b. The free Universal Health Care in UK

National Health Service in UK

Core principles

The NHS was born out of a long-held ideal that good healthcare should be available to all, regardless of wealth. At its launch by the then minister of health, Aneurin Bevan, on 5 July 1948, it had at its heart three core principles:

· That it meet the needs of everyone

· That it be free at the point of delivery

· That it be based on clinical need, not ability to pay These three principles have guided the development of the NHS over more than half a century and remain. However, in July 2000, a full-scale modernization program was launched and new principles added. The main aims of the additional principles are that the NHS will: · Provide a comprehensive range of services

· Shape its services around the needs and preferences of individual patients, their families and their carers

· Respond to the different needs of different populations · Work continuously to improve the quality of services and to minimize errors

· Support and value its staff

· Use public funds for healthcare devoted solely to NHS patients · Work with others to ensure a seamless service for patients

· Help to keep people healthy and work to reduce health inequalities · Respect the confidentiality of individual patients and provide open access to information about services, treatment and performance

Structure

The English NHS is controlled by the UK government through the Department of Health (DH), which takes political responsibility for the service. Parliament has devolved management locally to ten Strategic Health Authorities (SHAs), which oversee all NHS operations, particularly the Primary Care Trusts, in their areas. These are coterminous with the nine Government Office Regions for the most part, with the South East region split into South East Coast and South Central SHAs.

Nearly all hospital doctors and nurses in England are employed by the NHS and work in NHS-run hospitals, with teams of more junior hospital doctors (most of whom are in training) being led by consultants, each of whom is trained to provide expert advice and treatment within a specific specialty. But most General Practitioners, dentists, optometrists (opticians) and other providers of local health care are almost all self-employed, and contract their services back to the NHS. They may

operate in partnership with other professionals, own and operate their own surgeries and clinics, and employ their own staff, including other doctors etc. However, the NHS does sometimes provide centrally employed health care professionals and facilities in areas where there is insufficient provision by self-employed professionals.

The NHS also plays a unique role in the training of new doctors in England, with approximately 8000 places for student doctors each year, all of which are attached to an NHS University Hospital trust. After completing medical school, these new doctors must go on to complete a two-year foundation training program to become fully registered with the General Medical Council. Most go on to complete their foundation training years in an NHS hospital although some may opt for alternative employers such as the armed forces.

In July 2010 it was announced that the UK government planned to do a major decentralization of the English National Health Service. This plan entails shifting control of England’s $160 billion annual health budget from a centralized bureaucracy to doctors at the local level, as well as shrinking the bureaucratic apparatus.

Current reform proposals

The coalition government's white paper on health reform, published on 12 July 2010, sets out the most significant reorganization of the NHS in its history. The white paper, Equity and excellence: liberating the NHS, has implications for all health organizations in the NHS and very significant changes for PCTs and strategic health authorities. It aims to shift power from the centre to GPs and patients, moving somewhere between ￡60 to ￡80 billion into the hands of groups of GPs to commission services. The new commissioning system is expected to be in place by April 2013, by which time SHAs and PCTs will be abolished.

The money to pay for the NHS comes directly from taxation. The 2008/9 budget roughly equates to a contribution of ￡1,980 for every man, woman and child in the UK.

When the NHS was launched in 1948 it had a budget of ￡437million (roughly ￡9billion at today’s value). In 2008/9 it received over 10 times that amount (more than ￡100billion).

(Another source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447686/)

c. The current situation of health care system in China

Healthcare reform in the People's Republic of China

Today

The Chinese government still faces a mammoth task in trying to provide medical and welfare services adequate to meet the basic needs of the immense number of citizens spread over a vast area. Although China's overall affluence has grown dramatically since the mid-1980s — per capita income has increased many times over, and caloric intake has become comparable to that for Western Europe — a great many of its people live at socioeconomic levels far below the national average. The medical system, moreover, labors under the tension of whether to stress quality of care or to spread scarce medical resources as widely as possible. In addition, there has been repeated debate over the relative balance that should be struck between the use of Western and traditional Chinese medicine. While the Cultural Revolution pushed the balance toward widespread minimum care with great attention paid to traditional medicine, policy after the late 1970s moved in the other direction on both issues; by the late 1980s the proportion of doctors of Western medicine had exceeded those of traditional practices.

At the same time, the medical establishment also more or less has been affected by this major influence: along with 1980s initial period people's commune disintegration, the original rural cooperatives medical service system rapidly disintegrates in the majority of areas; In the cities scope, the public health services system and the labor insurance medical service system also gradually declines in the varying degree. But the medical service relates to national economy and the people's livelihood and the social stability, and the related problems are extremely complex, the establishment of this new system is slower continuously, compared to other professions.

The health of the Chinese populace has improved considerably since 1949. Average life expectancy has increased by about three decades and now ranks nearly at the level of that in advanced industrial societies. Many communicable diseases, such as plague, smallpox, cholera, and typhus, have either been wiped out or brought under control. In addition, the incidences of malaria and schistosomiasis have declined dramatically since 1949.

As evaluated on a per capita basis, China's health facilities remain unevenly distributed. Medical and health personnel work in rural areas, where approximately one-half of the population resides, where access to higher tier care is limited. The doctors of Western medicine, who constitute about one-fourth of the total medical personnel, are even more concentrated in urban areas. Similarly, about two-thirds of the country's hospital beds are located in the cities.

China has a health insurance system that provides virtually free coverage for people employed in urban state enterprises and relatively inexpensive coverage for their families. The situation for workers in the rural areas or in urban employment outside the state sector is far more

varied. There are some cooperative health care programs, but their voluntary nature produced a decline in membership from the late 1970s.

The severest limitation on the availability of health services, however, appears to be an absolute lack of resources, rather than discrimination in access on the basis of the ability of individuals to pay. An extensive system of paramedical care has been fostered as the major medical resource available to most of the rural population, but the care has been of uneven quality. The paramedical system feeds patients into the more sophisticated commune-level and county-level hospitals when they are available.

New Rural Co-operative Medical Care System

The New Rural Co-operative Medical Care System (NRCMCS) is a new 2003 initiative to overhaul the healthcare system, particularly intended to make it more affordable for the rural poor. Nowadays the permanent urban population (except migrants) takes out medical insurance. Many in the rural areas may struggle to afford with the new burden of healthcare fees, a result of the collapse of the old state-funded health system which existed before China's program of economic reforms in the 1980s.

The annual cost of medical cover under the NRCMCS is 50 yuan (US$7) per person. Of that, 20 yuan is paid in by the central government, 20 yuan by the provincial government and 10 yuan is paid by the patient. As of September 2007, around 80% of the whole rural population of China had signed up (about 685 million people). The system is tiered, depending on the location. If patients go to a small hospital or clinic in their local town, the scheme will cover from 70-80% of their bill. If they go to a county one, the percentage of the cost being covered falls to about 60%. And if they need specialist help in a large modern city hospital, they have to bear most of the cost themselves; the scheme would cover about 30% of the bill.

Primary care reform

Lu et al. reported in 2005 that China has no national primary care system, in particular general practice. The introduction of general practice in parts of urban China began in 1999. Lu et al. explain that “acceptance of general practice has been slow against the background of a strong urban tradition of hospitals as primary care providers, the widespread belief that specialists are more skilled than generalists even for minor complaints, and the perceived right of the individual to use the provider of their choice. But these attitudes are changing slowly. In several cities, notably in Zhejiang, Jiangsu, and Guangdong provinces, general practitioners (GPs) are acquiring a good local reputation and are attracting large numbers of patients.”