An Analysis of Odin Anderson's Article on Hearth Services in the U.S

Odin W. Anderson in his article “Issues in the health services of the U.S.” claimed that the United States of America and the United Kingdom occupy extreme ends of the market plus/ market minus continuum as far as their respective health systems are concerned. It is true that the U.S. system is market oriented, and that there is often a high degree of government intervention in the operation of the health system of the U.K., however, developments in both countries have arguably effected their position upon this continuum.

It is the purpose of this essay to outline the key features of both the U.S and the U.K.’s health systems in relation to their evolution over time. I also intend to discuss the problems facing both systems, which are often remarkably similar, and to outline the variations in policy style employed to tackle such problems. In so doing I hope to make explicit what might explain the variations to be found when comparing the two countries systems.

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The health system to be found in the United Kingdom is seen as a good example of the direct’ model of health care provision. It is a system of universal coverage paid for out of general taxation and administered by the state. Access to health care depends upon the need for treatment, and such treatment is free at the point of service. This system is both supervised by, and funded through, the Department of Health. However, approximately 14% of health care in the U.K. is privately funded. This takes two forms :- subscription to an insurance scheme, or payment upon receiving care. Such private sector provision of health care is part of he independent sector which also includes the contribution of voluntary and informal sectors in health care provision. The other key players in the U.K. health system, besides the previously mentioned central government and independent sector are local authorities, who have retained two important health responsibilities i.e. personal social services and environmental health services, and the National Health Service. Prior to the emergence of the N.H.S. there was a mixture of private and public services.

The private sector included voluntary hospitals whilst the public sector included a number of municipal health services. A series of reports in the 1920’s and ’30’s, such as the B.M.A. report in 1929, exposed the failure of the health system in catering for the needs of those requiring specialist care. It is the second world war, however, and the dramatic expansion of government intervention in health services that came with it, that is largely credited with the creation of the N.H.S.. In 1945 the Secretary of State for health, Aneurin Bevan, opted for the nationalisation of the entire hospital sector within a tripartite system of health care provision. The N.H.S. has under gone a number of organisational changes over the years. Today it is made up of bodies such as the fourteen Regional Health Authorities who claim responsibility for planning services, allocating resources and overseeing the work of the N.H.S. within its boundaries. The District Health Authorities are responsible for assessing the health needs of those living within their boundaries.

The ninety Family Health Service Authorities are responsible for managing family practitioner services within their boundaries. G.P. fundholders (who receive a budget for the cost of running a practice), self governing trusts and Community health councils also go to make up the structural organisation of the N.H.S.. The American health system differs in many repects from the U.K. model. It has been advanced as a prime example of the market system. It is pluralist in the sense that there is no one single system as much of its funding comes from private insurance. Most American citizens have health insurance provided through their employment, although the employee is usually expected to pay for any dependents on the same scheme. Health insurers are largely non profit organisations. For those not in employment, principally the poor and the elderly, the medicare (for the elderly) and medicaid (for the poor) systems are available. Despite this however, 37 million people are left without insurance, whilst 15 million are left under insured by their employment insurance. Personal health services have always been regarded as a personal problem, as opposed to a public one, in the U.S..

The idea of some type of national universal insurance was floated from the late ’30’s to the early ’50’s, but the issue went into decline when voluntary health insurance began to cover 75% of the population. It was not until 1965 that any form of government insurance, in the shape of Medicare and Medicaid, came into operation. On the whole, however, the U.S. health system reflects the entrepreneurial culture of U.S. business. The hospitals are largely owned by non profit boards, physicians are free standing private practitioners, and the private and public sectors are intertwined through funding sources. At first sight it may seem as if these two health systems are the policy decisions from which they are derived are poles apart. They do, however, have many key features in common, and such features largely centre around the problems thrown up by their respective societies and health systems.

There are many common problems within the health care systems of the U.S.A. and the U.K.. For example, the issue of access is omnipresent. In America, the Medicare and Medicaid schemes have been criticised in this respect. Medicaid does not apply to single people, the childless or the low paid, and Medicare patients often have to make top up payments’. This perhaps accounts for the 37 million people who are un insured in the U.S.. Concerns about access have also been voiced in the U.K.. The 1956 Guillebard report spoke of the need to redress geographical and social inequalities in health care provision. Even in the 1989 government white paper “Working For Patients”, the two key objectives were (a) to give patients better health care and to increase the choice of services, and (b)to increase satisfaction and rewards for those working in the N.H.S. who successfully respond to local needs and preferences. Perhaps a more inevitable problem common to the two countries is how to tackle new health trends. For instance, the increased burden of chronic illness, the increased importance of new infectious diseases, the growth of the elderly population, and the persistence of variations in health status according to social class, geographical location, gender and ethnicity. Such trends have ramifications for all aspects of health policy. Other common problem areas include the obvious need to control costs.

This problem was most obvious in the American system during the late ’60’s/ early ’70’s. Attempts to control expenditure took several forms indicating the complexity of the problem given that no one method appeared to be sufficient. In 1989 American health care provision cost £1300 per head, whereas this figure was as low as £550 in places such as the U.K. There is also the common need to monitor efficiency and accountability. In the U.K., bearing in mind the structure of the N.H.S., this problem largely centres around the overlap, duplication and lack of co ordination between its various components. There is also a fundamental contradiction at the heart of the N.H.S. in that the Secretary of State for health has full responsibility for health policy, but has little direct control over the activities of the N.H.S.. The health system in the U.S. suffers from the fact that there has been little overall planning, and this has arguably hampered co ordination and efficiency, as well as any attempts to attain universality and equity of health care provision. Despite the U.S and the U.K. sharing, in essence, many of the same challenges within their health systems, there has been some variation in the policies adopted to tackle such challenges. This is often a result of the political culture within the two countries.

For example, explicit government intervention in the U.S.A.’s health system runs contrary to the American political ethos. For instance, as regards policy to tackle accountability and efficiency, the Hospital Survey and Construction Act, 1946, which saw subsidy along with local money going towards the building of new hospitals, was deemed only to be acceptable because it saw the government make a one time contribution, and then pull out before being accused of having interfered with local autonomy. Policy making in the health system of the U.K. differs considerably in this regard, and again this is largely due to the political culture and the views of the electorate. The National Health Service is an extremely popular institution in the British psyche, and thus is one area where government interference is often applauded. The Thatcher years saw an attempt to lessen government intervention in the health service in line with the New Right ideology, favouring more freedom for business and more choice for individuals in the market.

In the government white paper “Working For Patients”(1989) the advantages of an increased role for the private sector in the health service were outlined. It was suggested that such a role would increase the range of options available to patients and G.P.s as well relieving the pressure on the N.H.S. and increasing the opportunities for the public and independent sectors to learn from each other. Hence, the introduction of concepts such as G.P.’s and patients using N.H.S. funds to pay for treatment in the private sector. However, despite the commitment to reducing the role of the state in the health care system, the popularity of the N.H.S. ensured that some concessions were made. For instance, as shown in the governments response to the Royal Commission on the N.H.S.. An increase in government intervention in the health system is expected in the future, in line with the long term trend. This is largely because the government will find it difficult to stand back over allegations of poor and varying standards of care, as well as public disquiet over hospital closures. As Sir Douglas Black once said, “It is impossible, as some wish, to take the health service out of politics – both the amount of money involved, and the sensitivity of anything to do with health, will keep the health service a major political pre occupation.”.

Another feature of policy making in the U.S. health service is the lack of overall planning. This often results in piecemeal reform to patch up problems if, and when, they arise. For instance, as regards the problem of achieving universal access, the U.S.A.’s most far reaching response was the introduction of the Medicare and Medicaid schemes in 1965. However, as mentioned previously, this policy has largely failed, with reports that by 1989 over 50% of the poor did not qualify. President Reagan made a half hearted attempt to improve matters in 1988, with his legislation to give the elderly coverage in cases of catastrophic care’. The scheme was self funding, however, meaning the elderly, as a group, had to meet the cost. This legislation was eventually repealed one year later.

Examples can also be found when relating to problems of efficiency and accountability in the U.S. health system. For instance, the need for more quality health care in the inner cities and the poor ruralities was temporarily fulfilled by post war federal initiatives to increase the supply of medical personnel. There were also attempts by federal government to subsidise voluntary community hospital councils to get hospitals to work together in evolving a rational distribution of hospital beds and high medical technology. Both these schemes were largely unsuccessful however. There are signs that things are changing, however.

For example, the suggested reforms outlined in Bruce Woods’ article “Policy Failure: The Non Reform Of American Health Care” are of a more comprehensive nature, and fall into two broad categories. The Enthoven-Kronick proposal suggests offering incentives to employers and workers, and to public sponsors and their purchasers, to use prospective payment systems to “reward those providers who deliver high quality care economically”. The Physicians for a National Health Programme on the other hand, seek the introduction of a state led universal coverage plan to replace market care. Both these plans are significant because “they go beyond a simple discussion of how to pay for uncompensated care and for the un insured, to a total restructuring of the U.S. health system.”. In the U.K.s health system, however, policy making appears to centre around the structure of the N.H.S..

For instance, the N.H.S. re organisation of 1974 created three tiers of health service management at regional, area and district level. However, this re organisation did not solve the structural problems inherent in the service as there still remained three separate agencies involved in the provision of state health care. However, the policy makers continued to place their faith in structural reform, giving rise to further re organisation in 1982. Policy making here differs from that of the U.S. in that the problem is seen to be inherent in the structure of the N.H.S., resulting in structural reform. In the U.S. more piecemeal, less general reform is used, and there appears to be no overall planning strategy, largely due to a dislike of mandated direction in the American political culture. In conclusion, it would appear that the challenges facing the two countries health systems are often very similar. For instance, the need to combat upcoming health trends or the goal of universal access. However, the methods used to combat such challenges are often very different, with the Americans invariably focussing on market led provision, whilst Britain has a strong tradition of government intervention in this area. This can often be put down to political culture and the importance placed on health systems within the two countries.

There is a sense in which things have changed, however. For example, the Thatcher years saw a move towards the American market led approach in health care, whereas a more comprehensive policy approach has recently emerged in U.S. health policy.

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An Analysis of Odin Anderson's Article on Hearth Services in the U.S. (2022, Mar 24). Retrieved from https://studymoose.com/c-essay

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