Introduction Chapter: Governmental Healthcare Centers Concentrate

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[. . .] A concomitant consequence of this law was to "entrenched the hospital and physician-centered model of Medicare by limiting insured health services covered by the five governing principles of the Act -- public administration, universality, accessibility, portability, and comprehensiveness -to medically necessary hospital and physician services" (Romanow & Marchildon, 2003, p. 284). With respect to accessibility in particular, Romanow and Marchildon emphasize that the vagaries of the CHA with respect to the delivery of health care services has created a privileged system in some territories and provinces. In this regard, these researchers report that, "Although the CHA has never blocked the provinces from providing a broader range of services under their respective health plans, it has meant that both hospital services and primary care physician services are historically privileged" (Romanow & Marchildon, 2003, p. 284).

The fact that Canada has universal health care but also has issues with respect to the availability of health care services suggests that Canadian health care consumers are not receiving the same level of diagnostic and evaluation as their counterparts in the United States, despite outperforming them on the life expectancy rating for quality of care. In this regard, the National Bureau of Economic Research reports that:

Canada provides universal access to health care for its citizens, while nearly one in five non-elderly Americans is uninsured. Canada spends far less of its GDP on health care (10.4%, versus 16% in the U.S.) yet performs better than the U.S. On two commonly cited health outcome measures, the infant mortality rate and life expectancy. (Comparing the U.S. And Canadian health care systems, 2013, para. 2)

Health Care Systems in the United Kingdom

In the United Kingdom, the National Health Service (NHS) operates and manages a nationwide system of hospital services through NHS trusts that ensure hospitals deliver high-quality health care services and that the resources allocated to these facilities is used effectively. The NHS trusts are also tasked with developing appropriate hospital development strategies (About NHS hospital services, 2013). All medical services are provided for free at NHS hospitals except for emergency care (About NHS hospital services, 2013). In addition, according to Lynch (2012), in the United Kingdom, "Community health centers have long provided an excellent model of multidisciplinary care that the private practice of medicine would do well to emulate" (p. 5).

Accessibility to health care services is regarded as generally good, but there are some regional differences (Lynch, 2012). Moreover, there are lengthy waiting times for some services and specialists (in some cases, up to 18 weeks or even longer) (About NHS hospital services, 2013). According to the National Health Service, "The NHS Constitution says you have the right to access certain services commissioned by NHS bodies within maximum waiting times. Where this is not possible and you ask for this, the NHS will take all reasonable steps to offer you a range of suitable alternative providers" (NHS waiting times, 2013, para. 2). These commitments are legally codified by NHS England and Clinical Commissioning Groups (CCGs) in the responsibilities and standing rules regulations published in 2012 (NHS waiting times, 2013).

Health Care Systems in the United States

Health centers that are funded by the federal government in the United States include those defined in Section 330 of the Public Health Service Act as follows:

1. Community Health Centers, Section 330 (e);

2. Migrant Health Center, Section 330 (g); and,

3. Health Care for the Homeless, Section 330 (h).

In addition, the federal government maintains the country's largest system of health care facilities in the Department of Veterans Affairs Health Services Administration, with tertiary health care facilities located in each state as well as hundreds of outpatient clinics and Vet Centers across the country. Eligibility for these health care services, though, is restricted to veterans of the armed services and in a few restricted cases, their family members.

In the United States, the majority of state and local authorities initiate managed care contracts with privately managed health organizations and health maintenance organizations (McDaniel & Spiegelman, 2006). Accessibility to these health care facilities, though, is carefully controlled and is not automatic (McDaniel & Speigelman, 2006). According to McDaniel and Spiegelman (2006), "Several organizational procedures are employed to manage access to care, or gate-keeping, and counties, states, and private payers adopt them either singly or in combination" (p. 276).

Although eligibility for access to public health care facilities in the United States is rigorously controlled, the administration of policies and programs, and therefore accessibility, may differ from state to state (McDaniel & Spiegelman, 2006). Generally speaking, McDaniel and Spiegelman report that, "Gatekeeping typically establishes a single point of entry or other control over access to the treatment system and may include elements such as telephone or in-person administration of a precertification screening tool, the application of medical necessity criteria, and triage to treatment or other programs" (p. 276).

Some general indication of the respective availability, accessibility and quality of health care services provided or supported by the governments of Australia, Canada, the United Kingdom and the United States can be discerned from the numbers of hospitals beds that are available (availability), the physician/patient ratio (accessibility) and the life expectancy at birth rates (quality of health care services) which are set forth in Table 1 below and depicted graphically in the figures that follow.

Table 1

Comparison of Australia, Canada, UK and U.S. For Availability, Accessibility and Quality of Health Care Services

Category

Australia

Canada

United Kingdom

United States

Availability (beds per 1,000 pop.)

3.82

3.2

3.3

3

Accessibility (physicians per 1,000 pop.)

2.99

1.91

2.74

2.67

Quality of Care (life expectancy at birth)*

81.98

81.57

80.29

78.62

Source: CIA world factbook (2013) at https://www.cia.gov/library/publications/the-world-factbook/geos/

* Life expectancy at birth is a commonly used indicator of quality of care (Comparing the U.S. And Canadian health care systems, 2013)

The respective ratings for health care availability for Australia, Canada, the UK and the U.S. are depicted graphically in Figure 1 below.

Figure 1. Respective Ratings for Health Care Availability: Australia, Canada, UK and U.S.

The respective ratings for health care accessibility for Australia, Canada, the UK and the U.S. are depicted graphically in Figure 2 below.

Figure 2. Respective Ratings for Health Care Accessibility: Australia, Canada, UK and U.S.

Finally, the respective ratings for quality of health care for Australia, Canada, the UK and the U.S. are depicted graphically in Figure 3 below

Figure 3. Respective Ratings for Quality of Health Care: Australia, Canada, UK and U.S.

Importance of the Study

Organization of the Study

This study used a five-chapter format to achieve the above-stated research objectives. Chapter one of the study introduced the issues of interest, including a statement of the problem, the objectives of the study, as well as the background of the study including a brief review of the respective health care systems used in Australia, Canada, the United Kingdom and the United States. Chapter two of the study provides a review of the relevant and peer-reviewed literature concerning the health care systems in these four countries and how accessibility, availability and quality of care affect emergency responses. Chapter three describes more fully the study's methodology, including a description of the study approach as well as the data-gathering method and the database of study consulted. The penultimate chapter provides an analysis of the data collected during the research process and final chapter presents a summary of the research and important findings concerning the status of the nationally sponsored health care services in Australia, Canada, the United Kingdom and the United States.

Chapter Two:

Literature Review

In recent times, the increase in population, shortage of land and rapid urbanization in developed countries such as Australia, Canada, United Kingdom and United States have increased the population of areas, which are most likely to experience natural disasters that would have negative consequences on health of the entire community (Public Safety Canada, 2013). In the last few decades, the outburst of natural disasters and epidemic outbreaks have increased significantly and have contributed towards social and economic damages as well as claiming lives of millions of people all over the world. Natural disasters such as Hurricane Katrina, U.S. flu epidemic, Whooping Cough Epidemic in United Kingdom and Canada, are some of the disasters that have clearly demonstrated that even developed countries are prone to these disasters and therefore, it is necessary to address these problems in order to maintain the health and welfare of citizens (Public Safety Canada, 2013).

After the occurrence of natural disasters, epidemic outbreaks of infectious diseases can further threaten the health of communities and can create panic, confusion and therefore, it is essential that governmental health centers utilize their emergency and natural disaster management plans in order to manage public health activities (Frykberg, 2002). Health centers must be available and accessible to provide health care to individuals in order to cater the needs of those who have been injured from these disasters. Mohammad et al. (2006) asserts that "The prolonged health impact of natural disasters on a community… [END OF PREVIEW]

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