Creating health policy involves many complexities and challenges no matter the current state of the country. This literature review will look at policy development in the United States (US), Canada, Uganda, and sub-Saharan Africa and examine the varying factors of development such as cost, quality, and patient access. One constant theme stands out amongst the literature. No matter the condition of the country or the type of health policy, no health system is without challenges, whether they are unique or shared.
Health Policy in Developed Countries
To examine health policy in well developed countries, we will look specifically at the US and Canada. Most Americans are insured privately through employer based programs, under market based control, while Canada has a government run single payer system that determines rates. One challenge in the US is the uninsured population and their access to care (Kennedy & Morgan, 2006). In fact, Kennedy and Morgan (2006) state that out of uninsured Americans aged 18 to 64, almost one-third of them were unable to get needed health care within the last year. On the contrary, all Canadians are covered and benefits include anything that is deemed medically necessary (Chua, 2005). Even with universal care, Canada also shares a needs gap. Insured Canadians report unmet needs related to long wait times and the ability to access care in a timely fashion (Kennedy & Morgan, 2006). Additionally, certain services are not included such as dental and outpatient prescriptions drugs, requiring Canadians to purchase supplemental insurance (Chua, 2005). Significant numbers of Canadians and Americans claim access difficulty and disgruntlement, thus showing that no system is perfect (Kennedy & Morgan, 2006). In addition to access difficulties and needs gaps in these nations, costs are on the rise. Health care costs equate to 16% of the gross domestic product (GDP) in the US (Bentley, Effros,
Palar, & Keeler, 2008). Bentley et al. (2008) mentions that the US’s system does not perform any better than other developed countries yet the per capita spending is double of others. Canada spent only 57% as compared to the US per capita (Chua, 2005). Even so, Canadian health care is expensive when compared to the world and, in 2001, 9.3% of Canada’s GDP was spent on health care (Chua, 2005). Canada’s universal system ranks as the third most expensive and Canadians are not receiving the quality of the care equal to the cost when compared to other countries with similar systems (Esmail, 2008).
Both nations also face constant pressure from a variety of groups involved in policy development. McNamara (2008) cited the efforts of health care professionals, lobbyists, and special interest groups to promote health care reform as a top priority during the 2008 US presidential campaign. Even the most developed nations, whether they have universal systems or not, face many challenges in health policy development.