Comparative Analysis of Healthcare Payment Systems for ACA Reforms

This paper investigates how learning from international healthcare systems can guide reforms in the U.S.'s Affordable Care Act (ACA). It highlights the potential benefits of examining models from countries like China, Canada, the UK, and France. By understanding different approaches to healthcare payment systems, policymakers can gain a broader perspective on improving the ACA's effectiveness in delivering accessible, high-quality, and affordable care. The analysis suggests that incorporating successful elements from these international systems could address existing gaps in U.S. healthcare policy, such as insurance coverage for all hospital and physician services, equitable policies, subsidies for affordability, and a focus on patient-centered care.

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Running head: HEALTHCARE PAYMENT SYSTEMS
Healthcare Payment Systems
Name of student:
Name of university:
Author note:

HEALTHCARE PAYMENT SYSTEMS
To: Congressional Committee
From: XXXX
Date:
Place: Washington DC
Sub: Reforms in ACA based on experience abroad
The Affordable Care Act is the most important health care legislation enacted in the
United States after the introduction of the Medicaid and Medicare in 1965. The law focused
on comprehensive strategies to bring improvement in the accessibility, quality and
affordability of healthcare. The Act might have made significant progress towards the
challenges coming up in healthcare. Despite that changes made, there is still a lot of scope for
improvements, and comprehensive reforms are welcomed at present. Policymakers must
build on progress brought about by the ACA through continual system reforms. Complex
change is unsuitable at the moment; however, a guiding point is to be narrowed on to that
would supervise these reforms, such as experiences abroad. For bringing reforms in the ACA,
the US must take lessons from relevant experience abroad (Barr, 2016). This paper addresses
how can learning from abroad help policymakers engage in the process of self-examination
of health policy at home. It also highlights what the members of Congress should know about
other country’s problems and aspirations, such as China, Canada, the UK and France in
health policy. Lastly, it discusses the lessons from abroad that are relevant to reform of ACA.
The key aspect to be drawn from international comparisons regarding healthcare
system’s performance is that there is a prevalence of workable alternatives to the present
system of US. Examination and learning from abroad might help policy makers gain a ‘gift of
perspective’ and have a better understanding of own system. A comparison could be made in

HEALTHCARE PAYMENT SYSTEMS
an effective manner. Policy learning would be a process of self-examination in which
reflection would be done on the features of the country and look into those of others. The
characteristics that are there in common between the US and other wealthy countries and
those that are not common can be highlighted appropriately. The experience and learning
from abroad would be valuable insofar since it is capable of prompting a process of critical
introspection through expansion of what is there at preset and what can be done in future. The
learning would be an adaption to local circumstances with the focus on the original.
Comparing the health care system of US with those of other wealthy countries would
be a desirable approach. China is a country that is quite different from the US and the focus
on comparing the US’s system with wealthy countries such as China can draw on the
experience of those who study economic trends and collect health data from a diverse
countries. China has a large population who have been known to benefit hugely from the fast
economic growth in the last two decades and has been successful in providing access to state-
of-the-art medical care system. China has a striking contrast with the US in relation to
national investments. The national investments in medical care and public health are very
small in comparison to other OECD nations. In addition, the out-of-pocket payments are a
representation of almost half of the health care expenditure. This insight is to be taken and
incorporated into the system of US for benefits (Blumenthal & Hsiao, 2015).
Special attention is also to be given to other countries such as UK, operating a
national health service (NHS), and France and Canada, having national insurance systems
(NHI). Though UK has the NHS which is one of the most reputed public systems in the
world, it is also known to provide the public with opportunities for private practice, private
hospitals and private insurance. When it comes to comparing the US with Canada, the
reasons for doing so are physical proximity between the two countries and similarity between

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the political culture. The financing systems and healthcare delivery systems of the two
countries were identical till the 1960s. It is to be noted that Canada has led to a better heath
outcomes in a consistent manner as compared to that of US. This is reflected by the fact that
Canada spends 11.2% of its gross domestic product on health care while the US spends 17.6
percent. This is a learning source for the US (Mossialos et al., 2015). The key point to be
drawn from the heath care system of France is that there is a possibility to have a universal
coverage in the absence of a single-payer NHI system. The French experience is similar to
that of UK and Canada where such universal coverage prevails (Shi & Singh, 2014).
The lessons from abroad are relevant to reform ACA in the US. It is found that other
countries perceive healthcare to be more than a matter of medicine and money. It is an apt
expression of the core national values. Based on this approach the US would need to have a
change in ACA, so that supports such vision. A federal requirement is needed in the US that
provides insurance for covering all hospital and physician services, something that has been
lacking at present (Obama, 2016). Each part of the country needs to have provision for free
point-of-care treatment to the individuals and there must be one central payer for the
comprehensive services guaranteeing coverage for a package that is agreed-upon and
essential. Changes in the rules of the ACA are to be coupled with the individual mandate. The
focus would need to be on the insurance companies who are to provide equivalent policies to
all individuals at a similar rate, and no variation is to be tolerated. There is no need of
cancelling polices or excluding the pre-existing ones. Risks can be taken upto a certain limit.
For making this approach work, a representative is to be enrolled from the representative
cross-section of the population so that the average risk from the new policies can be
highlighted at initial stages. This can be done by engaging the whole country and getting
maximum participation (Rhodes et al., 2016).

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The idea of compelling everyone to purchase an insurance might be nonsensical as
many might not be in a position to afford it. Therefore, major subsidies are to be included in
the ACA. Lastly, true reform of the ACA would be possible if there is a redesigning of the
care with focus on patient and not heath care settings. In addition, financial incentives would
need to reward desirable health outcomes rather instead of filling of hospital beds. Access to
information is also to be made better (Folland et al., 2016).

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References
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