Comparison of Healthcare Systems: USA and Russia

ABSTRACT

When comparing two countries, it is no longer a surprise that people who reside in those countries have a lot to say about their health care systems and its relation to the counties demographics. In fact, in 2018 ( https://en.wikipedia.org ) reported that the United States population increase rapidly from year to year compared to other countries. For instance, United States population is 0.75% (328,953,020) while Russia is 0.05% (144,530,031) since the last census. During this project, I would like to go deeper on the healthcare system of both countries, and how Demography impact healthcare delivery. Upon reviewing different articles for the paper, I noticed that there are similarities, differences between Russia and the United States healthcare system which I will share in detail in this project.

INTRODUCTION

Number One: Brief History

The United States locates in the continent of North American with Alaska in the northwest and Hawaii extending the nation’s presence into the Pacific Ocean. The U.S has a total of 50 states, and her current president is Donald Trump. Meanwhile, Russia is located in the borders of European and Asian countries as well as the Pacific and Arctic oceans (www.worlatlas.com). Russia is also known as the world’s largest nation, and the current President is Vladimir Putin.

The United States has a population of 328,953,020 and Russia has a population of 144,530,031. When it comes down to the similarities, both suffer from the rising costs, access, quality of service, technological development, and providing adequate health care for its people (James O’Connor, 1973). United States government or NGOs has stepped in to help with the health reform, but Russia, it is continuing to rebuild till date.

Demography

1.1   Ethnic groups

In the United States, the ethnic groups are based on ancestors who migrated from different places and currently living in America. According to the 2010 U.S. Census, most ancestries came from German, African American, Mexican, Italian, American, and so on. While Russia is a multi-national state with over 186 ethnic groups (e.g. Tatar, Ukrainian, Bashkir, Chuvash, and so on)

1.2   Religions

The United States is culturally diverse with Protestant/Christian tradition is rated 48.9%, Judaism is the religion of 2.1%, including Islam (0.8%) and Mormonism (1.8%), while smaller numbers identify as Buddhists, Hindus, Sikhs, Wiccans, and many other varieties of religious faiths. (www.worldpopulationreview.com). However, the freedom to practice one’s religion is among the most important rights in the United States, to the extent that it is enshrined in the US Constitution.

Meanwhile, In Russia, Islam is the second largest religion in Russia after Orthodox Christianity says ( https://en.wikipedia.org ). It is the historically dominant religion among some Caucasian ethnic groups (notably the Chechens, the Ingush and the Adyghe), and some Turkic peoples (notably the Tatars and the Bashkirs).

1.3   Literacy rates

According to a study conducted in late April by the U.S. Department of Education and the National Institute of Literacy, 32 million adults in the U.S. can’t read. That’s 14 percent of the population. 21 percent of adults in the U.S. read below a 5th-grade level, and 19 percent of high school graduates can’t read. Russia: The country with the highest literacy rate in Russia with almost 53% of the population has a tertiary education. It was estimated that 95% of adults in Russia have higher secondary school education and the country spends a sum of 4.9% of GDP on education.

1.4   Government structure (type)

For the United States: ‎Legislative branch · ‎Executive branch · ‎the Judicial branch; For Russia: federal semi-presidential republic

1.5   Population size

For United States Population 308,745,538; For Russia Population 144,530,031

1.6   Age structure of the country

In 2017, about 18.91 percent of the U.S. population fell into the 0-14-year category, 65.67 percent into the 15-64 age group and 15.41 percent of the population were over 65 years of age. In 2016, Russia is about 17.29 percent of Russia’s population fell into the 0-14-year category, 68.92 percent into the 15-64 age group and 13.79 percent were over 65 years of age. (Age distribution 2016 | Statistic.)

1.7   Gender ratio

Sex ratio in the U.S. population aged above 65. Red represents more women, blue more men than the world average of 0.79 males/females. Russia population 65 and over is14.4% (0.86 male(s)/female (2009))

1.8 Infant mortality rate

      Infant mortality rate 5.6 deaths/1,000 live births

1.9 Life expectancy at birth

For United States

      Life expectancy 80 years

      Male 77.7 years

      Female 82.2 years

For Russia

      Life expectancy 72.70 years

      male 67.51 years

      female 77.64 years

Number Two: History of U.S and Russia health care system

Despite its differences, articles have proven that there are some similarities in both countries. According to (https://en.wikipedia.org/wiki/Healthcare_in_usa), Russian and USA healthcare might seem similar because of the history between them dating back to 2009 when U.S. President Barack Obama and Russian president Dmitry Medvedev called for institutionalized contacts that would help develop the relationship between the two governments “in a more structured and regular way.” By signing Memorandum of Understanding on Cooperation in the Field of Public Health and Medical Sciences. (Matthew and Izabella, 2013).

Russia and USA kept working together to provide grants like HIV/AIDS prevention; Text4baby (a mobile device to improve maternally and infant care in Russia), and even was to prevent child death caused by malaria. Individually, U.S passed different healthcare policy’s such as The Patient Protection and Affordable Care Act and Affordable Care Act passed in 2010. The Health Care and Education Reconciliation Act of 2010 (H.R. 4872), was there to amend the PPACA and became law on March 30, 2010. (https://en.wikipedia.org/wiki/Healthcare_in_usa)

     As we know, with new leadership comes new rules and regulation, and that occurred when Donald Trump went into administration. As President, he signs Executive Order 13813 which allows insurance companies to sell low-cost, short-term plans with lesser coverage, and enables small business to purchase association health plans collectively and expands health savings accounts. And for Russia, things deteriorated when Russia face a financial crisis since 2014; this cut down their significant expenditure especially when providing quality healthcare system. Things got worse when 40% of their basic medical facilities had fewer staffed members and others being closed, leaving patients to pay for more services that were previously free. (https://en.wikipedia.org/wiki/Healthcare_in_Russia)

Number Three: Description of U.S and Russia current health care system

3.1 Number of acute care beds and types of services

In the USA, there are fewer critical care hospital beds per capital. The number of acute hospital beds per 1000 in population fell in the U.S. from 3.7 in 1990 to 2.6 in 2010.  While for Russia There are about 9.3 beds per thousand population—nearly double the OECD average (Gallagher, 2018). Acute care hospitals provide short-term care for illness, disease, injury, or surgery; both countries focus on these types of services where treatment is provided for illnesses, diseases, injuries, surgeries and recovery, and obstetric care., and Postnatal care. [By Bradley, Nolan, Kaiser Family Foundation, 2016].

3.2   Ambulatory care services

Ambulatory care or outpatient care is medical care provided on an outpatient basis, including minor surgical and medical procedures, most types of dental services, dermatology services, and many types of diagnostic procedures (e.g., blood tests, X-rays, endoscopy and biopsy procedures of superficial organs). Other types of ambulatory care services include emergency visits, rehabilitation visits, and in some cases telephone consultations in the USA. To call an ambulance, dial 911. There are medical services in Russia; the service is provided by a city or regional government, public emergency hospital, or the Disaster Medical Service. The emergency number for dialing an ambulance in Russia is 03 or the generic European 112. (https://en.wikipedia.org/wiki/Ambulatory_care).

3.3Medical education (MD’s, nurses)

According to the “Medical education in Russia” presently, medical education is provided by more than 70 Russian universities. Higher medical school in Russia is only available to intramural students. Length of study depends on the medical specialty. For example, a bachelors degree in nursing care is awarded after four years of study. In the United States, medical students’ study for 12 to 18 years, which requires four years of study at a medical school, and as many at a university.

Part B: Costs

How is the system financed? Both systems are financed through their government. According to the overview of Health Care Financing by Roger I. Schreck, In the United States, health care is technologically advanced but expensive. Health care is paid for by government programs (such as Medicare and Medicaid), private health insurance plans (usually through employers), and the person’s funds (out-of-pocket). Healthcare in Russia is provided by the state through the Federal Compulsory Medical Insurance Fund and regulated through the Ministry of Health. The Constitution of the Russian Federation has provided all citizens the right to free healthcare since 1996. In 2008, 621,000 doctors and 1.3 million nurses were employed in Russian healthcare. The number of doctors per 10,000 people was 43.8, but only 12.1 in rural areas. The number of general practitioners as a share of the total number of doctors was 1.26 percent.

How are costs controlled? According to “Health insurance in the United States – Wikipedia” United States health cost is funded by employers for the most part. Insurance can be purchased individually as well. The market for insurers increases when immigrant workers are required to purchase health insurance to obtain work permits. Statics: The average yearly cost of an employer-sponsored scheme ranged from 30,000 to 40,000 rubles ($530 – $700) in 2016, while prices for individuals were about 30% higher. Critical conditions, such as cancer or heart disease, are often excluded from entry-level policies. Furthermore, to control health cost increase, there is a limit to type and number of visits that are reimbursed (for example, for mental health care or physical therapy). There is an Increase in deductibles and co-payments and a decrease in the amount that they will pay for specific procedures.

The Russian health insurance market is oriented towards large companies, with corporate clients accounting for 90% of all the policies. Most of the individuals who buy health insurance are related to people covered by employer-sponsored schemes, with the rest accounting for less than 2% of all policies. The largest private healthcare provider by revenue is Medsi, whose main shareholder is the Sistema conglomerate. Foreign healthcare providers with a presence in Russia include Fresenius, which has a network of dialysis centers in the country. Fertility and maternity clinics are an important element of the Russian private healthcare network. The Mother and Child network of clinics account for 9% of all IVF treatment cycles in the country.

Per capita cost for health care? According to the article “How does health spending in the U.S. compare to other countries”  The U.S. spends more per person on health than comparable countries. Health spending per person in the U.S. was $10,348 in 2016. According to “the Institute of Russia” Russia’s healthcare spending per capita (using the purchasing power parity conversion) is estimated at $1,474, which is also below the OECD average of $3,484

Part Three: Access

How does the public access their system for care? U.S and Russia access their health care through the government whether its free (Russia) or not. In the U.S they also access through Medicaid, Medicare, chip, jobs, and others.

Part Four: Quality

How is quality measured? According to “Measuring Health Care Quality: An Overview of Quality” In the U.S. quality measurement in health care is the process of using data to evaluate the performance of health plans and health care providers against recognized quality standards. Quality measures can take many forms, and these measures evaluate care across the full range of health care settings, from doctors’ offices to imaging facilities to hospital systems. Research consistently shows that there is chronic underuse, overuse, and misuse of services. Furthermore, the way health care is delivered is often fragmented, overly complex, and uncoordinated. These problems can lead to serious harm or even death.

Satisfaction:

How satisfied are the users of each country’s health system? For all countries combined, the level of satisfaction with health systems increased from 19.4% in 2001 to 40.6% in 2010 but varied considerably by country. Changes in satisfaction with the health system were similar to changes with the public sector, and non-users of healthcare were slightly more likely to report satisfaction than users. Characteristics associated with higher satisfaction include younger age, lower education, higher economic status, rural residency, better health status, and higher levels of political trust. Our results suggest that satisfaction can provide useful insight into public opinion on health system performance, particularly when used in conjunction with other subjective measures of satisfaction with government performance

CONCLUSION

United States and Russia has always had some feud (military or partnership with different president) or similarities between them as we seen and heard in the news or in different articles. I was unaware of how their healthcare system worked and honestly, this became an eyeopener for me. I learnt so much about Russia and their similarities to other countries like Sweden, or Canada or UK, other than the U.S. healthcare system. 

When considering if Russian’s healthcare system would work in the U.S., we need to first remember that Russia practice universal healthcare system, meaning that citizens are entitled to free universal health care. How about non-citizens? We also have to keep in mind that Healthcare is not a right nor is it in the constitution or in amendment as something that is mandated. Healthcare should be looked at as a necessity for humanity. The question that needs to be asked is should the government be in charge of detecting what healthcare one needs to practice? My answer is “NO”. I would say that I did prefer the options I have with healthcare system in United states.

Initially, I stated how the United States, the ethnic groups are based on ancestors who migrated from different places and currently living in America. Under this umbrella are undocumented immigrants, temporary visitors, illegal immigrants, and individuals who stay past their permit dates. When the coverage is for citizens alone, then it goes against what American stands for. That would mean we are moving backwards.

According to “Student voices, Is Healthcare a right?” In United States, the government already provides healthcare for the poor and the elderly through large and costly programs such as Medicaid and Medicare and this is paid for by taxpayers. If the government were to mandate universal healthcare coverage, the additional cost to the taxpayers will be huge and a drag on the economy, even though those taxpayers are not receiving any benefits from it. Reforming our health care delivery system to improve the quality and value of care is essential, and they should keep people healthy and prevent common, avoidable complications of illnesses to the greatest extent possible. Thoughtfully constructed reforms would support greater access to health-improving care — in contrast to the current system, which encourages more tests, procedures, and treatments that are at best unnecessary and at worst harmful.(Sam Hanoura, 2013).

References

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