Running head: HEALTH INSURANCE IN USA VERSUS OTHER COUNTRIES 1

Health Insurance Issues in the United States Versus Other Countries

Elliott Conklin

University of Saint Mary

HEALTH INSURANCE IN USA VERSUS OTHER COUNTRIES 2

Abstract

The pros and cons of Americas health care plans are compared to the pros and cons of

three other countries health care plans. The nursing profession stands out when looking at

what factors have a big impact on a countries health insurance as a whole; this is because

nurses play a vital role in every patients outcome. Improving on nursing-sensitive patient

outcomes can make a huge difference in a nations health insurance; therefore, ways to

improve nursing practices are always looked at. Nurses are also held responsible for

teaching the clients they see about ways the countries health care plan can affect the

clients health care, this is often because governments poorly communicate about changes

that are taking place. These nursing actions can negatively and positively health care

plans all over the world

Keywords: health care plans, patient outcomes, nursing-sensitive patient

outcomes, teaching
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Health Insurance In the USA Versus Other Countries

Health insurance is a major issue in many countries including the United States.

There are many different reasons all over the world why people cant receive the health

care they need in order to live a healthy life and a lot of those problems are related to

health insurance issues. Nurses play a huge role in some of these health insurance issues

and could make a big impact on how we see health insurance in the world today. The

United States has several health insurance related issues that could be changed for the

better therefore benefitting a vast majority of the American population. Other countries

also have some things that could be addressed with their Medicare policies to help aid the

population with their medical expenses; Canada, Switzerland, and the Netherlands will be

some main foreign focuses in this article. We will look at a few different Medicare plans

in a few different countries in order to get a good understanding of how countries can

differ from each other and how all countries can have their own unique perks with their

health insurance policies.

The United States is an amazing country with plenty of great opportunities

however, when the time comes for a citizen to receive medical attention the costs can

start adding up and be quite intimidating without good health insurance or without health

insurance at all. There are some exchanges being made according to Gardner (2013) and

these exchanges will provide the consumer several options for health insurance coverage.

These changes are huge for the United States because it will help Americans who dont

work for large corporations acquire equal benefits as large corporations. These exchanges

are from the Patient Protection and Affordable Care Act (PPACA) and the options for

coverage are made available at a market place which is a website that was created by the
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government. On this website citizens of the United States who need health insurance can

select from several different state or federal policies that fit them the best.

Yes the PPACA sounds great to many Americans in need of it, but to some it just

creates problems instead of eliminating them. Trossman (2013) covers how nurses play a

huge roll in this exchange because nurses can educate and pass information regarding this

exchange onto consumers. Several RNs around the country expressed their thoughts to

Trossman (2013) about the PPACA; most of the nurses discussed patient concerns.

Almost all of the nurses were worried about how little the public knew about the change

that had taken place, another worry is the lack of understanding the population had about

the PPACA, and the lack of understanding how the exchange could benefit each person.

Since nurses have so much interaction time with the local population they have a huge

chance to advocate for people in their community so some of these nurses took advantage

of this opportunity and found ways to inform the community about the exchanges details.

One nurse said in Trossmans (2013) interview that there was a huge anti-exchange

campaign in her state this was because many of the people there will be negatively

affected by the exchange and their premiums will actually increase, some were worried

about no longer being able to receive health care they had already received years prior to

the exchange. Yes the PPACA has good intentions but that doesnt really matter if the

people it was created for are not taking advantage of it; this is why education on the new

plan is crucial. The PPACA is still important as of now, but with a new president in

office it is hard to tell what the future has in store for the PPACA.

Another health insurance issue in the United States is nursing related preventable

outcomes. No matter what system any country has in place nursing-sensitive outcomes
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will affect Medicare plans. These outcomes can be good or bad but we typically hear

about the negative patient outcomes since they impact so many different parts of the

health care system. When a nurse makes a mistake and the patient is negatively impacted

then the hospital usually has to bear the expense for any treatment that could have

previously been avoided. However there are tons of cases each year that go unseen for

example Bae (2016) pointed out 11 different patient outcomes that could have been

prevented with proper nursing care. This is an issue because insurance companies are

spending large amounts of money on treatments that could have been prevented. The

more evidence these health insurance companies receive the more they want lower

hospital costs to promote better patient health care. A few examples of preventable

nursing errors that can occur are pressure ulcers, falls, medication administration errors,

infections, and many other mistakes that can happen while performing any other skills.

Some factors from Potter, Perry, Stockert, and Hall (2017) that could help prevent these

outcomes are shorter work hours, more nurses on duty, nurse evaluations, and more

continuing education hours for training.

Canadian Health Insurance sounds like a good plan at first but as soon as we look

more in depth the more questionable it can be. In Canada everyone pays for a medical

insurance plan and everyone receives the same coverage. It sounds great but

Schonewilles (2015) article Canada Votes: Move Health Care Forward article elicits

greater detail about the Canadian health insurance. The Canadian Health Insurance works

for very routine and basic health services but other different healthcare visits like a

dentist appointment would not be covered and the patient would have to pay out of
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pocket. Regardless of the kind of medical bills, they will still have a chance of being

extremely expensive.

When comparing the two countries they are both going to have downsides to their

policies, its just a matter of which one is more effective when assisting people with

expensive medical bills. The United States has some good health insurance opportunities;

for example, if Americans have a large employer then they wont have a hard time

getting good health insurance because of the deals that the large employers offer.

However, if you are self-employed or work for a small business then health insurance is

not the greatest, this is because good insurance policies are difficult to get at a good price

for these small businesses. That is why exchanges could be crucial for some people. In

Canada the idea of everyone paying is awesome but figuring out a way for insurance to

cover a bigger variety of services would be ideal. So every country will have its ups and

downs when it comes to health insurance its just a matter of how many ups and how

many downs they have. Some down falls to a health care plan may be the consequence of

a few ups but that is what it takes for a country to create an efficient health care plan. A

perk of a healthcare plan could be that nobody is declined coverage based on their

medical needs; a downfall to this would be people who require copious amounts of

medical attention will be paying the same amount of money for health insurance as a

person who doesnt require any medical attention at all over the year. It is situations like

this one that are looked at when country leaders are discussing risk versus reward in

health care policies.

There are more examples of great national health care plans all over the world;

two specific countries with substantial health insurance plans are Switzerland and the
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Netherlands. These two countries have several policies that are great examples of what

other countries in the world could do to improve their populations healthcare coverage.

Both countries require their citizens to have health insurance but the citizens must buy

insurance from private insurers; these private insurers are required to offer their own

baseline coverage with the same prices available to all people seeking health insurance.

People can find all of these private insurance companies and their policies on a

government website, here they can shop and compare what health insurances they think

will fit them best at a reasonable price they can afford. This requires health insurance

companies to compete with one another; therefore, keeping prices affordable and under

control. These plans are very similar to the PPACA in the United States as far as having

an option of what health insurance each citizen desires. Because of this plan in the

Netherlands and Switzerland medical providers will have more affordable costs since

insurance companies are strict about what health care providers they will work with

based on the quality and price of care provided from each facility.

Problems that occurred from these systems consisted of people not signing up for

insurance or just simply not paying for what they had signed up for. Of course this

brought up issues that both of these governments would have to figure out; Ginneken,

Swarts, and Wees (2013) address what both countries did to fix or prevent these problems

from happening. Switzerlands government responded by covering 85 percent of unpaid

premiums for the people with severe financial issues. The Netherlands started out by

revoking health insurance from people who didnt pay for a period of six months or

longer, and by making uninsured individuals pay fines. This lasted for about five years

but it was never successful, so in 2011 the Netherlands began to search for people who
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remained insurance free, and they also began to take premiums directly from the salaries

of people who have had troubles paying their dues in the past.

Another issue that occurred in the Netherlands and Switzerland is risk-adjustment,

which is when an individuals medical cost is remarkably higher than the coverage they

are paying for. This is a big issue because these people will encounter expensive

premiums and sometimes they will receive poor medical attention. These individuals may

receive poor medical attention because they are high cost patients paying underpriced

rates for the care they are receiving; however they should still receive appropriate

medical attention. From a nursing perspective it is hard to understand how some people

are not cared for equally because of insurance complications, when a nurse is caring for

someone they should treat every patient to the best of their ability no matter what

complications are in the way. In the Netherlands risk selecting is not allowed at the

companies basic level of insurance; however, once clients have purchased additional

insurance plans the companies may risk-select. Even though risk-selection occurs with

additional coverage some companies will still work with clients to meet their medical

needs if the price is reasonable. If the medical expenses are not within reason and the

patients condition is chronic then people in the Netherlands are allowed to form groups

of people to work with insurance companies and the companies will then figure out a

reasonable way to get each individual the care that is needed. The United States has

prevented the risk-adjustment issue in the PPACA by not allowing a person to be

declined coverage based on his or her age, sex, or past medical history. Yes these systems

in the Netherlands and Switzerland have some flaws like any system does but with a little

bit of work they function extremely well.

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So in order for all people to live a good and healthy life style in a country, they

must have good health insurance. Without good health insurance not everyone will be

taken care of because not everyone will be able to afford the cost of the medical attention

they need. There are kinks to every system but its all about working those out and

making the system the best that it can be. Some countries have a lot more to work on than

others but thats okay because each country has its own example of a good policy like we

see with the United States, Netherlands, Switzerland, and Canada they all have some

great things to look at and to learn off of each other. The United States has just recently

done something similar to what the Netherlands and Switzerland did years before and

that goes to show what each country can do to learn from one another. Then there is

countries like Canada who just have their own system, all countries have something new

to bring to the table some of them just may be more unique than others.
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References

Schonewille, S. (2015). Canada votes: move health care forward . Registered Practical

Nursing Association of Ontario, 11-13. Retrieved from CINAHL.

Gardner , D. B. (2013). Health insurance exchanges: A call for nursing action. Nursing

Economics , 31(3), 152-154. Retrieved from CINAHL

Bae, S. (2016). The centers for medicare & medicaid services reimbursement Policy

and nursing-sensitive adverse patient outcomes Nursing Economics 34(4),

161-170. Retrieved from CINAHL

Ginneken, E. V., Swartz, K., & Wees, P. V. (2013). Health insurance exchanges in

Switzerland and the Netherlands offer five key lessons for the operations of

United States exchanges. Health Affairs ,32(4), 744-752.

doi:10.1377/hlthaff.2012.0948. Retrieved from CINAHL.

Trossman, S. (2013). Nurses take on various roles with insurance exchanges. The

American Nurse ,45(6), 5-5. Retrieved from CINAHL.

Lathrop, B., Hodnicki, D. (March 31, 2014). The affordable care act: Primary care and

the doctor of nursing practice nurse. OJIN: The Online Journal of Issues in

Nursing ,19(2). doi: 10.3912/OJIN.Vol198No02PPT02. Retrieved from ANA

Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M. (2017). Fundamentals of

Nursing, (9th ed.). St. Louis , Missouri: Elsevier .

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Appendix

I. Introduction

a. What is the topic?

II. Health Insurance in the United States

a. Discuss issues

b. What affects does the Affordable Care Act have

c. How nurses can teach ACA

d. What is the current presidents plan

e. Compare the United States throughout paper

III. Nursing-sensitive outcomes

IV. Health Insurance in a foreign country

a. Discuss issues

V. Comparing both sides

a. What are the positives and negatives of each?

VI. More examples of good insurance policies outside of the United States

a. Discuss the positives of other healthcare plans

b. Bring up the negative risks that can result from positive plans

VII. Conclusion
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