Comparative Healthcare Systems Analysis

Introduction:

Based on the definition set by WHO (World Health Organisation) Comparative healthcare study is the method of comparing two or more healthcare systems in order to analyse the usefulness, similarities and differences of these systems [Weerawansa and Samarasinghe, 2017]. Healthcare system is the process of executing, organising and delivering high-quality healthcare facilities to community in order to promote their health and wellbeing [WHO, 2019]. This report will discuss comparative healthcare system of three different countries such as the UK, Germany and US. With discussing NHS in the UK, this report will focus on representing the comparative healthcare framework in the Germany and the US. This report will also discuss the usefulness as well as the limitations of each healthcare system in order to highlight how these healthcare systems provide impact on the health and wellbeing of community people. Additionally, for those seeking healthcare dissertation help, understanding these comparisons is essential. Finally, this report will discuss the comparative analysis of healthcare management and population management process in the above mentioned three countries, with discussing the inequalities, structural management and population health in these countries. Finally, this report will recommend, how overall health system in selected countries such as Germany, the UK and US can be improved in order to provide high quality care to service users.

Discussion and description of the chosen country:

When it comes to compare the NHS, US healthcare system and Germany healthcare process, it is important to describe the unique characteristics of each healthcare system. In Germany, entire healthcare system is a multi-payer process which represents the combination of private healthcare insurance and statutory health insurance. According to WHO (World Health Organisation), in Germany, nearly 77% of entire health spending is funded by the government and the rest 23% is carried out by the private sectors insurance companies [WHO, 2019]. Insurance is compulsory for citizens in Germany, in order to get the affordable treatment process. salaried employees with high income range (above 60,750 Euros per year), are automatically entitled under one of the 130 public non-profit insurance agencies. Self-employed staffs have to pay the entire contribution of the insurance premium by themselves (Bozorgmehr and Razum, 2015). In addition to statutory health insurance which can availed by the people with high range salary, there are also private insurance for civil servants and students. In Germany 11% of the citizens opt for private insurance process. According to Ahonen et al. (2018), in today's world comparative analysis of the health care system of two or more countries is one of the most popular and interesting things. As compared to Germany, the US and UK healthcare system is different, in which the former has a large private-owned healthcare framework and later has the largest public sector health care framework. Therefore, through selecting these two counties, it is possible to highlight the differences between this two-healthcare system as well as the uniqueness of each healthcare system. In addition to this, the US and UK healthcare system have shown their own process of financing, controlling and executing in the healthcare framework which is completely different for each other. In the US, the coverall healthcare structure and ethics of healthcare service delivery process are different from those of the UK (Waterson, 2014). Through discussion the healthcare system of US and UK countries this report is able to demonstrate a clear understanding of two healthcare models such as private healthcare model and national model. Moreover, through selecting these two healthcare systems this report is able to discuss the impact of the healthcare system of the financial, social and cultural framework of these countries.

Discussion and overview of the healthcare system in the chosen countries:

In comparison with healthcare system in Germany, NHS is British government led health care framework which is universal at any point of the UK. Where in Germany citizens are entitled under either statutory or private health insurable process in order to get affordable treatment process, in the UK the entire healthcare system is governed and provided by eth British Government through NHS [NHS, 2019]. NICE [National Institute of Care and Excellence] sets standard for NHS, which is implemented by NHS professional into practices for promoting compassionate care to each service users. Many recent types of research have shown that the British National Healthcare framework is so far better than the privately-owned healthcare system in the US on many objective indicators. In the UK, the health of the entire population is covered under NHS [National Health Service], which is controlled and run by the DOH [Department of Health]. The entire financing and fund for NHS are done by the general taxation process in the UK (Weerawansa and Samarasinghe, 2017). NHS provides equal and high-quality healthcare service to the entire permanent citizen, which is free at the point of need. Although public-owned system dominates the overall healthcare framework in the UK, there are some non-profit private owned hospitals and healthcare centres which can be used by the people who can afford the costly treatment process (www.aha.org 2018). NHS provides ranges id healthcare facilities to the citizen of the UK such as primary care, long term healthcare, in-patient care, emergency care and ophthalmology [NHS, 2019]. From the survey conducted by WHO, it is seen that majority of citizens in the UK (82%) use the healthcare facilities from NHS and only 8% people use privately owned healthcare services from hospitals and care homes. Under the guidelines of the National Health Service Act 1946, NHS provides equal and high-quality healthcare facilities to all the permanent citizens in the UK. On the other hand, in Germany, the entire healthcare framework can be divided into two main types of health insurance process, private and statutory health insurance. Through these health insurance process, Germans are provided with three major types of health facilities that is co-funded by the employers and employees (Razum and Bozorgmehr, 2016). The health benefits are accidents insurance, health insurance and long-term care insurance. Accidents insurance is provided by employer to each employee, in which employees are entitled to get the expenses of treatment and care for any accidents or sudden injuries that have been occurred at their workplace during working (Litmathe, 2016). In long-term care process, the insurance coverage is payed half by the employers and other half by the employee. This type of health benefits is entitled for persons who ae unable to carry out their daily routine such as cleaning of apartment, provision of the foods. In this process, 2% of the salaried income of employee is funded through the health insurance process.

As compared to the public-owned healthcare system of the UK and the insurance-based healthcare process in Germany, the health framework in the US is not universally accessible healthcare system; rather it is the integration of both privately and publicly funded fragmented healthcare systems as well as health programs (www.legion.org 2015). Citizens in the US, who are insured, are covered under both the private and public health insurance, with a majority of them are covered by the private health insurance plans. There are some government-funded programs such as Medicare, Medicaid that provides proper health coverage to the vulnerable population in the US (www.nice.org.uk 2018). In addition to this, the US government also provides funds to health coverage for vulnerable groups, military people and the poor community in order to meet their health needs. The US government runs different healthcare programmes, such as Veteran Health Administration, Children’s Health Insurance Programs, Medicaid and Medicare in order to fund the health spending in the country.

Discussion of findings:

According to Squires and Anderson (2015), different factors are associated with opposing import impact on overall health care systems. The factors are finance, organisation and controls, which influence the execution, operation and service delivery process of the healthcare system in a country.

Factors contributing to the healthcare system:

Organisation:

Organisations play important role in setting health policies and cdes of conduct which need to be implemented into practices for promoting best healthcare process (Litmathe, 2016.). In case of Federal Republic of Germany, healthcare is mainly funded and controlled by statutory contribution process. the statutory healthcare ensures free health facilities for citizens in Germany through all public insurance fund. Statutory health insurance process in Germany is known as GKV (Gesetzliche Krankenversicherung) (bundesaerztekammer.de, 2019). GKV plays the important role in controlling the overall healthcare framework in the Germany. About 88% population in country is under the statutory health insurance system. Basic healthcare system in Germany is associated with four principles, such as:

Funding via insurance premium:

Healthcare is funded primarily by the premium paid of insured employee and the employers.

Compulsory insurance:

Every citizen in Germany must has the statutory health insurance, that is provided and controlled by GKV (Kuehne et al. 2015). Thus, statutory insurance is provided to each German citizen according to their gross income under the fixed limit. Individuals with more earning can chose private insurance in addition to statutory insurance.

Principles of solidarity:

In case of German health system, the statutory insurance members carry the risk of medical care process in any illness (Busse et al. 2017). Every citizen who are entitled under statutory insurance process, have the rights to access the government led medical care and treatment at the time of need, regards less of premium level and income. In Germany the premium of insurance is set according to the income of the individuals. Therefore, rich can help and support the poor and heathy people can assist the ill people in order to get proper insurance facilities.

Principles for self-governance:

Besides the statutory healthcare bodies, there are organisations as well as individual medical services, that are responsible for controlling and governing the self-governing health care process in this country (Razum and Bozorgmehr, 2016). These individuals’ medical bodies and the organisation consists of several doctors, nurse and general physicians, who ae associated with promoting the high-quality healthcare to each citizen.

As compared to the Germany based healthcare system, the US healthcare system is largely operated as well as owned by the private sector businesses (Sampson et al. 2016). From Commonwealth report 2018, it can be stated that, in the US, 58% of the community hospitals are non-profit, 21% are for-profit and rest 21% are government-owned. According to WHO, the US government has spent 17% of its GDP and $9,403 in the healthcare sector. As compared to the UK based healthcare system, in which healthcare service is provided by NHS, in the US, healthcare coverage is actually provided through public health coverage such as Medicaid and Medicare and private health insurance plan. The US does not represent universal healthcare services, like the UK in which NHS provides equal and uniform, healthcare facilities to all permanent citizens. From the recent report of WHO, it is seen that the US government spends more than 64% of healthcare spending in this country through funding different healthcare programmes (www.commonwealthfund.org 2014). Medicare is the Federal social insurance plan for senior citizens with age group 65 and above. On the other hand, Medicaid is a state-based insurance plan which covers the health needs of people residing in the lower social class. CHIP (Children Health Insurance Program) is also state-owned healthcare program for children with age up to 19, who belongs tit eh family who are unable to afford the private insurance plan. Most of the Americans who have private health insurance are entitled to understand the group plan that is subsidized by the employers (www.legion.org, 2015). Majority of the US people are not covered under employer-sponsored insurance plan or private insurance packages. From the WHO report of 2017, it can be stated that, in the US, more than 13.4% of people (42 million) are uninsured which have to depend on the non-profit community healthcare centres as well as hospital emergency rooms under EMTALA [EmergencyMedicalarrangement and Active labour Act ] (www.theguardian.com 2015). Mostly of Americans who have the group insurance plan either through arranged individually or by the employers, are entitled to some kind of managed healthcare plan. These plans are associated with contracting network of different health professionals and service providers including doctors, nurses, hospitals, health clinics and different healthcare providers such as a pharmacist, gastroenterologist and general practitioners.

In the case of the UK, the British National Health Care System focuses, in fact, healthcare is the citizens; rights but not the privilege. In the UK he entre healthcare process operated ad controlled by the NHS [NHS, 2019]. NHS provides all kind of healthcare facilities to all the permanent citizens of the UK, which is free at the point of needs. Understand the NHS led healthcare system; pocket expenses are only for the outpatient prescriptions (www.england.nhs.uk 2018). Healthcare in the UK is devolved matter with Northern Ireland, England, Wales and Scotland. Each of these regions has its own system of publicly funded healthcare that is accountable to and funded by the separate governments as well as parliaments (www.legion.org 2015). Along with public-funded healthcare system, there are some private hospitals, non-profit healthcare organisational and voluntary organisations. Despite the existence of the separate healthcare services in each country in the UK, the overall healthcare system is operated by NHS which is a DOH-led healthcare framework. According to the Commonwealth report if 2014, NHS ranks the best healthcare service across the world in terms of quality of care and well-organised service delivery process. UK’s palliative care process provided by NHS professionals also ranks as the best care process across the world by the Economic Intelligence Unit (www.legion.org 2015). According to Wachs et al. (2016), organisation plays important roles in the healthcare system in order to maintain proper service delivery process, quality of care and long terms usefulness of eh care in term of meeting health needs of community people. As compared to the US healthcare system, NHS is known for the quality of care, patient-oriented approach, and coordinated working process of professions and equal access of quality care for the citizens (www.commonwealthfund.org, 2014). A report of WHO, 2019, on national healthcare organisational agencies show that the UK government spend more on NHS in order to improve the overall quality and care process in this system. According to this report, in 2011, the UK government has spent 143 billion pounds into the healthcare system in order to improve the overall structure and functions of NHS and other private as well as a non-profit organisation. According to (0), the UK government has also taken effective healthcare initiates which assist the healthcare professional in NHS to develop their skill and proficiency level in order to deal with critical and complex needs of patients. Although the natural healthcare system in the UK is dominated by the government-led public system, there are some privately owned health care organisation and agencies that are too small to cover the majority of citizens to meet their health need. According to Waterson (2014), as compared to the public healthcare system, the privately-owned healthcare system is restricted for the people who reside in higher economic class due to the high hospital's bills. As compared to the healthcare system in the US, in the UK there are no private insurance plans and policies. Therefore, in the UK, the majority of the population researches affordable healthcare facilities from NHS rather than using private healthcare service. Due to providing equal access to the healthcare system to all permanents citizens, NHS is considered to platys important roles in reducing chances of mortality, morbidity and health issues in the UK (www.england.nhs.uk 2018). This is because all the residents in the UK are covered under healthcare facilities provide by the government-led NHS, which assures that, each permanent resident in his country will receive the high quality and relevant treatment in order to meet their critical and complex health needs. From WHO survey on mortality and morbidity in the UK, it is seen that for females, the mortality rate is 3.9 per 1000 live births and for males, the rate is 4.7 in every 1000 live births, which far less than that of the other developed countries.

Finance:

Finance is one of the most important factors that pose a potential impact on the overall healthcare system of a country (Weerawansa and Samarasinghe, 2017).

Germany face the challenge of ever-increasing health care cost, most of which is paid by the statutory healthcare body (Bozorgmehr and Razum, 2015). Although the health system in Germany is paid through combination of private and statutory health insurance, more than 77% of health spending in Germany is funded through government and only 23% is through the private insurance agencies [WHO, 2019]. In statutory or public health system I the premium is set by Federal Ministry of Health, which is associated with providing fixed set of the covered health service that is described in the German Social Law (Litmathe, 2016.). Currently, 15.5% of the salary of an employee is covered under the statutory health insurance out of which 7% is funded by the employers. In Germany employee with salary under €54,450 per year, is covered under the statutory health insurance process. People in Germany with high range of salary can afford the private health insurance. Report from WHO shows, that only 11% of the Germany is covered under the private healthcare system. In the US the overall healthcare system is funded and financed by the integration of both the private and public insurance plans. According to Waterson (2014), the majority of the healthcare sending in the US is financed by the private-owned insurance plan and health programs. According to the health survey conducted by WHO, the healthcare system is funded by the private healthcare agencies organisation. The report also stated that more than 48% of the healthcare and comes from private insurance agencies and health organisation. Only 28% of the fund in US healthcare framework comes from household and the rest 20% of the healthcare funds comes from different private sectors businesses. Unlike the UK, in the US there are different insurance plans including social insurance program and privately purchased insurance. Social insurance programs are the government-sponsored insurance plan that is accessed by the poor people and children in order to meet their health needs. According to Villines et al. (2018), the cost of healthcare in the US is higher than that of the other countries, which pose a potential strain on the overall economy. From recent health survey conductd by WHO, It is seen that, the healthcare system in the US is expensive and advance. The report also shows that overall healthcare expenses during 2016 were $3.3 trillion dollars. According to Goran et al. (2012), for records, healthcare expense in the US healthcare system is improved faster rate as compared of the economy grows. Based on eh report published by Organization for Economic Cooperation and Development (OECD) on 2016, the US spent 17.9% of the GDP into the healthcare system which is highest across the other countries in the world. As the US government spend more on the healthcare system in the US, the fund invested in other programs has been decreased. According to Grant et al. (2017), as compared to the UK and other developing countries, in the US healthcare system is highly expensive for each person. According to the report published by WHO, out of 116 million people in the US, only 37% of people are insured under the health coverage under private and public health insurance agencies. On the other hand, rest people have to face difficulties in order to pay a high-value premium of private health insurance. Moreover, as the majority of the fund in the spending in the US comes from private business and private health insurance agencies, the level of transparency in offering quality healthcare system to the citizen is low as compared to the UK based healthcare system. In these aspects, Loopstra et al. (2015) stated people in the US have to face high-level disparity in insurance coverage that interferes with and transparency of the healthcare system.

Unlike the financial framework of the eth healthcare system in the US, the UK has a completely different healthcare structure. In the UK, NHS is mainly funded and financed by National Insurance contributions and general taxations (Malhotra et al. 2015). From the report of WHO it is seen that, from 2011, more than 80% of the NHS funding is done through general taxation. With the increasing number of patient and health professionals in the UK, the proportion of the fund through the National Insurance also increased at faster rates. According to Cohen and Marshall (2017), some the healthcare funding is done by the service users such as charges for the prescriptions, spectacles and dental treatments. These charges are accounted for only a small portion of the NHS income. Through the report published by the DOB (Department of Budget), NHS also developed some of its incomes from the land sale and parking charges. According to WHO, NHS finance, as well as funding, is set by the central government by using the Spending Review Process. Through using the process central government estimate that how much the NHS will develop the revenue through general taxation and national insurance (Goran et al. 2012). Moreover, if the patient charges and National Insurance make fewer funds to NHS that estimation, then the fund is received from general taxation in order to meet the estimated amount. According to the Office of National Statistics, the citizen in the UK has today 9% of their entire incomes as the income tax which is the main sources of NHS. As in UK healthcare system is funded by the central government, it makes the healthcare system affordable and accessible for all citizens. On the contrary Grant, et al. (2017) argued, although in the UK the healthcare system is free for all permanent citizen as compared to the US which has the highly expensive framework., the structure and quality of healthcare in the US is more advanced as compared to the UK based healthcare system. This is because the majority of the healthcare fund in US healthcare system comes from private insurance agencies and private healthcare programs, which assists healthcare authority to gain a high level of financial strength to make effective modification in the healthcare system (Keehan et al. 2015). NHS receives the majority of fund from National Insurance and general taxation, which poses financial limitations and obligations on the government in order to take cost-effective healthcare initiatives. However, as compared to US healthcare system, UK provides high-quality treatment process to all permanent citizens in the UK, which provide the high-quality treatment process to in order to meet complex and critical health needs of the community.

Control:

In Germany, the healthcare is controlled and regulated by Federal Joint Committee (Busse et al. 2017.). It is the public health organisation which is associated with setting health care policies and regulation for promoting the equal and high-quality healthcare service for the citizens. In Germany the health system is operated through many institutions and organisation. German health process is classified into three major areas such as rehabilitation facilities, inpatient care and outpatient care. Organisations that are associated in regulating the overall healthcare process in this country are statutory health bodies, Federal Health ministry, self-help group, patient organisations and representatives of different health professionals and providers. Important health institution and provider in Germany are a follow

Health insurers:

There are two types of health insurers in Germany, the statutory health insurers and the private insurers (Litmathe, 2016.). The National Association of Statutory Health Insurance Funds regulates the operations of pubic healthcare process, in order to ensure the equal health services to people, regardless of their income and salary. On the other hand, Association of Private Insurers ("PKV-Verband" is associated with regulation ad control of private insurance system, in order to promote high quality treatment process.

Association of the statutory dentist’s ad physicians:

All the doctors of statutory insurance physicians are obliged to follow and implement the healthcare policies for providing equal care ad treatment process to each citizen.

Hospital Federation:

Deutsche Krankenhausgesellschaft" – DKG, the German Hospital Federation, represent et regional ad central health bodies which supervise that hospitals and healthcare centres run and operates in proper manner in order to ensure the best treatment and care to service users (Razum and Wenner, 2016).

In the UK, the entire healthcare system is regulated and controlled by British government bodies (Malhotra et al. 2015). The health care services and policies are the responsibility of the central government in England, whereas in Scotland, Northern Ireland and Wales the healthcare services and policies are responsibilities of devolved government (www.ncbi.nlm.nih.gov). Although entre healthcare services in the UK is run and operated by the NHS, the NHS has its own structure ad responsibilities in each UK countries (Malik et al.. 2015). NHS is led by the DOH, which focuses on the national health prioritise in order to promote the health and wellbeing of the overall UK community. DOH ensures that NHS will deal provide timely add high-quality treatment and service to each service in the UK with maintaining proper respect and dignity of the patient. Moreover, it also ensures that the entire city in the UK will get compassionate care and support at the time of need to meet their critical health needs (Sampson et al. 2016). The DOH ensures that all social and health care bodies will work on national health priorities and also work with the other parts of the central government in order to achieve common organisational finals. Secretary of State for Health ensures that the entire local health care system work in the proper manner in order to meet needs to the community people in terms of improving their health and wellbeing (Villines et al. 2018.). In the UK there are NHS England, NHS Trust Development Authority, Public Health England and Health Education England, who work in close collaboration with each other for ensuring that ball permanent citizen in the UK will get the equal and quality treatment at the time of needs. According to Luengo-Fernandez et al. (2015), at the local level, there is CCG [Clinical Commissioning Group], which is made up of GP [general practitioners], nurses, doctors health professions. This organisation work in partnership with the local health board in terms of promoting public health and wellbeing through ensuring affordable and high-quality treatment process for all the UK based citizens. CCG buy health are services from any services providers in the community including NHS hospitals, voluntary organisation, social organisations and the social enterprise for providing high-quality healthcare services to eth local community and meeting the NHS standard (Malik et al. 2015). There is the Health and Wellbeing Board in each area of the UK, which ensures that all the services work together in a synergistic manner in order to meet the community priorities and needs. Moreover, this board involved the community organisation as well as elected people in deciding and determining what types of needs comment require. After analysing as well as determining the community needs, the board inform all these needs to eth CCG, local health care authorities and NHS trust (NHS, 2014) According to Cohen and Marshall (2017), in each area there is another healthcare body, the Local Health watch. It emphases on the fact, that whether the country is able to provide the proper care and support from eth local health and social care bodies. Moreover, the Local Health Board makes the report on different health issues on the community, needs of community people and the overall standard of eth National Health. In the UK there are other national healthcare bodies that are associated with working together with the NHS, in order to ensure the health and wellbeing of the public. NICE [National Institute of Care and Excellence] provides proper guidelines for the social and health care professional in order to deliver the compassionate and best possible care to the community people. Moreover, NICE focuses on involving all the health professional, doctors, nurses and community people into following and implementing the national health standards. There is also NIHR [National Institute of Health and Research], which forms the clinical research network, that emphasizes on maintaining consist research on the healthcare system in order to improve the overall standard of the care delivery process (www.legion.org 2015). The HSCIC [Health and Social Care Information Centre] analyse and publish statistical and national information on healthcare. Through executing and analysing the accurate information regarding health and healthcare services in the country, this organisation focuses on maintaining the proper standard of healthcare set by NICE.

Unlike the UK, in the US control and ownership of the healthcare system is mainly on the hand of private organisational and agencies, though the city, country, state and federal government also have some responsibilities (www.nice.org.uk 2018,). In eth US there is no universal healthcare system, rather than patient have to pay for their treatment from their own pocket. According to Waterson (2014), in the US the healthcare system is controlled as well as owned by separate healthcare facilities in this country is mainly facilitating the private insurance agencies and private healthcare programs. According to the Commonwealth database, in the US, 58% of the healthcare centres are owned by private businesses. In the US, there are some public health organisations as Medicaid and Medicare, that are conducted specially for eth elder people, children with disabilities and families with lower income. In order to get the treatment process, every citizen in the US needs to have an employer-sponsored plan. In case of any critical treatment and emergencies, the patient is responsible for bearing all the expenses of his or her own. In the overall healthcare system in the US, federal, state and local government work in partnership with all private insurance agencies and business, in order to control and operate the entire system (Weerawansa and Samarasinghe, 2017). As the entire healthcare system is primarily run by the organisation of the private sector in the US, the federal government have less power to interfere in the overall healthcare system. Although the overall, healthcare services focus on maintaining the guidelines set the federal healthcare committee, the controlling power of the entire healthcare system in one hand of the private agencies and businesses. This is why the treatment process in the US more expensive as well as advanced as compared to other developed countries.

Comparative discussion of health inequalities in the Germany, US and UK:

According to WHO (World Health Organisation), healthy inequality is considered as unequal distribution of health determinants in different groups in the community [WHO, 2019]. Health inequalities in a country are associated with developing poverty, lack of employment, poor healthcare facilities poor people, marginalisation and costly healthcare services. As compared to other countries such as the UK and USA, healthcare system in Germany is stronger in terms of reducing the risk health issues, mortality and morbidity ((Kuehne et al. 2015). As the entire population in Germany is covered under statutory health care system that is regulated by the statute, the majority of the Germans are entitled to equal healthcare facilities regardless of their income. Based on the WHO report on 2016, in Germany, the life expectancy rate at birth is 80.7 years which is higher than that in EU countries with 80.6 years [WHO, 2019]. Moreover, Germany has very low rate of infant mortality and obesity classes. Based on 2015 WHO report, the percentage of total obese population in Germany is 15% which is lower that the other EU countries with 17%. In case of the US health care system, although eth healthcare services have been highly advanced and modified throughout the last three decades, the effectiveness of healthcare system is confined only to the rich and high society people. According to Goran et al. (2012), people with lower income cannot afford the high-value premium facility of the private health insurance packages, which ales hem, unable to pay the heavy hospitals bills. This causes the unequal distribution of proper health and social care facilities to eth community people. As stated by Loopstra et al. (2015), in the US, there is apparent inequality in insurance coverage, which provides privileges to eth high society people rather than assisting lower and middle-class people to afford healthcare services. According to the health survey report from WHO, when it comes to making the comparative analysis of health outcomes between richest and poorest people, Americans shows the highest level of health inequality among other counties in the world. From the health survey of WHO it is seen that in America, a household with an annual income of $22,500 faced three-fold more health issues and disease prevalence than the households with the annual income of $47,700. In case of the households with lower income, the disease prevalence is 38%, whereas, in case of middle and high-income households, disease prevalence is only 12% in the America (www.england.nhs.UK 2018). In this aspect, the recent research in health inequalities in developed countries shows that wealthy people have better health outcomes as compared to their fellow lower-income households. In the US the gap of health outcomes between the richest and poorest people is highs, due to the fact that the majority of the people are not able to afford private insurance coverage private insurance planning. In this aspect, Malhotra et al. (2015) mentioned that in addition to the inability of the majority of US people to entitle under high-value private insurance packages the Federal healthcare programs conducted by eth US government (Medicaid and Medicare) do not provide the healthcare coverage to all uninsured people. WHO shows that only a few people including disabled individuals and poor people are entitled under the federal healthcare programs, which creates a high level of health inequality in the community. As stated by Squires and Anderson (2015), the coverage area provided to poor families disabled people and children through Medicaid and Medicare are not sufficient to get high-quality healthcare facilities infamous nursing homes or renowned healthcare centres. This process leads to an increased number of mortality and morbidly in the US due in the poor and middle-class community due to lack of proper health and social care services. Statistical data published by the ONS [Office of National Statistics] shows that life expectancy in the US is reduced to 78.6 years in 2017. In addition to this, the report of ONS also shows that eth age-adjusted death rate is increased by 0.4% (ncbi.nlm.nih.gov, 2019). The death rerate is increased from 728 deaths per 100,000 live births to 731 live births in 2019. Age-specific death rates in the US are also increased from 2016 to 2017 by 0.3%. According to WHO report 2017, infant mortality in eh the US has been increased o 580 deaths in every 1000,000 births. From the 2017 report by WHO, it is stated that the increased number of infant mortality, death rates, mortality and morbidity is associated with different medical and demographic characteristics. As stated by Waterson (2014), in case of medical characteristics, there are different health reared factors such as poor health care facilities for the low-income people, lack of health education, lack of health literacy and very few numbers of public health care centres in the US ((www.bbc.com 2018). Moreover, ethnic community people residing in the US also face discrimination in eh income distribution and employment which reduces their financial capability to afford costly treatment process in the US. For example, in the case of eth African-Americans, Asian-Americans and Hispanics, they have to bear the 35% of the entire medical cost hat exceeds heir affordability and financial capability. From the recent report of WHO, it can be stated that infants of the ethnic community in the US are 20% more likely to die just after their birth due to the disease prevalence and increased chances of severe infections (www.cms.gov 2016). This is because the majority of ethnic people are compelled to receive the maternity care from public health centre which has very poor healthcare facilities that are unable to provide proper and treatment to both newborn and the mothers just after the delivery. According to Sampson et al. (2016), black women in the US are more like to die due to breast cancer and another complicated disease as compared to whitish women. In the US, more than 24% of black women residing in poverty and income inequalities as compared to 9.6% whitish women (www.ncbi.nlm.nih.gov, 2018). From the recent study by WHO, it is seen that lack of health resources leads to huge differences into health outcomes, treatments responses and survival rates. Majority of the black women face a lack of health literacy which makes them unable to get proper information regarding the screening, early detection of health issues and self-management process of own health. As compared to white women in the US, the black women face a high level of income inequality, due to lack of proper jobs of their family members. Due to this income inequality, black women are more prevalent to infections, health disorders and a lethal health condition such as cancer, COPD and lung infections.

As compared to the US, in the UK the number if health inequality cases are less, due to implementation of the universal and affordable healthcare service across the country by NHS [NHS, 2019]. However, regarding health inequality in the UK, there are several viewpoints and opinions. According to Loopstra et al. (2015), although health care system is highly developed and affordable for all permanent citizens in the UK, there are still inequalities in getting better healthcare outcomes in different countries such as England. A recent survey conducted by the WHO shows that, in England, people residing in the ethnic community have to face a high level of health inequality due to their poor economic condition. PHE [Public Health England] has released the 2018 report in public health status, in which it stated that, although some healthcare initiatives have been made in order to make proper modification in the healthcare survive, there are still inequalities in health outcomes in many deprived areas of England (www.nice.org.uk 2018). According to the report from PHE people residing in the most deprived areas in the UK are more prevalent to disease, morality and morbidly as compared to people reducing in the least deprived areas. In most deprived areas people have the chances of high mortality due to the occurrence of different chronic diseases such as lung cancer, heart disease and respiratory disease (www.england.nhs.uk 2018). There is huge life expectance between the women residing in the least deprived areas and females residing in most deprived areas. Recent report if WHO shows that, in England propel from e most deprived communities have four times higher risk of dying due to cardiovascular disease and pulmonary disease as compared to people residing in the least deprived community. As stated by Sampson et al. (2016), in the UK, there are also cases of mental inequality and child health inequality. Mental health inequality in the UK is associated with different factors such as inequality in the employment status and ethnicity of women. From the recent report published by PHE, it is seen that people who are unemployed or do not have job satisfaction due to very poor salary structure as compared to their peers are more likely to be suffered from mental illness such as dementia, short-time memory loss and poor decision-making ability. in addition to this, the report also stated that ethnic inequality also poses a potential impact on the mental health outcomes in the community. As stead by Cohen and Marshall (2017), in the UK, women residing in the Asian and South Asian community are 10% more likely to have common mental illness as compared to the UK origin community. Majority of the black women from the African community residing in the UK are exposed to the potential risk of psychological disorders due to their poor access to the employment ad healthcare resources. The recent report of PHE shows that child inequality in the UK is associated with unequal healthcare facilities in the least and most deprived community, emerging health protection issues in the country and lack of trained and well-skilled health professional in NHS hospitals. The report also stated that children have shown the inequalities in weight gaining between most deprived and least deprived community which pose an adverse impact on the health and wellbeing. As stated by Waterson (2014), in the deprived community, children have the excess weight due to malnutrition, insufficient intake of nutritional foods and irregular lifestyles. From the WHO report of 2018, it is seen in the most deprived community in the UK, children have 1.8% higher risk of having overweight as compared to the least deprived community. Children within the age group of 10-11 years belonging to eth African and South Asian community are more likely to become overweight which enhance their chances of getting affected but the different disease (www.england.nhs.uk 2018). Reports from PHE shows that during 2014 the gap between the life expectancy in males and females of least deprived add most deprived community was 7.4 years in case of females and 9.3 in case of males. Currently, in England, people residing in the most deprived have a life expectancy of 20 years less than the people residing in the least deprived areas (Goran et al. 2012). Therefore, it can be stated that in the UK although all permanent citizens are covered under the public health system that is operated by NHS, people in the deprived and ethnic community have to suffer from the high level of inequality in terms of getting proper health outcomes. In order to deal with this situation, it is important for the UK government to take roper initiatives in order to protect health and wellbeing in all community.

Comparative analysis of healthcare management, population health and structural management:

Population health and structural management:

Management of public health ad healthcare structure is maintained as well as controlled in the UK by BNHS [British national Healthcare System]. The BNHS is social health system which is run and operated by the NHS. In the Germany the healthcare system is multi-payer process, which is run by two major systems such as statutory health insurance and private healthcare insurance. However, majority of the healthcare fund is spent through the Federal in Germany, and only 23% is spent through private sector agencies. The overall public health system in the UK focuses on the principles that health care is a legal right of the citizen rather than considered it as a privilege (www.england.nhs.uk 2018). The overall structural and functional management of the healthcare system is done in the UK by DOH, which works in close coordination with national, state, city and local health care authority in order to assure that all permanent citizens in this country will receive equal and affordable healthcare services. DOH is associated with the overall administration of health care services that are provided by the NHS hospitals in different regions, in order to ensure the integrity, ethics and transparency of the endure healthcare service (Waterson, 2014). NICE has set the standard for the healthcare system in NHS, which the health professional and healthcare staffs need to follow and implement during their work. PHE and DOH are associated with monitoring the overall management of the healthcare system and functions of different organisation within the country. Like the UK and Germany, the healthcare system in the US is not managed and controlled by any governmental body; rather the entire healthcare structure is funded and administrated by the private business, private insurance agencies and the private healthcare programs (www.ncbi.nlm.nih.gov, 2018). The US government have very small authority into healthcare administration, as it is able to provide enough funds to the countries healthcare system. Through public health insurances programs such as Medicaid and Medicare, the US government provides find to healthcare framework. The overall administration of the overall health care initiates, functions of health professional s and work procedures of healthcare organised is done by the private health insurance agencies and business (www.cms.gov 2016). The US government has set important healthcare codes and guidelines that, the healthcare professionals need to implement into their work practices.

Strength and weakness of the chosen system:

German Healthcare system:

Strength:

Major advantage of German health care system is, it is largely funded and regulated by Federal Health Ministry (Busse et al. 2017). As majority of the healthcare fund is manged and spent by government (77%), it ensures that each citizen in the Germany would access equal quality care irrespective of their income level, caste, gender, race and ethnicity [WHO, 2019]. Moreover, as majority of the citizen who have lower income level is covered under the public insurance system, they can afford government led health benefits at the point of needs.

Limitations:

Limitations: Although Germany health are framework is multi-payer system, due to major control of government on the healthcare process, private insurance agencies and institutions cannot invest more fund into the system (Kuehne et al. 2015). However, WHO report says, that German government has reduced the public sector insurance agencies and motivate public insurance systems to enter into et healthcare stem in order to improve the standard of treatment and quality of healthcare.

UK based healthcare system

Strength:

One of the most important advantages of UK based healthcare system it has the universal healthcare system which assists UK based citizens to access the equal as well as affordable healthcare facilities from any corner if the country (Cohen and Marshall, 2017).

Another advantage of the UK based healthcare system is it assist all kind of people whether they are rich or poor, get the free treatment process at the time of need of they are permanent citizens of this country (www.ons.gov.uk, 2016). They do not need to have any insurance coverage or employer-sponsored insurance packages in order to avail the high-quality treatments and care process.

As the overall healthcare system in the UK is operated and run by the British Government, there is not controlling the influence of any private organisations. This transparency and integrity of the overall healthcare system in order to provide equal care to all citizens.

Weaknesses:

The major disadvantage of this healthcare system in the UK is it is less innovative and advanced as compared to h US healthcare system due to lack of private investments (www.nice.org.uk 2018).

As the overall treatment process is run by the fund from generational taxation and National Insurance, the UK government has obligations in order to maintain an effective process in the country. UK government also faces a shortage of fund and resources, which makes the NHS treatment process less advanced and effective for treating critical disease.

US healthcare system:

Strength:

UK healthcare system gets huge investment from the private businesses which assist eth government to afford high-quality treatment process, highly advanced equipment and clinical process.

Private investment prioritises consistent investigations and clinical researchers in order to make proper modification medical field in this country for easily dealing with the critical needs of people.

Weaknesses:

The major disadvantage of the US health care system is costly treatment charges that cannot be afforded by poor and middle-class people (www.cms.gov 2016). Poor people cannot afford the costly premium of private health insurance plans, which makes hem unable to take the high-quality treatment process from private hospitals due to the high charges.

The US government has a very lower influence on the healthcare system as the majority of the healthcare fund comes from privet businesses. Therefore, the lack of governmental inspection and administration increase chances of inequality in the healthcare outcomes (www.ncbi.nlm.nih.gov, 2018). For example, poor people suffer from unequal premium charges and insurance facilities which leads to the largest gaps between the healthcare outcomes of poor and rich people.

Similarities and differences:

Similarities:

In Germany the healthcare process is quite similar as that of NHS and US healthcare system. It is multi-payer health care process, in which both the statutory health insurance and private healthcare insurance are associated. Like NHS, German health care process is controlled and regulated by the federal Government. More than 77% fund are come from government spending into healthcare. In addition to this, like US healthcare system, private insurance agencies also play important role in German Health care process. in Germany 11% people having high range of incomes avail the private insurance process.

Like the US and German healthcare system, the UK based healthcare system also includes private health care agencies as well as private hospitals, but in the lower number.

Although the majority of healthcare fund in the US comes from private businesses, like the Germany and UK, government funding is also associated with healthcare operation but in very few amounts.

Difference:

German healthcare system differs from the US healthcare in some aspects such as , majority of the healthcare funds come from federal Government, which reduce the chances of discrimination and bias in healthcare delivery process. on the other hand, German health care system differ from the NHS, in terms of involvement of private insurance agencies into healthcare delivery process. Unlike the UK, in which entire citizen is covered under universal healthcare process provide by NHS, in Germany, private insurance agencies also play important roles in along with the statutory insurance agencies, in order to prove the high-quality healthcare service. even, German government now focuses on providing more freedom and opportunities to the private insurance agencies in order to ensure modern, highly updated and smart healthcare delivery process.

In the Germany and UK, the health care system is regulated and operated by the statutory body such as Federal Health Ministry and BNHS [British National Healthcare System} respectively. On the other hand, the healthcare system in the US is regulated by private insurance bodies and private agencies (www.ons.gov.uk, 2016).

In the Germany and UK the healthcare system is universal public health system, which provides the equal treatment process to all permanent citizens at any point of this country. As compared to this, in the US the healthcare system is not universal, which poises the economic burden of eth patient in order to get the high-quality treatment process (www.cms.gov, 2016).

In the UK the fund for the healthcare system comes from eh general taxation and National Insurance. On the other hand, in the US the fund comes from private insurance companies, private businesses and agencies.

Recommendation:

In the case of Germany and UK based healthcare system, the government should include the privatisation of healthcare centres and hospitals in order to gain huge investment from private agencies. It is important for implementing the advances and innovative treatment process in the healthcare framework.

In the US, the government need to focus on inaugurating more public health insurance programs that will cover a large number of poor and disabled people to get proper treatment process. Moreover, the private insurance companies and businesses in the US need to make possible changes into healthcare framework in order to make cost-effective treatment process for ensuring that poor people also can access the high-quality treatment process.

Conclusion:

In the Germany the healthcare system is multi-payer process, which is run by two major systems such as statutory health insurance and private healthcare insurance. However, majority of the healthcare und is spent through the Federal in Germany, and only 23% is spent through private sector agencies. The healthcare system in the UK is administrated by the British government and is paid through general taxation process. Above mentioned discussion on concludes that the healthcare system in the UK is operated through NHS, which is run and controlled by DOH. On the other hand, in the US, the healthcare system is operated and funded by private business and private insurance bodies. There are cases of health inequalities in both countries due to poor access to healthcare facilities are the people residing in the lower-income group. Therefore, it is important for both the UK and the US to focus on promoting required changes in the healthcare system which will assist the community people to get equal and high-quality healthcare system.

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