Comparing Health Systems: Australia, UK, and US Population Health

This report provides a comparative analysis of the healthcare systems of Australia, the United Kingdom, and the United States, focusing on their governance structures, operational functions, and overall effectiveness. It begins by examining the distinct characteristics of each system, including the role of Medicare and the Pharmaceutical Benefits Scheme in Australia, the National Health Service (NHS) in the UK, and the hybrid public-private system in the US. The report then delves into the differences in health coverage, government spending, and political cultures that contribute to the variations in healthcare outcomes. Key aspects such as efficiency, effectiveness, and equity are evaluated, highlighting the strengths and weaknesses of each system. Furthermore, the report explores proposed reforms within each country and examines the implications of these changes on population health. The analysis underscores how factors like government involvement, political ideologies, and financial models shape the accessibility, affordability, and quality of healthcare, offering insights into the complex dynamics of these three prominent healthcare systems.

Running head: POPULATION HEALTH
Population health
Name of the student:
Name of the University:
Author’s note

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Introduction:
Health care system of different countries is a product of its culture, demographic, history
and politics. Every health care system has some diverse elements and some of the elements may
be better than elements of other health care system. Since the acceleration in health care demands
and complexity of integrative care models across different health care system, it is necessary to
understand link between governance structures and its impact on peak system performance and
operationalisation of a system (Hastings et al., 2014). This may help to understand the reason for
shifting to privatized health care system from public health care system. Although many people
describe Australian health care system as one of the best in the world, however there should be
some framework to measure and evaluate any health care system. This report also has a similar
focus and the main aim is to compare and contrast different health systems of Australia, the UK
and the US. After discussion on governance, structure and function of each of the systems, the
report also analyzes the effectiveness of the three systems by utilizing the analytical framework
of efficiency, effectiveness and equity. In addition, the report also gives an overview about the
reform proposed in each system.
Evaluate the governance, structure and function of each of the systems:
Australia:
The health care system of Australia is regarded as the most affordable, accessible and
comprehensive health care system in the world because of the presence of Medicare Benefits
Scheme (MBS) and the Pharmaceutical Benefits Scheme (PBS). It has combination of both
private and public sector health service providers. Medicare was introduced in 1984 and

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introduction of this scheme in Australia paved the way for universal access to comprehensive
range of health services. Although introduced in 1984, Medicare is still central to the Australian
health care system (Palmer & Short, 2000). Health services are mostly public-funded and
universal access to free treatment and subsidies are available in public hospitals and medical
services respectively. This implies that the main purpose of the health care funding system is to
increase access to health care for all and at an affordable cost (NSW Government, 2018).
The governance structure of Australia also plays a major role in providing universal
access to care. There are three levels of government existing in the country such as federal, state
and territory and local government (Taylor, Foster & Fleming, 2008). The federal government
has the importuning function of providing funding and developing national policies. It provides
findings to state and subsidies to health care providers through MBS and PBS, whereas the state
and local government have the responsibility to manage public health services. The state
government is involved in the management of public health and community health services and
the local government is involved in the delivery of preventive health programs (Duckett &
Willcox, 2015). With the presence of such governance structure, the life expectancy data of
Australia is strong, however the country is struggling with gap in health outcome of indigenous
and non-indigenous population.
UK:
The United Kingdom (UK) provides access to both public and private health care
services. Unlike universal access to free treatment in Australia, the health care coverage in UK is
free to the point of need and it is paid by general taxation. The National Health Service or NHS
founded in 1946, looks after the public health sector of UK. Before 1946, health care was

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available only for wealthy people, however with series of reformation, health care standards in
UK improved and health services became more affordable for people. The NHS is regarded as a
government-sponsored universal health care system which is formed by amalgamation of series
of public funded systems like NHS England, NHS Wales and Health and Social Care in Northern
Ireland. A study done for seven industrialized countries showed UK to be one of the most
efficient in the world and closely competing with Australia. The quality of care improved with
the increase in total national spending on health. Apart from public health sector, the private
health care sector is acquired by private health insurance and funded directly by customer or by
employer funded health care scheme (Chang et al., 2011). The Department of Health has the
responsibility to improve health and well-being of people and publish policies in their website.
On the whole, it can be said that the NHS is the main command and control systems that
promotes accountability within NHS. Reinforcement of centralized funding and shared values of
free access, equitable access and universality reflects the quality of UK health care system
(Peckham, 2014).
US:
The health care system of US is a hybrid system consisting of both single-payer and
multi-payer universal health insurance system. Health care fundings come both from private
sector and governance structure (Squires & Anderson, 2015). Hence, it can be said that financing
responsibility of the US health care system is shared both by private insurance companies and
the government. From this perspective, U.S health care system can be said as a multi-payer
system. The government used fundings from Medicare and Medicaid to reimburse health care
providers and the private insurers collects premiums from businesses, people and government.
Among the insured group, 36.5% people received coverage through Medicare, Medicaid and the

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veteran administrator. However, there were about 32.9 million people, who were uninsured too
(dpeaflcio.org, 2016).. Hence, from these statistics, it can be said that US did not provide
universal access to health care coverage. Uneven coverage has contributed to many issues for
U.S. citizens. For example, due to uneven coverage, health premium is rising. The full
implementation of the ACA act is also blamed for lack of health insurance coverage among full-
time workers. U.S. spends huge amount in health care expenditure and high cost is one of the
reason for filing bankruptcy. Although in 2010, the U.S. president Obama implemented the ACA
Act to improve access to health care coverage and promote consumer protection, however health
care coverage remains fragmented across the population (Buchmueller et al., 2016).
Critically analyze and explain why they are different:
UK, Australia and the US are all developed and industrialized countries and similarities
and differences in health care system of the three countries can be understood by looking at
health coverage and amount of government spending on health care. The review of the health
care system of the UK, Australia and the U.S. suggest that Australia and UK has a proper
universal health care coverage, however US does not have a uniform health system. Australia has
a multi-payer system that maintains health coverage whereas UK has public-owned single payer
system where government spends on health (Hall, 2015). In contrast, no such universal health
coverage exists in US. The advantage of multi-payer system is that it has the potential to meet
diverse preference of medical beneficiaries. For this reason, Australian health care system
became immensely successful in controlling rising health care cost and delivering good health
outcome too. It enjoys longest life expectancies (Hall, 2015). Such outcome was achieved
through efficient interaction between private and public financing and division of responsibilities
between federal and the state government. However, US struggles with health care cost and poor

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quality of care because of division of health care insurance and lack of appropriate subsidies for
vulnerable people (Glied, 2014).
Although Australia and UK were found to have an efficient health care system, however
US is the country which was found to have high health care expenditure and uneven access to
universal care. The difference is understood from the data that 15% of GDP of US is spend on
health care compared to 8% of GDP in UK. The difference in coverage is also understood from
the fact that UK NHS provides care to 100 % of the population compared to 28% of the US
population covered by US public health service (Chang et al., 2011). In contrast, Australia
spends half the percentage of the GDP on health care cost compared to USA. Australia has less
health care expenditure and it covers all population. However, in US, about 16% of the
population is still uninsured. A study by also confirmed that among five industrialized nations,
U.S came last in the area of equity, coordination, patient safety and access (census.gov 2016).
Although the enactment of recent legislation, the Affordable Care Act (ACA) was the only
factors the mandated health coverage for all, however it was not effective in achieving health
equity and equal coverage for all.
Based on the difference in health system of UK, Australia and US on the basis of health
care spending, it can be said that uneven coverage or lack of universal coverage is the reason for
increase in health care spending. A study done in thirteen high income countries also showed that
U.S far exceeds other high income countries in terms of health care spending. Unlike Australia, it
does not have a publicly financed health system, however still US spends large dollars on health
care. Due to such spending, key health outcome variable for the country should have improved
(Squires & Anderson, 2015). However, life expectancy of US population is lower than that of
Australia. The life expectancy of Americans was found to be lower than Australian population. A

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person born in Australian 2013-2015 is expected to live up to 80.4 years compared to 78.74 years
for US (Australian Institute of Health and Welfare, 2017). Excess health care spending might be
driven by greater utilization of medical technology and high price. Such high expending may
have negative consequences on the country’s economy and lead to budget deficits, personal
bankruptcy and stagnation too.
Differences in political culture of the three countries also explain the reason behind
difference in achieving universal health coverage in UK, US and Australia. The government and
the political structure and values of Australia and UK played a major role in achieving near full
coverage. They focused not only on making the health care system equitable and effective, but
also protecting the interest of the vulnerable section of the population was also their agenda. For
example, the government of Australia developed the National Health Care Agreement to set-
national priority direction and improves health outcomes. A target was also set by COAG to
close the gap in life expectancy of Aboriginal and Torres Strait Islander people (Duckett &
Willcox, 2015). In addition, the UK has a national health that is public-owned and financed by
payers. UK is the country that got the highest share of total health care spending from the
government and this was possible because of highest priority given to health. The NHS played a
role in reducing insecurities for families at times of economic uncertainty too (NHS England
2017). By the development of the most-cost effective health system, it contributes to the success
of the British economy. In contrast, US is struggling in terms of health quality and expenditure
because of strong belief in liberalism idea in America. The concept of universal coverage clashed
with the idea of individualism and complete coverage was not achieved in the country. For this
reason, universal health care became a source of continuous political conflict in the country
which affected its welfare system. Policy makers in US refrained from adapting price control

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measures and fulfilling the criteria of cost-effectiveness in reimbursement decisions (Borgonovi
& Compagni, 2013). Hence, from this discussion on reasons for differences in health care system
of three countries, it can be said that the sustainability of the universal health care is dependent
on level of action taken by government and policy makers in the areas of equity,
interconnectedness and political alignment within the health care system.
Comparatively evaluate the effectiveness of each of three systems:
The above comparison gave an insight into the benefits of the health care system of UK,
US and Australia in terms of health care spending and types of health care coverage. However,
the concept of effectiveness, efficiency and equity can also be used a framework to evaluate
health services of the target countries. These three elements are important criteria for health care
system evaluation as they contribute the goal of improving quality of life and life expectancy
outcome of the population (Begley et al., 2013). The three parameters will be judged to evaluate
and compares the health care system of three countries.
Effectiveness in health care system can defines as the extent to which improvement in
health status of population is achieved. It can be determined in terms of quality of life, mortality
and morbidity data of a population. Australia ranked sixth in terms of health care efficiency in
2014 and it achieved this outcome because of the high life expectancy and excellent health care
system. The country has current life expectancy of 80.4 years and it is estimated that the average
life expectancy may reach to 95.1 years for men and 96.6 years for women in 2055. The
effectiveness of health system and its quality in Australia is also understood from the fact that
standardized death rate decreased to 5.4 deaths per 1000 in 2016 compared to 5.5 in 2015. Te
infant mortality rate also decreased and only 2.9 deaths per 1000 live births were reported in

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major cities (abs.gov.au. 2016). Such optimal health outcome and improvement in health status
of the population was achieved because of universal access to range of health services funded
through PBS and MBS (Department of Health 2017). It ranked as the best performing country
for healthy life expectancy because of effective integration of private health sector with universal
public health sector. Their integration has balanced health quality parameters and ensured good
health status for the population (Willis, Reynolds & Keleher, 2016). .
Compared to Australia, the health care system of US is not as efficient as Australia. This
can be said because of poor outcome in mortality and life expectancy statistics. US is regarded as
the world’s most expensive yet most ineffective health care system because of high health care
cost and poor health outcome (Kumar, Ghildayal & Shah, 2011). The life expectancy rate for US
is 78.8 years compared to 80.4 years for Australia (Center for Disease Control and Prevention,
2017). In addition, Australia occupies the dominant position in terms of effectiveness compared
to all three countries because UK also had a lower life expectancy outcome. In 2016, the life
expectancy statistics for male was 79.2 years and 82.9 years for females (ons.gov.uk, 2016). The
number of deaths, infant mortality rate and death rate can also predict the performance of the
health care system of two countries. For USA, the death rate was 844.0 deaths per 1,00, 000
population and infant mortality rate was 5.90 per 1000, live births (Center for Disease Control
and Prevention, 2017). The date for infant mortality rate in UK in 2015 was 3.8 deaths per 1,000
live births (ons.gov.uk (2016). This is much higher than the infant mortality rate of 2.9 per 1000
births for Australia. From the evaluation of this statistic, it can be said that that Australia is the
most effective health care system followed by UK and then US.
Efficiency of health care system can be evaluated by finding the way in which the three
countries addressed resource necessary to achieve desired health outcome. The success of the

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health care system can be understood by exploring the relationship between health improvement
and resources. The availability of health care funding through MBS and PBS is the main
resource that has resulted in health care improvement in Australia. The universal health care
scheme became the driver for cost growth and proper negotiation with suppliers. The PBS played
in role making subsidized drugs available to common public. The federal government was
involved in direct negotiation on price with pharmaceutical company and all this helped in
making health care service cost effective and efficient. The Australian government also
introduced mandatory requirement for economic evaluation of health care system (Ali et al.,
2015). Hence, through such cost-effective health funding, right resources were available to
people and health improvement automatically occurred. Hall (2015) also supported the fact that
Australia is successful in achieving optimal health cost at reasonable cost control. Several
innovations in the system was also the reason for positive health care performance and high
quality of care.
Compared to Australia, the health care system of UK is governed by NHS. NHS is
regarded as an efficient health care service because of complete funding by the government and
control of additional cost to care. Due to increase in funding, health improvements have been
achieved in the area of cancer mortality rates. It is considered superior to Australia to in terms of
efficient health system as it ranks second in the list from 19 developed countries. In contrast, the
dismal performance of the health care system of US is understood from the fact its ranked 17th in
the most efficient healthy system ranking (Gulland, 2011). Pritchard & Wallace, (2011) also
proved the efficiency of UK from other developed countries by comparison of developed
countries on reducing mortality rates. Poor mortality rate was observed in US because of high
health care cost and poor access to universal care. Besides this the dominance of private sector in

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US compared to public sector increased the number of uninsured groups and those groups
remained out the treatment or care system. In contrast, positive results for UK explains the fact
that with the availability of public funded care system, accessibility to care increased and this
paves the way for health improvement in population (Pritchard & Wallace, 2011). It can be
concluded that UK is the most efficient health care system followed by Australia and then USA.
Equity is the method or approach used to equally distribute health care services to all
sections of the population. The evaluation of equity can give idea about the presence of health
disparities or effectiveness of health care service. Australia is regarded as an efficient health care
system in terms of equity as it provides universal health coverage for all. However, the country
still needs to take steps to reduce gap in health outcome of indigenous Australians. The provision
of universal coverage is one criterion that determines the ability of health care system in
achieving health equity. NHS services in England is successful in providing universal access to
all (Asaria et al., 2016). However, US lagged behind as it could not fully implement the concept
of universal health coverage. Hence, UK is also superior to other too countries in terms of health
equity.
Describe and critically evaluate reform proposed or underway in each of the systems:
In case of Australia, some major reforms and innovations that was introduced by the
federal government was that they implemented health care homes for 20% of patients who were
in need of health care support. The government also took the action to double their investment in
dental care program. These are effective response to maintain health equity and reach to the
underserved population group who are deprived of care. The dental care program can also be
beneficial in helping more children and low-income families achieved health coverage

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(Parliament of Australia, 2017). The reform was successful in improving oral health of young
Australian and making preventative care easily available to children.
In response to the burden of UK health care system in dealing with chronic disease like
obesity, coronary heart disease and cancer, major reforms were implemented after the Health and
Social Care Act 2012. This helped in making in improve separate funding arrangements for
primary care, social care, mental health and community health services. Many policy initiatives
were also proposed to develop better integrated services (Humphries, 2015). These are examples
of innovation in health care sector which can increase the health related outcome of patient and
improve lives of UK citizens.
After the review of the performance of U.S. health care system, the urgent need for
reform in eminent. Due to the lack of universal funding and increase in poor health outcome,
attention was given to people who were uninsured. The Obama administration considered ways
to reduce cost and achieve full coverage. However, despite implementation of ACA act, full
coverage could not be achieved because of several challenges such as underutilization of
preventive care. Although US outperforms in bottom-up innovation and localized responsibility,
however the country still need to take innovative steps to create a single-payer universal care
system that can address health inequalities and provide more options related to preventive care
(Obama, 2016).
Conclusion:
The reports presented a comprehensive analysis and comparison of the health care system
of UK, Australia and US. All the three countries are developed and industrialized countries and
however difference in structure and function of the health care system of the three countries has