Healthcare Delivery and Reform: A Comparative Analysis of Australia, United Kingdom, and United States of America

This article provides a comparative analysis of healthcare delivery and reform in Australia, United Kingdom, and United States of America. It discusses the structure, functioning, and governance of the healthcare system in each country, as well as key healthcare system reforms. The article also critically analyzes why the United States of America lags behind in healthcare delivery and reform compared to other countries.

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Healthcare Delivery and Reform
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Healthcare Delivery and Reform
INTRODUCTION
Structure and functioning of the Healthcare system in Australia
The Australian healthcare system is very complex in terms of the roles as well as
responsibilities across all the levels of the government. This is because in Australia, there is the
federal system of governance that is supplemented by the national or rather the commonwealth
government and the six states of territories. At the federation level, the responsibility of health
falls within the states. However, it is the commonwealth government that is responsible for
raising the revenue (Keirns, 2017). This therefore implies that the States still rely on the
commonwealth government for funding. Besides, the structure of the healthcare system in
Australia is further complicated by the fact that there is a complex interplay between both the
public as well as private sectors. The source of funding in the healthcare system in Australia is
through general taxes from the citizens. Besides the general taxation, there is also a specific form
of tax geared towards the healthcare system and is known as the Medicare levy. This however
only raises a small fraction of the finances. In Australia, the Healthcare system also relies heavily
on the out of pocket payments which contributes 17% of the total expenditure (Mossialos,
Wenzl, Osborn, & Sarnak, 2016,). It is however the government that provides a junk of the
expenditure at 43% through the commonwealth government as explained earlier. The remaining
25% of the expenditure is from other levels of the government. Since the Commonwealth
government is the gigantic in expenditure towards the healthcare system, it makes it the
dominant force when it comes to policy making.

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In the Australian Healthcare system, State as well as Territory Governments own and
operate all the public hospitals. Besides, the government also offer services like mental health,
dental, health promotion, school health and finally community based health programs (Squires &
Anderson, 2015). The good thing about the healthcare system in Australia is that there is an
agreement with the commonwealth whereby all citizens are subjected to free treatment as public
patients in all public health facilities. Public hospitals can admit private patients who have the
freedom to choose their preferred doctors. Public patients on the other hand work with Doctors
who are assigned to them by the hospital. Emergency departments are located in all public
hospitals. The teaching and research departments are however found only in very large public
hospitals.
In Australia, it is the role of the Pharmaceutical Benefits Scheme to provide subsidized
drugs at lower prizes to welfare recipients. The Pharmaceutical Benefits Scheme was set up more
than fifty years ago and currently it is estimated that close to 600 different drugs in around 1500
formulations are covered by the PBS .Of all the drugs, more than 90% of the prescriptions are
written within Australia (Paolucci, Paolucci, & Ergas, 2011). Regardless of the cost of drugs
patients receive, they make a set of co-payment services. It is the role of the Government to
negotiate the prices of the drugs with the pharmaceutical company. Besides, Australia was the
pioneer countries to introduce a necessary need for comparative effectiveness as well as the
economic valuation.
Governance of the Healthcare system in Australia
The governance of the health system in Australia is under the Australian Government, the
state and the territory government health ministers. The relevant health minister is the one who is

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particularly responsible of managing both the individual national as well as the state and territory
health systems.
Collectively, these health ministers are known as the Health Council under the leadership
of the Council of Australian Government. This is termed the highest intergovernmental forum in
Australia. The Health Council has the responsibility of providing a forum through which
cooperation on matters concerning health more so the primary and secondary care are concerned.
The Health council also considers raising cost pressures ("Healthcare Information Management
Systems," 2016). In support of the Health Council is the Australian Health Ministers Advisory
Council which is made up of heads of the Australian Government Health Departments, the states
as well as well as territory health departments.
Key Health Care System Reforms in Australia
The bigger political context
There are different healthcare reforms in Australia. One such reform is the introduction of
an array of policy initiatives with the aim of increasing participation in private health insurance
and this include government funded rebate for premiums, the Medicare Levy Surcharge and
finally the lifetime Health Cover. After the elections, the prime minister did indicate to review
different sectors with the health sector being among them.
Priority areas for health
The current ruling party in Australia known as the Australian Labor Part has prioritized
different areas for health. Some of the areas include implementation of national drugs strategy
with the aim of preventing potential drugs abuse. The other key area is integration of current
technology in providing healthcare services and better management of patient information. Focus

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on the wellness promotion as well as prevention of chronic disease is a key area that need
priority. Improvement of the Medicare as well as the public hospital system is at the top of the
agenda for the ALP.
Broad Health Sector reforms as well as review since 2008
There were reforms and review activities set up in 2008 with the view to reviewing the
Australia Health Care system and they include the National Health and Hospitals review that was
set up in 2008 to provide long term reform plan in the dent care, governance reforms, data
collection and finally the electronic health record. The national preventative health taskforce as
well as the National primary Health Care Strategy and finally the Public Reporting and Federal
funding arrangements reforms have been in existence since 2008 with different objectives.
Structure, functioning and governance of the healthcare system in United Kingdom
In the United Kingdom in countries like England and Scotland, it is the Department of
Health that has the mandate to run the National Health System, the social care as well as the
public health and delivering policies related to the healthcare. The Ministry of health is also
responsible of securing resources as well as monitoring the performance and setting of the
national health standards. In the United Kingdom, there are currently 10 strategic Health
Authorities that are responsible in managing the National Health System at the local level as well
as the Primary Care Trusts (PCTs) that are responsible for controlling 80% of the National
Health System budget (Cadogan, 2012). The Primary Care Trusts also offer governance as well
as different commission services. They also ensure that services for public healthcare are readily
available and they provide community services as well. However, there is a proposal in the white
paper that will see the abolition of the SHAs and PCTs. The National Health system Trusts in the

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United Kingdom usually operate on a basis that involve payment by results and most of their
income are from providing healthcare which has been commissioned by the Practice based
commissioners as well as the PCTs. There are different types of trusts in the United Kingdom
Healthcare and they include Acute, care, and the mental health, Ambulance and finally the
Children’s and Foundation Trusts. However, the Children’s and Foundations Trusts were set up
as nonprofit making entities and they are free from the control of the Government. Besides, they
have increased financial obligations and it is the independent monitor that regulates them.
The Adult social care and Health in the United Kingdom are independently regulated by
the Care Quality Commission. However, there are different specialized bodies that offer
financial, treatment and professional regulation. The particular bodies are the Audit commission
and National Audit office for financial services and the National Patient Safety Agency and the
Medicines and Healthcare Products Regulatory Agency for treatment services (Newton et al.,
2015). Finally, the British Medical Association that is responsible for professional regulation.
In England, the National Institute for Health and Clinical Excellence was set up in the
year 1999 and the objective of the institute was to develop different guidelines as well as
standards that relate to health, promotion and prevention, assessment of different new and
existing technologies and treatment and care clinical guidelines that are available across the
National Health System (Sørensen et al., 2015). The National Institute of Health Research is
currently implementing the health research strategy of the National Health System with a budget
of $1 billion allocated for that purpose.
In section 242 of the National Health System Act, it is stated that trusts have the mandate
to engage as well as involve the patients and the public. The feedback about patient experience is
gathered nationwide through a survey that is conducted on an annual basis and this forms part of

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the National Health System Acute Trust and performance framework (Exley, Karanikolos, Mays,
& Nolte, 2014). Feedback and involvement are supported by the Patient Advice Liaison Service
as well as the Local Involvement Networks. Generally, both the inpatient and outpatient surveys
have indicated that the patients rank the services they receive from the National Health System
very highly and actually three quarters of the response have been either very good or excellent.
Trusts have already replaced the National Health System in Scotland and they offer
integrated system for strategic direction, performance management as well as the clinical
governance. In Wales however, it is the National Delivery Group that perform these same
functions. The Scottish National Health System as well as the Special Boards deliver services but
the care for particular conditions are provided through managed Clinical Networks ("Economics
of Health and Health Care," 2016). The Scottish Intercollegiate Guidelines Network publish
clinical guidelines while the Scottish Medicines Consortium provide advice on how to use new
drugs in the Scotland National Health System. In Wales on the other hand, it is the Local Health
Boards that is responsible for planning, securing and delivering different healthcare services in
their localities and actually there are three National Health System Trusts that offer emergency,
cancer care and the public health services nationally.
In Northern Ireland, it is the Health and Care Board that single handedly oversee the
commissioning, performance, resource management and finally improvement of the healthcare
sector. It is the six health and social care Trusts however that are responsible for delivering the
mentioned services. Besides, there are different health agencies that are responsible for
supporting ancillary services and dealing with different health and care issues like cancer
screening, blood transfusion and public health services. In Wales, it is the Wales Community
Health Councils which is a statutory body that is responsible in advocating for the interests of the

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public in the healthcare sector in their district while in Northern Ireland, it is the Patient and
Client Council that represent patients, clients as well as cares.
Structure, functioning and governance of the United States of America Healthcare system
The structure of the healthcare system is centered on different stakeholders. The different
stakeholders include the regulators and policy makers, the payers, different advocacy
organizations, the providers and suppliers and finally the consumers. Just like other different
countries, both the public as well as the private insurers exist in the health care system of the
United States of America (Anderson, Chalkidou, & Herring, 2012). The system is however
unique from the rest due to the fact that it is the private element that dominates over the public
element.
A case study conducted in 2013 for example found out that 62% of non-elderly Citizens
of America got private employer sponsored insurance while 5% bought insurance on the private
market. However, 15% were on the other hand enrolled in different programs that include
Medicaid.18% on the other hand were uninsured ("USA - New inventory of HHS quality
measures released to improve public- and private-sector performance measurement efforts,"
2009). The good thing about the health system in the USA is the fact that those with 65 years and
above are enrolled in Medicare plans.
There are two public Health Insurance policies in the United States of America and they
include the Medicare and the Medicaid. The Medicare program covers all citizens above 65
years of age and is provided to the disabled as well. This program is administered by the
government and it is financed by the federal income taxes. There are three parts of the Medicare

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program, Part A that covers the hospital services and Part B which covers the physicians and
finally part D that provides a prescription drug benefit.
The Medicaid on the other hand is a program for the low income earners as well as the
disabled. It also cover pregnant women, children, the elderly and the disabled .It is administered
by the States and the District of Columbia and it is financed jointly by both the states and the
Federal government through taxation. Other public systems in the healthcare sector in USA
include the S-CHIP and the VA which is administered to the military citizens. The private Health
Insurance are also two and they include the Employer sponsored insurance and the private non-
group. Financing of the healthcare system in the USA involve two streams of money, the
collection of money health care and the reimbursement of healthcare service providers.
Reforms in the USA healthcare system
The former president barrack Obama narrowly won the battle against the health reforms
with focus on the National Health System. This was however met with stiff opposition from the
Republic party representatives. The National Health System is the system widely utilized in the
United Kingdom with countries like England leading at the fore front. The argument by the
Republicans is that the National Health System will mean more taxes to the citizens. However,
the National Health System would serve the poor communities since they will have free access to
the healthcare services. These reforms would however take some time as the expected time
frame is ten years and it is likely to cost the government a whopping $940 billion.

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Critical analysis as to why the health systems are different from each other.
Based on the comparisons made above, it is very clear that all the health systems in the
three countries are different from one another. The United States of America healthcare system
for example is very much private sector oriented than the public sector. This according to
analysis is due to the fact that in the United States of America, citizens struggle so much towards
self-provision. The struggle for self-provision therefore drives the country to design the
healthcare system in a way that people are responsible for their own healthcare plans that they
feel suitable.
The Australian healthcare system has both the private and public health system just like
the United States of America. However, both the private and public healthcare are held in the
same regards as opposed to the United States of America that dwell so much on the private
sector. In Australia, both the private and public health sector are held in the same esteem due to
the fact that Australians struggle for equity. The idea of equity is of very much value in Australia
and this is the underlying factor behind the difference in healthcare structure. There even exist
policies like adequate care to everybody in Australia despite the level of income, ethnic
background and social status.
Evaluation on the effectiveness, efficiency and equity of each health system
The health system of Australia is not effective enough. That is a judgement based on the
quality of services. In most cases, any service gains value when it is paid for. Looking at the
Health system in Australia where the commonwealth government funds the health system, the
services become degraded. The system is however good in terms of considering the poor as well
as the low level income earners since they have the chance to get access to any medical attention

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they wish for at no costs. That is why there was recent proposals on having the Government to
alter or reduce funding the healthcare system and adopt the private healthcare system efficiently
so as to improve on service delivery. The service delivery in healthcare in Australia still remains
relatively low and the waiting lists are so long as well and this makes it difficult to provide
different resources.
In terms of service delivery, the healthcare system in the United States of America is by
far the best as compared to the Australian and the health system in the United Kingdom. In the
United States of America healthcare system, the service delivery as well as the resources are of
the best quality. The waiting lists is very low and the variants are quite many. The best service
delivery is due to the fact that there is over spending towards the healthcare sector as a result of
the privatized system. According to the research in 2000, the United States of America is the
biggest spenders in terms of healthcare and this coincides exactly with improved quality in terms
of service delivery. The only disadvantage with the healthcare system of United States of
America is the fact that the unemployed or elderly may be denied a chance to quality healthcare
services due to lack of income.
In the United Kingdom, healthcare services are also paid for through taxation and not at
the point of service. The fact that healthcare is not paid for at the point of service also negates
that kind of healthcare system. There has been reports of long waiting lists in the healthcare
services in the United Kingdom which is the same case with Australia. There is no value for
money since it is not provided at the point of delivery. Based on this explanations, it is evident
that the best Healthcare system in the United States of America remains by far the best among
the three countries.

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Based on the descriptions, the Australian Health system is by far the most equitable form
of healthcare since it is the government that provides funds for treatment of every
citizen .However, the system is not efficient since there is no payment of the service at the point
it is being offered and that is why there are always long lines of patients at the hospitals.
The USA healthcare system is not equitable since it only favors citizens with high
income. However, the system is very effective and efficient due to the fact that the service is paid
for at the point it is being provided. Finally, the UK healthcare system is as well not equitable
since high income earners are highly taxed as compared to their counterparts. However, it is also
not effective and efficient as compared to the US healthcare system.
Description and Evaluation of proposals for reform in all the healthcare systems.
Apparently, one of the healthcare reforms in Australia is for the government to reduce or
alter government expenditure on the healthcare sector so as to adopt the over-emphasis on the
private sector. This is by far the best move by the government since there would be improved
service delivery like in the United States of America since services are only valuable whenever
they are paid for.
In the United States of America, there are reform policies to improve access to healthcare
services as well as reducing the costs of the healthcare services. Besides, there is a proposal for
public participation to reduce competition at the market places. This is according to the
affordable care Act in the United States of America. This reforms are however not healthy in
terms of the quality of the services. As explained earlier, any service is only valuable when it is
paid for and therefore reducing the costs of healthcare means reductions in expenditure and this

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will deteriorate the quality of the services to be adopted. I would therefore wish the United States
of America healthcare system to dwell on the private sector to maintain quality services.
In the United Kingdom, there are current reforms to increase the taxation of employees
since the current National Health System might crash to bankruptcy. This is a good move since
more tax means more revenue and expenditure towards the healthcare and therefore affordable to
all the citizens. However, whenever there are so much beneficiaries, chances are very high that
the general quality will fall considerably.
CONCLUSION
The structure and functioning of the healthcare system in United Kingdom, USA and
Australia are very different from each other. The healthcare system in United States of America
for example is private centered while that in Australia is equal both private and the public sector.
The United Kingdom healthcare on the other hand is more public centered in that funding is
through the National Health System through taxing the citizens. Based on their evaluations, the
healthcare system in the United States of America is by far the best in service delivery since
there is much spending. The healthcare system in Australia and UK are characterized by long
waiting lists since service are not paid for at the point they are offered. All the countries should
therefore learn from The United States of America and lean towards the privatization of the
health sector to improve the quality of service delivery.

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