Health Care

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Discussions of global healthcares:

Health Care in Germany

I. Abstract

Germany the world’s third largest economy much alike the one we have in United States provides for a great standard of living for some 80 million people. Much of that may be accredited to the aptitude of the government to implement free healthcare for every individual. At organisational level, German healthcare delivery system achieves its objectives by statutory contribution system by the means of health insurance funds. This paper explores how the government accumulates the necessary capital by statutory and private schemes to afford the notion of free healthcare and explore the associated shortcomings of the plan.

II. Introduction

Otto Von Mismarck, the Prussian chancellor of the late 1800’s who has invented the notion that is still successfully used today. Motto of which relays that government shall provide for all its people to receive free healthcare as needed. Such model is used worldwide today, and while the rich can opt out, 90% of the population chooses to stay with the national system. And that system doesn’t only provide for the basic care, but also covers dental, mental and alternative homeopathic therapy. In some cases of preventative and palliative care it is sometimes known to cover spa and belly dancing classes. While the benefits seem promising, Germany’s vast population could face waiting lists in certain cases.

III. Efficacy and Drawbacks

According to Miriam Blümel (2013), various levels of government have virtually no role in the direct delivery of health care. A large degree of regulation is delegated to self-governing associations of the sickness funds and the provider associations. Both the employers and employees are taxed to compensate for healthcare initiatives. The most important body is the Federal Joint Committee, created in 2004. Many efforts to improve care coordination are being implemented. Since the introduction of multispecialty clinics in ambulatory care in 2004, their number had grown from 70 clinics and 251 working physicians to 1,814 clinics and 10,020 working physicians (6.8% of ambulatory care physicians) by 2011. According to Bundesaerztekammer, there are approximately some 3.4 physicians per 1000 inhabitants. In respects to waitlist, there may be 2-3 week wait time to consult a specialist and certain guidelines need to be met in cases of highly specialized procedures. Physician reimbursement comes at great scrutiny amongst healthcare providers as many see their salaries to be vastly underpaid for the services provided as was demonstrated in a mass protest by physicians in March, 2006.

IV. Cost Control

A central element of the 2007 health reform legislation aimed to enhance competition in health care services with the introduction of various elective insurance schemes (such as disease management programs, family physician care models, and optional deductible schemes). Enrolling in an elective insurance scheme is voluntary and the contract lasts for at least three years. Sickness funds are obliged by law to report regularly on the results of these insurance schemes, especially regarding efficiency and savings. Pharmaceutical costs are being controlled by reference pricing in contrast to medical benefit which serve as the standard of insurance coverage reimbursement. Hence, if a patient desired a different type of drug choice, they would be liable for the difference from the standard treatment plan. Much emphasis is being made on efficacy of the treatment options. Consequently, physicians are financially liable if they exceed regular volumes for their patient mix above the prescription cap.

References

Federal Ministry of Health (Bundesministerium für Gesundheit) (2012). Daten des Gesundheitswesens 2012, http://www.bmg.bund.de (accessed Oct. 19, 2014).

Federal Association of Sickness Funds (GKV Spitzenverband) (2013). Kennzahlen der gesetzlichen

Krankenversicherung, http://www.gkv-spitzenverband.de (accessed Oct. 19, 2014).

Federal Association of SHI Physicians (Kassenärztliche Bundesvereinigung) (2013).

United States vs UK

The United States national health expenditures have historically increased faster than the national income. American annual per capita health expenditure is the highest in the world—US$8,508 in 2011. Ostensibly, there is a logical loophole in cost control mechanisms that are failing the 50 million uninsured and another 30 million underinsured citizens. In retrospect, Great Britain operates under the ‘universal’ healthcare system which transpires into ‘free’ healthcare for all; including emergency and infectious diseases treatment for the inhabitants of UK without the proper immigration status. Concomitantly, specialists could be both salaried and in private practice and are not limited in their income. General practitioners (GP’s), on the other hand, operate as private contractors under the government contract and are paid using a mixture of capitation, contract payments for specific services and performance-related bonuses, which by the way account for a third of the total salary.

With regards to cost effective mechanism in the UK, Public Health England—has been established to provision the public health functions of local authorities, including reducing health incongruences (Department of Health, 2012). Funding will be allocated directly to local authorities to pay for public health programs. Budget for the NHS is set at the national level, usually on a three-year cycle with annual performance goals. The new commissioning organizations, are allocated funds by NHS England, which closely monitor their fiscal performance to ensure that overspending is rare. Several initiatives modulate the touchstone base to help the NHS meet this criterion, including strict limits on pay increases, improvements to purchasing of NHS supplies, support for increased use of generic drugs, reductions in the DRG-type(diagnosis related group) payments for hospital activity, and a range of measures designed to improve operational efficiency including competition in both hospital- and community-based services.

In essence, the capacity to deliver treatment for the entire population should ideally rely on the governments’ will to implement the appropriate schemas within its economic dimensions. I am however, compelled to address that if such changes were to be applied to the United States; they would carry an ideological burden on those operating the bureaucratic throne of medical, pharmaceutical and insurance corporations. Subsequently, if the government limits the corporate profits and modifies taxation rates to compensate healthcare delivery cost effectiveness while maintaining quality control it would need to first seek compromise with the elite of US health industry.

NHS Information Centre (2012b). Prescriptions Dispensed in the Community, Statistics for England: 2000–2010.

Department Of Health (2012). The Mandate: a mandate from the Government to the NHS Commissioning Board.

Davis, K., Guterman, S., Collins, S.R., Stremikis, K., Rustgi, S., and Nuzum, R. (2010). (New York: The Commonwealth Fund, Sept. 2010).

National Healthcare Quality Report and National Healthcare Disparities Report (2013). Agency for Healthcare Research and Quality, http://www.ahrq.gov/research/findings/nhqrdr/index.html.

Great Britain

Among the key issues surrounding the healthcare system in Great Britain, three things are certain and these would include the following observations. First of all, like other developed countries, Great Britain is struggling with increasing healthcare costs as a result of the ever-changing medical demands and standards in the world. Following these demands, the government of Great Britain is implementing a number of programs and interventions that are aimed at taking the country’s healthcare services to the next level. Lastly, the nation has joined other developed countries in instituting reforms that will ensure that all citizens gain access to quality and improved healthcare services under minimal costs.

Great Britain has a national health system that offers universal healthcare coverage to the people (Grosios, Gahan, & Burbidge, 2010). Healthcare in the country is funded by the public using revenues collected from taxation. According to current global health reports, healthcare spending in the country increases by £43 billion in every five years. There is also a private healthcare sector which provides healthcare through private health insurance. The private system matches the services offered by the National Health Service, but it gives citizens access to quicker, high quality healthcare services.

Although the primary source of funds for healthcare is through taxation, the effectiveness of those funds are attributed to the cost control mechanisms that drive the healthcare system in England. Public Health England—has been established to provision the public health functions of local authorities, including reducing health incongruences (Department of Health, 2012). Funding will be allocated directly to local authorities to pay for public health programs. Budget for the NHS is set at the national level, usually on a three-year cycle with annual performance goals. The new commissioning organizations, are allocated funds by NHS England, which closely monitor their fiscal performance to ensure that overspending is rare. Several initiatives modulate the touchstone base to help the NHS meet this criterion, including strict limits on pay increases, improvements to purchasing of NHS supplies, support for increased use of generic drugs, reductions in the DRG-type(diagnosis related group) payments for hospital activity, and a range of measures designed to improve operational efficiency including competition in both hospital- and community-based services.

Great Britain’s healthcare system is actually one of the most efficient in the world today in terms of quality, equity, performance, and accessibility. However, the biggest problem with the system is in the waiting time that patients have to endure before receiving medical attention to various categories of illnesses. Some of these categories include cancer screening and treatment, open heart surgeries, and kidney dialysis, among other special cases. The issue of awaiting time has consistently raised many concerns among the citizens. The reason that waiting time for healthcare services is a growing problem is mainly attributed to the largely static budget of NHS while the demand continues to rise. Although the law mandates that the entire population is eligible to receive healthcare from any chosen healthcare provider, it doesn’t always prove to be the case in practice. In reality, a person seeking medical attention may do so with any given medical doctor would often find oneself having to seek elsewhere as many doctors have already fulfilled their full panel and are not accepting new patients. The public’s concern and healthcare demand had influenced the government to implement maximum and variable waiting time depending on the procedure in question as outlined on NHS website.

References

Grosios, K., Gahan, P. B., & Burbidge, J. (2010). Overview of healthcare in the UK. The

EPMA journal, 1(4), 529-534.

NHS Information Centre (2012b). Prescriptions Dispensed in the Community, Statistics

for England: 2000–2010.

Department Of Health (2012). The Mandate: a mandate from the Government to the

NHS Commissioning Board.

Canadian Healthcare

The Canadian healthcare system is comprised of a group of health insurance programs. The system is funded by the public to offer medical coverage to all citizens in the country. The healthcare system operates under a number of guidelines that have been set by the federal government. Through the system, people are provided with both preventive care and medical treatment for various health problems.

Provision of healthcare services in Canada is a right for all citizens, regardless of their income, living standards, and the types of illnesses they are suffering from, among other things (Woolhandler, Campbell, & Himmelstein, 2003). This right is exercised through the Canadian Health Act that was passed in 1984 with the aim of ensuring that all Canadian citizens have access to good and affordable healthcare. In this regard, each and every citizen is covered by a regional health insurance plan specific to the place where they reside. As it would be observed, there are common specific features for each of the regional health insurance plans.

Remarkably, under the Canada Health Act of 1984, Long-term care (LTC) services and end-of-life care provided in a non-hospital setting are not considered as insured services. Although all regions opt to fund long term care locally, the coverage varies among the regions. Financing for LTC institutions is mostly as a result of public contribution (72%); spending on nonhospital institutions accounted for about 10 percent of total health expenditure in 2010 (CIHI, 2012). Certain states have implemented minimum periods of residency as a requirement for being eligible for admission to a facility. A combination of private for-profit, private not-for-profit, and public facilities provides LTC, with variation in ownership across the country.

The Canadian healthcare system has always been a subject of great political controversy with some of the big concerns revolving around the inefficiencies of the system. There have also been calls for reforms in the private sector to make it equivalent to that of other developed countries. These concerns about the current healthcare system have divided the Canadian citizens into two main opinion categories. While there are those who think that the system is doing better in its current form, others have expressed concerns that there is a need to end the free healthcare system as one way of improving healthcare services in the country. These issues have continued to trigger many worries among the citizens, with the biggest concern being that privatisation can contribute to inequality in the sector, where certain care services are likely to become a preserve of the rich in the society.

References

Woolhandler, S., Campbell, T., & Himmelstein, D. U. (2003). Costs of health care

administration in the United States and Canada. New England Journal of

Medicine, 349(8), 768-775.

Canadian Institute for Health Information (2012). National Health Expenditure Trends

1975–2012. Ottawa: Canadian Institute for Health Information.

Swiss Healthcare

by - Tuesday, 4 November 2014, 4:41 PM

Switzerland provides quality healthcare services to all its citizens. The current healthcare system in the country was implemented in 1996 under the Health Insurance Law of 1994. Over the years, the system has been modified and expanded to include a basic package that aims to make healthcare services better for all citizens. Every adult individual in Switzerland is expected to buy a basic health insurance covering various treatments as it is stated in the Swiss Federal Law on Health Insurance. This type of package is very extensive and it is divided into three main areas of healthcare services that include Maternity insurance, Sickness insurance, and the emergency or accident insurance. This new law was not only intended to provide a definition on the level of healthcare that can be given to a patient under various circumstances, but it will also encourage competition among different insurers, thus helping to improve healthcare standards and lower the cost of premiums. Apart from the basic package, Swiss citizens can buy supplemental insurance coverage to fund any extra medical services they might require.

The law requires private insurers in Switzerland to provide health coverage to all people in the country, regardless of their age and medical history (Allegranzi et al., 2011). However, citizens are expected to purchase health insurance to cater for additional medical and healthcare services. The most significant aspect of the private insurance policy is that it enables citizens to gain access to medical coverage of some treatment categories that are not catered for by the compulsory insurance.

The Swiss healthcare system is ranked among the best healthcare systems in the world presently, despite the fact that the country’s health expenditures per capita is the second highest worldwide. However, Switzerland is a wealthy nation with a stable economy, and in that case, has no issues dealing with the heavy financial burden of its people who are ever willing to spend more money on matters regarding healthcare. The role of the citizens in catering for their own healthcare services through the purchase of private health insurance premiums is observed to have paid off in Switzerland. This observation is evident in the fact that Switzerland’s expenditure on health matters is the lowest in the developed world. The Swiss healthcare system is currently undergoing a significant phase of transition with the current reforms being focused on improved medical costs and quality performance.

Allegranzi, B., Nejad, S., Combescure, C., Graafmans, W., Attar, H., Donaldson, L.,

& Pittet, D. (2011). Burden of endemic health-care-associated infection in

developing countries: systematic review and meta-analysis. The Lancet, 377(97),

228-241.

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Re: Swiss Healthcare

by Nancy - Thursday, 6 November 2014, 11:20 AM

Excellent observation; however, regarding the costs, the sustainability is based on the assumption that Switzerland's economy will continue to florish and wealth will continue to be created, and no exogenious factors affecting the world economy on the downside would have an adverse impact on the Swiss economy. Do you think that the Swiss economy will continue to florish indefinitely without drawbacks?

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Re: Swiss Healthcare

by - Monday, 10 November 2014, 7:41 PM

Yes. Why? Because it is a banking heaven for many extraordinarily rich individuals. Which is precisely why Switzerland tends to stay out of any conflicts. Why do you think it was never involved in World War 2? Well, because most people of power and wealth had their money there, including members of the Third Reich. Hence, why Switzerland is notorious for being neutral in world affairs and is very likely to maintain is economic prosperity.

Health Care System in Taiwan

Taiwan is well known around the world for its sound public health system which has continued to serve as a backbone for the country’s economic success. The country adopted a national health insurance system in 1995. This program is administered by the government through the Ministry of Health and Welfare of the Executive Yuan. As it would be observed, the country has only one payer system for healthcare services, which is the National Health Insurance. NHI provides equal access to medical care for all people in the country.

Even though the National Health Insurance system has amassed massive praises globally in terms of comprehensive population coverage, good and timely accessibility, relatively low costs, and short waiting times, it is fraught with various problems. Some of the common issues affecting the healthcare system include a weak government role, information disparity, variable quality of medical care, and heightening financial pressure (Wu, Majeed, & Kuo, 2010). Among the problems highlighted above, financial imbalance remains the biggest crisis that has persistently affected the healthcare system.

There is a need for improvements in some key sectors of the National Health Insurance system to make healthcare services better. These changes will ensure that Taiwan citizens, who have consistently been exposed to various problems and crises, eventually gain access to adequate health care services. In order to effectively address these issues, the Taiwan Health Reform Foundation has come up with several areas of concern that must be taken into consideration when evaluating the healthcare system. These advocacies would be placed in three categories that include health care system, information transparency, and healthcare quality.

The first category of healthcare system would comprise aspects such as medical practices, call for the Fiscal supervision of healthcare matters, and healthcare staff shortage. Information transparency would feature accessibility of medical record which has always proved to be a big challenge for Taiwan citizens, medicine bag improvement, drug prescription reform, and citizens’ right on the surgery consent forms. Finally, there is the aspect of healthcare quality which features things such as expansion of hospital shopping alley, improvement of dialysis treatment, and improvement of paediatric drug. All these advocacies are aimed at making the Taiwan healthcare system better in the near future.

The second-generation system will not only spread the insurance premium burden more fairly, it will also adopt a mechanism that automatically links revenues and expenditures, an important step in ensuring the health insurance program’s sustainability. It also strengthens the medical services available to disadvantaged groups and residents of remote areas of the country. As for information transparency, the new system encourages health care institutions to release information on medical quality and their financial statements to the public. Another of the reforms is to grant the right to health care of inmates at correctional facilities and cover them under the NHI program. The second-generation reform, which aspires to “improve quality, care for the disadvantaged, ensure the health insurance system’s sustainability, and set an international benchmark (The National Health Insurance Statistics, 2013).”

References

Wu, T. Y., Majeed, A., & Kuo, K. N. (2010). An overview of the healthcare system in

Taiwan. Lond J Prim Care, 3(15), 115-119.

The National Health Insurance Statistics, 2013. (2013, January 1). Retrieved November

6, 2014, from http://www.nhi.gov.tw/English/index.aspx

Chinese health care system.

by - Wednesday, 26 November 2014, 12:10 AM

Despite the rapidly growing economy and implementing healthcare reforms, China faces a difficult task of delivering healthcare to the largest population in the world. It comprises of roughly 20% of the World’s population and healthcare accessibility and affordability is massively unequally distributed. Those in rural areas often face shortage of doctors as well as economic hardships to afford the treatment. Prof. William Hsiao from Harvard University School of Public Health explains how the Chinese hospitals and clinics overwhelm the patients with out of pocket fees which would then be disbursed amongst the physicians and other hospital personnel. He notes, often a goal of such practices is to overcharge, or rather exploit the patients for the maximum expenditure amount for the treatment. Surprisingly, as a communist state, China fails to deliver equal and adequate treatment to all of its citizens despite the main communist manifesto of equal benefits and other gratuities. Among those in question, is yet another problem of malnutrition. As shocking as it seems, parts of Asia, Africa and South America still struggle to provide nourishment for every individual. It becomes even more apparent with the cases of Kwashiorkor and Marasmus seen in malnourished children and virtually unheard of in the United States.

As a consequence of unequal affordability and distribution of healthcare, the nation faces the potential for a number of epidemics due rapidly evolving infectious species. Much of it can also be attributed to first generation treatment regimen which could increase microbial and viral resistance to such antibiotics. Community-acquired resistant strains pose a serious threat both domestically and globally. A limited capacity to address the novel strain outbreaks swiftly, constitutes the epidemiologic mechanism of global pandemics.

China is among the leading nations in matters regarding economic potential and development in the modern world. The country enjoys a more stable economy than any other country globally. As a matter of fact, the living standards of the Chinese have improved greatly over the last several years as a result of this stability. However, despite the many changes that have been witnessed in the country following recent economic developments, China’s healthcare system has not yet reached the level that befits the country’s current status as a giant global economy. As a matter of fact, China still lags behind other developed countries in the world in healthcare-related matters.

The Chinese healthcare system is currently under the leadership of the National Health and Family Planning Commission. However, healthcare governance and management is decentralized among health Bureaus in various autonomous regions. China’s healthcare system has been focused on ensuring that all citizens gain access to affordable and quality health care (Blumenthal & Hsiao, 2005). Under the new healthcare system, the government of China is planning to offer basic medical care to all citizens by the year 2020. In order to achieve this objective, the country has come up with a healthcare reform plan comprising several key components of development that include creation of a rural-cooperative health system and expansion of basic health insurance programs.

On top of these components, the Chinese government has consistently shown great concern towards the healthcare system through a number of strategies. For example, the government has shown great commitment in addressing various problems affecting the current healthcare system, such as the issue of drug quality and abuse of intravenous drugs. More importantly, the government has joined hands with other key stakeholders in the country to establish mechanisms that are aimed at evaluating various issues affecting the healthcare system (Yip et al., 2012). All these reform plans are aimed at laying the groundwork for a more solid healthcare system in China.

References

Blumenthal, D., & Hsiao, W. (2005). Privatization and its discontents—the evolving

Chinese health care system. New England Journal of Medicine, 353(11), 116-

119.

Yip, W. C. M., Hsiao, W. C., Chen, W., Hu, S., Ma, J., & Maynard, A. (2012). Early

appraisal of China's huge and complex health-care reforms. The Lancet, 379(18),

83-89

CUBAN SYSTEM

The Cuban government considers healthcare to be a fundamental right for all humans, as it is described in the country’s Constitution. In this regard, the country has taken significant developmental measures to make its healthcare system universal and free for all citizens without any restrictions. As a matter of fact, Cuban healthcare system has received international recognition owing to its numerous achievements and accomplishments. Cubans tend to believe that human health can only be improved through innovative approaches. This perception clearly explains the reason why research has become a key component of the country’s healthcare system. Currently, the country is said to have great socialised medicine which is much greater compared to that of other developed countries put together.

Cuba mainly relies on preventive-based medical system which has proved to be more effective compared to the curative model in addressing various illnesses affecting the country’s population. The country’s emphasis on research and preventive medicine has contributed to great developments in the health sector. For instance, the country has succeeded in developing its own vaccines against several life-threatening illnesses. Cuba is also known for its significant role in producing a vaccine of meningococcal meningitis. Cuba’s great achievement in the healthcare sector is evident in the fact that, together with France, the island plays a major role in the development of the vaccine pentavalent.

Another interesting aspect of the Cuban healthcare system is that it extends its services across the international borders to serve other countries that are in need of urgent medical attention. For instance, the system, under the directive of the Cuban government has been sending medical experts to the third world countries to assist in taking care of various medical problems. Currently, about 30,000 medical professionals from the country are serving in over 50 countries across the world (Kingma, 2007). Despite this huge number of Cuban medical specialists serving abroad, the country is still among the few countries with the highest doctor per patient ratio in the world today.

Kingma, M. (2007). Nurses on the move: a global overview. Health Services Research,

42(3p2), 128-131.

Re: Cuba's health care system

by - Saturday, 29 November 2014, 7:37 AM

Although the Cuban healthcare system may sound wonderful on paper and many non-Cuban citizens may enjoy this amazing healthcare system; it is not like this for citizens of the country. Everyone seems to forget the Cuban government is a dictatorship and unfortunately their own citizens are not allowed to be treated in these amazing hospitals visitors go to and speak about; instead they go with hospitals without air conditions and doctors make much less than a waiter. Not to mention how, this medical aid that Cuba sends out to aid other countries consist of doctors from Cuba who are only allowed to keep 30% of their paycheck and the other 70% goes to the cuban government. Their statistics are made up by the government itself which again is a dictatorship. My question is, if the government feels that healthcare is a fundamentals human right for all than why do Cuban citizens risk their life on a daily to flee Cuba? If Cuba is so concerned about their citizens why are Cuban citizens not allowed into the same hospitals tourists go into?

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Re: Cuba's health care system

by - Monday, 1 December 2014, 7:57 PM

Stephanie, you have very valid points and I have no doubt all of which are consistent with totalitarian regime where advocacy groups and citizen's rights are diurnal targets of desecration. It’s one thing to have something on paper, and another to live it.

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Re: Cuba's health care system

by Ashley - Saturday, 29 November 2014, 11:03 AM

Vitaliy,

Great response. I read Stephanie's reply below and was a little mind blown. The research that I found stated things such as the WHO said Cuba was making progress in providing better care for its citizens. I was not aware this was all false. It's kinda scaring doing researching and then finding out this research only applies to non-citizens. It's hard for many Americans to think of not having healthcare available to them. I live in a state with many illegal immigrants and even they are not denied healthcare. The articles make is sound nice, that the cuban physicians are helping other developing countries, I had no idea that they lost most of their paycheck to the Cuban government. Amazing response Stephanie, thank you for sharing your side and the true side of the story.

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Re: Cuba's health care system

by - Monday, 1 December 2014, 8:08 PM

Ashley,

Indeed, I was rather astonished to have missed such a fine print of the big picture. Although I must admit, that I am not entirely surprised, in fact because that's a common theme left behind from the Soviet Union and its comrades; isolated, corrupt, and ethically compromised.

Brazilian healthcare sector; efficiency determinants and capacity limitations.

by - Friday, 28 November 2014, 9:55 PM

Despite the vast problems facing the Brazilian government today, it has ensured that healthcare provision remains a fundamental right to all citizens. Subsequent reforms have been made to the country’s healthcare department over the years since 1970, when the first promising amendments were made to the sector. As it would be observed, primary healthcare is a major pillar of the country’s healthcare system which ‘guarantees quality care’ to the country’s over 190 million citizens. The Brazilian national healthcare system is managed through a number of taxes received from the three levels of government which include the federal, the state, and the municipal (Paim, Travassos, Almeida, Bahia, & Macinko, 2011).

The primary healthcare system caters for about 70 percent of the country’s population through various medical interventions that include preventing illnesses, tackling serious illnesses, promoting health, and treating the sick. In order to carry out its objectives to the society more effectively, the national healthcare system works through a number of health initiatives. Some of these initiatives are deployment of auxiliary medical practitioners to serve citizens in poverty-stricken regions and the idea of the Family Health Programme that was established in 1994.The latter serves as the main primary health care strategy in the country, and it aims to offer maximum quality medical care to people in their residence and in healthcare facilities.

Despite the many efforts applied by the Brazilian national healthcare system in ensuring that people have access of quality care, the system has not been lucky to elude various challenges that have threatened to paralyse health care services in the country. Some of these challenges include lack of financial resources, increased risk of noncommunicable diseases, and the burden of infectious illnesses, among other aspects. A successful attempt by the government to expand its financial capacity by $1 billion US, included manufacturing AIDS drugs locally and negotiating a lower-cost imported medicines by threatening to manufacture them at a very modest rate locally as well. Long waiting time is also another serious problem affecting the Brazilian national health system nowadays. This outcome is influenced by the fact that public hospitals offer free health services to the people, thus attracting more people compared to the ones in the private sector that offer excellent medical facilities, but which are more expensive. Brazil’s for-profit hospitals are better equipped and are generally better staffed as a result of increased supply/demand ratio in comparison to the public sector. In the broad spectrum of Brazilian healthcare, the fundamental goal of government’s initiative lies with improving the socio-economic gap in the population, reducing the financial limitation of obtaining quality healthcare in a private sector, thereby also alleviating public hospitals congested workload. There is also the problem of sufficient health care personnel in the country with 1 doctor per 833 people, in comparison to 1/416 in US, based on CNN report in 2012. All these are key issues which the Brazilian government should address effectively if it must achieve its unwavering desire of taking maximum care of its population.

Paim, J., Travassos, C., Almeida, C., Bahia, L., & Macinko, J. (2011). The Brazilian

health system: history, advances, and challenges. The Lancet, 377(97), 177-182.

Russian Federation’s free healthcare; but can you pay?

by - Friday, 28 November 2014, 10:24 PM

Provision of healthcare is a primary social function of the Russian government. This provision would comprise several aspects of care such as prevention of diseases, medical care delivery, and improvement of health. Basic medical care in Russia is offered for free to all citizens, in theory rather than practice. Currently, Russia boasts the highest number of medical professionals and healthcare facilities on a per capita basis globally (Rese, Balabanova, Danishevski, McKee & Sheaff, 2005). However, in spite of these achievements, the quality of healthcare services in the country is relatively lower than that of other advanced nations in the world, probably as a result of the social, economic, and lifestyle factors that have affected the country in the past.

The Russian healthcare system is currently in a miserable state. This means that there is serious shortage of quality healthcare in most parts of the country. Everybody who has a particular interest in the country’s healthcare system is ever complaining about the system’s poor state and how this has continued to deter quality health care services to the Russian people. Even though quality medical treatment can be found in some parts of the country, this remains a preserve of the upper middle class and the wealthy who can afford it (Kuhlmann & Saks, 2008). The grim reality of Russian healthcare delivery with regards to poor and debilitated lies by the principles of Darwin’s model of natural selection and the survival of the fittest. In other words, if you can’t afford treatment you have two basic choices; to survive or perish.

Among other issues, financial problem is the biggest challenge affecting the Russian healthcare system currently. Health expenditure in Russia is equivalent to 3.5 percent of the country’s GDP and this is a relatively higher amount compared to what other advanced countries are receiving for the same need. This, however, is understandable considering the country’s large surface area and its high population, among other countless issues that continue to make life extremely difficult for the Russians. In order to improve the health care system, the Russian government is planning to employ a number of strategies that would include elimination of the free health care system and a cut of the national budget on healthcare. These could hardly seem as steps towards improvement but the ideology of Russian government is unfortunately not always logically motivated.

Kuhlmann, E., & Saks, M. (Eds.). (2008). Rethinking professional governance:

International directions in healthcare. Policy Press: United Kingdom.

Rese, A., Balabanova, D., Danishevski, K., McKee, M., & Sheaff, R. (2005).

Implementing general practice in Russia: getting beyond the first steps. BMJ,

331(750), 204-207.