How System (NHS) and National Health Insurance (NHI) are

How Learning from Abroad helps Policymakers


            When creating policies, it’s important for policymakers to educate themselves on strategies that are used abroad. Looking abroad at other healthcare systems can provide a window that enables the United States to develop a better understanding of our own health system. Looking at health care systems that have worked and failed can help policymakers choose which facets to include in their own policies. In regards to the United States, we have the most expensive health care system, but rank low in overall health system performance. Our top rated medical technology sets us apart from other countries, but we fail to provide universal health coverage (Knickman & Kovner, 2017). It can be tempting or easier to look inward rather outward when searching for solutions. However, that is not always the best choice as it limits the opportunity to discover innovative ways health care is implemented. Taiwan is a perfect example of what learning from abroad can do for a health system. They began looking into other health systems and borrowed certain practices that would fit their country. Since then, the country went from a dysfunctional health system to a more uniform one that provides health care to every citizen. Overall, looking abroad can only provide benefits and insight as the U.S. could pick the practices best fit for Americans.

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Difference between NHS and NHI Systems

            The National Health System (NHS) and National Health Insurance (NHI) are two health system models used outside the United States and vary in terms of funding source. The NHS is a single payer system and found in places such as the United Kingdom, Denmark, and Italy. NHS came into effect after World War II to replace volunteer hospitals that came to rely on government funding (Harrell, 2009). Appointments and treatments are free for the patient through tax payments. Individuals are taxed 18% of their payroll and the remainder is derived from private payments. National Health Insurance, also a single payer, was first established in Germany where it is currently used as well as Canada and Australia. NHI insures a national population through payroll-tax financing (Knickman & Kovner, 2017). In regards to Canada, their health care spending comes from corporations and the provinces supplement the taxes with additional funding (Knickman & Kovner, 2017). Both health models were developed under the premise of providing health care for all. The main difference between the two are the funding sources. NHS systems use government resources to operate the delivery whereas NHI raises the funds through payroll tax. NHI also supplements through the use of block grants accounting for 20% of expenditures. Compared the United States, NHS and NHI systems are based on the ability to pay where the U.S. is based on insurance premiums.

China’s Problems and Aspirations in Health Policy

            Similar to the United States, China has made substantial changes to their health care policies. In 2009, they adopted a health care reform that would provide health insurance to all their citizens. Prior to the reform, health care delivery in rural areas was run by communes providing services such as housing and medical care (Knickman & Kovner, 2017). The government then ended the services in rural areas after the introduction of market mechanism in the health sector leaving many without adequate access to services. The cities aren’t well off either. Only 57% of cities provide community based care and 40% of the population say it doesn’t have easy access to primary care (Knickman & Kovner, 2017). The Chinese government has vigorous health goals, but they fail to acknowledge how much ground must be covered to meet fundamental challenges. Many question what will be the tradeoff for the government and individuals.

Reforming the ACA using Lessons from Abroad

            The Affordable Care Act was passed in an attempt to provide coverage for the uninsured and has been a topic of debate since 2010. With a new White House administration, the fate of the ACA is uncertain. Since policymakers still agree on its effectiveness, it would be beneficial to look oversees for guidance on reformation. The Netherlands health care system would be the closest resemblance of what the ACA hopes to create for the U.S. (Cohn, 2011). Individuals in the Netherlands are covered primarily under private insurance made available to everyone regardless of preexisting conditions. The Dutch system provides everyone with high quality care at a cheaper price. Per captia health spending was $4,914 compared to $7,960 in the U.S. in 2009 (Cohn, 2011). The government also plays a central role in their health care, as a regulator and financer. Recreating their system, the U.S. would need to expand the government’s reach into health care beyond the expansion of the ACA (Cohn, 2011). The Dutch have also improved the access to urgent care, something that has plagued the U.S. A partnership with the government and medical societies developed a seamless network of urgent care centers providing services through telephone consultations and walk in centers. Today, the Dutch have some of the out of pocket costs compared to the rest of the world and report fewer hassles with insurance. 


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