19.4 Comparative Health and Medicine
4 min read•june 18, 2024
Healthcare systems vary globally, impacting access and quality of care. The US has a mix of private and public coverage, while other countries use single-payer, two-tier, or insurance mandate systems. Each approach has pros and cons for cost, access, and outcomes.
challenges include communicable and non-communicable diseases, maternal and child health, and access to medicines. International organizations and partnerships work to address these issues, focusing on prevention, treatment, and reducing health inequities worldwide.
Healthcare Coverage and Systems
Types of US healthcare coverage
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- Private health insurance
- provides coverage through an employer, often with shared costs between the employer and employee
- plans purchased directly from insurance companies or through health insurance marketplaces (Healthcare.gov)
- insurance
- provides federal health insurance for people aged 65 and older, and some individuals with disabilities, covering hospital stays, doctor visits, and prescription drugs
- offers joint federal and state program providing health coverage for low-income individuals and families, including children, pregnant women, elderly, and people with disabilities
- (CHIP) provides health coverage for children in families with incomes too high for Medicaid but unable to afford private coverage, often with lower premiums and copayments compared to private insurance
- Uninsured population includes individuals without any form of health insurance coverage, often facing high out-of-pocket costs for healthcare services and potential financial hardship
Healthcare systems across countries
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- Government acts as the sole payer for healthcare services, negotiating prices with healthcare providers
- Funded through taxes, ensuring universal coverage for all citizens regardless of income or health status (Canada, United Kingdom, Norway)
- Patients have limited out-of-pocket costs but may face longer wait times for non-urgent procedures
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- Combination of public and options, with basic coverage for all citizens and the option to purchase additional private insurance for faster access or expanded services
- Funded through a mix of taxes and private insurance premiums (Australia, France, Japan)
- Allows for patient choice and potentially shorter wait times, but may result in disparities in access based on ability to pay for private insurance
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- Government mandates individuals to purchase health insurance, either through public or private plans
- Insurers are required to accept all applicants and charge the same rates regardless of health status, ensuring coverage for people with pre-existing conditions (Germany, Netherlands, Switzerland)
- Funded through a combination of individual premiums, employer contributions, and government subsidies
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- No coverage, with individuals paying for healthcare services directly or through private insurance
- Often results in high healthcare costs and financial barriers to accessing care, particularly for low-income individuals (United States before Affordable Care Act, many developing countries)
- May lead to disparities in health outcomes based on socioeconomic status and ability to pay for healthcare services
Global health challenges and responses
- Communicable diseases
- HIV/AIDS, malaria, and tuberculosis continue to pose significant global health challenges, particularly in developing countries
- Efforts to combat these diseases include the ; ; and various WHO initiatives focused on prevention, treatment, and access to care
- Non-communicable diseases
- Cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases are leading causes of death worldwide, with increasing prevalence in low- and middle-income countries
- The aims to reduce premature mortality from these diseases through prevention, early detection, and improved management
- Maternal and child health
- High maternal and infant mortality rates persist in developing countries due to limited access to quality healthcare, malnutrition, and poor sanitation
- The United Nations' and initiatives by and WHO focus on improving maternal health, reducing child mortality, and promoting child development
- Access to essential medicines and vaccines
- Low- and middle-income countries often face challenges in accessing affordable and quality-assured essential medicines and vaccines
- Efforts to address this include , the Vaccine Alliance, which works to improve access to new and underused vaccines, and the , which guides countries in selecting and procuring essential medicines
- Health inequities and
- Disparities in health outcomes are often linked to socioeconomic factors such as income, education, and living conditions
- The and efforts to address poverty, education, and gender equality aim to reduce health inequities and improve overall population health
- Global health partnerships and initiatives
- The (WHO) serves as the leading authority on global health, setting norms and standards, providing technical support, and coordinating international health efforts
- United Nations agencies like UNICEF and work to address health challenges as part of broader development goals
- Non-governmental organizations (NGOs) and foundations, such as the and , play a crucial role in funding and implementing global health programs and research
Public Health and Epidemiology
- Public health focuses on promoting and protecting the health of populations through disease prevention, health promotion, and health policy
- studies the distribution and determinants of health-related events in populations, informing public health interventions and
- Social determinants of health, such as education, income, and living conditions, significantly impact health outcomes and contribute to
- aims to eliminate unfair and avoidable differences in health outcomes among different population groups
- Healthcare policy shapes the organization, financing, and delivery of healthcare services, influencing access to care and health outcomes
- Global health addresses health issues that transcend national boundaries, requiring international cooperation and coordination to achieve health equity worldwide
Key Terms to Review (35)
Bill & Melinda Gates Foundation: The Bill & Melinda Gates Foundation is a private philanthropic organization founded by Bill Gates and Melinda French Gates. It focuses on addressing global health and development issues, with a particular emphasis on improving access to healthcare and education in developing countries.
Children's Health Insurance Program: The Children's Health Insurance Program (CHIP) is a government-funded health insurance program that provides coverage for children in families with incomes too high to qualify for Medicaid, but too low to afford private health insurance. It is designed to ensure that all children have access to quality healthcare, regardless of their family's financial situation.
Employer-Sponsored Health Insurance: Employer-sponsored health insurance refers to a health insurance plan that is provided and subsidized by an employer for their employees. This type of health coverage is a common benefit offered by companies to attract and retain talented workers.
Epidemiology: Epidemiology is the study of how diseases spread and can be controlled within populations. It involves identifying patterns, causes, and effects of health and disease conditions in specific groups.
Epidemiology: Epidemiology is the study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to the control of health problems. It is a fundamental science of public health that focuses on understanding the patterns, causes, and effects of health and disease conditions in human populations.
Gavi: Gavi, the Vaccine Alliance, is a global health partnership committed to increasing access to immunization in poor countries. It brings together public and private sectors to provide vaccines and strengthen health systems in developing nations.
Global Fund to Fight AIDS, Tuberculosis and Malaria: The Global Fund to Fight AIDS, Tuberculosis and Malaria is an international financing organization that aims to accelerate the end of these three deadly infectious diseases as epidemics. It mobilizes and invests funding to support prevention, treatment, and care programs in countries and communities most affected by these diseases.
Global Health: Global health is an area of study, research, and practice that places a priority on improving health and achieving health equity for all people worldwide. It encompasses a wide range of issues, from infectious disease control to the promotion of mental well-being, and involves collaboration across disciplines and national boundaries to address complex, interconnected health challenges that transcend geographic borders.
Health Disparities: Health disparities refer to the significant and often persistent differences in health outcomes and access to healthcare experienced by certain population groups compared to others. These disparities can be influenced by social, economic, and environmental factors that create unequal opportunities for good health.
Health Equity: Health equity refers to the fair and just distribution of the conditions necessary for all people to achieve their full health potential, regardless of social, economic, or demographic factors. It is a fundamental principle in the pursuit of optimal health and well-being for all individuals and communities.
Healthcare Policy: Healthcare policy refers to the set of laws, regulations, and guidelines that govern the provision, financing, and delivery of healthcare services within a society or country. It encompasses the decision-making processes and the implementation of policies aimed at improving the health and well-being of individuals and communities.
Individual Health Insurance: Individual health insurance refers to a type of private health insurance plan that is purchased directly by an individual or family, rather than being provided through an employer or government program. These plans offer coverage for medical expenses, including doctor visits, hospital stays, and prescription drugs, and are designed to provide financial protection against the high costs of healthcare.
Individual mandate: An individual mandate is a requirement by law for all individuals to purchase or otherwise obtain a minimum level of health insurance. This policy aims to reduce the number of uninsured citizens and spread the financial risk across a larger pool.
Insurance Mandate System: An insurance mandate system is a policy approach where individuals are required by law to have a minimum level of health insurance coverage, either provided through their employer or purchased individually. This system aims to increase the number of insured individuals and spread the risk across a broader population, ultimately improving access to healthcare and reducing uncompensated care costs.
Medicaid: Medicaid is a government-run health insurance program in the United States that provides coverage for low-income individuals and families. It is jointly funded by the federal and state governments and is the largest source of health coverage in the country, serving millions of Americans.
Medicare: Medicare is a federal health insurance program in the United States that provides coverage for individuals aged 65 and older, as well as certain younger people with disabilities or end-stage renal disease. It is a critical component of the social safety net that helps ensure access to healthcare for the elderly and vulnerable populations.
Out-of-Pocket Healthcare System: An out-of-pocket healthcare system refers to a healthcare financing model where individuals are responsible for directly paying for a significant portion of their medical expenses, rather than relying primarily on insurance or government-funded coverage. This system places a greater financial burden on patients and can impact access to healthcare services.
Private healthcare: Private healthcare is a system where medical and health services are provided by entities or individuals that operate independently of the government. Patients typically pay for services through insurance, out-of-pocket payments, or a combination of both.
Public Health: Public health is the science and practice of protecting and improving the health and well-being of populations through organized efforts and informed choices. It focuses on preventing disease, prolonging life, and promoting physical and mental health for all members of a community.
Public healthcare: Public healthcare is a system where the government provides medical services and health care coverage to all citizens, typically funded through taxation. It aims to ensure equitable access to health services regardless of personal income.
Rockefeller Foundation: The Rockefeller Foundation is a philanthropic organization established in 1913 by John D. Rockefeller, a prominent American industrialist and oil tycoon. The foundation's primary focus is on addressing global challenges in the areas of health, education, and economic development.
Single-Payer Healthcare System: A single-payer healthcare system is a type of universal healthcare system where a single public or government entity acts as the sole payer for all healthcare services. In this system, the government is responsible for financing and administering healthcare, providing comprehensive coverage for all citizens, and negotiating prices with healthcare providers.
Social Determinants of Health: Social determinants of health are the conditions in which people are born, grow, live, work, and age that shape their overall health and well-being. These factors, often outside of an individual's control, can have a significant impact on their physical and mental health outcomes.
Social epidemiology: Social epidemiology is a branch of epidemiology that focuses on how societal factors such as socioeconomic status, culture, poverty, and access to healthcare influence the health outcomes of populations. It studies patterns, causes, and effects of health and disease conditions in defined populations.
Socialized medicine: Socialized medicine is a health care system where the government owns and operates health care facilities and employs the health care professionals, providing services to all citizens at no direct cost to them. It aims to ensure equal access to health services for all segments of society regardless of their financial status.
Sustainable Development Goals: The Sustainable Development Goals (SDGs) are a collection of 17 interlinked global goals designed to be a 'blueprint to achieve a better and more sustainable future for all.' They were adopted by the United Nations General Assembly in 2015 and are intended to be achieved by the year 2030. The SDGs are relevant to the topics of global health and comparative health and medicine, as they address key challenges related to improving the overall well-being and quality of life for people around the world.
Two-Tier Healthcare System: A two-tier healthcare system is a healthcare model where there are two distinct tiers or levels of healthcare services available to the population. This system is characterized by the coexistence of a publicly funded universal healthcare system and a parallel private healthcare system that operates alongside it.
UNAIDS: UNAIDS is the Joint United Nations Programme on HIV/AIDS, a global partnership that leads and inspires the world in achieving universal access to HIV prevention, treatment, care and support. It works to promote an evidence-informed and human rights-based approach to effectively respond to the HIV/AIDS epidemic worldwide.
UNDP: UNDP, or the United Nations Development Programme, is the United Nations' global development network that works to help countries develop and share solutions in the areas of sustainable development, democratic governance, and crisis prevention and recovery. It aims to connect countries to knowledge, experience, and resources to help people build a better life.
UNICEF: UNICEF, the United Nations Children's Fund, is a United Nations agency responsible for providing humanitarian and developmental assistance to children and mothers in developing countries. It focuses on improving child health, nutrition, education, protection, and access to clean water and sanitation.
Universal healthcare: Universal healthcare is a system where all residents of a particular country or region have access to essential healthcare services without suffering financial hardship. It aims to provide equitable health services based on need rather than the ability to pay.
WHO Commission on Social Determinants of Health: The WHO Commission on Social Determinants of Health was established in 2005 to provide global leadership in addressing the social factors that influence health outcomes. It aimed to raise global awareness about the impact of social, political, and economic conditions on people's health and well-being.
WHO Essential Medicines List: The WHO Essential Medicines List (EML) is a core list of the most efficacious, safe, and cost-effective medicines that are essential for addressing the most common and pressing public health needs globally. It serves as a model for countries to develop their own national essential medicines lists and guides healthcare systems in ensuring access to these critical medications.
WHO Global Action Plan for the Prevention and Control of NCDs: The WHO Global Action Plan for the Prevention and Control of Noncommunicable Diseases (NCDs) is a comprehensive strategic framework adopted by the World Health Organization to guide global and national efforts in reducing the burden of NCDs. This plan aims to provide guidance and set targets for countries to prevent and manage conditions such as cardiovascular diseases, cancers, diabetes, and respiratory diseases.
World Health Organization: The World Health Organization (WHO) is the United Nations' specialized agency for international public health. It is responsible for providing leadership on global health matters, shaping the health research agenda, and monitoring and assessing health trends worldwide.