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International Health Systems

LaShelle R Melton

Department of Nursing, Jacksonville State University

NU 710: Healthcare Policy and Finance

Dr Leigh Ann Keith

February 16, 2021

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International Health Systems

The purpose of this paper is to compare and contrast health care spending in the United

States to that of other countries and review why it is so much greater than in other high-income

countries. In 2016, the United States spent nearly twice as much as ten high-income countries on

medical care and performed less well on many population health outcomes. Contrary to some

explanations for high spending, social spending and health care utilization in the United States

did not differ substantially from other high-income nations. Prices of labour and goods, including

pharmaceuticals and devices, and administrative costs appeared to be the main drivers of the

differences in spending. Efforts targeting utilization alone are unlikely to reduce the growth in

health care spending in the United States; a more concerted effort to reduce prices and

administrative costs is likely needed (Papanicolas et al., 2018)

Comparison Table

Criteria United States Germany Canada United Japan

to Kingdom
Evaluate
Healthcar Hybrid Everyone must National National Japan provide
e system have health Health Health equitable access
Philosop Patient- insurance. insurance Service. to necessary and
hy Centered In Germany, program. Central and adequate
Care, In the the role of Canada's Eastern medical service.
U.S. nonprofit health care Europe Japan breaks
healthcare organizations system's (CEE) that down barriers
system, has in in-hospital organisation have with consumers
often been healthcare is is primarily changed by perceiving
taken as an deeply determined from socialist and accepting
ideal-type intertwined by the healthcare them merely as
Private with welfare. Canadian systems to human beings
model. Organizations Constitution, social health who share the
However, and facilities. in which insurance same difficulties
today it is roles and systems and recovery
mainly responsibiliti are currently experiences.
financed out es are characterized Everyone else
of public divided by may be essential
funds since between the comparativel to help build a
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it is heavily federal and y weak actors more inclusive

tax-subsidized provincial of the social society.
and insurance
territorial systems and
governments a high
. proportion of
healthcare
Access to Medicare Health Canada's Sustainable Japan’s statutory
Care plays an insurance is publicly Development health insurance
Model-- outsize role in mandatory in funded Goal (SDG) system (SHIS)
(How the U.S. Germany. health care aims to covers 98.3
does a health care Approximately system is "ensure percent of the
citizen of system. The 86 percent of best healthy lives population,
this program is the the populationdescribed as and promote while the
country nation's is enrolled inan well-being separate Public
get into largest payer statutory health
interlocking for all at all. Social
the of health care insurance, set of ten Ages”. Assistance
healthcar services. It is which providesprovincial Program, for
e system? major support inpatient, and three impoverished
How do for medical outpatient, territorial people, covers
they gain education and mental health,health the remaining
access to rural and systems. 1.7 percent.
personal providers and prescription Known to
health serves as the drug coverage.Canadians as
services testing ground Nongovernmen "Medicare,"
to for innovative tal insurers the system
achieve payment handle the provides
the best models. administration.
access to a
health broad range
outcomes of health
?) services.
Cost to Medicare Sickness funds Publicly Since the Japan’s statutory
Consume payment are financed funded development health insurance
rs policy often through general health and system provides
sets a wage expenditures implementati universal
benchmark contributions accounted on of the coverage. It is
for the (14.6%) and a for seven out SDGs in funded primarily
commercial dedicated, of every 10 2015, global by taxes and
market, and it supplementary dollars spent health individual
is usually held contribution on health spending has contributions.
up as a (1% of wages, care. The increased, Young children
possible on average), remaining reaching and low-income
model for both shared by three out of $7·9 trillion older adults have
universal employers and every 10 (95% lower
coverage. workers. dollars came uncertainty coinsurance
Copayments from private interval 7·8– rates, and there
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apply to sources and 8·0) in 2017 is an annual

inpatient covered the and is household out-
services and costs of expected to of-pocket
drugs, and supplementa increase to maximum for
sickness funds ry services $11·0 trillion health care and
offer a range of such as (10·7–11·2) long-term
deductibles. drugs, dental by 2030. In services based
Germans care and 2017, in low- on age and
earning more vision care. income and income. There
than $68,000 governments middle- are also monthly
can opt-out of pay for 65% income out-of-pocket
SHI and choose of health countries maximums.
private health expenditures spending on
insurance in Canada HIV/AIDS
instead. was $20·2
billion

Average 78.5 81.0 82.8 81.4 84.2

Age of
Death
Infant 5.8 3.4 4.5 4.3 2.0
Mortality
Rate
Obesity Sixty-five per 4.0% of adults A cross- The U.K. is Overweight/
percentag cent in the in Germany are sectional the most obesity 21%
e U.S. overweight or study overweight higher in Japan,
The obese. Men are including nation in 4% higher in
prevalence of more often 19,363 Western China, 29%
obesity was affected by adults aged Europe. higher in the
significantly overweight 18 years or Twenty- United
greater among than women, more from seven per Kingdom, and
women living with 43.3% of the 2004 cent of the 24% higher in
in men having a Canadian population the United
nonmetropolit BMI between Community are now States, all P
an statistical 25 kg/m2 and Health clinically values < 0.05.
areas. The 30 kg/m2, Survey, obese, and
prevalence of compared to cycle 2.2. another 36
severe obesity women Ultra- per cent are
in non-MSAs (28.8%). In processed overweight,
was higher Germany, the food intake making the
than in large prevalence of was combined
MSAs among obesity is estimated figure among
men (9.9% vs 18.1% using daily the highest in
4.1%, relative the world.
respectively) energy
women. intake of
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ultra-
processed
food
Major Coronary Coronary Heart Coronary Coronary Coronary Heart
Diseases Heart Disease, Lung Heart Heart Disease, Stroke
Affecting Disease, Cancer and Disease, Disease, and
the Alzheimer’s Stroke Lung Cancer Alzheimer’s Flu/Pneumonia
Populatio and Lung and Stroke and Lung
n Disease Cancer
With Coronary
With Heart Disease With Cancer With
Coronary being the being the Alzheimer’s With Coronary
Heart Disease #1cause of #1cause of & Dementia Heart Disease
being the death death being the #1 being the
#1cause of cause of #1cause of death
death death.

Most Effective International Health Plan

I believe I favour Japan as having the most effective healthcare system in the world in my

research. This country has the lowest infant mortality rate of 2.0, and although coronary heart

disease is the number one cause of death, this country has the longest life expectancy of 84.2.

Japan also have low cost health insurance that is funded primarily by taxes and individual

contributions. Four years ago, Japan celebrated 50 years of good health achievement at low cost

and increasing equity for its population. In 1961, at the beginning of a period of rapid economic

development, while the country was still relatively poor (with a gross domestic product [GDP]

half the size of Britain's), Japan reached full health insurance coverage of its population. In the

next half-century, it continued to develop its health system and improve equity, even applying

this principle of universal health coverage in global health diplomacy. Japan followed a

nonlinear path to universal coverage. Previous Japanese policymakers were sometimes motivated

to develop the health system for political economy reasons that were unrelated to health. Since

1986, Japan has ranked first in the world in women's life expectancy at birth, which reached 87
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years in 2014. In addition to improving health outcomes, Japan's social insurance system has

made incremental improvements in inequity through cross-subsidies and tax transfers, which

contributed to income redistribution in addition to risk pooling. As many countries have done,

Japan expanded health coverage population group by population group through policies designed

for different groups with differing coverage levels, thereby creating disparities and problems of

fairness (Reich & Shibuya, 2015).

Recommendations

The first recommendation would be, Equal and Fair Healthcare access for all. Although

cancer mortality rates declined in the United States in recent decades, some populations

experienced little benefit from advances in cancer prevention, early detection, treatment, and

survivorship care. Some cancer disparities between people of low and high socioeconomic status

widened during this period. Many potentially preventable cancer deaths continue to occur, and

disadvantaged populations bear a disproportionate burden (Alcaraz et al. 2020). An association

between social and neighbourhood characteristics and health outcomes has been reported but

remains poorly understood due to complex multidimensional factors across geographic space.

The consequences of social determinants of health (SDOH) increasingly dominate public health

discussions in the United States. Population health outcomes have not kept pace with those of

other developed nations despite higher per-person spending for medical services (Kolak et al.

2020).

My second recommendation would be a universal fee for services. The United States has

a complex governmental public health system. Agencies at the federal, state and local levels all

contribute to protecting and promoting the population's health. However, whether the modern

public health system is well situated to deliver essential public health services is an open
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question. In some part, its readiness relates to how agencies are funded and to what ends. A mix

of Federalism, home rule, and incident has contributed to a siloed funding system in the United

States, whereby health agencies are given particular dollars for particular tasks. Little

discretionary funding remains. Furthermore, tracking how much is spent, by whom, and on what

is notoriously challenging. This review outlines the challenges associated with estimating public

health spending and explains the known sources of funding used to estimate and demonstrate the

value of public health spending (Leider et al. 2018).

And my third and last recommendation would be independent care provided by nurse

practitioners in all fifty states. You may say why this would be a recommendation, my belief is

that if more nurse practitioner were allowed to practice independently, it would impact health

care cost and access to care. There is a significant variation across states in nurse practitioner

(N.P.) scope of practice moderated by state regulations. The purpose of this study was to

synthesize the evidence from studies on the impact of state N.P. Practice regulations on U.S.

health care delivery outcomes (e.g., health care workforce, access to care, utilization, care

quality, or cost of care), guided by Donabedian’s structure, process, and outcomes framework.

The results indicate that expanded state N.P. Practice regulations were associated with greater

N.P. supply and improved access to care among rural and underserved populations without

decreasing care quality. This evidence could guide policymakers in states with more restrictive

N.P. practice regulations when they consider granting greater practice independence to N.P.s

(Yang et al. 2020).

Conclusion

In conclusion, this assignment has opened my eyes to many things to include life

expectancy and obesity. When I review the leading cause of death, it was insightful how, in three
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of the five countries, Coronary Heart Disease was the leading cause of death; however, the life

expectancy differed. This assignment helps me have more insight into how important it is as a

future doctoral prepared provider to impact healthcare and push towards autonomy as a

healthcare provider. Doctor of Nursing Practice programs prepares nurse leaders for unique roles

to address healthcare needs across the quality spectrum. However, additional mentoring and

training in implementation science and analytical skills are needed to effectively lead system-

wide quality initiatives (Reynolds et al. 2021).

The program's strengths included the in-depth mentoring by faculty and relationships

built across the more extensive health system. Both scholars and the planning team noted that the

scholars' system-wide project was relevant, timely, and quality-focused. This innovative DNP

post-doctoral program leveraged DNP-prepared nurse leaders' skill-sets to lead system-wide

quality improvement initiatives explicitly tailored to healthcare organizations (Reynolds et al.

2021).
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References

Alcaraz, K. I., Wiedt, T. L., Daniels, E. C., Yabroff, K. R., Guerra, C. E., & Wender, R. C.

(2020). Understanding and addressing social determinants to advance cancer health

equity in the United States: a blueprint for practice, research, and policy. CA: a cancer

journal for clinicians, 70(1), 31-46.

Hales, C. M., Fryar, C. D., Carroll, M. D., Freedman, D. S., Aoki, Y., & Ogden, C. L. (2018).

Differences in obesity prevalence by demographic characteristics and urbanization level

among adults in the United States, 2013-2016. Jama, 319(23), 2419-2429.

Kolak, M., Bhatt, J., Park, Y. H., Padrón, N. A., & Molefe, A. (2020). Quantification of

neighbourhood-level social determinants of health in the continental United States. JAMA

network open, 3(1), e1919928-e1919928.

Life Expectancy Research. (2020). World Life Expectancy.

https://www.worldlifeexpectancy.com/life-expectancy-research
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Nardocci, M., Leclerc, B. S., Louzada, M. L., Monteiro, C. A., Batal, M., & Moubarac, J. C.

(2019). Consumption of ultra-processed foods and obesity in Canada. Canadian Journal

of Public Health, 110(1), 4-14.

Papanicolas, I., Woskie, L. R., & Jha, A. K. (2018). Health care spending in the United States

and other high-income countries. Jama, 319(10), 1024-1039.

Reich, M. R., & Shibuya, K. (2015). The future of Japan's health system—sustaining good health

with equity at a low cost. New England Journal of Medicine.

Reynolds, S. S., Howard, V., Uzarski, D., Granger, B. B., Fuchs, M. A., Mason, L., & Broome,

M. E. (2021). An innovative DNP post-doctorate program to improve quality

improvement and implementation of science skills. Journal of Professional Nursing,

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Schienkiewitz, A., Mensink, G., Kuhnert, R., & Lange, C. (2017). Overweight and obesity

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nursing philosophies. Perspectives in Psychiatric Care, 55(4), 636–643.

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