Health Care Economics_US UK Health Systems

Running Head: A Comparative Analysis of the Organization and Structure of the United States
and United Kingdom Health Systems 1
Source: Stay Smart Stay Healthy RSS – SSSH
A Comparative Analysis of the Organization and Structure of the United States and United
Kingdom Health Systems
Annushree Patel
Newbury College

Contents
Executive Summary……………………………………………………………………………. 3
A Chronology of United States Health Care Reforms........................................................... 4-6
A Chronology of United Kingdom Health Care Reforms...................................................... 6-9
Foundation of a National Health Care System..................................................................... 9-10
The National Health Service..................................................................................... 10-11
Organization structure of United Kingdom
Overview of Organization and It’s Roles................................................................ 11-12
Clinical Commissioning Groups.............................................................................. 12-13
Health and Wellbeing Boards....................................................................................... 13
Regulation - Safeguarding People’s Interest
Monitor............................................................................................................................ 14
Healthwatch..................................................................................................................... 14
Other Ministries......................................................................................................... 14-15
Private Sector......................................................................................................................... 15-16
Organization of the United States Health Care System.......................................................... 16
Public Health Insurance............................................................................................ 17-19
Private Health Insurance
Employer Sponsored Insurance................................................................... 19-20
Private Non-group/Individual Market........................................................ 20-22
Conclusion……………………………………………………………………………………... 23
References…………………………………………………………………………………. 24-26

Executive Summary
The philosophies which underlie systems of medical organization are developed through
cultural, social, and political development. The fundamental premise of the American free
market system is that consumer welfare is maximized by open competition and consumer
sovereignty -- even when complex products and services such as health care are involved. The
structure and organization of the United States health care system comprises the ideal of
individual market. The agencies created within the health care system play an important role in
safeguarding the free market system from anticompetitive conduct, by bringing enforcement
actions.
The majority of the population in England consider it not a disgrace, but the most natural
thing in the world, when they fall ill, to demand and receive free treatment without delay. The
basis of the National Health Service was from the idea that health care should be available to the
public regardless of the income. The NHS remains a free health care system for citizens of the
United Kingdom; the NHS is the commissioning services in England.
Today, hospitals in both countries tend to follow national guidelines rather than their
own. Hospitals have begun to utilize best practices and have initiated programs to look events
associated with care. Centers of excellence are becoming prevalent in both the United States and
the United Kingdom. The UK utilized Academic Health Science Network and the Center of
Excellence is responsible for identifying and driving best in class services. Local commissioners
will have the responsibility at looking at the quality data in their area and setting goals for quality
improvement that addresses their specific gaps. The two countries advance towards achieving a
cost efficient, quality-based system that serves the interests of consumers.
A Chronology of United States Health Care Reforms

Health care in the United States is an evolution of the English “Poor Laws” where
Americans were taking care of individuals who had fallen ill (SSSH,1). Additionally, the Poor
Laws influenced the establishment of alms houses. Blockley Almshouse in Philadelphia was
constructed in 1732. It provided the first government-sponsored care of the poor in America, as it
offered an infirmary and hospital for the sick and insane, besides housing and feeding the
impoverished. The Blockley Almshouse became the foundation for the development of the
Philadelphia General Hospital. The earlier hospitals of the United States were referred to as the
“marine seaport hospitals.” The purpose of the marine seaport hospitals was twofold; first, take
care of the ill and second, to quarantine the ill to prevent the spread of diseases.
On July 16, 1798 John Adams signed into law the Act for the Relief of Sick and Disabled
Seamen, which established what is now the Public Health Service. Twenty cents were deducted
from monthly wages of each merchant seaman to build or rent hospitals and pay for the medical
care provided. The President of the United States authorized and nominated directors of the
marine hospitals in America. U.S. Marine Hospital in Chelsea, Massachusetts became the first
formal hospital in 1834.
Dr. John M. Woodworth was the first surgeon general in the United States and in 1871
was appointed Supervising Surgeon of the Marine Hospital Service. Some of the administrative
challenges that the marine supervisors faced were “who was covered?”, “who to collect tax
from?”, and “if contracts from providers were viable?”. Policies were interpreted locally; tax
collection was so uneven and insufficient to meet local health care costs. Such shortcoming in
funds contributed to the lack of health care in local communities.
Marine hospitals were the first form of national health system in the United States. At the
same time, the private sector was developing their own hospitals. Famous hospital include:

Pennsylvania Hospital of 1752, New York Hospital of 1790, and Massachusetts Hospital of 1821
(SSSH,1). Hospitals were only providing care to patients that required surgery and did not harbor
communicable diseases or unknown diseases. The Pension Act of 1776 was enacted to provide
soldiers and sailors with compensation for injuries that hinder working (PBS,1). The law granted
half pay for the length of the disability or life and became the first disability insurance in the
United States. In 1917, the War Insurance Act amendment provided medical services to veterans
with service-connected disabilities. The Sheppard-Towner Act enacted in 1921, provided grants
to states to develop health services for women and infant children. In 1929, the first Blue Cross
Plan was established, which was a significant development in health care delivery. The Social
Security Act was established in 1935 and national health insurance was not part of the act
(PBS,1). This act put into place Medicare and Medicaid.
World War I, as people were being enlisted for military services, they were still harboring
childhood diseases or lack of vaccinations. The purpose of the Sheppard-Towner Act was to
provide vaccination and take care of infants and mothers so we had a healthy population. These
laws created a demand for health care. The Hospital Survey and Construction Act was
established in 1946 and allotted money to communities and states to build hospitals, essentially
putting federal money into the private market to increase capacity in the private market
(SSSH,1). The Comprehensive Health Manpower Training Act of 1971 increased the enrollment
in schools of medicine, optometry, dentistry, veterinary medicine, and pharmacy (PBS,1). This
law helped train thousands of medical professionals in America. The cost of health care
continued to rise astronomically. Cost containment measures were focused on the Social Security
Act. In 1977, the Health Care Financing Administration (HCFA) was created to manage
Medicare and Medicaid separately from the Social Security Administration. This agency was

changed to Center for Medicare and Medicaid Services (CMS) in 2001. The United States
government continued to aid the most vulnerable population: young children through the State
Children’s Health Insurance Program (SCHIP) in 1997 (SSSH,1). This enabled states to extend
health coverage to uninsured children, safeguarding them from communicable diseases. Both
cost containment and access to health care for all Americans paved the way for the passage of
Affordable Care Act in 2010 (PBS,1). The law put into place comprehensive U.S. insurance
reforms.
In the early development of the United States, the government sponsored health insurance
covered the merchant marines and later spread to the most vulnerable populations in the United
States including the elderly, indigent, and war veterans through Medicare and Medicaid. The
principle perception that health care is a personal responsibility prevails in America where
parents are responsible for their children and children are responsible for their parent dating back
to the English Poor Laws. Concluding, the hallmark of American individualism prevails in the
American health care market.
A Chronology of United Kingdom Health Care Reforms
Before a centralized health system in the United Kingdom, there was a patchwork of
private, charity, and voluntary run hospitals. In 1911, the chancellor, Lloyd George, established a
system of National Health Insurance, keeping the Elizabethan Poor Laws of 1601 at heart
(Medical Facilities,1). Poor Laws created a system that administered poor relief at the local level
and was paid for by levying taxes. Similarly, the National Health Insurance offered benefits to
the contributor below a certain level of income. Insurance contributions were paid at a flat rate
shared equally by the employer and the employee. In return for their contributions, individuals

received cash benefits for sickness, accident and disability. Individuals also had the right to free,
but limited, care from a doctor on a local list and were entitled to hospital treatment for major
illnesses. In return, doctors received a capitation fee which provided a fixed income for their
services (Socialist Health Association, 1).
National Health Insurance was the largest health service provider in the early 20th
century (Medical Facilities, 1). By the 1930s, it had expanded its hospital provision, taking on
Poor Law hospitals. The Poor Law offered relief to the most impoverished Britons seeking
medical care. Lloyd George’s health system faced financial shortcomings rather quickly. The
two primary deficiencies were lack of access to hospital care and lack of access to health care for
family members. Seeking medical care during an illness posed high financial problems for
British families across the country.
Aneurin Bevan, architect of the National Health Care Service set out to create a single,
centralized British health care system that was not based on the insurance principle - entitlement
following financial contribution. The NHS was of crucial importance in establishing the post-
Second World War pattern of health service finance and provision in the United Kingdom. It
introduced the principle of collective responsibility by the state for a comprehensive health
service. The NHS received mixed views from privately practicing doctors that saw the
movement of a centralized, government controlled system as a socialist movement. The doctors
organized an offensive against the government; no doctors therefore no national health service.
Bevan negotiated with physicians and brought them under a single umbrella (Socialist Health
Association, 1).
On July 5th, 1948, Park Hospital in Manchester, Bevan unveiled the National Health
System. It was the biggest and most expensive social reform conceived by United Kingdom. The

NHS the first health system to offer free medical care to the entire population at the point of need
and was financed out of taxation (Medical Facilities, 1).
All over Britain people suffering from hernia, toothaches, ulcers, etc. flooded into
hospitals without fearing humiliation for not being able to afford treatment. For the first time,
hospitals, doctors, nurses, pharmacists, opticians and dentists are brought together under one
umbrella organization to provide medical service (Socialist Health Association, 1). The new
medical service remained totally free until 1951 when charges were imposed for prescriptions,
dental care, and spectacles. Charges of one shilling was introduced for prescriptions. Prescription
charges of one shilling was introduced and a flat rate of a pound for ordinary dental treatment
was also brought in on June 1, 1952 (Medical Facilities, 1). Universal access was a tremendous
step forward for women. The removal of fear of illness cannot be underestimated and, as a result,
the NHS was popular at its inception.
The NHS continued to face strong structural criticism throughout its early development.
In 1962, the medical profession criticized the separation of the NHS into three parts: hospitals,
general practice and local health authorities. They believed that a more unified national system
would work coherently to provide medical care. The Hospital Plan approves the development of
district general hospitals for population areas of about 125,000 people. Additionally, in 1967 the
Cogwheel Report considered the organization of doctors in hospitals and proposes specialty
groupings, to meet future health needs. It also highlights the efforts being made to reduce the
disadvantages of the three part NHS structure with hospitals, general practice and local health
authorities.
Critics of the NHS, including David Ennals, commissioned the Black Report in 1980 to
investigate the inequalities of health care in Britain (Socialist Health Association, 1). The report

aims to investigate the inequality of healthcare that still exists despite the foundation of the NHS.
There were distinctions between the social classes in the usage of medical services, infant
mortality rates and life expectancy. Poor people are still more likely to die earlier than rich ones;
the system favored one set of the British population over the other. The 1981 Census shows that
11 babies in every 1,000 die before the age of one. In 1900 this figure was 160 (Medical
Facilities, 1). Childhood survival has been revolutionized by vaccination programs, better
sanitation, and improved standards of living, resulting in better health of both mother and child.
The Community Care Act of 1990 was passed in order to provide localized and standard
care to all NHS patients (Socialist Health Association, 1). Health authorities managed their own
budgets and health care from hospitals and other health organizations. Individual organizations
became part of the NHS Trusts and provided standard of care to all its patients regardless of
wealth of the patient. The British health system continues to evolve to provide the utmost
medical care to its citizens. In 2000, NHS walk-in centers were introduced. These new health
facilities stay open offering convenient access, round-the-clock, 365 days a year (Medical
Facilities, 1).
Foundation of a National Health Care System
The philosophies which underlie systems of medical organization are developed through
social and political development. The majority of the population in England consider it not a
disgrace, but the most natural thing in the world, when they fall ill, to demand and receive free
treatment without delay. The British population believed that health care was a right. For
centuries, England has regarded it as a public responsibility to make provisions for the sick poor.
Poverty has been interpreted generously. These provisions were started by the Catholic Church
in England and gradually the hospitals were transferred to the government. Before 1948, a

majority of the cost of hospitals were endured by charitable bodies and the rest were covered by
the government (Socialist Health Organization, 1).
The charity organizations and the British government set out to provide service to the low
income public. The criterion was need of medical service not payment. The question of payment
was not raised until 1881 when British hospitals did not have a method of incorporating patients
that were paying out-of-pocket (Medical Facilities, 1). Free hospital care was made available to
the poor after the Poor Law was passed. England encouraged its medical professionals to provide
medical care for the poor.
The National Health Service
The National Health Service is the health care system that is responsible for coverage not
only in United Kingdom, but also in Northern Ireland, Wales, and Scotland. The NHS was
launched in 1948 and has grown to become the largest national health care system. The basis of
the NHS was from the idea that health care should be available to the public regardless of the
income. The NHS remains a free health care system for citizens of the United Kingdom (The
NHS in England, 1).
The NHS serves more than 53 million people and employs an estimated 1.7 million
people. There are approximately 39,780 general practitioners (GPs), 370,327 nurses, 18,687
ambulance staff, 105,711 health and community health service medical and dental staff, etc. The
giant health system serves one million patients every 36 hours (The NHS in England, 1).
Organization Structure of United Kingdom
Overview of Organization and It’s Roles

First, there are a series of groups and divisions (shown in Figure 1) with professional
responsibilities including: Clinical Commissioning Groups, Health and Wellbeing Boards,
Monitor, and Healthwatch.
Figure 1, Overall structure of the new NHS in England
Second, there is the Department of Health (DH), under the direction of the Secretary of State,
which has ultimate responsibility for the provision of a comprehensive health service in England
and ensures the whole system works together to respond to the priorities of communities and
meets the needs of patients. DH is responsible for strategic leadership of both the health and
social care responsible, including improving people’s health and wellbeing through its
stewardship of the adult social care, public health and NHS systems (The NHS in England, 1). .

Third, there is the office of NHS Commissioning Board (NHS England). The NHS
England’s main role is to improve health outcomes by commissioning care for people in
England. Additionally, it acts as a national leader for improving outcomes and driving up the
quality of care. Quality of care is insured by NHS England by overseeing the operation of
clinical commissioning groups, allocating resources to clinical commissioning groups, and
commissioning primary care and specialist services. As well as its headquarters, the NHS
England has four regional offices located around the country. These offices are responsible for
the regional implementation of national policies and, with this aim in mind, monitor the
performance of health authorities. They occupy an important position of accountability from the
local level to the center.
Clinical Commissioning Groups
Clinical Commissioning Groups (CCGs) have replaced Primary Care Trusts (PCTs),
which controlled 80% of the NHS budget (The NHS in England, 1). CCGs have taken on many
of the functions of PCTs and, in addition, some functions previously undertaken by the
Department of Health.
All GP practices belong now to a CCG and the groups also include other health
professionals, such as nurses. CCGs commission most services, including planned hospital care,
rehabilitative care, urgent and emergency care, most community health services, and mental
health and learning disability services.
Essentially, CCGs can commission any service provider that meets NHS standards and
costs. These can be NHS hospitals, social enterprises, charities, or private sector providers.
CCGs must be assured of the quality of services they commission, taking into account both
National Institute for Health and Care Excellence (NICE) guidelines and the Care Quality

Commission's (CQC) data about service providers. Both NHS England and CCGs have a duty to
involve their patients, health care providers, and the public in decisions about the services they
commission (The NHS in England, 1).
Health and Wellbeing Boards
The NHS established Health and Wellbeing Boards to act as a forum for local
commissioners across the NHS, social care, public health, and other services (The NHS in
England, 1). The boards are intended to increase democratic input into strategic decisions about
health and wellbeing services, strengthen working relationships between health and social care,
and encourage integrated commissioning of health and social care services. Boards strengthen
democratic legitimacy by involving democratically elected representatives and patient
representatives in commissioning decisions alongside commissioners across health and social
care. The Health and Wellbeing Boards also provide a forum for challenge, discussion, and the
involvement of local people. Health and Wellbeing Boards will have strategic influence over
commissioning decisions across health, public health, and social care. Ultimately, the boards will
help give communities a greater say in understanding and addressing their local health and social
care needs.
Regulation - Safeguarding People’s Interest
Monitor
Monitor is a regulatory agency of the NHS; its main role is to regulate all providers of
health and adult social care services by protecting and promoting the interest of patients (The
NHS in England, 1). Monitor aims to promote competition, regulate prices and ensure the
continuity of services for NHS foundation trusts. Competition is promoted by regulating the
provision of health care services to ensure it is effective, efficient and economic, and maintains

or improves the quality of services. Additionally, Monitor has an ongoing role in assessing NHS
trusts for foundation trust status, and for ensuring that foundation trusts are well-led, in terms of
both quality and finances.
Healthwatch
Healthwatch is another element of the regulatory system and functions as an independent
gathering (The NHS in England, 1). It represents the views of the public about health and social
care services in England. The public view of the health care system is based on both a national
and a local level by Healthwatch. Locally, Healthwatch will give patients and communities a
voice in decisions that affect them, reporting their views, experiences, and concerns to
Healthwatch England.
Other Ministries
Additional responsibilities of the NHS regulatory system is transferred to individual
professional regulatory bodies. These include:
● The General Medical Council which is responsible for protecting, promoting, and
maintaining the health and safety of the public by ensuring proper standards in the
practice of medicine (General Medical Council, 1)..
● The Nursing and Midwifery Council which is responsible for safeguarding the health
and wellbeing of the public. The Council sets standards of education, training, conduct,
and performance so that nurses and midwives can deliver high quality healthcare
consistently throughout their careers (Guidance On Professional Conduct, 5).
● The General Dental Council which is responsible for registering qualified dental
professionals, setting and enforcing standards of dental practice and conduct, protecting

the public from illegal practice, assuring the quality of dental education, and investigating
complaints (Council Member Appointments, 1).
● The Health and Care Professions Council develops and monitors strategy and policy
and consists of 20 members including the Chair.
Private Sector
In 1997, 12% of the British population was covered by private medical insurance. Today,
10% of the population choose medical coverage through a private market; one million operations
are performed privately every year (Doyle, 2). The private sector provides many services for the
NHS, such as 75% of acute medical and psychiatric care and long-term residential care for
people with learning disabilities. Private medical insurance is more common among older people
and those in living in wealthier parts of the country; 20% of the population in the outer London
metropolitan area are covered, but only 4% in the north of England (Doyle, 1). Private health
insurance is paid one-third by the individual and two-thirds by the employer (Doyle, 1). Britons
benefit economically from the collaboration of the NHS and the private market. The NHS is a
substantial supplier of private beds; there were an estimated 39% of dedicated pay beds in NHS
private units in 1997 (Doyle, 3). In spite of the commonality of new medical technologies in
private practice, collaboration between public and private health care sectors would serve the
United Kingdom better than continued isolation.
Organization of the United States Health Care System
The United States’ health care system comprises both private and public markets. Unlike
any other country in the world, the U.S. health system is dominated by the private market. In

2011, 55.1% of the population received private employer-sponsored insurance (ESI) (Chua, 2).
15.2% of the population were enrolled in public insurance programs like Medicare, and 16.5% of
the population were covered by Medicaid (Multack, 3). 15.7% of the population were uninsured
(Multack, 3). Elderly individuals aged 65 or over are uniformly enrolled in Medicare and
Medicaid.
Figure 2, Sources of Insurance Coverage, 2011
Public Health Insurance
Medicare is a Federal health insurance program that has provided coverage for
individuals age 65 and older since its establishment in 1965. The program also covers certain
people under age 65 with disabilities. Medicare is a single-payer program administered by the
government, which is a single entity performing the insurance function of reimbursement. In
2011, Medicare covered more than 15% of the population (Multack, 3). Medicare comprises four
individual components: Part A (Hospital Insurance), Part B (Supplementary Medical Insurance),
Part C (Medicare Advantage Program), and Part D (Voluntary Outpatient Prescription Drug
Benefit).

Part A covers a multitude of services from inpatient hospital to nursing facility services.
Inpatient hospital services cover up to 90 days per benefit period. Patients can also enjoy the
skilled nursing facility services for up to 100 days per benefit period following at least a three-
day inpatient hospital stay. Medicare part A allows homebound individuals home health care and
allows patient psychiatric care for up to 190 days for patients in need of psychiatric attention
(Multack, 2).
Part B is a supplementary medical insurance that covers the expenditures associated with
a hospital visit. Patients can utilize physicians’ services, including office visits, a one-time
physical examination for new beneficiaries, and a yearly wellness visit. Other supplementary
coverage includes medical equipment (wheelchairs, oxygen) and clinical laboratory access
(blood tests, x-rays screening tests) (Multack, 3).
Medicare Part C is the part of the Medicare policy that allows private health insurance
companies to provide Medicare benefits. Health Maintenance Organizations (HMOs) and
Preferred Providers Organizations (PPOs) are private health plans covered by the Medicare
Advantage plans (Multack, 3). HMOs and PPOs administer Medicare benefits. Part D of
Medicare is a voluntary program that subsidizes the cost of pharmaceutical drugs; Medicare Part
D provides insurance to cover the cost of drugs (Multack, 4).
Medicaid is the largest publicly financed program, providing health and long-term care
coverage for certain groups of low-income people throughout the United States since 1965.
Federal law identifies over 25 different eligibility categories, including children, pregnant
women, individuals with disabilities, and the elderly. In addition, individuals must also meet
income and asset requirements, as well as immigration and residency requirements. In 2011,
Medicaid covered 52.6 million people in the United States (Flowers, 2).

Medicaid is financed jointly by the states and Federal government through taxes. Every
dollar that a state spends on Medicaid is matched by the Federal government at least 100%. In
poorer states, the Federal government matches each dollar more than 100%. Overall, the Federal
government pays for 57% of Medicaid costs. In order to receive Federal matching funds, state
Medicaid programs are required to cover the services for mandatory populations including,
inpatient and outpatient hospital services, physician, midwife, and nurse practitioner services,
home health services for persons who qualify for nursing home care, pregnancy-related services,
laboratory and x-ray services, and some other services (Flowers, 3).
Other national public programs include the Veteran's Administration (VA) and
Children’s Health Insurance Program (CHIP). The Veteran’s Administration is a federally
administered program for military veterans. Services are administered in government-funded VA
hospitals or clinics; the VA is funded through taxpayer dollars. Disability benefits include
compensation or pension. VA can pay veterans monthly compensation if they are at least 10%
disabled as a result of military service (Chua, 2). Pension plans support wartime veterans who
have limited income or are over the age of 65.
CHIP provides health coverage to nearly 8 million children in families with incomes too
high to qualify for Medicaid, but unable to afford private coverage. Signed into law in 1997,
CHIP provides Federal matching funds to states to provide this coverage. Additionally, CHIP
shares similar administrative and financing structure to Medicaid’s. Mandatory services covered
through CHIP include inpatient/outpatient hospital services, home health services, physician
service, rural health clinic services, laboratory and x-ray services, and several others (Chua, 2).
Private Health Insurance

Employer Sponsored Insurance
Employer-sponsored insurance plays a central role in the financing of health care in the
U.S. In 2012, 162 million Americans had ESI, representing over 60 percent of the non-elderly
population. ESI dominates the private insurance market, accounting for 90 percent of the market
(Buchmueller,1). ESI not only is an important source of insurance coverage for workers and their
families, but also affects individuals' employment decisions; employers provide health insurance
as part of the benefits package for employees.
ESI coverage is strongly correlated with firm size, with 97 percent of firms with over 100
employees offering coverage vs. 40 percent of firms with fewer than 25 employees
(Buchmueller,1). Currently, the share of premiums paid by employers averages 85 percent for
individual coverage and 75 percent for family coverage. However, due to the rising cost of health
care, employee premiums skyrocketed between 2001 and 2011; the total premium for family-
based ESI coverage increased from $7,061 to $15,073 or 113%. Such premium increases have
outpaced the growth in workers’ earnings, which increased only 33 percent from 2001 to 2011
(Georgetown University, Employer Sponsored Insurance Coverage).
Figure 3

There are three key components associated with the success of ESI in America. First,
there are substantial economies of scale when purchasing insurance through a group. Second, the
problem of adverse selection -- sicker individuals being more likely to sign up for coverage -- is
reduced in an employer-sponsored group. Companies have an efficient way of risk pooling as
compared to an individual in the market. Third, the fact that health insurance premiums are not
subject to income taxation effectively reduces the price of insurance purchased through the
employer (Buchmueller,1).
Private Non-group/Individual Market
The individual market covers part of the population that is self-employed or retired. In
addition, it covers some people who are unable to obtain insurance through their employer. In
contrast to the employment-based insurance, the individual market allows health insurance
companies to deny people coverage based on pre-existing conditions.
Individuals pay an insurance premium out-of-pocket for coverage. Risk in the individual
market depends only on the health status of the individual, in contrast to the group market, in
which risk is spread out among multiple individuals. As such, low-risk, healthy patients will

have a low premium, whereas the opposite is true for high-risk, sick patients. although, on
average, non-group insurance premiums are lower than for ESI, enrollees pay 100% of the cost
because they cannot share that premium expense with an employer.
Nationwide, the average monthly premium per person in the non-group market in 2010
was $300.5 with an annual cost of $3606. For a family plan through the individual market, the
monthly and annual cost totaled around $591.83 and $7102 respectively (refer to Table 1).
Table 1, Average reported annual premiums for non-group health insurance
by coverage type and age, 2010
Despite the cost benefit associated with the individual market health insurance plans,
there are shortcomings. Insurance premiums in the non-group market may vary by age and health
status and may be less comprehensive than group plans purchased by employers. Under the
current system, applicants with health problems who are offered non-group coverage may be
charged a higher premium due to their medical history. Obtaining coverage in the individual
market can be difficult, particularly for those who are older or have had health problems. In
2008, 29% of individuals age 60 to 64 who applied for non-group insurance were denied
coverage based on their health status (Kaiser Family Foundation, 17-19).

Conclusion
The National Health Service of England provides universal health care that is free at
point of service; it is governed centrally and funded from taxes. The United States health care
system if funded by a patchwork of public and private insurance with large point-of-service fees
on many patients. Quality of care is one of the key focuses of both the British and American
health care system. Indeed, one of the stated goals, of both systems, is to enhance the quality and
safety standards of health and social services. Quality issues are addressed in a variety of
methods. There are a number of regulatory bodies in place which monitor and assess the quality
of health services provided by public and private providers. This involves regular, periodic
assessment of all providers, investigation of all individual issues that have been drawn to the
attention of regulatory body, and careful consideration in order to recommend the best methods.
of practice. Additionally, the two countries are seeking similar changes in their health care
systems including: better value for money from health care, medical professionals and health
care institutions to focus on quality and adopt value enhancing behaviors, and control the cost of
health care to the patient. The United Kingdom’s NHS can benefit from assessing the spending
growth required by the American system; a financial transparency within the system could serve
to enhance the NHS. On the other hand, U.S. needs to put into place accountable care
organizations, similar to NHS’s Monitor, that can bend the health care cost while improving
patient outcomes. Given that similar issues are being faced by the two countries, ideally the
process of restructuring can be accelerated by sharing lessons learned across health systems on
both sides of the Atlantic.

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