NURSING SCIENCE: Comparative Healthcare Financing (US vs UK)

This report provides a comparative analysis of healthcare financing in the United States and Great Britain. It examines access to healthcare systems, focusing on Medicaid and CHIP in the US and the National Health Service (NHS) in the UK. The report explores financial implications, including medication coverage, prescription costs, and specialist referrals. In the US, access to healthcare is influenced by employment status and employer-sponsored insurance, while in the UK, the NHS provides free services funded by taxation. The report highlights differences in medication coverage, with the US relying on health plans and the UK offering prescription pre-payment certificates. It also discusses referral processes and health coverage for pre-existing conditions. The conclusion suggests no significant differences in healthcare access, with both countries facing financial implications such as cost reduction and subsidized medicines.

Running head: NURSING SCIENCE
Nursing Science
Name of the Student
Name of the University
Author Note

NURSING SCIENCE
Healthcare utilization and financing is different in different states(Unger, 2012). The
following report aims to perform a comparative study between the healthcare financing of
America and Great Britain. The report will mainly focus on the access to health care system
in America and Great Britain and financial implications of the health care delivery.
Access of healthcare system in US
According to Manos et al. (2016), over the past 25 years there has been dramatic
increase of Medicaid and State Children’s Health Insurance Program (CHIP). In 2010, CHIP
and Medicaid together covered half of the total population of children in US under the age of
19. According to National Health Survey (2016), Medicaid or CHIP coverage is more likely
to have a normal source of medical care in comparison to the privately insured children.
Children with Medicaid and CHIP are more likely to visit a mental health professionals or
general physicians for behavioral problems in comparison to privately insured counterparts.
However, Medicaid or CHIP coverage is less advantageous when it comes to spotting
physicians who accepts their health insurance (Medicaid and CHIP Payment and Access
Commission, 2016).
According to the reports published by the Centre of Disease Control and Prevention
(2012), unemployment rate is US highest during 2010 (9.6%), a condition not experienced
since 1983. Unemployment affects the comprehensive access to health care services due to
the significant loss of employer-sponsored health insurance along with lack of stable monthly
income. In United States, unemployed group of population is eligible to avail an affordable
health insurance plan via the Marketplace based on the savings of their family income and
overall size of the households. They also qualify for the free or low-cost coverage via the
Medicaid and CHIP (Health Care Gov, 2018).

NURSING SCIENCE
In the domain of retired employees, it can be said that a vast majority of retired full-
time employees aged between 55 to 64 years received their health benefits via their
workplace. The majority of the early retirees enjoy employer’s health benefits along with
spousal coverage. There are no reported cases that the employer coverage has been refused
among the retired workers in America for the past 10 years (Drucker, 2013).
Access of healthcare system in Great Britain
According to Wolfe et al. (2016), the health of a child in Great Britain has improved
significantly over the past few decades but at the same time has failed to live up to the
expectations of the considerable gain in health and subsequent reductions in the rate of
achieved mortality by other countries in Europe. Child inequalities and poverty are increasing
in Great Britain. The National Health Service (NHS), which is funded by taxation, is free at
the point of use and is undergoing substantial reforms. This reforms is aiming towards the
improvement in care quality, care experience, cost along with meeting the rising demand of
health care. However, the quality of care for children is the domain of long-term and chronic
disease is decreasing. Among these worsening conditions, key achievements include
equitable care and accessibility.
NHS offers free service for all the residents in UK including the professionals of the
armed forces who are retired or based abroad. The citizens of Great Britain who stay outside
of UK are subject to certain charges irrespective of whether they have paid National
Insurance contributions. This service is funded from the compulsory taxation given by the
employees directly through their salaries and at the same time supplemented via obligatory
contributions from the employers. The onus is over the employer to deduct the contributions
from wages of the employees. The members of the dependent family and vulnerable group of
population like unemployed people are exempted from this contribution (Europe Cities
Health Care, 2018).

NURSING SCIENCE
In Great Britain, The Department for Work and Pensions (DWP) is dedicated towards
pension, welfare and child maintenance policy. DWP is UK’s largest service department and
it aptly administers and controls State Pension along with the range of ill health benefits and
disability among 18 million claimants and customers. Being a ministerial department, DWP
is supported by 14 different public bodies and agencies (Government of UK, 2018).
Medication coverage in US and Great Britain
According to the reports published by The Commonwealth Fund (2010), Americans
especially the healthy and the young individuals are more likely to consume prescription
drugs in comparison to Great Britain. However, they also pass through greater financial
barriers in accessing medications and at the same time spent out-of-pocket for prescriptions
drugs. According to Health Care Government (2018), health plans in US will to pay the
expense of certain prescription medication. One may be able to buy other medication
however; medications covered in health insurance plans are less expensive. In Great Britain,
the scenario is different. According to NHS England (2018), there exist prescription pre-
payment certificates (PPC) which are cost-effective in nature. At present prescription charge
is £8.80 per item. For a three months PPC (£29.10) and 12 months PPC (£104.00) , a person
can save money if or she requires more than three prescribed medicines in three months or 12
prescribed items in a year respectively. PPC are available through 10 monthly instilments
packed under direct debit card payment.
Referral to a specialist doctors
In Great Britain, referral for specialist treatment of NHS doctors depends on whether
the concerned general physicians (GP) feel there are clinical requirement for specialized
support. One cannot self-refer to a specialist doctors. Even if anyone asks GP to refer to a
specialist, they will probably suggest to conduct various pathological test or other treatment
options to see whether the health condition improves and then only depending upon the

NURSING SCIENCE
condition, they will refer to a specialist. A specialist will only examine the patient if he or she
has a referral letter (NHS, 2016). In America also the scenario are similar. One needs to have
a referral letter from primary healthcare professionals in order to pay a visit to a specialist
doctor (US News, 2016).
Health coverage for preexisting condition
In America, before Affordable Care Act (ACA), people with pre-existing health
conditions are denied health insurance coverage or are charged with high higher rate of
premiums. However, during the tenure of 2013 to 2015, upon full implementation of ACAQ,
at least 16.5 million non-elderly adults gained full coverage. Of them at least 2.6 million had
pre-existing conditions that could have otherwise excluded them for medical coverage due to
discriminatory pricing and denials (The Commonwealth Fund, 2016). In UK if one had a pre-
existing condition of diabetes (for past 5 years) and for which he is taking medicines, he can
only avail pay for private treatment for say leg fracture but not for diabetes treatment (NHS,
2016).
Finance Implications for Healthcare Delivery
The main financial implications for healthcare delivery in US is reduction in premium
among patients with pre-existing condition and reducing in overall cost effective healthcare
as now the prescribed in America are subsidized (Unger, 2012). In GreatBritain, also the
main financial implication in health care is reduction in the overall cost of care along with
delivery of subsidized prescription medicines (NHS, 2016).
Thus from the above discussion it can be concluded that there are no significant
different in the healthcare access both in America and Great Britain. The health care
implication includes overall reduction in the cost of care to the patients.

NURSING SCIENCE
References
Drucker, P. F. (2013). The unseen revolution: How pension fund socialism came to America.
Elsevier.
Europe Cities Health Care.(2018). Healthcare in UK (England). Access date: 2nd May.
Retrieved from: http://www.europe-cities.com/destinations/uk_england/health/
Government of UK, (2018).Department of Works and Pension. Access date: 2nd May.
Retrieved from: https://www.gov.uk/government/organisations/department-for-work-
pensions
Health Care Government (2018).Health coverage options if you’re unemployed. Access date:
2nd May. Retrieved from: https://www.healthcare.gov/unemployed/coverage/
Health Care Government (2018).Getting prescription medications.Access date: 2nd May.
Retrieved from:
https://www.healthcare.gov/using-marketplace-coverage/prescription-medications/
Manos, M. M., Leyden, W. A., Resendez, C. I., Klein, E. G., Wilson, T. L., & Bauer, H. M.
(2016). A community-based collaboration to assess and improve medical insurance
status and access to health care of Latino children. Public Health Reports.
Medicaid and CHIP Payment and Access Commission. (2016). Access in Brief: Children’s
Access to Health Care. Access date: 2nd May. Retrieved from:
https://www.macpac.gov/news/access-in-brief-childrens-access-to-health-care/
National Centre for Health Statistics. (2012). Health and Access to Care Among Employed
and Unemployed Adults: United States, 2009–2010. Access date: 2nd May. Retrieved
from: https://www.cdc.gov/nchs/products/databriefs/db83.htm

NURSING SCIENCE
National Health Service (NHS) (2018). NHS in England: help with health costs. Access date:
2nd May. Retrieved from:
https://www.nhs.uk/NHSEngland/Healthcosts/Pages/Prescriptioncosts.aspx
NHS general practitioners (GPs) services.(2016) Specialist referrals and services your GP
may recommend. Access date: 2nd May. Retrieved from:
https://www.nhs.uk/NHSEngland/AboutNHSservices/doctors/Pages/gp-referrals.aspx
NHS. (2016). Can you get health insurance with pre-existing conditions?. Access date: 2nd
May. Retrieved from:.https://www.money.co.uk/health-insurance/can-you-get-health-
insurance-with-pre-existing-conditions.htm#link2
The Common Wealth Fund.(2010) Prescription Drug Accessibility and Affordability in the
United States and Abroad. Access date: 2nd May. Retrieved from:
http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2010/
Jun/1408_Morgan_Prescription_drug_accessibility_US_intl_ib.pdf
The Commonwealth Fund (2016).Access to Coverage and Care for People with Preexisting
Conditions: How Has It Changed Under the ACA?. Access date: 2nd May. Retrieved
from: http://www.commonwealthfund.org/publications/issue-briefs/2017/jun/
coverage-care-preexisting-conditions-aca
Unger, F. (2012). Health is wealth: considerations to European healthcare. Prilozi, 33(1), 9-
14.
US News., (2016). What’s Behind That Medical Referral?. Access date: 2nd May. Retrieved
from: https://health.usnews.com/health-news/patient-advice/articles/2016-04-07/
whats-behind-that-medical-referral

NURSING SCIENCE
Wolfe, I., Sigfrid, L., Chanchlani, N., &Lenton, S. (2016). Child health systems in the United
Kingdom (England). The Journal of pediatrics, 177, S217-S242.