Universal Healthcare

In the recent years, Universal Healthcare has received considerable attention. A universal healthcare system is one in which the population enjoys a specific number of health services free of charge. Such services are usually linked to a list of diseases. The services are normally financed by the government through some compulsory social security contributions or payroll, a general taxation, or in some cases, a combination of both. A universal tax-based system of healthcare funding is used in countries such as the United Kingdom, Canada, Australia, Cuba, Sweden, Denmark, Brazil, and Italy, while countries such as Germany, France, Japan, Singapore, and Costa Rica use the mandatory payroll to finance their universal healthcare programs. On the other end, most Caribbean countries use budgetary allocations from the central government as a principal source of healthcare financing. A majority of the Caribbean countries do not have universal healthcare programs, although many of them are keenly considering introducing one, to tackle the high spending on healthcare from the citizens own pockets.

The underlying principles for public intervention in healthcare provision are well documented in the available literature. They are associated in the matters of public goods, insurance failures, and presence of externalities. The goals of financing health are often quoted as arguments for public intervention. They include inequality reduction through reducing the out of pocket expenditure, avoiding cases of individuals falling into abject poverty in the event of tragic medical expenses, as well as improving the outcomes of health system by making sure everyone can afford the basic health services.
The differences that exist between healthcare systems of different countries are worth examining. They explain why some countries enjoy superior health care services than others. The world would become a better place if everyone could access similar types of services from their health providers. Countries that do not have a universal healthcare program currently or those thinking of initiating one can borrow some tips from those that have successfully implemented their own. Furthermore, those countries that are experiencing difficulties can also borrow some ideas from the more successful ones. This paper intends to compare and contrast the universal health care systems of various countries to establish why these systems have differences across these countries. The analysis will compare and contrast the cost and quality of healthcare found in various countries and the part that universal healthcare provision plays towards this. The study will also incorporate the positive and the negative consequences of having a universal healthcare system rather than other forms of healthcare systems.
Options for financing a universal health care
Reforms in the health sector should be undertaken in the framework of the governments available and predicted fiscal space. In principle, a better tax administration, or a tax increase, external financing, and government borrowing could increase the fiscal space of a country, but additional borrowing is not a very desirable way of financing universal healthcare. In global comparisons, the less developed countries are among the most extremely indebted countries (Ellis and McGuire, 380). The less developed countries are among the most extremely indebted countries in global comparisons.
External funding is not an option for the low-income countries for even the donors commitments have been unpredictable in the recent years owing to a number of factors, including budgetary and political decisions, administrative delays by the donors, and bureaucratic requirements that result in non-compliance. Even if donor funding is provided, it raises the question of whether the country will be in a position to facilitate the health care services when the donor funding ceases. Therefore, healthcare service reforms must largely depend on internal or domestic sources of funding (Heller, 23). Because of the fact that spending on health involves recurrent expenses, it is always advisable to use taxation as the main source of funding universal healthcare.
How many providers
In a majority of countries that provide universal coverage, a network of providers is involved in the service. Nevertheless, the government frequently contracts services from private providers and non-governmental institutions, offering the public a wider free will to choose their healthcare supplier. However, higher administrative costs arise because of the increased freedom associated with many insurers. For example, a country with fewer service providers are usually the most triumphant at containing high health costs, possibly through negotiating lower fee for doctors. Overlooking the number of service providers, it is essential to ensure that the appropriate incentives and regulatory tools are in place so as to avoid undue provision of service. Such hitch could induce cost increase, as currently observed in a majority of OECD (Fogel, 5). The Aruba, kingdom of England is a famous example of this case, which suffered increased health costs after the expansion of the health insurance scheme by the government to include all population sections, because of limited protection clauses.
The fee for service method that was used in Aruba applied to specialists and it led to unnecessary service provision that resulted to escalation of costs. Under the system, there was no observation authority to connect each service provided with a patients name. Eventually, the doctors ended up obtaining huge payments for same services on the same patients. These mistakes have later induced a drastic modification of the system regarding premiums and coverage, with positive economic repercussion. Despite a similar type of service in Canada, the government was able to control health costs by establishing comprehensive budgets for physicians services and for hospitals as well. Each Canadian territory controls the amount of services by regulating the amount of service each physician can offer (Heller, 28).
Furthermore, the provider payment system should incorporate incentives that push providers to conduct themselves rationally and efficiently in terms of amounts, types, and quality of the service they provide. There exists an extensive literature on the most favorable provider payment arrangement, which argues that the welfare of the consumer is maximized when suppliers are given incentives to limit the supply of their services through the reimbursement program. According to Ellis and McGuire (1990), the optimal payment system is attained through a mixture of the reimbursement system and the cost-based system. In this case, some payments are prospective, while others are cost based (Ellis and McGuire, 394).
Political, social, and economic considerations normally dictate the combination of health services a government provides. Most under-developed countries face budget constraints and extremely high debt levels. Thus, the choice of the services that a government can finance requires special considerations. The selection of an optimum package, despite how it is financed, could have significant connotations for the opportunity cost of the funds used and could produce far-reaching economic contingencies, given epidemiological and demographic changes in a particular country. Designing an appropriate package that can benefit all should start by recognizing the needs of the entire country. it is vital for a country to prioritize  those health services that would be incorporated or prohibited under universal health care system coverage (Fogel, 7). In the Easter Caribbean region, it is known for example that although epidemiological statistics are not systematically collected, the major causes of death are diabetes, neoplasm, and cardiovascular diseases.
It seems therefore that the most appropriate system for the government to finance initially would involve a small, universal package. The general benefit package should basically cover public goods, items with externalities, and other involvements with verified impact on the health targets set by the government, and leave other medical care and tragic payments to be funded for the poor through a given targeting system (Musgrove, 1820). Concerning pharmaceuticals, the benefits should be applicable to a classified and limited catalog of prescribed medicines, and standard prescribing should be employed only when it is possible in order to save on costs.
For the whole population, a simplified benefit package should be employed, and definite measures could be instigated to enhance the targeting of spending to the underprivileged in the society. Especially in Africa, studies have suggested that mostly the high-income and the middle-income household use health services. This is owed largely to the access difficulties and high opportunity costs for the working hours that the poor would lose in order to visit a doctor. In many Caribbean and Latin American countries on the other hand, conditional money transfers have been used successfully. The poor households in these countries use the direct cash payment method, subject to detailed behaviors. Evidence shows that elegant provisional cash transfers have the prospective to improve poverty and health outcomes, and develop human resources with reasonably negligible administrative costs (Heller, 33).
Exceptional systems that mostly target the poor
In Columbia, universal coverage covers two forms of essential coverage depending on the income of a patient. Payroll and tax contributors have a limited access to a lowest level of definite coverage and others who contribute to payroll and pay tax as well have access to a sponsored compulsory health plan, which encompasses some extra services (Musgrove, 1813).
Jamaica has the Program for Advancement through Health and Education (PATH). This program seeks to raise the educational achievement and enhance health outcomes amidst the poor through cash benefits made available only when the targeted person has met the credentials for attending school and visits to health facilities(Musgrove, 1816). The target groups in this category include kids up to six years and adults 65 years or more, poor folks, and pregnant mothers.
In Suriname, the poorest persons receive a health card that allows them access to drugs, ambulatory and inpatient services from both public and some private providers at very low or no cost at all. The program is part of the social security net for the underprivileged by the Ministry of Social Affairs. Eligibility for the program is based on applications and field visits(Musgrove, 1815).
Medical experts propose that private funding is more appropriate for private goods, like the individual institutional and ambulatory care services, medical interventions, and pharmaceuticals. Many refer to the Swiss mandatory fundamental health insurance scheme that encompasses accidents, illness, some preventive measures, and maternity for all citizens as a model for establishing the necessary level of care that should be universally provided. France also distinguishes between public and private goods in their healthcare package. For example, a patient pays 30% of the ambulatory service, 40% of the cost in the laboratory, and 35 to 65% of the cost on pharmaceuticals(Fogel, 8). These costs are however not payable for mothers who are pregnant, disabled children, and people with specific illnesses like AIDS and diabetes. Similarly, in Britain, the health insurance system includes cost effectiveness measures and as a result, efficiency allocation in determining which services to be financed by the government and which would be supplied by private providers.
Amongst the industrialized countries in the world, the United States and South Africa are the only countries that have a universal healthcare system that is not funded by the government. The healthcare reform in America states that nearly all the governments of the developed countries have been an element of a process that ensures free healthcare for all citizens. In year 2000, the world Health Organization (WHO) produced a groundbreaking study to rank 191 of the worlds best healthcare systems. The US was position 37, following Costa Rica. All countries in Europe, developed countries in Asia, and most countries in the Middle East provide healthcare systems that incorporate universal coverage. Canada also, operates a similar system (Musgrove, 1811).
Reforms need to be instituted to improve the present healthcare deficiencies evident in many countries today. The reforms, when enacted, will tackle the access, quality, and cost deficiencies in the healthcare systems. Tax cuts and deterrence of insurance denials will improve access to people with pre-existing conditions. Preventive medication for chronic diseases could help reduce cases of losses from such diseases and this would save on costs as well as improving medical outcomes. Additionally, computerization of records could minimize the amount of paperwork and this would help cut cost (Ellis and McGuire, 387). Improved access for more people would in turn improve the quality of healthcare, as would be the focus on preventative medicine. It is however not very clear whether tax cuts would translate to universal coverage for all, or whether the people in a particular country would change their usual lifestyle through a program aimed at preventing diseases. Many countries success pertaining universal healthcare systems is at the experimental stages that requires further research. It is undoubtedly a hopeful endeavor to try creating one, but the success of the system will require extensive research, just to be sure.
Conclusion
Before moving in the direction of a universal healthcare, a country should ensure that it has sustainable funding that corresponds with the long-term requirements resulting from the problems that arise from ageing population and the epidemiological changeover. Relying on internal revenues, and more particularly on taxes, for the size of financing is a precondition, because most assistance for development of health is centered on extremely low-income nations and if at hand, its expenditure is usually short-lived and erratic. The country would be required to sustain the same spending incase aid flow stops. There is no single solution in determining the most suitable way in which to finance universal healthcare system. the best financing strategy will chiefly depend on the economic, institutional, demographic, cultural, and epidemiological characteristics of a country. In general, regardless of the finance option chosen, it is imperative to ensure that the administration of the tax system is reasonable, that there is transparency in the financing, and that it tackles the informal sector as well.
When designing the most beneficial package, it is wise for the authorities to think on a streamlined and optimal package that will meet the essential needs of the population first. enlarging the optimal package to incorporate private goods usually benefits the less needy or the rich disproportionately. This could impair the financial viability of the system and if that is the case, reducing the coverage of the program later might prove difficult. A country could implement explicit measures in order to develop the targeting of extra health care spending to the poor.
A self-sufficient institution could be instituted to prioritize the type of services that would be financed by the government, based on the clinical and cost-effectiveness measures.
Control measures should be put in place to prevent abuse and should be established through supervising operation within stipulated limits, especially if the scheme of payment involves direct payment to the provider. In addition to close supervision, the most favorable reimbursement of providers should include a combination of capitation and payments for service.it is also worth ensuring that the health structure is well organized and that public spending is managed and controlled properly, and that it is accounted for with transparency.
 Works Cited
Ellis, R.P and G McGuire. "Optimal Payment Systems for Health Services." Journal of Health Economics (1990): 375396.
Fogel, R. "Forecasting the Demand for Health Care in OECD Nations and China." Contemporary Economic Policy (2003): 110.
Heller, P. S. What Should Macroeconomists Know About Health Care Policy. IMF. Washington, DC: International Monetary Fund, 2007.
Musgrove, P. "Judging Health Systems: Reflections on WHO's Methods." The (2003): 18101820.