Introduction
The provision of qualified and timely medical care is one of the most important aspects of a person’s life. The American healthcare system is often subjected to criticism and proposals for reform. To do this, it is proposed to take into account the experience of foreign countries. This is due to the fact that in many countries, health care costs are much lower than in the United States, and the efficiency of medical services is much higher. Squires and Anderson (2015) point out that “cross-national comparisons allow us to track the performance of the US health care system, highlight areas of strength and weakness, and identify factors that may impede or accelerate improvement” (para. 2).
American healthcare should take into account the experience of foreign colleagues to create an even more advanced and effective state system of providing medical care to the population. Five countries were selected for the analysis: Germany, the United Kingdom, France, Canada, and Sweden.
Germany
A distinctive feature of the German healthcare system is accuracy, a high level of organization, and maximum efficiency. The main principles are considered to be social equality and accessibility of medical care. The German healthcare system is considered to be one of the best in the world (Kuhn et al., 2017). As in the United States of America, people have the right to receive medical care if they have a German state or individual health insurance policy. All citizens need to apply for either a policy under the state health insurance program, which is called gesetzliche Krankenkasse, GVK, or a policy under the individual health insurance program, private Krankenversicherung, PVK. The choice of a health insurance program depends on the type of activity of a citizen.
The presence of an insurance company policy, the so-called hospital insurance fund (Krankenkasse), gives people the opportunity to receive outpatient or inpatient medical care. In addition, a service called “Rettungsdienst” has been established in Germany, which provides assistance in case of urgent intervention. Private offices are very common in the country’s polyclinics. Such an office can be opened by any doctor who has a specialization. Almost half of all German doctors carry out their activities in this way. However, the number of such offices is limited by the quota for the locality.
For citizens who have a state insurance policy, the bill for medical services is sent to the insurer. The insured person has the opportunity to make an advance payment independently with subsequent reimbursement of expenses. Once every three months, Germans are required to pay a fee of ten to fifteen euros for the first visit to the doctor.
Many Germans, like Americans, turn to family doctors when they need medical care. They help the patient, and if doctors can’t do it on their own, the patient is given a referral to a specialist. Specialist doctors can work either individually or in a group with other medical professionals. In one private office, doctors of related specialties can also work, for example, an orthopedist and a therapist or a surgeon and a gynecologist.
All clinics in Germany can be divided into three categories: public, private, and charitable organizations. The quality of medical services in all clinics does not have great differences. The main feature is that the patient has the right to independently choose an organization for treatment without being tied to the region of residence. Clinics can be both highly specialized and wide-profile.
A distinctive feature of Germany is also the method of purchasing medical products. So, unlike in the United States of America, the sale of medicines is made by prescription by the name of the drug company and not by the active ingredients. If patients have been prescribed a fairly expensive medicine, they may ask about the availability of a cheaper analog with the necessary active ingredients.
Recommendations
One of the aspects that the US healthcare system can borrow from Germany is the contribution system. Payments for state medical insurance in Germany depend on the income of citizens. However, it should be noted that the benefits are distributed according to the needs of the insured people. German insurance fees are calculated individually. For example, young people can pay less. For people with serious illnesses, this type of insurance may be more profitable.
The basis of German social medicine is based on the opposition to the American system of assistance to the poor. In America, the quality of services provided is directly correlated with the payment for these services. German doctors directly follow the principle of equality among the population, regardless of the status and condition of the patient.
The German healthcare system is centralized and well-integrated. This gives the country the opportunity to respond to public health emergencies as soon as possible. In addition, centralization allows you to mobilize the necessary equipment in a timely manner. Moreover, a single information system contains data on all patients, equipment, medicines, and clinics, whether private or public, or charitable.
The United Kingdom
The United Kingdom differs from other countries by having a free National Health Service (NHS). The NHS is different in that it is funded by taxes and not by the health insurance system. In addition to the NHS, there is also private health insurance in the country. NHS medical services are available to residents based on their country resident status. All of them, including ex-pats, can receive medical services for free. Citizens who do not have citizenship in the country have the opportunity to receive emergency assistance or medical services for family planning free of charge. However, other medical services are provided to them if they have a medical insurance policy.
The British have the opportunity to ensure not only individually but also to insure the whole family. A person who purchases insurance can independently pay for part of the cost of medical services when an insured event occurs. Moreover, many employers introduce private health insurance policies into employees ‘ social packages. Also, in the country, citizens are given the opportunity to issue an insurance policy for one medical service if the patient needs a certain type of treatment or surgery. This innovation is due to the fact that sometimes waiting for emergency medical services within the NHS can be too long. It should be borne in mind that the cost of such a policy is high and depends on the type of treatment.
It should be noted that all medicine in England is of a recommendatory nature. That is, the doctor does not insist on anything. That is, a medical specialist will not force patients to undergo a medical examination or take any tests without his will. If the doctor acts against the will of the patient, he may be deprived of his license. Moreover, filing a lawsuit against a doctor is very common among residents of the United Kingdom.
Another distinctive feature of the UK is the free provision of medicines. Disabled people, people under 16 and over 60 years of age, the unemployed, students, and cancer patients have the opportunity not to pay for the necessary medical preparations. However, when receiving the medicine, people must pay a fee for processing the prescription.
In addition to the above, the United Kingdom is distinguished by its specific attitude to the termination of pregnancy. Abortion is legal in most parts of the country if it is performed during the first 24 weeks of pregnancy. Moreover, in individual cases and certain circumstances, termination of pregnancy is allowed at a later date.
Recommendations
Free medical care for residents of the country can be taken over by the United States of America from the United Kingdom.
Despite the fact that the topic of abortion is a controversial topic, the US could make abortion more accessible to women. This is due to the fact that women should have a choice to bear a child or not. The choice may be due to their financial situation or psychological state of health, which may interfere with the normal upbringing of the child.
As in Germany, the United Kingdom is characterized by a centralized health system. Centralized management and financing make it possible to restrain the growth of the cost of treatment for citizens of the country. Moreover, such monetary budget constraints force medical specialists to save money, which reduces the likelihood of imposing unnecessary procedures, manipulations, and medications on patients.
France
The first feature of the French health care system, in relation to the American one, is the fact that the French have two types of health insurance. It is divided into voluntary and compulsory health insurance. The Ministry of Health, the Government of the country, and the Parliament are responsible for the proper functioning of the system of providing assistance to the population.
All clinics in France, as in the United States, are divided into private and public, which are the majority. The only difference between these two types is the number of services provided. Private clinics are also divided into commercial and non-commercial. Basically, citizens turn to state clinics for general medical care. However, if a patient needs long-term additional care or supervision that the state cannot provide, then the French turn to a private clinic.
Hospitalization and emergency calls in emergency situations are covered depending on the selected insurance package. If it is not available, citizens have to pay from one hundred to one hundred and fifty euros for calling an emergency service. In the case of surgical interventions, in France, the patient is either left in the hospital under observation or immediately discharged home on the day of the operation in the absence of complications. This is all done at the discretion of the patient’s attending physician. For the intermediate and final examination, the nurse comes to the patient at the place of residence.
Recommendations
The United States of America can borrow from France the system of taxation for the provision of medical services. In the country, insurance affects both citizens of the country and people permanently residing in its territory with the right to work. The operation is carried out by charging almost twenty percent of the income of officially employed citizens by local social security departments. It is worth noting that about a third of this contribution is paid by the employee, and the rest is paid by the employer. If people’s salary is below the subsistence minimum, they can get a free insurance policy, which will also include dental services.
In France, the basic level of universal compulsory health insurance is provided and ensured through the system of insurance funds. Most of them relate to the place of work of a citizen. Technically, these organizations are private companies. However, they are strictly regulated and controlled by the state. The levels of insurance premiums, which are supported by a tax on employees ‘ salaries, are determined by the government.
The advantage of the health care system in France is the compensation for the provision of medical care to vulnerable segments of the population. In the country, this system applies to citizens who have lost their job or are breadwinners or do not have a permanent job or place of residence. The Law on Public Health Policy states that when an insured event occurs in such cases, the full cost of services, medicines, procedures, and operations is paid (Amdaoud et al., 2021). Citizens with an income below seven and a half thousand euros per year can apply for this type of insurance.
Canada
Canadian medicine is funded by the state and has many similarities with the American one. There is a widespread system called Medicare, which provides almost complete free medical care to all Canadian citizens (Montague et al., 2018). The actions of the federal government in relation to the health care system end with the establishment and control of compliance with the principles of the insurance system.
Despite the many positive aspects of the Canadian system of medical care, there are some shortcomings in it. Therefore, the main one is the fact that patients are waiting for the necessary doctors or operations for a long time.
The majority of practitioners are primary care therapists. They are an intermediate link between the patient and the healthcare system. These specialists control people’s access to most of the medical specialists, hospitals, diagnostic and preventive checks, and prescriptions of medicines prescribed to them. The attending physician can be changed an unlimited number of times.
Recommendations
Unlike in the United States of America, in Canada, medical care is free. It is financed by taxation, both local and state income taxes and corporate income tax. That is, the state compensates the costs of medical services to citizens who have medical insurance.
As in the United Kingdom, abortions in Canada are legalized throughout the country. In each so-called province, different pregnancy periods are established for which surgery is allowed. Medical termination of pregnancy is carried out for a period of nine to twelve weeks. Surgical intervention is carried out for up to twenty-three weeks. Financial expenses related to the termination of pregnancy are not covered by insurance programs.
Sweden
Sweden is known for its high level of provision of services in the field of medical care. As in most countries, health insurance in Sweden also exists in the public and private sectors. State insurance is provided to all people who have lived in the country for more than one year. The national system of providing medical care is financed by taxes. They are received by the budget and local authorities at the level of districts and municipalities. Citizens of the European Union and the European Economic Area who own a special health insurance card also have access to the country’s healthcare system.
To visit a doctor within the framework of the health insurance system, a referral from a general practitioner is required. Such medical professionals conduct routine medical examinations, prescribe treatment, and refer the patient to a more narrowly focused specialist. At the initial visit to such a doctor, people must first register at the state medical center at their place of residence. People can visit a medical specialist at any convenient time without a referral from a therapist.
A distinctive feature of Swiss health care is also that the expenses associated with pregnancy are fully covered by the state health insurance system. That is, women do not spend money at the birth of a child.
Recommendations
Sweden has a separate insurance system for children, unlike the United States. All children in the country have access to free medical care under the State health insurance system. For them, vision checks, vaccination, necessary medical examinations, visits to the dentist, and the provision of specialized and qualified treatment are carried out. Moreover, there is a planned developmental examination for children under five years of age, which is carried out in the children’s health center (Barnavårdscentralen).
In addition, the United States can borrow some aspects related to dental care for the population. Thus, in Sweden, every registered resident of Sweden under the age of twenty-three has the right to free dental care. When people reach this age, they receive special subsidies for dental care. In cases where patients do not go to the dentist for more than one year, they are recommended to use mandatory subsidies for the next year. If they do not do this, the amount is debited, and a new charge occurs the next year.
Conclusion
In conclusion, it should be noted that health care is an important part of the functioning of the country. The quality of life of the population, the economy, social and cultural aspects, and success in other areas of the country directly depend on it. To make the system of medical care more effective, some countries may resort to analyzing the ways of regulating the health of the population of other countries. In this case, people can highlight aspects that can be successfully applied in practice. For example, in Germany, the United States can borrow the principle of equality in the provision of medical services for all segments of the population or change the system of selling medicines based on the experience of the United Kingdom.
References
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