1

International Health Systems

According to Bordbar et al. (2022), “Because health is a major factor in the welfare of

countries and all countries must provide health services for the population, the performance of

the health systems of other countries must be evaluated” (p. 19). This paper will compare the

differences in healthcare systems in the United States (U.S.), Germany, Canada, the United

Kingdom (U.K.), and Japan. The writer will discuss the healthcare philosophy for each country,

access to care, the cost of care, the average age of death, infant mortality, obesity rate, and the

five top diseases in each country. The most effective international healthcare system will be

argued and recommendations for improving patient outcomes in the U.S. will be identified.

Criteria to United States Germany Canada United Japan

Evaluate Kingdom
Healthcare The U.S.’s Germany’s Canada’s The U.K.’s Japan’s
Philosophy healthcare healthcare healthcare healthcare healthcare
philosophy is philosophy is philosophy philosophy is philosophy is
based on a mandatory utilizes a universal universal
hybrid health decentralized healthcare coverage
approach. The insurance. universal, through the through the
U.S. includes Most of the publicly National statutory
public and population funded health Health Service health
private health are enrolled insurance. (NHS). insurance
insurance. in statutory This program Citizens can system (SHIS)
Private health is called purchase which covers
insurance insurance Canadian private health 98.3% of the
includes (SHI) which Medicare. insurance population.
employer- is financed Private through Public Social
sponsored through insurance can employer- Assistance
health sickness be obtained funded Program for
insurance and funds. for services healthcare or impoverished
health Private not covered pay directly. people covers
insurance health by universal 1.7%.
purchased by insurance health Some
individuals can be coverage. residents have
from for-profit utilized if an private
and nonprofit individual insurance
carriers. makes more used as a
Public and than supplement to
government- $68,000. life insurance.
2

assisted Germany
insurance also has
programs statutory
include long-term
Medicare, care
Medicaid, insurance
Children’s (LTCI).
Health
Insurance
Program
(CHIP).
Veteran
Health
Administration
(VHA) and
Tricare.
Access to Medicare is a All Canadian All citizens are SHIS has two
Care federal health insurances in Medicare is a eligible; non- types of
Model-- insurance Germany use national European mandatory
(How does program for the same health visitors and insurance:
a citizen of adults 65 and providers insurance undocumented employment-
this older and and program that immigrants based (59% of
country people with hospitals. is a can receive the
get into long-term SHI is government- free treatment population) or
the disabilities or mandatory run program in the residence-
healthcare end-stage insurance with emergency based health
system? renal disease. provided automatic department insurance
How do Individuals through 110 coverage and and for certain plans (Citizen
they gain must apply for nonprofit offers health infectious Health
access to the program. sickness insurance to diseases. Insurance
personal Medicaid is a funds. the entire plans for non
health federal and Individuals population. employed
services to state health earning more Each individuals
achieve insurance for than $68,00 province and aged 74 and
the best low-income can choose territory have under (27%)
health families, private its insurance and Health
outcomes? individuals, insurance plan and Insurance for
) children, and opt-out receives the Elderly
pregnant of SHI. federal plans cover all
women, and Civil assistance per adults aged 75
people with servants are capita. and older
disabilities. exempt from Private (12.7%).
Individuals SHI. insurance is Citizens and
must apply for Military, mostly resident non-
the program police, and employment- citizens must
and recertify public-sector sponsored enroll in the
3

annually. employees policies SHIS plan;

CHIP is for are covered covering undocumented
children with by other vision, immigrants
low-income programs dental, and visitors
families that separate prescription are not
earn too much from SHI. drugs, allied covered.
for Medicaid. professionals,
Individuals and private
must apply. rooms in
VHA is hospitals.
limited to
veterans and
Tricare
services are
limited to
active and
retired military
and their
beneficiaries.
Veterans must
enroll. Active
duty members
are
automatically
enrolled.
Retired and
dependent
beneficiaries
must enroll.
Private
insurance is
the most
prevalent and
is provided
primarily by
employers.
Individuals
must sign up
for a plan that
is offered
through the
employer.
Affordable
Care Act
(ACA)
launched a
4

federal
marketplace
where
individuals
purchase
health
insurance
through
private plans.
Cost to Cost is set by Sickness Canadians NHS is mainly SHIS is
Consumers individual funds are pay funded through funded by
insurers and financed by healthcare taxes and taxes,
varies. The general wage fees through payroll taxes mandatory,
average health contributions their taxes. paid by individual
insurance is and The average employees and contributions,
$456 for an additional cost is employers. and out-of-
individual contributions around Approximately pocket
$1,152 for a shared by $8,019 per 4.5% of a charges.
family. employers Canadian a citizen’s Employers
However, and workers, year. average and
some ranging from income goes employees
employers pay 14.6% to towards share
a portion of 15.6% of healthcare. mandatory
the health monthly pay. Services are contributions
insurance Dependents free for in
policy. are free. outpatient and employment-
Medicaid is A copayment inpatient based plans,
free or low- must be paid hospital contribution
cost based on for inpatient services. rates are about
income. services and Out-of-pocket 10% of
Medicare has drugs; payments monthly
four different however, apply to salaries and
parts and sickness specific bonuses, and
prices vary. funds offer services. contribution
Part A is deductibles. rates are
typically free An capped based
but can cost up individual on employees’
to $499 a who has income.
month; Part B private The national
averages about insurance government
$170. pays a risk- funds a
VHA is based related portion of
on service- premium. mandatory
connected Private contributions
disabilities and insurances for the
a sliding scale are residence-
5

based on regulated, so based

income. individuals insurance
Tricare do not incur plans.
premiums premium Citizens pay
depend on the increases premiums,
coverage with age or if 30%
obtained and income coinsurance
can be up to decreases. for most
$504 annually services, and
for an copayments.
individual and Young
$1,008 for a children and
family. adults 70 and
older with
lower income
are exempt
from
coinsurance.
There is an
age and
income-based
annual
household
out-of-pocket
maximum and
monthly out-
of-pocket
maximums.
Average Male 76.0 Male 78.7 Male 80.9 Male 79.7 Male 81.1
Age of Female 81.0 Female 83.3 Female 84.7 Female 83.2 Female 87.1
Death All 78.5 All 81.0 All 82.8 All 81.4 All 84.2
Infant 5.44 per 1,000 3.1 per 1,000 4.38 per 3.62 per 1,000 1.82 per 1,000
Mortality live births live births 1,000 live live births live births
Rate births
Obesity 36.2% 22.3% 29.4% 27.8% 4.3%
percentage
Major Ischemic heart Ischemic Ischemic Alzheimer’s & Ischemic heart
Diseases disease heart disease heart disease Dementia disease
Affecting
the Alzheimer’s & Alzheimer & Alzheimer’s Ischemic heart Stroke
Population Dementia Dementia & Dementia disease
Lower
Chronic Stroke Trachea, Lower respiratory
Obstructive bronchus, respiratory infections
Pulmonary Trachea, Lung infections
Disease bronchus, Cancers Trachea,
6

Lung Stroke bronchus,

Stroke Cancers Chronic lung cancers
Obstructive Trachea,
Trachea, Chronic Pulmonary bronchus, Chronic
bronchus, lung Obstructive Disease Lung Cancers Obstructive
cancers Pulmonary Pulmonary
Disease Stroke Disease

Most Effective International Health Plan

Ruggles et al. (2019) believe Japan’s healthcare system provides better patient outcomes

and costs half as much as the U.S. The philosophy of Japan’s healthcare includes full healthcare

coverage for its population. Japan believes in universal coverage through the statutory health

insurance system (SHIS) which covers 98.3% of the population (The Commonwealth Fund,

2020d). Private insurance can be bought to supplement life insurance. In Japan, both citizens and

nonresident citizens must enroll in SHIS; however, undocumented immigrants and visitors are

not covered (The Commonwealth Fund, 2020d). “Employed individuals and employers support

the universal health insurance system through payroll taxes” (Ruggles et al., 2019, p. 58).

Contributions can range anywhere from 5.8% to 9.5% of monthly income according to the

organization’s size. Self-employed individuals pay a premium based on their income, while

government employees are covered by Mutual Aid Societies (Ruggles et al., 2019). The

government sets a fee schedule for reimbursement to healthcare providers and patients cannot be

billed more than the authorized fee (Ruggles et al., 2019). This means that everyone pays the

same price. There are no deductibles in Japan; however, citizens may have to pay a copayment

with specific services, coinsurance, or premiums, although young children and adults 70 and

older with lower income are exempt (The Commonwealth Fund, 2020d). Socialized medicine in

Japan shows the highest average age of death, the lowest percentage of obesity, and the lowest

infant mortality rates. According to World Health Rankings (2018c), Japan’s average age of
7

death is 84.2, which is higher than the compared countries. The percentage of obesity in Japan is

4.3% compared to 36.2% in the U.S. (World Population Review, 2022). Infant mortality is 1.82

per 1,000 live births, which is the lowest compared to the other countries. Compared to the U.S.,

Germany, Canada, and the U.K., Japan had similar diseases that were the leading causes of

death, including ischemic heart disease, stroke, lower respiratory infections, trachea, bronchus,

lung cancers, and chronic obstructive pulmonary disease (WHO, 2022c). Japan’s use of universal

healthcare ensures medical care is available to everyone and is cost-efficient for all citizens. It

also provides low-income individuals and the older population equal access to care.

Recommendations

Three recommendations to improve patient outcomes in the healthcare system in the U.S.

include focusing on prevention, increasing telehealth to improve access to care, and standardized

full practice authority (FPA) for all nurse practitioners (NPs) in all states. One of Healthy People

2030 objectives is to increase preventive care. Preventive care decreases the risk of disease,

disabilities, and death (Office of Disease Prevention and Health Promotion, n.d.). Song et al.

(2019) noted preventive care encourages healthy behaviors through recommended screening,

education, counseling, and vaccinations. This, in turn, can increase the average age of death and

decrease the infant mortality rates in the U.S. Incorporating prevention measures could lessen the

cost associated with the unhealthy population. Expanding the use of telehealth in rural or

impoverished areas can enhance access to care issues frequently faced. “When face-to-face care

is not feasible, telehealth can connect vulnerable patients to their health-care providers during

disasters and other times of stress and uncertainty and reduce the likelihood of adverse patient

outcomes” (Der-Martirosian et al., 2020, p. 3). Mason et al. (2016) mentioned telehealth impacts

patient behaviors and outcomes and allows access to clinical and disease management
8

specialists. Lastly, to improve patient outcomes in the U.S.’s healthcare system, standardizing

FPA for nurse practitioners is imperative. Despite national standards in nursing, state laws and

legislative bodies are inconsistent with NP practice laws (AANP, 2022). “Studies show that in

FPA states, NPs are more likely to practice in rural and underserved areas and have improved NP

workforce recruitment while meeting the highest care quality and safety standards” (AANP,

2022, para. 3). FPA can improve access to care, quality of care, and patient outcomes while

decreasing costs.

Conclusion

Assessing different countries’ healthcare systems can provide an opportunity for

policymakers to compare their healthcare systems to their international equivalents and influence

changes to improve patient outcomes (Bordbar et al., 2022). This paper compared the healthcare

philosophy, access to care, cost of care, average age of death, infant mortality, obesity rate, and

top five diseases leading to death in the U.S., Germany, Canada, the U.K., and Japan. The writer

explained why Japan is the most influential international healthcare system. This writer noted

ways to improve patient outcomes in the U.S. healthcare system including focusing on

prevention, improving access to care, and standardizing FPA in NPs.

References

American Association of Nurse Practitioners (AANP). (2022). Issues at a glance: Full practice
9

authority. https://www.aanp.org/advocacy/advocacy-resource/policy-briefs/issues-full-

practice-brief

Bordbar, N., Shojaei, P., Ravangard, R., Bastani, P., Joulaei, H., & Kavosi, Z. (2022). Evaluation

of the world countries health referral system performance based on world health

organization indicators using hybrid multi-criteria decision-making model. Value in

Health Regional Issues, 28, 19–28.

https://doi-org.lib-proxy.jsu.edu/10.1016/j.vhri.2021.06.006

Canadian Institute for Health Information. (2022). Health spending.

https://www.cihi.ca/en/health-spending

Der-Martirosian, C., Chu, K., & Dobalian, A. (2020). Use of telehealth to improve access to care

at the United States Department of Veterans Affairs during the 2017 Atlantic hurricane

season. Disaster Medicine and Public Health Preparedness, 1–5.

https://doi.org/10.1017/dmp.2020.88

Mason, D., Gardner, D., Outlaw, F., & O'Grady, E. (2016). Policy & politics in nursing

and health care. (7th ed.). St. Louis, MO. Elsevier.

Office of Disease Prevention and Health Promotion. (n.d.) Preventive care.

https://health.gov/healthypeople/objectives-and-data/browse-objectives/preventive-care

Ruggles, B. M., Xiong, A., & Kyle, B. (2019). Healthcare coverage in the US and Japan: A

comparison. Nursing, 49(4), 56–60. https://doi-org.lib

proxy.jsu.edu/10.1097/01.NURSE.0000553277.03472.d8

Song, X., Klein, J. D., Yan, H., Catallozzi, M., Wang, X., Heitel, J., Kaseeska, K., Gorzkowski,

J., & Santelli, J. S. (2019). Parent and adolescent attitudes towards preventive care and
10

confidentiality. Journal of Adolescent Health, 64(2), 235–241. https://doi-org.lib-

proxy.jsu.edu/10.1016/j.jadohealth.2018.08.015

The Commonwealth Fund. (2020a). International health care system profiles: Canada.

https://www.commonwealthfund.org/international-health-policy-center/countries/canada

The Commonwealth Fund. (2020b). International health care system profiles: England.

https://www.commonwealthfund.org/international-health-policy-center/countries/england

The Commonwealth Fund. (2020c) International health care system profiles: Germany.

https://www.commonwealthfund.org/international-health-policy-center/countries/

germany

The Commonwealth Fund. (2020d). International health care system profiles: Japan.

https://www.commonwealthfund.org/international-health-policy-center/countries/japan

The Commonwealth Fund. (2020e). International health care system profiles: United States.

https://www.commonwealthfund.org/international-health-policy-center/countries/united-

states

U.S. Centers for Medicare and Medicaid Services. (n.d.). Your Medicare costs.

https://www.medicare.gov/your-medicare-costs

World Health Rankings. (2018a). Health profile: Canada.

https://www.worldlifeexpectancy.com/country-health-profile/canada

World Health Rankings. (2018b). Health profile: Germany.

https://www.worldlifeexpectancy.com/country-health-profile/germany

World Health Rankings. (2018c). Health profile: Japan

https://www.worldlifeexpectancy.com/country-health-profile/japan

World Health Rankings. (2018d). Health profile: United Kingdom.

11

https://www.worldlifeexpectancy.com/country-health-profile/united-kingdom

World Health Rankings. (2018e). Health profile: United States.

https://www.worldlifeexpectancy.com/country-health-profile/united-states

World Health Organization (WHO). (2022a). Canada.

https://www.who.int/data/gho/data/countries/country-details/GHO/canada?

countryProfileId=245adf99-b348-4bbf-82db-921447a5a6c4

World Health Organization (WHO). (2022b). Germany.

https://www.who.int/data/gho/data/countries/country-details/GHO/germany?

countryProfileId=d40a3186-091f-4302-b86f-7e3e4f527ea7

World Health Organization (WHO). (2022c). Japan.

https://www.who.int/data/gho/data/countries/country-details/GHO/japan?

countryProfileId=b4e079dd-08b2-4373-af36-78ebaaa5cfbf

World Health Organization (WHO). (2022d). United Kingdom of Great Britain and Northern

Ireland. https://www.who.int/data/gho/data/countries/country-details/GHO/united-

kingdom-of-great-britain-and-northern-ireland?countryProfileId=9ecfbce7-f44a-4660-

97d6-44b6a5d54887

World Health Organization (WHO). (2022e). United States of America.

https://www.who.int/data/gho/data/countries/country-details/GHO/united-states-of-

america?countryProfileId=5360f948-9917-4b8d-bea3-b3e593d10897

World Health Organization (WHO). (2022f). Global health estimates: Leading causes of death.

https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates/ghe-

leading-causes-of-death

World Population Review. (2022). Obesity rates by country 2022.

12

https://worldpopulationreview.com/country-rankings/obesity-rates-by-country