage
for such things as tonsillectomy, treatment of mental and nervous disorders,
or treatment of alcoholism or drug addiction.
Higher payments of $150.00 to $257.00 USD per month grant doctor
visits, hospitalization due to any illness, accident, or emergency
and hospitalization with intensive care. Costs and coverage vary
by state.
According to the United States of America Census Bureau, more
than 43 million Americans - 16 per cent of the population -
lacked health insurance in 2003. This remains a main problem in
the American healthcare system, as populations that are low income,
and therefore often not covered, tend to have more health problems
because they either do not have access or do not have access to
the same quality of services provided to those who can pay for
it.
A study by the American Heart Association, for example, found
that low-income populations have poor cardiovascular health and
related disorders.
George Mensah, M.D., acting director of the National Center for
Chronic Disease Prevention and Health Promotion states that the
population subgroups most significantly and adversely affected
are “African Americans, Hispanics/Mexican Americans, people
with low socioeconomic status, and residents of the southeastern
United States and the Appalachians."
While the United States is one of the richest and most politically
powerful nations in the world, its health care system exhibits
numerous sociological, political, and economic dilemmas. Embedded
in private market competition, the U.S. health care system has
become one the most costly systems among those of western industrialized
nations.
At the same time, the United States delivers some of the finest
health care in the world.
|
