Xavier Perez

Spencer Gaye
Shannon Csapilla
Final Paper
1.
Comparing healthcare systems
United States

Germany

United
Kingdom

1.
Public vs.
Private

Private (2)
Market place
exchanges

Mainly Private/
public`

Primarily
state-run and
publicly
financed

2.
System Funding
(source of the
healthcare spending)

Private health
insurance,
Medicare,
Medicaid, outof-pocket
spending (1)

Private funds and

statutory funds

National
Health
system (NHS)

3.
Insurance
Choice (e.g.
Required? Universal?
Tax incentives?)

Individual
mandate and
tax provisions
(3)

Required/univers
al (3)

Universal(3)

4.
)Employer
payment for
healthcare insurance

Business 50+
employees
must cover
insurance

Covered by
profession

Not through
employer

5.
Patient co-pay
at point of care

Depends on
insurance plan

Yes, service
copayments

No

6.
pay

Depends on
insurance plan,
mediocre part
D

Yes copayments

Yes but
depends on
the drug

7.
Maximum
annual spending

$8,713 (4)

$4,810 (4)

$3,235 (4)

8.
Scope of
physicians that

Depends on
insurance plan

open

controlled

Prescription co-

patients can choose

from
9.
Physicians
contracts and payment
schemes
10. Specialist/GP ratio

42%

65%

49%

11. Access to
specialists (e.g. need
referral)

Depends on
plan

No need for
referral

Needs
referral

12. Hospitals

Pre-dominantly
for profit
hospitals

28% of hospitals
were private and
for-profit, 38%
were nonprofit,
and 34% were
owned by the
government.

750 NHS
hospitals, 190
private
hospitals and
93 NHS
hospitals
housed
dedicated
private
facilities.

13. Preventive care

establishing
taxes on highcost insurance
plans, cutting
costs through
preventive
screenings and
immunizations,
and increasing
revenue from
pharmaceutical
and medical
device firms
through new
fees and taxes
(5)

Funds had to
cover disease
management
programs for
chronic
conditions and
provide financial
incentives to
physicians and
patients for
preventive
care(5)

NHS salaried
and contract
physicians
were
compensated
through
capitation
fees, which
encouraged
preventive
care(5)

14. Advertising and

patient education

15. Health care

industry

2.

When it comes to organizing and delivering health care, there are many ways to go about
it. Depending on where you are in the world results in what time type of health care. Three
countries that have distinct ways are doing this is Germany, United Kingdom and The united
states. Each of them have their unique benefits and drawbacks. In this portion of the paper I will
be discussing how these benefits and drawbacks and the effect they have one society.
The healthcare system in Germany was the first element of Germanys welfare state introduced
by Chancellor Otto von Bismarck. This system was built on a wage-adjusted premiums with the
employer's matching the contributions of the employees. Through this system they established
solidarity which is one of the key principles that built this system.
This style of healthcare in Germany has had profound benefits on the country. For starters
health care is much cheaper in Germany compared to the United States. This is due to the fact
that very little tax money goes into the system. This is because of the wage-adjusted premiums.
Which means that all Germans pay about 10 percent of their salaries to what are known as sick
funds. Also according to the NPR.org there is very little there's usually little or no wait to get
elective surgery or diagnostic tests, such as MRIs. Which is very good in comparison to America
which according the Washington Post have the worst waiting times in the developed world.
There are also some drawbacks to the healthcare system in Germany. One is that the
discrepancy between the privately insured and everyone else has grown ever larger over the
years, creating a de facto two-class system. Thus, the better off do in fact receive better care
exactly what is not supposed to happen in Germanys great social welfare state. Another

drawback of the German health system that there is slow development in biotechnology due to
the fact that investors are not willing to take risks due to the fear of strict regulations on effluents
from research and manufacturing facilities. With the lack of advancement of technology the cost
of health care would later rise which lead to reform.
In the United Kingdom the organization and delivering of health care can be described a
combined payer and delivery system to replace a longstanding mix of private, municipal, and
charity insurance called The National Health Service(NHS).The NHS was written by William
Beveridge and launched in the 1948. The purpose of this system was to divorce the ability to get
the best health and treatment from the ability to pay according to Beveridge.
The NHS was very popular with the people because of how it benefited society. These
benefits included an Effective beds are up 6%, in-patients admitted are up 19%, the ratio of
treatment to beds is up 22%, new outpatients treated are up by 12%, and the waiting lists are
down. Another way society benefits from NHS is that is free which means people dont need
insurance premiums, no co-payments, no fees for doctor visits, no billing, and minimal
paperwork.
The drawbacks of the NHS also effect have effects on society. The first major drawback
is the waiting list. The goal of the waiting list is to ensure that all patients are seen on a firstcome-first-serve basis. Which often leads to patients with lesser ailments receiving treatment
faster than patients with serious conditions. This leads to patient frustration and opt to pay more
for private care so that they can see the doctor. Since the UK offers healthcare to all residents the
resources become very limited and the patient demand is high. Another drawback of the NHS is
how expensive it is. According to U.S. Healthcare Reform: International Perspectives as British

government debt rose from below 40% of GDP in 2007 to 72% in 2010, worries emerged that
above-inflation spending had saddled the country with unsustainable commitments
The organization of and delivering of health care in the US consists of many types of
privately- and publicly-funded health insurance plans, all of which offer different types of health
care services. These types vary from HMOS (Health Maintenance Organizations) in which the
insurance plan, the doctors, and the hospital either are all in the same organization or closely
related, FFS and IPA.
The benefits of the US Health care system is that has one of the best medical research
systems in the world. Because of this, people can afford it have access to some of best insurance
plans in the world. The US is also home to the worlds largest and least restricted pharmaceutical
market, delivering $312 billion in sales, over 40% of the world total. Through this the US health
care is one of the better ones in the world.
Like every other health care system described previously the US also has to drawbacks
and disadvantages. One of the biggest disadvantages of the current American health care system
is that people are spending much more in the U.S. for health care, but Americans are not having
healthier results compared to other nations that spend much less. This spending is not resulting in
positive results as shown in this graph.

3.
Numerous policy choices have been made through the years that have led the United
States to spend far more capita on healthcare than in other country. During a recession, the
Diagnosis Related Groups became mandatory in 1983 by the Reagan administration. Hospitals
warned that DRGs failed to capture the difference between serious and moderate conditions.
Hospitals began to under-treat patients and shorten the length of stay. Since the United States
lacked universal health insurance, Political Progressives considered them an as incomplete
welfare state. Obtaining insurance through private firms lead to incomplete optimal care. 75% of
the U.S health care spending came from patients with chronic illnesses. Another policy choice
that drove the United States into a rut was supporting the veterans and creating Medicare. The
government paid up to 58% more for medicines under Part D than through the VA. The VA was
also penalized for its expensive care yet low quality in facilities.

The United States spent more than twice as much per capita on healthcare than England
and Germany for various reasons. From social security plans to sickness funds, the public began
to negotiate prices with hospitals and drug companies. Market forces were minimized in
countries whose healthcare was primarily state-run and publicly financed. One mistake the
United States was their lack of control on financing Medicare and Medicaid. The delivery of care
was free and private insurers negotiated reimbursements. In a study, the United States was found
to treat cancers more aggressively than in any other country. This is just another factor as to why
the US spends twice as much per capita on healthcare than in England and Germany.
The Patient Protection and the Affordable Care Act can not satisfy the cost control purpose in the
U.S. Our opinions all very similar agree that this is true. With Medicaid and Medicare
comprising in over 6% of GDP, the two combined made up 20% of the federal budget. For one
taxes are a huge part that affect many people especially those who are well-off. Those who do get
cost assistance will not only have to adjust tax credits on their tax form, but those who barely
miss the Federal Poverty Level get hit the hardest for not qualifying. Insurance companies who
have to cover sick people only increases the cost of all of our insurance. Only being allowed to

find coverage during open enrollment periods also cause more complications; for example owing
a fee due to forgetting to pay the premium. Today the healthcare system costs $3 trillion and
about $9,000 per capita spending. The costs were supposed to decline once the ACA began, but
costs remain the same. Our group hopes the ACA will start to benefit otherwise some better and
bigger changes need to be made. Hence, the Patient Protection and the Affordable Care Act can
not satisfy the cost control purpose in the U.S.
There are many aspects of the German and/or British healthcare systems that the United
States can draw upon. In Germany, privately insured patients experience shorter wait times and
saw more specialists than those in the statutory funds. They created dedicated accounts for
members to help keep premiums at a good level. A wave of mergers reduced the number of
sickness funds by 40%. If the global budget was exceeded in Germany, payments were cut. From
this, hospitals focused on reducing budgets rather than to extend costly inpatient care. The
United Kingdom also benefited in numerous aspects that the United States can take into
consideration. In 1997 the UK increased spending on the NHS. Achieving their goals, wait times
were reduced by 50% to 70%. The UK also had control over medical education and the
involvement of the British Medical Association in NHS decisions. General practitioners directly
employed by Primary Care Trusts earned between 53,000 and 80,000, depending on their
length of service and the number of patients in their care. What lead to encourage preventive care
were the 44 NHS physicians who were compensated through capitation fees.

Resources

Daemmrich, Arthur A. "Reading Material U.S. Healthcare Reform: International Perspectives."

(n.d.): 1-35. Print.
https://www.washingtonpost.com/blogs/ezra-klein/post/americas-waiting-times-are-the-worst-inthe-world/2011/05/09/AFGIxr2G_blog.html
http://www.npr.org/templates/story/story.php?storyId=91971406
1. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-andReports/NationalHealthExpendData/index.html?redirect=/NationalHealthExpendData/
2. CRS Report R43048, Overview of Private Health Insurance Provisions in the Patient Protection and
Affordable Care Act (ACA)

3. https://www.irs.gov/Affordable-Care-Act
4. http://www.pgpf.org/chart-archive/0006_health-care-oecd
5. U.S. Healthcare Reform: International Perspectives