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Health Care Paper

Health care systems around the world vary in their ability to provide high-quality services,

ensure equitable access, and manage resources efficiently. The structure and policies guiding

health care delivery in different nations are a reflection of their political, economic, and social

priorities. As global comparisons of health systems become increasingly common, countries can

learn from each other and adopt practices that improve overall health outcomes. The system can

be judged based on five main components—care process, access, administrative efficiency,

equity, and health care outcomes—which help recognize the areas for improvement

(Commonwealth Fund, 2021). This paper will explore these five dimensions and assess how

different countries rank in terms of health care access, focusing on what these rankings reveal

about global health care disparities.

Dimensions of Health Care

To accurately compare health care systems, it is essential to define the five key dimensions that

are used as benchmarks.

1. Care Process: This dimension refers to how effectively health care services are delivered

to individuals. It encompasses patient-centered care, preventive services, and the overall

coordination of care (Commonwealth Fund, 2021) . Effective care processes ensure that

patients receive timely, safe, and appropriate interventions, which improve overall health

outcomes.
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2. Access: The access dimension evaluates how easily individuals can obtain health care

services when needed. It includes factors such as affordability, insurance coverage, and

geographic proximity to health care facilities (Commonwealth Fund, 2021). A system

with high access ensures that individuals, regardless of socioeconomic background, can

seek treatment without significant barriers, such as high costs or long waiting periods.

3. Administrative Efficiency: Administrative efficiency assesses the smoothness of health

care system operations. This includes how well resources are managed, the extent to

which bureaucracy hinders or facilitates care, and the time patients must wait for

services. Efficient systems reduce unnecessary paperwork, ensure that patients are seen

quickly, and optimize the use of health care resources (Commonwealth Fund, 2021).

4. Equity: Equity in health care means that all individuals have equal access to health

services, regardless of income, race, ethnicity, or geographic location (Commonwealth

Fund, 2021). This dimension highlights disparities in health care access and outcomes

among different population groups. A highly equitable system ensures that care is

distributed fairly and without discrimination.

5. Health Care Outcomes: Health care outcomes measure the results of health

interventions, focusing on overall population health, patient survival rates, and quality of

life (Commonwealth Fund, 2021). Systems with good outcomes help to improve the

general well-being of the population by reducing mortality rates, preventing diseases, and

offering effective treatments for chronic conditions.

Rank Comparison of Health Care Systems

Access is especially important among these five dimensions as it decides if individuals can

actively seek and receive timely care. A health care system may have excellent processes or

outcomes, but if people cannot access those services due to financial or logistical barriers, those

advantages are meaningless. Access ensures that health care is inclusive and available to

everyone who needs it, playing a fundamental role in the overall effectiveness of a health system.

The 2021 Commonwealth Fund report indicates that Norway has the best access to healthcare

services. Norway’s success in this dimension is largely due to its universal health care system,

which provides comprehensive coverage for all citizens and legal residents. Norway offers a

single-payer system in which the government ensures that everyone has access to necessary

medical care, with minimal out-of-pocket expenses for patients (Tikkanen et al., 2020). This

system allows Norway to eliminate many of the financial barriers to care, ensuring that cost is

not a prohibitive factor for those seeking treatment. In addition, the country has a well-

distributed network of hospitals and primary care centers, making health services readily

available across both urban and rural areas (Tikkanen et al., 2020). By offering care that is

affordable and geographically accessible, Norway ensures that its population enjoys high levels

of access to health services.

In contrast, the United States ranks lowest in terms of access. The U.S. health care system

struggles with accessibility, despite having some of the most advanced medical technologies and

treatments in the world. A key reason for this is the lack of universal health coverage, which

leaves millions of Americans uninsured or underinsured (Commonwealth Fund, 2021). For those

without adequate insurance, the cost of medical care can be prohibitively high, resulting in

delayed or skipped treatments. Even individuals with insurance often face high deductibles and

co-payments, further limiting their ability to access necessary care (Commonwealth, 2021). The
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article also states that geographical distribution of health care services also contributes to the

issue, with rural populations facing significant barriers in accessing specialized medical care.

This combination of high costs and uneven service distribution explains the U.S.’s low ranking in

health care access.

Patient Protection and Affordable Care Act (PPACA)

The Patient Protection and Affordable Care Act (PPACA), commonly known as the Affordable

Care Act (ACA), was enacted in 2010 to tackle key challenges in the American healthcare

system, such as accessibility and cost (Rosenbaum, 2011). Two key components of the ACA

have significantly impacted health care in the U.S. over the past decade.

Component 1: Coverage for Young Adults

One of the most significant aspects of the Affordable Care Act is the provision that mandates

insurance companies to permit young adults to be covered by their parents' health insurance

plans until they reach the age of 26.(ASPE, 2015). This policy was implemented to reduce the

uninsured rate among young adults, a group that was historically less likely to have health

insurance coverage. Since the law was enacted, this provision has remained unchanged and

continues to benefit millions of youth. According to the U.S. Department of Health and Human

Services, more than 2.3 million young adults gained health insurance through this provision,

reducing the uninsured rate for this age group by nearly half (ASPE, 2015). By allowing young

adults to stay on their parents' plans, the ACA has ensured that a critical demographic group

maintains access to health services during a time when they are often transitioning between

education and employment.

Component 2: Medicaid Expansion

The Medicaid expansion is another significant component of the ACA. The law expanded

Medicaid eligibility to include individuals and families earning up to 138% of the federal poverty

level, with the goal of providing health coverage to more low-income Americans

(Commonwealth Fund, 2023). States were given the option to expand Medicaid, and as of today,

39 states have chosen to do so (HealthMarkets, 2023). This expansion has had a profound impact

on access to care for millions of low-income individuals, with an estimated 15 million people

gaining coverage through Medicaid since the ACA was implemented (Commonwealth Fund,

2023). However, 11 states have opted not to expand Medicaid, which has left a coverage gap for

many low-income residents in those states. While the expansion has been a major success in

states that adopted it, the lack of nationwide implementation has contributed to ongoing

disparities in health care access.

Conclusion

After examining different aspects of healthcare in the United States and other countries, it is

evident that the United States encounters major difficulties in terms of accessibility and fairness.

The PPACA has taken steps to tackle some of these issues, especially through measures such as

expanding Medicaid and permitting young adults to remain on their parents' insurance policies.

In my opinion, although the PPACA represents progress, further action is necessary to guarantee

that all Americans have access to affordable healthcare. I have seen firsthand how challenging it

can be for individuals without insurance or with inadequate coverage to receive the care they

need. While I support the continued expansion of health care coverage through policies like the

ACA, I also believe that more comprehensive reforms are necessary to address the underlying

issues of cost and access in the U.S. health care system. Overall, the current direction of health

care reform is positive, but much work remains to be done.

References
The Commonwealth Fund. (2021, August 4). Mirror, mirror 2021: Reflecting poorly.

Commonwealth Fund.

https://www.commonwealthfund.org/publications/fund-reports/2021/aug/mirror-mirror-2021-

reflecting-poorly#:~:text=Key%20Findings:%20The%20top%2Dperforming,children%20and

%20working%2Dage%20adults.

The Commonwealth Fund. (2023, September 11). Impact of the Medicaid coverage gap:

Comparing states that have and have not expanded eligibility. Impact Medicaid Coverage Gap:

States Have and Have Not Expanded | Commonwealth Fund.

https://www.commonwealthfund.org/publications/issue-briefs/2023/sep/impact-medicaid-

coverage-gap-comparing-states-have-and-have-not#:~:text=A%20key%20provision%20of

%20the%20Affordable%20Care,138%20percent%20of%20the%20federal%20poverty

%20level.&text=As%20.

Health Markets. (2022, December 19). Affordable care act changes for 2023. Affordable Care

Act changes for 2023. https://www.healthmarkets.com/resources/health-insurance/aca-changes/

Rosenbaum, S. (2011, January). The Patient Protection and Affordable Care Act: Implications

for Public Health Policy and Practice. Public health reports (Washington, D.C. : 1974).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3001814/#:~:text=The%20Patient
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%20Protection%20and%20Affordable%20Care%20Act1%20(hereinafter%20referred,series

%20of%20crucial%20intermediate%20steps.

Tikkanen, R., Osborn, R., Mossialos, E., Djordjevic, A., & Wharton, G. A. (2020, June 5).

Norway. International Health Care System Profiles.

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

norway#:~:text=Norway%20has%20universal%20health%20coverage,greater%20choice%20of

%20private%20providers.

U.S. Department of Health and Human Services. (2015, September 21). Health insurance

coverage and the Affordable Care Act. ASPE. https://aspe.hhs.gov/reports/health-insurance-

coverage-affordable-care-act-0#:~:text=2.3%20million%20additional%20young%20adults

%20(aged%2019%2D25),on%20a%20parent’s%20plan%20until%20age%2026.