Global Health Blogs with Professor Swahn

China has risen to global stardom in the last few decades. Its economy is increasing in capacity and is estimated to surpass the US and be the world’s largest economy in the next couple of years. They have successfully lifted a considerable percentage of the population out of poverty through economic reforms starting in 1978.  With China as a new world player, it begs the question, “ how is the healthcare system is evolving?’”. With all the success, there are still some issues. It does not come as a surprise to learn China and the United States have differences in health systems funding and organization, resulting in health disparities. There are also similarities and differences regarding health insuring offerings. Both countries have benefits and downfalls. 

https://econ274.academic.wlu.edu/2015/10/chinese-healthcare-a-rural-problem/

There is a robust primary care system in China where community centers address most health issues regarding prevention measures and acute care. It is possible to see specialists, but the government advocates for patients to use primarily primary care services. However, there is a low doctor-to-patient ratio in the country, and therefore, the government offers large subsidies for tuition for medical school to entice students. The lack of doctors creates health disparities between rural and urban areas. Urbanites enjoy the benefits of access to high-quality health care and have licensed general practitioners. Larger cities often house secondary and tertiary hospitals as well. It is a different story for the 48.2% of the Chinese population living rurally. To reduce health disparities between urban and rural communities, educational institutions will lower entrance requirements for those who will work in rural communities, resulting in practitioners who are not licensed and often require assistance from medical professionals in larger organizations.  

The US health care system is less centralized and has slightly different problems. First, there is a shortage of primary care doctors and a cultural preference for specialists. This shortage has happened because of a few reasons. Salaries for primary care doctors are significantly lower than that of specialists. Does this make the primary care position desirable when the average medical student graduates with $200,000 in debt? Not really. The lack of access to primary care physicians often pushes the uninsured and marginalized populations to emergency rooms and urgent care, where treatment can be expensive. Second, there is a business element to healthcare with a symbiotic relationship between physicians, pharmaceutical companies, health insurance companies, and medical device manufacturers. The more services provided, the more money to be made. The fee-for-service model in US healthcare makes it desirable for specialists to prescribe unnecessary procedures to earn extra income.  All of these reasons are why the US is number one in the world for healthcare spending without positive health outcomes. 

In the past few decades, China has pushed to close the gap in health disparities between rural and urban  Through successful policy implementation; China is on a nearly universal healthcare system where they offer its population essential health services without financial hardship. They have two different types of public insurance depending on the citizen’s employment and location; again, most disparities are between urban, rural, and migrant populations. The most common form of insurance is the Urban Employee Basic Medical Insurance, which is mandatory for employed urban dwellers. Employee and employer payroll taxes finance the program, and it requires very little federal funding. Urban-Rural Resident Basic Medical Insurance fills in some gaps and is offered to all others, including the self-employed, children, students, the elderly, etc. The Urban-Rural Resident Basic Medical Insurance plan is optional and financed by annual premiums. The government provides subsidies in parts of the country with less prosperous economies; in healthy regional economies, the insurance subsidies are locally funded. The benefit of universal health care is that it offers marginalized communities access to vital preventative care. With the fast economic growth, there are still gaps in the regulation for quality control. That is where private health insurance comes in.  The wealthier population is more likely to afford this insurance and allows access to better healthcare. Needless to say, the Chinese insurance system is making improvements but still has some issues to address. 

The US does not have universal health coverage. It is a piecemeal system. According to the Common Wealth Fund, employer-sponsored health insurance covers around 55% of residents. Federally-funded Medicare, Medicaid, and Children’s Health Insurance Program, which depends on citizen health status, income, and age, covers 37% of the population. The programs cover essential hospital services.  In 2010 the Obama Administration passed the Affordable Care Act, which expanded government involvement in the health insurance system. This law had four main points. First, all citizens can stay on their parents’ private health insurance until the age of 26. Second, it expanded Medicaid eligibility. Third, there was a mandate for most citizens to be enrolled in health insurance or face a penalty (removed now). Fourth, the government required states to open virtual insurance marketplaces, where lower and middle-income citizens can choose plans with optional federal subsidies.  The health insurance offerings are moving in the direction of universal healthcare. The incoming Biden administration has made promises to address significant health insurance issues to improve healthcare access and quality. 

In conclusion, all countries have problems to address within their health systems. Even though China is a fastly growing economy, it still struggles with healthcare organizations and support. While offering almost universal healthcare, there is room for growth to support the quality of care. The US has structural issues with its healthcare system. It is more of a business and a significant driver of the economy. While the broad offering of health insurance is an improvement, it still can be expensive for the marginalized population. Are the governing bodies in these countries up to the challenges? Only time will tell.

Healthcare system we always talked about. It’s always been a hot topic for discussion and diabetes. What is health care..? Health care is the maintenance or improvement of health via the prevention, diagnosis, treatment, recovery, or curve of disease, illness, injury, and other physical and mental impairments in people. The definition looks like it’s a lot of services, to provide healthcare service there are healthcare professionals and allied fields. Every country has its system to provide health care. Talking about the health care system of developed countries, insurance usually plays an important role. On the other hand, if we talk about countries like India, the insurance concept is not very common. People usually pay in cash for their health care expenses.

      Health care reflects how the country is using its resources for the betterment of the public. It’s always not the case that the developed can only provide good healthcare.  If you see the ranking of countries according to the quality of healthcare, you will be surprised to see that Singapore, Hong Kong, Italy, and Spain are leading in terms of their healthcare system. Although they are not very rich countries, they utilize their resources in a very efficient manner. 

       Let’s talk about the healthcare system of two countries that are sharing borders. The United States of America and Canada both are developed countries, full of resources and hub of modern migrations. Most people all around the world wanted to move to the USA and Canada for a better future. Healthcare access and insurance coverages are the main topics of discussion in both countries. 

HEALTHCARE IN THE UNITED STATES – 

    I would like to elaborate on the American healthcare system. Healthcare in the US is individually funded. It can either through the employer which covers almost about 48.8% of the population. Then there are government-funded insurances like MEDICAID, MEDICARE, and Veterans health administration. People who are below the poverty line and poor people usually qualify for government-funded health plans. But in the U.S the employer doesn’t need to give insurance coverage, not all people get insurance from their employer. This is the main reason that 15.5% of people are without insurance, which usually includes adults and couples without children. https://www.sgu.edu/blog/medical/comparing-us-and-canadian-health-care-systems/

  There is a lot of competition among private insurance providers to get business by selling insurance policies to the employers in the form of benefit packages for employees. They also tried their level best to influence private customers. Along with insurance companies, the health care provider also competes for the patients. They compete through areas of specialty, quality, and cost. Those who are getting insurance privately not through employers usually have to go in-network providers only, their access to services is also limited depending on the coverage of the services. Introduction of Patient Protection and Affordable Act (ACA) in 2010 law mandates all insurances to provide coverage for basic services at least. About two-thirds of primary health care providers provide services to the populations, they also can give a referral to the specialist when it is required, but it’s usually the patient’s decision depending on whether it is in-network or not.

HEALTHCARE IN CANADA –

Canada, on the other hand, provides government-funded health insurance to the public. According to the Canada Health Act (CHA) in 1984. All insurance companies are government-funded and it provides full coverage health insurance to all citizens of Canada. So technically all Canadian citizens are fully under coverage. Most of the health care providers work independently in their private practice or are hired by private hospitals and private health service management organizations. As it’s a government-funded system, they get revenue through the government instead of sending claims to private insurances like in the United States.

       Canada follows the Universal health care system in which all Canadian citizens are covered under insurance however the service coverage is limited to hospital, medical practitioners, and dental work. Apart from the basic coverage, the province provides services like coverage for prescription, homecare, long-term care, vision, mental health, etc. But the dental practices are not covered by insurance, people have to get insurance separately for it or have to pay out of pocket. Approximately half of health care providers are general practitioners. They can give a referral to the specialist if needed. But specialists will get less payment if the person comes to them without a referral. Since the government is funded, the primary provider usually negotiates with the minister of the health care system for the payments. The patient has no role in the negotiation, it’s always between the government and the provider.

 STRENGTHS- 

1- Both the U.S and Canada are providing good quality health care to the population. There is no compromise on the quality of the health care system.

2- Both countries had advancements in their technology and highly qualified and trained health care professionals.

3- Customer protection is considered very important in both countries.

4- Both systems have competition in the health care service, as a result, there is always quality care to the public.

5- Both countries and federal agencies supervise the consumer protection and health provider competition.

LIMITATIONS- 

1 – In my opinion, the biggest limitation is that the U.S has a universal health care system. I like the Canadian model of healthcare more than the U.S as all citizens are covered.

2- In both countries, since the paying party is insurance or the government, more misuse can be seen, in terms of unnecessary tests, MRIs, and C.T scans to get more money. 

3- In the USA, I think people had better choose their providers depending on the insurance they have. Since patients have to pay deductible and co-payments. They are fully aware of all the expenses.

4- In the Canadian system, patients had no role in the financial issue, it’s all between the government and providers.

5- Although both countries believe in consumer protection I unnecessary tests and scans are also a kind of exploitation of the consumer.

6 – Last is Dental coverage, both countries are on the same page. There is not much difference in terms of dental services.

Cskopecce. (2019, April 09). Comparing the US and Canadian Health Care Systems: 4 Differences You Need to Know. Retrieved from https://www.sgu.edu/blog/medical/comparing-us-and-canadian-health-care-systems/

Piper, K. (2019, April 12). India’s poor don’t want money – they want health care. Retrieved from https://www.vox.com/future-perfect/2019/4/12/18306457/india-poor-money-health-care-cash-transfers

Health systems comprise of people, institutions, and resources to meet the health needs of populations. With a robust adjusted health system’ that seeks to meet the needs of different individuals, countries can focus on prevention, diagnosis, treatment, disease control, violence prevention, and improving individuals’ physical or mental health needs. Countries with efficient and effective access to quality healthcare systems have better health outcomes that identify care variations, reduce per capita cost, and improves patients experience and overall population health. According to the World Health Organization (WHO), access to quality health care requires governments to ensure all individuals receive universal health coverages that promote services without financial hardship. I believe the burdens of financial cost, access, and unequal systems have negatively affected developed and developing nations. How can we address such issues to improve health systems worldwide when governments do not accept their methods are failing. Therefore, collaboration and contributions from all parties are needed to strengthen health systems worldwide. Despite knowing this, I question what classifies as an excellent healthcare system? Through research, I came across WHO’s critical components to improving health care systems. Not stating it works. However, it’s a start.  

WHO’s key components of a well-functioning health system include:

• Improving the health status 
• Defending the population against what threatens the health
• Protecting people against the financial burdens of health
• Person centered-care
• Including people n decision-making

I believe these critical concepts described are essential for improving the needs of populations. However, the achievement of a well-functioning health system is proven to be challenging. Many health systems worldwide fail to meet the critical components mentioned above, and that failure leads to adverse health outcomes. In the United States, which is considered a high-income country,  describing and understanding tits healthcare system can be challenging, yet there are some advantages and disadvantages. I solely believe we have some strengths-based on the Affordable Care Act (ACA) provision. Some strengths include but are not limited to;  

U.S. System’s Strengths: 

•  If insured, high-quality service is available.
• Great clinical research
• Technological breakthroughs for disease diagnosis, prevention, and treatment
• Physicians and specialist accessibility (based on geography)

Based on these system’s strengths, if you have access to health insurance, the services received(based on race and socioeconomic status) benefit consumers. Also, the U.S. advancement in research has made them influencers in disease control and prevention. Lastly, Individuals living within a location with access to care benefit from the U.S. health system because the timeliness of care is essential to eliminating adverse health outcomes. Perhaps a pregnant woman lives miles away from the hospital and is experiencing pregnancy-related health complications; she becomes a high risk for maternal mortality and morbidity due to transportation or access to services.

With the evolution of technology, research, and medicine, access is a factor in inequalities, which causes significant weaknesses within the U.S. health systems.

 Disadvantages: 

• Lack of universal health coverage
• More spending on healthcare
• Adverse health outcomes
• Inequalities between low-income communities/cultural competency                                             In the U.S., the ACA aims to provide near-universal coverage, but without state-level expansion of healthcare, inadequate coverage to disadvantaged communities remains a concern. Universal coverage is essential; it ensures healthier people, poverty reduction, and improves health inequalities. Inequalities have been a historical factor in how individuals perceive health systems. For example, although decades ago, the U.S. Public Health Service Syphilis Study at Tuskegee still plays an integral role in the perception of research and vaccination amongst minority populations. In this study, a federally funded experiment conducted on African Americans with syphilis in rural Alabama would reveal that researchers withheld treatment and informed consent of the risk to over 400 men. Researchers’ negligence despite their knowledge of the drug penicillin used as a treatment of syphilis led to numerous African American’s deaths. According to the Centers for Disease Control and Prevention analysis, minorities are dying at a higher rate than white Americans from the COVID-19 virus. Therefore, public health officials addressing the mistrust stemmed from mistreatment related to the Tuskegee syphilis study might increase vaccination acceptance amongst minorities.

Despite having the most expensive health care system, the U.S.  ranks lower than other developed countries. I spoke to a friend who lives outside of London, and he stated their health system was better than the U.S. 

U.K. Healthcare System: 

• Free healthcare from National Health Service (NHS)
• Widespread accessibility
• Promotion of human rights/equality
• Improve public health.

These factors noted the encouragement of widespread accessibility, universal healthcare, and a better chance to dispel adverse health outcomes amongst communities. The NHS publicly funded healthcare system focuses on community health and well-being versus financial consequences. Because the Department of Health is responsible for the healthcare and funding in the U.K., they evaluate what works continually or not. Although inequalities exist, U.K. has made efforts to reduce health inequalities by strengthening universal primary care services through the NHS. They grew the health budget, reduced the infant mortality rate, increased life expectancy, and promoted vaccination.

These initiatives have allowed the U.K to be successful; however, there remains room for improvement. 

Disadvantages: 

•  Frequent changes
• Lack of options
• Lower wages for medical professionals
• Longer wait times/ low services

 Universal coverage has its advantages, yet as with any system, constant improvement is needed. Individuals who need to receive care find the process daunting because of long wait times. Often, the care is not the best, partly due to medical professionals’ low wages. Care usually mimic the national public health performance standards; however, it does not. For many professionals, compensation is essential to the quality of care. From previous experience working overseas, many of my colleagues stated they found it easier to purchase private health insurance coverage due to the quality and timeliness of care. 

Therefore, what equates to a sound health system? As we compare countries, health systems appear complex and challenging. There is no easy fix. However, I believe global collaboration may assist nations who health care systems have more significant disadvantage than advantages. The cost of care, medicine, technologies, and quality access to care is a significant factor for why the health system is not well functioning.

In the past year, our world experienced something that many would have never thought would ever occur…a global pandemic. The Coronavirus or as some would like to abbreviate it as COVID-19, became an enemy of the world and with that has caused strain on healthcare systems and economies on numerous countries across the globe (Peter G. Peterson Foundation, 2020). As great as America is, it is no exception and we got hit relatively hard by this. Did the American population have a fighting chance before being attacked by this microscopic enemy? Although we have a “healthcare system” in place, was it good enough to support our population?  How did we do compare to other countries, say Germany to be specific? For the remainder of this blog, I shall discuss a comparative analysis of how our healthcare system (i.e., The United States of America!) compares to Germany’s healthcare system prior to the 2020 coronavirus pandemic.

               The United States of America although a very young country compared to the rest of the world, has made a name for itself and progressed enough to be a top tier country. It also stands out in many ways compared to the rest of the world from its government, the melting pot of our society, the fact we use the imperial system of measurement and specifically our topic of discussion, our healthcare. The United States has no single nationwide system of health insurance, but instead a combination of health insurance provided by the government and private marketplace (Ridic et al., 2012). Most of the health insurance purchased in the United States is comprised of employer-based health care coverage (Ridic et al., 2012). Germany on the other hand has what is known as a dual public-private system (InterNations GO, 2012). In Germany it is mandatory to have some form of health coverage whether it is public health insurance or private health insurance (InterNations GO, 2012). Just like in the United States most employers supply insurance to their employees, however when deciding insurance plans in Germany, it is completely transparent which is a huge advantage, but we will get to that later. Germany has free public healthcare, but it only covers ‘” medically necessary” care which is funded by their social security, and the purpose of the insurance policy is to cover hospital and outpatient medical treatment (i.e., pregnancy) (InterNations GO, 2012). Compared to the rest of the Organization for Economic Cooperation and Development’s (OECD) which has maintained a gross domestic product (GDP) spending of roughly 11%, in this case Germany with 11.7% for healthcare spending from 2010 to 2019, America on the other hand has increased spending from 16.3% to 17.0% (Peter G. Peterson Foundation, 2020). Figure 1 illustrates this by comparing how America is nearly doubled that of 9 other OECD countries. You can how with America’s GDP of ~17%, it increases the OECD average. On Figure 2 we get a little more in depth by looking at how the United States spends nearly twice the average per capita healthcare spending (Peter G. Peterson Foundation, 2020). Figure 2 compares how the United States is nearly double that of Germany (approx. $4,426) by average per capita costs of healthcare.

Figure 1: Healthcare Expenditures in the United States are significantly higher than those of other developed countries.

Figure 2: U.S. per capita Healthcare spending is almost twice the average of other wealthy countries.

Now does spending more than other countries mean we are better, well not exactly, but there are pros to higher spending in our healthcare system being high quality of healthcare services, minimal waiting lists for major procedures, different Medicare options, and adequate number of resources (theclintoncourier.net). If you have the money to pay for premium health insurance, we have the right care for you. By absorbing more money from higher insurance plans, patients get access to more advanced medical facilities and overall better health care from advanced equipment to highly qualified doctors. This in turn due to high costs of medical care under America’s direct-fee system, medical facilities in the United States are equipped to battle a variety of diseases and illnesses (theclintoncourier.net). Having adequate resources and options for different Medicare plans are bonuses that allow individuals or families to decide on what they will need and what they can afford. Along with the higher spending comes lower wait times at hospitals, due to the amount available per population size in each area. The United States compared to other OECD countries have some of the lowest wait times to see a surgeon or specialist (theclintoncourier.net).

With pros comes some of the cons of America’s high spending healthcare system. These would include limited insurance coverage, lack of transparency, no preventative care and the big one being how expensive our healthcare costs us. It is no surprise by now that the rest of the world knows we spend a lot on everything, but do individuals really spend a lot on their care? The answer is yes, Americans pay high premiums for their insurance with out-of-pocket costs, and if individuals do not have insurance well then, they still must pay through fee for service plans. The standard plans Medicare (government insurance) offers, is not always enough to cover costs and American always worry about going bankrupt due to high medical bills (theclintoncourier.net). Lack of transparency is a big deal as well, because with having high costs and limited insurance options, people also must guess on what their cost of care will be. Peoples lack trust in the medical system in America, is their because they “don’t know what they are buying” when getting treated. To add icing to the cake after all the bills and high costs are taken care and treatment has been administered, the physicians or surgeons do not advocate for preventative care to ensure the reason for the patients visit does not happen again. By not educating or offering quality follow up services, patients especially older patients tend to have to be seen repeatedly thus billing insurance again and again (theclintoncourier.net).  

Now that we know the pros and cons of the American healthcare system, how does this compare to Germany? The benefits of the German healthcare system are decreased number of prescription dependencies, does not have a 100% socialized single-payer system that most Americans fear, reasonable cost for hospitals and prescription drug co-pays, ability to purchase private insurance, no penalty for switching from public to private insurance if employed, high quality care and doctors are readily available (Gaille, 2019). Most of the pros are simple enough to understand, but what is meant by not having a 100% socialized single-payer system? In Germany you still pay for health insurance, however the individuals who are excluded from paying, but still receive medical care are elderly, disabled, unable to work, or individuals living in poverty (Gaille, 2019). This is because of their limitation to afford insurance, but to the German population that should not exclude them from receiving quality medical care like the rest of the population.

There are downsides to the great healthcare system in Germany however, being; doctors do not make as much money, limited distribution of medications, private insurance does not always cover pre-existing conditions, mandatory public health insurance unless you do not qualify, and it is illegal to not carry health insurance if you live in Germany (Gaille, 2019).

References

Gaille, L. (2019, April 21). 19 Pros and Cons of German Healthcare System. Vittana.org. https://vittana.org/19-pros-and-cons-of-german-healthcare-system

InterNations GO. (2012, November 22). Health Insurance and the Healthcare System of Germany Explained. Internations.org; InterNations GO. https://www.internations.org/go/moving-to-germany/healthcare

Mills, A. (2014). Health Care Systems in Low- and Middle-Income Countries. New England Journal of Medicine, 370(6), 552–557. https://doi.org/10.1056/nejmra1110897

Peter G. Peterson Foundation. (2020, July 14). How Does the U.S. Healthcare System Compare to Other Countries? Www.pgpf.org. https://www.pgpf.org/blog/2020/07/how-does-the-us-healthcare-system-compare-to-other-countries

Ridic, G., Gleason, S., & Ridic, O. (2012). Comparisons of Health Care Systems in the United States, Germany and Canada. Materia Socio Medica, 24(2), 112. https://doi.org/10.5455/msm.2012.24.112-120

The Clinton Courier. (2020, September 14). The Pros and Cons of the US Health-Care Model (the Direct-Fee System). The Clinton Courier. https://www.theclintoncourier.net/2020/09/14/the-pros-and-cons-of-the-us-health-care-model-the-direct-fee-system/

Tikkanen, R., & Abrams, M. (2020, January 30). U.S. health care from a global perspective, 2019: Higher spending, worse outcomes? Www.commonwealthfund.org. https://www.commonwealthfund.org/publications/issue-briefs/2020/jan/us-health-care-global-perspective-2019

           Australia and the United States are two very different countries. They are far away from each other, have contrasting fauna and flora, differ immensely by population, and have vastly different healthcare systems. The United States has a population of 331 million people, compared to Australia’s population of 25.5 million people.

According to the United States Census for 2018, 8.5% of Americans, or roughly 28 million people, did not have health insurance for that year. When it comes to health services, each of these countries offer great medical services as well as very advanced technology to treat communicable and non-communicable diseases. With that in mind, they both have very different healthcare systems. I have lived more than a decade in both, and my experience in each country has definitely opened my eyes to how they and the world operate.

Australia has a national public health insurance scheme in which taxpayers pay an estimate of 2.0% tax levy to Medicare. The United States has a pluralistic health care delivery system provided by many distinct organisations.

This includes private health insurance as well as public health coverage, such as Medicare and Medicaid.  In this blog, I want to talk about the similarities and differences between the health system of these two countries.       

        Australia has been able to provide Medicare, which is safe and affordable, for every person that is resident of the country. The Medicare program in Australia has been designed with the cooperation of the federal, state, and local government. The Federal and the State Government of the United States provides Medicare for retirees and Medicaid for people of low income, and employers provide private health insurance to Americans.  Australians have an abundant number of primary health physicians who are easily accessible for children to receive regular check-ups as well as all the necessary vaccines.  American residents can visit a general physician, or they can directly visit a specialist of their choice. The Medicaid program allows patients to visit the general practitioner first. In Australia as well as in the United States there are a number of hospitals that are private and public throughout the metropolitan areas. Both countries have in urban areas a number of doctor clinics for wellness programs for children to get their regular vaccines. Australian women have prenatal and postnatal care available at their local clinic, or they can visit the hospital where they plan to deliver their babies. American women have access to prenatal and postnatal care with a doctor of their choice or regular clinic if they have Medicaid.

Pharmaceuticals Benefits Scheme which is run by the Australian government provides affordable medicine coverage to all Australians who have Medicare. This scheme subsidises a number of approved medications and allows anyone the ability to afford their medication regardless of its actual cost. The United States has the best pharmaceutical research in the world with advanced technology. Therefore, Americans have access to the latest medical inventions and pharmaceutical discoveries.

Since everyone has Medicare, Australian’s are required to go on a waitlist for specialist visits. When a person needs to see a specialist, he or she may sit on a waiting list for about 3 months to 2 years depending on the problem and the specialist type. In contrast to the Australian Medicare program, health insurance in America is not provided equally to all.

The unemployed and people below the poverty line can only get access to government programs. The rest of the population can access better programs with large choices of healthcare providers, specific medical exams, hospitals, and other facilities. Another major hurdle with the medical system in Australia is that the outback of Australia has less access to medical facilities. Therefore, aboriginals may have less opportunities of preventative care. Doctors visit rural areas only periodically in intervals of three months to provide wellness programs. In the United States, the big issue is Racial inequality in terms of medical coverage. Minority groups have less access to private health insurance. They have less opportunities to visit doctors of their choice if they have Medicaid.

The Australian health care system fails to provide coverage for dental and vision, which are considered optional to the Medicare program. In America the dental and vision health coverage is provided by private insurance but it is very expensive. Through the pharmaceutical benefit scheme, medications can be price capped, but newest medications are not readily available to all Australians. American’s pay a lot for their medicine, there is not a cap system and pharmaceutical companies can price their medicines more freely.

Another weakness in theUnited States health system, is the cost of insurance, high premiums, out of pocket expenses, and co-pays are all very high. There are not

regulations to cap or to reform the way insurance companies charge and calculate their fees. Federal and local regulations are not coordinated well in supporting and monitoring the quality, cost, and effectiveness of health services. Federal and local government are not monitoring charges and services equally; and there is not control on who can charge one price or the other.

        From my personal experience with both countries, I conclude that Australia’s Health system is better. There is a better coordination between Federal, State and Territory, and local government. The Australian government has improved the standard of living by allocating more resources to the medical system per capita. They monitor the efficiency of each program at state level. They are more inclusive with minority groups such as aboriginals and pacific islanders, because they provide them with specific programs exclusive to their needs. They also make an effort to reach rural areas of the country with the Royal Flying Doctor Service, a program in which a doctor visits rural area via airplane to give preventative and wellness care to people in remote areas of the country. The Australian Medicare program is comprehensively and universally accessible throughout the country regardless of the geographical area in which a person lives. In this way, most of its citizens have fair and equal access to affordable healthcare services, and medicine thus, keep them healthy and economically stable.