Health Care Systems: Cross-national Comparison - Essay Example

?Health Care Systems: Cross-national Comparison Health care systems are the most important cornerstones of welfare s and are designed with the aim of meeting an individual population’s health care needs including but not limited to prevention of disease, provision of diagnostic, curative, rehabilitative, caring and analgesic services. Health care system entails an organized plan that links the agencies, facilities, and every other provider of health care in a given country. Recent literature has presented varied suggestions in trying to categorize the health care systems of countries. Health care systems are generally founded on specific political, historical, cultural and socio-economic traditions which make the organizational arrangements considerably different between countries, in this case Sweden and Germany. Each of the two systems attempts to address the citizens’ need for health and health however the extent to which the demand for health care appropriately reflects the actual population is an issue that arises. We cannot measure health in a direct way thus a variety of indicators for quantity and quality of health should comprise features of population and indicators of health such as life expectancy, morbidity and mortality. It is all under these criteria that cross-country comparison of healthcare systems of Sweden and Germany is carried out. The outline of health status indicators and outcomes can assist to approximate the quantity and quality of health care of Germans and Swedes. However, there is need to appreciate the fact that cross-country comparison of health care in the two countries is only applicable within the constraints of data availability and comparability. Healthcare System in Sweden The population of Sweden in 2011 was 9.4 million and has ranked above Germany in several key health indicators. It has consistently ranked at the top for nearly all health outcomes when compared to the German outcomes, with a particularly low infant mortality rate of three per 100,000 live births and a high life expectancy of 78 years for men and 82.8 years for women according to 2005 statistics (Anell, Glennga? and Merkur, 2012). Healthcare is seen as a fundamental element of the extensive Swedish welfare system where the whole population has access to a comprehensive variety of services and is covered by the National Insurance Scheme, funded mainly through employer contributions. The most outstanding feature of the healthcare system is the main role the twenty three county councils and the three municipal councils play. These councils majorly play a central role of ensuring that the system is efficiently planned, financed and delivered to the population of their respective territories. Inpatient care is approximately entirely funded by taxes collected by the country’s councils and delivered by hospitals that the councils run and own. The prominence of the Swedish healthcare system has long been on equity and has been rather successful in containing healthcare costs at a stable fraction of national GDP standing at 9.9% as at 2009 (Anell, Glennga? and Merkur, 2012). Sweden has been able to achieve these better-quality outcomes at a comparatively lower cost. According to statistical outcomes from 2002, Germany spends US$3635 per capita on health care whereas Sweden’s expenditure is lesser (US $2517) yet achieves vastly better health care. However, the system has faced some challenges that have affected its delivery of healthcare due to swindling financial resources. There have been oversupplies in hospital services caused mainly by the strong traditional emphasis on hospital care. The choices of patients are very limited and output and competence in healthcare delivery is a major focus for transformation. The provision of health care coverage in Sweden though universal, it is limited for residents to choose outside their registered counties when a referral is not needed. Within their own county council, citizens normally have the freedom to choice of where they wish to obtain healthcare. Referrals may be needed if a resident opts to obtain healthcare from a hospital that is located outside the home county, but those to specialists are not requisite within the council’s jurisdiction. The main health indicators, which seem to be strongly related to environmental factors and standard of living, are to some extent above those of Germany with an indication of a growing gap between health statuses as measured by social class. Health care delivery is likely to see a rise in demand due to the large and increasing percentage of the elderly in Sweden. By EU standardizations and averages, health status in Sweden is very high, apart from more than average cases of cardio-vascular disease. However there seems to be growing morbidity rates in previous years, as measured by the amount of sick leave and early retirement. Health issues are mainly linked to environmental factors and the style of living of residents. Evidence has shown that families with lower incomes, those without employment, single citizens and immigrants have poorer health than other groups. Financing The provision and funding of healthcare in Sweden is chiefly the public responsibility determined by the twenty three county councils and the three large municipal councils. The county councils are self-governing bodies elected through the ballot while the state government plays a limited role of providing a guiding agenda. The Association of County Councils plays a coordinating role of its activities of the county councils and those of the state government at all levels. The health care system in Sweden is highly decentralized and financed at the sub-national stage by county councils with money collected from domestic taxation. Moreover, county councils have the ability to control the provision of healthcare independently within loose structure sketched out by the central government (Burau, Theobald and Blank, 2007). The state in most cases employs the health care service providers while some or reimbursed for their services with taxpayers’ money on the basis of contracts. Patient access to services is subject to state regulations and restrictions, such as the requirement to use the services of a provider close to one’s place of residence, and also to prioritization schemes and waiting lists for certain services (Burau, Theobald and Blank, 2007) In Sweden, County councils cover most of the funding of healthcare by raising their own funds chiefly through tax while the remaining part of healthcare funding is from funds allocated by the state, private insurance and to a very small and limited extent from direct payments by patients. Reallocation of funds to cater for healthcare services between the national insurance system and the county councils takes place in two different ways; the councils obtain funds depending on the health care activity while the social insurance system refunds providers of dental care and outpatient care. In Sweden, hospitals have until recently obtained yearly funding that is calculated to cater for the cost of staff, drugs, supplies and equipment but in the nineteen eighties, budgets for clinical departments were also introduced. In 1998 there were significant deviations in the system of funding set up by the county and municipal councils. Some county councils have established procurement arrangements on the basis of contracts usually founded on prospective per-case payments. The county councils employ a majority of doctors either in the hospitals or in primary care centers and are remunerated by salary, with just a small number proportion involved in private practice and paid fee for- service. Remuneration of physicians is based on individual qualification and work schedule. Whenever patients spend on drugs from their own pockets for prescribed drugs, the expenses are reimbursed partly by the national health insurance when listed on a national formula (positive list). Primary health care in Sweden is an important and integral part of the healthcare system as it supports individuals and families in making sound decisions touching on their health. Sweden’s primary health care services are well coordinated and are accessible to every patient whenever they need advice on how to promote their health, prevent diseases, diagnostic advice and treatment among other services. Current Issues Despite Sweden being ranked above Germany and in fact as having the best health care system in the world, the system has some flaws mainly relating to care provision and coordination. The country’s hospitals provide an inconsistent share of primary care that is brought about by a deficiency in primary healthcare providers and the short working hours for doctors. Before the year 2005, there were widespread experiences of scheduling delays that exceeded three months for preplanned care including cataract or hip replacement surgery. The citizens expressed their discontent with the situation which led the county councils and national government to establish a care guarantee that promised that, if three months expired after the provider scheduled the necessary care, the patient had the freedom to obtain such care in another county and the home county would cater for both the care and any related travel costs. Coordination of care provision between the municipal and county councils is also difficult partly due to the decentralization of the system that has created varying levels of efficiency, quality and patient safety. Lastly, the funding system is becoming unsustainable as the quickly ageing population may soon not be supported by the income tax. There have been some structural and organizational reforms in regard to the Swedish health care system. The structural transformation of the Swedish health care system is an accumulation of varying steps taken in each of the councils and municipalities. Some of the most significant measures put in place, for example in the county of Stockholm, were primarily aimed at to boosting efficiency in service provision, introducing market orientation, increasing consumer choice and to reducing waiting list. German Healthcare System Germany, on the other hand, is a typical illustration of a corporatist health care system founded on the principle of social solidarity, decentralization and self-regulation. The corporatist health care system of Germany is a model system of compulsory social insurance and has not undergone major structural transformations since its foundations were laid by Bismarck in 1883, although it has seen significant expansion and elemental reforms in health insurance structure. Germany has 82.4 million residents with a life anticipation of 81.9 years in women and 78.7 years in men, outcomes, which are nearly similar to those, recorded in Sweden; however, based on other measures, quality in Germany is comparatively low, predominantly given the higher cost of the health care system. For example, in 2004, Germany spent US$3635 per person on health care totaling US$300 billion or 10.9% of the GDP compared to 9.9% that was spent by Sweden (OECD, 2007). The system has been able to attain a high level of comprehensive healthcare coverage with provision of equal access to a large number of medical services. These achievements have mainly been credited to the decentralized system of decision making and an efficient negotiation system between the service providers and third parties at the state and local levels. The financing of healthcare in this country comes from sickness funds which are collected as a fraction of the salary of the individuals covered. Those with salaries or monthly incomes that fall below a certain level together with the self-employed have the option of opting out of the system and seeking private health insurance coverage while the unemployed are fully covered by the state. The statutory social insurance system of Germany covers almost ninety percent of the country’s population (Green and Irvine, 2001) The sickness funds bargain healthcare delivery and refunding directly with providers on behalf of the patient but the patient is free to choose a preferred health care provider. The state plays both a regulatory role and legislatively determining a comprehensive catalogue of provisions to be covered by the insurance system and a structure under which the sickness funds and the health care service providers act independently. (Burau, Theobald and Blank, 2007; Busse and Riesberg 2004). In Germany, just like in Sweden, funding of healthcare comes from different sources including the compulsory and voluntary contributions to the statutory health insurance that covered almost 88% of the population prior to 2007, private insurance purchased by 9.7% and to a very small and limited extent from direct payments by patients (OECD, 2007). Public and private hospitals listed on plans recognized by the Lander, are funded by a two-way system that involves coverage of capital costs by the Lander and financing of operational costs by the sickness funds (Green and Irvine, 2001). There are standardized prices for pharmaceuticals in Germany with a majority of expenses on them being reimbursed based on a reference-price system which gives the doctor the freedom of prescribing a more exclusive produce but the patient has to pay extra when the amount of the approved medicine surpasses its reference value. The benefit package for social insurance is under the regulation of federal legislation and provides for the various benefits in kind including prevention of disease, screening for disease, diagnostic procedures, and treatment of disease, rehabilitation, and transportation of the patient. Current issues and challenges in health care The health care system in Germany however continues to face substantial challenges, the quickly ageing population, just like Sweden’s, presents a growing instability of the pay-as-you-go basis upon which social security is founded. Germany has one of the most expensive healthcare systems in the EU and surpasses Sweden in healthcare in terms of per capita spending, share of GDP (Busse and Riesberg, 2004). The cost of German healthcare calls for reforms that would ensure that cost-stabilization and efficiency is gained. There has been considerable debate regarding the country’s social insurance and given the growing financial deficit of the social insurance that has imposed great pressure on the economy, one prime focus of attention will therefore remain the balance of income and expenditure in social insurance. References Anell, A., Glennga?rd, A. H., & Merkur, S. 2012. Health Systems in Transition: Sweden health system review. 2012, 14(5):1–159. Burau, V. D., Theobald, H., & Blank, R. H. 2007. Governing home care: a cross-national comparison. Cheltenham, UK, Edward Elgar. Organisation for Economic Co-operation and Development. OECD. 2007. Society at a glance: OECD social indicators. Paris: OECD Publishing. Busse, R., & Riesberg, A. 2004. Health care systems in transition: Germany. Copenhagen, European Observatory on Health Care Systems and Policies. Green, D. G., & Irvine, B. 2001. Health care in France and Germany: lessons for the UK. London, Institute for the Study of Civil Society. Read More