Global Health Blogs with Professor Swahn

I was oblivious to the importance of health care, and how access to it is almost a privilege, until last semester in my Fundamentals of Health Systems, Leadership and Policy course. Our discussions on health care costs, access to care, and quality of care were quite eye opening. It was in this course that I learned of the United Kingdom’s healthcare system and how they granted their citizens universal coverage. Comparing the United States and the United Kingdom’s healthcare systems is helpful in identifying the pros and cons of each system. Each country has its successes and challenges in regards to the relationship between its citizens and the healthcare services they receive.

The Organization for Economic Cooperation and Development Average (OECD) is an international organization that consists of 34 countries to compare and discuss government policies to “promote policies that will improve the economic and social well-being of people around the world”.  I used some of its statistical findings to compare and contrast the US, UK, and a few other countries healthcare outcomes. It is widely known that the US spends an overwhelming amount of money on healthcare. In 2018 we spent 16.9 percent of gross domestic product (GDP) on healthcare, which was almost twice as much as the average OECD country. Other countries such as New Zealand and Australia spent almost only half of that, with 9.3 percent of GDP being spent.

Interestingly enough, the United States public spending on healthcare is comparable to its peer countries. It is the citizen’s private spending on health insurance that is drastically higher than its peers. About half of health care spending derives from private funds with most working adults being covered by an employer funded health insurance plan.

The average US residents pays $1,100 out of pocket for health care because of copayments for doctor’s visits, prescription drugs, or health insurance deductibles. In contrast, residents of the United Kingdom do not have to personally afford any of these things because they are all covered under their universal healthcare that is implemented by the National Health Service. Like the UK, the US does have government assisted health care programs such as Medicare, Medicaid and the Veterans Administration which cover 36.5 percent of the population’s health insurance. However, despite employer funded and governmental coverage there is still an overwhelming amount of citizens (32.9 million) that do not have health insurance. This is due to low-income citizens being likely to not visit a doctor when sick, receive a test/treatment/follow-up care that was recommended by their physician, get a prescription filled, or visit a dentist. I can personally attest to being extremely hesitant on receiving a test my primary care physician recommended I get due to abnormalities detected within my heart rate. Once I inquired with my insurance on how much I would have to pay out of pocket for the test I was discouraged on getting it done. I triple-checked with my physician to make sure it was something I needed before scheduling my appointment to receive the heart scan. Due to it being my heart that needed to be examined I went forth with the test and requested to be placed on a payment plan to pay for it.

 I am sure my experience and hesitance on seeking the treatment I needed is a common one among US citizens, and is a significantly contributing factor to our countries unfavorable health outcomes when compared to other countries. The life expectancy in the U.S. was 78.6 years in 2017, which is two years lower than the OECD average. This life expectancy can be further broken down by racial and ethnic groups; African-Americans have a life expectancy of 75.3 years, which is 3.5 years lower than whites who have a life expectancy of 78.8 years. Hispanic Americans have the longest life expectancy of 81.8 years.

The United States lower life expectancy can partially be attributed to its higher suicide rates. When comparing these rates with the UK, it is observed that their suicide rates are half of what ours is.

 This could be due to the UK including mental health care within its universal coverage and offering a full range of services to its citizens. Mental illnesses such as depression and anxiety are typically treated by general practitioners, and illnesses requiring more advanced care are treated by mental health specialists. America’s steadily increasing rates of suicidality, and substance use, could be caused by a high burden of mental illness and individuals finding relief in substances, instead of seeking proper treatment.

Along with mental health care, the UK’s National Health Service (NHS) covers preventive services, inpatient and outpatient care, maternity care, physician services, inpatient and outpatient drugs, clinically necessary dental care, rehabilitation, home visits, and even assistive devices such as wheelchairs and hearing aids. All of England’s citizens are privy to its universal health care however some residents opt to obtain their own private policies. Choosing to receive private insurance offers more rapid access to care, personally selecting health care specialists, and better amenities. One would choose to deny free health care provided by the government and fund their own policy due to the oftentimes insufferable waiting times patients experience. Individuals seeking emergency care experience long wait times due to the overwhelming amount of patients ER doctors see on a daily basis. General practitioners can only see their patients for an average of 10 minutes for this same reason. If an individual needs to seek treatment from a specialist, they will likely be placed on a waiting list because of the overwhelming demand of services needed and shortage of specialists available to provide them. Opting for private insurance alleviates these wait times and is a major reason why about 11 percent of UK residents choose to obtain private insurance. Contrastingly, America’s quality of care is quite commendable. The average length of a hospital stay in the U.S. is 5.5 days, which is significantly lower that the OECD average.

 On a positive note, both the United States and the United Kingdom have outstanding rates of implementing preventive measures.

The United States has one of the highest rates of breast cancer screening among women ages 50-69, and the second-highest rate (after UK) of flu vaccinations among people age 65 and older. While both countries have their respective strengths and weaknesses within each of their healthcare systems, perhaps they could adopt certain qualities from each other to improve them. For example, the United States could begin working toward lowering healthcare costs to increase citizen’s accessibility. Doing so could improve our populations overall health outcomes. In contrast, the United Kingdom could seek to improve their quality of care by either hiring more physicians and specialists, or including more services covered in private health insurance policies so that this option is more appealing to citizens that can comfortably afford it. It is my hope that our country can begin to make sincere, efficient efforts to remediate our current healthcare crisis.