Public policy and health in the UK and the USA

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Public policy and health in the UK and the USA

Odin W. Anderson in his article "Issues in the health services of the U.S." claimed that the United States of America and the United Kingdom occupy extreme ends of the market plus/ market minus continuum as far as their respective health systems are concerned. It is true that the U.S. system is market oriented, and that there is often a high degree of government intervention in the operation of the health system of the U.K., however, developments in both countries have arguably effected their position upon this continuum. It is the purpose of this essay to outline the key features of both the U.S and the U.K.'s health systems in relation to their evolution over time. I also intend to discuss the problems facing both systems, which are often remarkably similar, and to outline the variations in policy style employed to tackle such problems. In so doing I hope to make explicit what might explain the variations to be found when comparing the two countries systems.

The health system to be found in the United Kingdom is seen as a good example of the `direct' model of health care provision. It is a system of universal coverage paid for out of general taxation and administered by the state. Access to health care depends upon the need for treatment, and such treatment is free at the point of service. This system is both supervised by, and funded through, the Department of Health. However, approximately 14% of health care in the U.K. is privately funded. This takes two forms :- subscription to an insurance scheme, or payment upon receiving care. Such private sector provision of health care is part of he independent sector which also includes the contribution of voluntary and informal sectors in health care provision.

The other key players in the U.K. health system, besides the previously mentioned central government and independent sector are local authorities, who have retained two important health responsibilities i.e. personal social services and environmental health services, and the National Health Service. Prior to the emergence of the N.H.S. there was a mixture of private and public services. The private sector included voluntary hospitals whilst the public sector included a number of municipal health services. A series of reports in the 1920's and '30's, such as the B.M.A. report in 1929, exposed the failure of the health system in catering for the needs of those requiring specialist care. It is the second world war, however, and the dramatic expansion of government intervention in health services that came with it, that is largely credited with the creation of the N.H.S.. In 1945 the Secretary of State for health, Aneurin Bevan, opted for the nationalisation of the entire hospital sector within a tripartite system of health care provision. The N.H.S. has under gone a number of organisational changes over the years. Today it is made up of bodies such as the fourteen Regional Health Authorities who claim responsibility for planning services, allocating resources and overseeing the work of the N.H.S. within its boundaries. The District Health Authorities are responsible for assessing the health needs of those living within their boundaries. The ninety Family Health Service Authorities are responsible for managing family practitioner services within their boundaries. G.P. fundholders (who receive a budget for the cost of running a practice), self governing trusts and Community health councils also go to make up the structural organisation of the N.H.S..

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The American health system differs in many repects from the U.K. model. It has been advanced as a prime example of the market system. It is pluralist in the sense that there is no one single system as much of its funding comes from private insurance. Most American citizens have health insurance provided through their employment, although the employee is usually expected to pay for any dependents on the same scheme. Health insurers are largely non profit organisations. For those not in employment, principally the poor and the elderly, the medicare (for the elderly) and medicaid (for the poor) systems ...

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