Organizational Systems and Quality Leadership: Access to Healthcare in UK and US

Organizational Systems and Quality Leadership: Access to Healthcare in UK and US

Introduction

There is a significant contrast between the US and UK healthcare systems. While the US represents the largest private sector healthcare, UK boasts one of the largest public sector health systems (Sakellariou & Rotarou, 2017). Moreover, it is worth noting that whereas the US spends more on healthcare than most countries across the globe, UK healthcare expenditure as a fraction of its budget is among the least when compared to other industrialized countries (Linney et al., 2020). Further, upon deeper analysis, it emerges that the UK’s health system is more accessible compared to the US health system.

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Accessibility

Coverage for Medications

Mandatory salary and taxation pay for the UK health system – the NHS, which supports not only the delivery of healthcare services but also some dental and social services to all the populations including children, unemployed people, and retirees. Typically, a child, an unemployed individual or a retiree would receive diagnosis and prescription at any hospital without being presented with any bill. In the US, most people have access to healthcare through a mixture of Medicare, Medicaid and health insurance programs. While Medicaid provides health coverage to individuals of age 65 years and above regardless of their income, Medicaid is a state and federal program that covers individuals who have very low income and cannot fully cover their health costs (Cyr et al, 2019). This leaves the rest often the population to be dependent on private insurance, Medicaid and Medicare at their expense.

In the United Kingdom, the healthcare system (National Health Service, NHS) is a socialized health system, meaning that all the health services are managed by a single-payer – government, and is funded by taxpayers (Nellums et al., 2018). Therefore, all the treatments, consultation appointments and medicine prescriptions are provided for free. However, as per Gordon et al (2018), the NHS services are not entirely free because there are some services such as eye and dental care that are provided at the patient’s expense, even though at lower prices compared to those in the UK.

Notably, the maximum cost of an NHS prescribed drug is $12. Alternatively, the UK allows employers to offer private insurance services to employees, and therefore some individual decide to opt-out of the NHS to join the private insurance system (Jayaweera., 2018).  Regarding the accessibility of healthcare to the aged population, the National Institute for Health and Care Excellence (NICE) consults with individuals to help maneuverer the difficult ethical issues associated with patient prioritization based on age.

Requirements to get a Referral to see a Specialist

The requirements to get a referral to see a specialist in the US differs from those in the UK mainly because whereas the former is a highly privatized healthcare sector, the latter manages a socialized system. In the UK, all patients are entitled to a referral for specialist treatment, even though this depends on what the GP feels is necessary for them (Charlton et al., 2018). Any patient who wishes to be referred to a specialist needs to see their GP because the GP generally understands their health history and will base their decisions for a specialist referral based on concrete health data. Before making the referral, according to Gunner et al. (2019 Organizational Systems and Quality Leadership: Access to Healthcare in UK and US), the GP will probably suggest for the patient to attend alternative tests and treatment options to establish whether their conditions could improve.

Contrastingly, in the US, getting a referral to a specialist is a more structured process particularly due to the many private institutions and services involved in the process. According to Jang et al. (2018), the patient must acquire a written order from the primary care doctor to see the specialist. This is typically the case across many health maintenance organizations (HMOs), where the patient must acquire a written order from their primary care doctor before they can get medical care from any other healthcare provider apart from their primary doctor, or else the insurance plan may decline to pay for the service.

Coverage for Pre-existing Conditions

There is not much difference in the coverage for pre-existing conditions between the US and UK. However, in the US, existing legislation prohibits insurance companies from declining coverage or charging more to patients with pre-existing medical conditions including cancer, diabetes, or asthma (Charlton et al, 2018). Moreover, they are prohibited from limiting the benefits of those conditions. However, an exception to this rule is that it does not apply to ‘grandfathered’ insurance policies, which are policies that an individual bought for themselves or their family members on or before 23rd March 2010 and have not changed in specific ways to reduce increase costs to consumers or reduce benefits (Jang et al., 2018).

In the UK, individuals can get coverage for their pre-existing conditions even though it is unlikely that they might find a policy cover. Nonetheless, according to Gunner et al. (2019), the type of insurance policy underwriting a patient receives determines whether their pre-existing conditions are coverable. This applies to the common types of insurance underwriting: moratorium and full medical underwriting.

For instance, for the moratorium policies, medical conditions that occurred five years before the start of the policy are excluded for the first two years after the policy is in force (Jayaweera., 2018). Any cover excluded in the moratorium policy can later be reinstated upon a continuous reoccurrence of the medical condition two years since the last treatment date.  On the other hand, for full underwriting, the insurer will need specific details about the patient’s pre-existing condition and medical history. The new insurance may then cover some or all the medical conditions (Gordon et al., 2018).

Financial Implications

With the increased demand from citizens for governments to improve the lives of people while lifting them out of poverty, countries with universal healthcare have reaped substantial economic benefits, proving the UK’s NHS system to be one of the most economically valuable public investments of its class. The financial benefits for UK’s universal healthcare are strong. For instance, universal healthcare protects the poor and low-income earners from economic and social costs associated with health expenditures, which are estimated to have impoverished millions of populations in other countries. By reducing its population’s expenditure on healthcare, the UK can achieve increased disposable incomes thus improving their social and economic lives.

Healthcare is one of the most consequential parts of the country’s economy partly because of its budgetary implications and its economic size. Due to its highly privatized nature, the healthcare sector currently employs more than 10% of the American worker’s Bureau of Labor Statistics, BLS 2019b). Moreover, the highly privatized sector accounts for 24% of Federal expenditures (Centres for Medicare & Medicaid Services, 2018). More interestingly, data by BLS (2019a) indicate that health insurance is one of the country’s largest consumer spending areas, revealing just how much the country’s well-being and effectively functioning health sector can be a significant indicator of the public’s economic well-being.

Conclusion

The US healthcare system is highly privatized and contrasts with the UK’s NHS, which significantly takes a more socialist approach to healthcare. Also, whereas the US healthcare system largely depends on a mixture of Medicare, Medicaid and health insurance programs for funding, the UK’s healthcare system is significantly funded by the taxpayers. Consequently, the US health system is less accessible to children, unemployed individuals, and to retirees, a group that has easy access to healthcare in the UK. Further, whereas the UK provides most of its services to these population groups for free, the U.S. healthcare system only provides some of those services.

References for Organizational Systems and Quality Leadership: Access to Healthcare in UK and US

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Centers for Medicare & Medicaid Services (CMS). (2018). National Health Expenditure

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