Despite being among developed countries’ top spenders in healthcare, the U.S. healthcare coverage system disproportionately underserves older adults relative to other developed countries like Norway. An ideal healthcare coverage plan promotes universality in the outcomes and access to all levels of healthcare (WHO, n.d.). The differences between countries’ healthcare systems and policies result in significant differences in healthcare coverage administration and stakeholder outcomes at all levels of healthcare. For instance, countries whose healthcare policies promote universal care are more likely to have positive stakeholder outcomes like reasonable national healthcare spending, high life expectancy, and limited conflicts (Tikkanen & Adams., 2020). On the contrary non-universal health coverage-promoting healthcare policies are relatively more likely to promote poor healthcare outcomes like unsustainably high expenditure, high cost of care, and socioeconomic and political conflicts between healthcare stakeholders. The relative validity, feasibility, or efficiency of the country-specific healthcare policies in realizing a particular healthcare objective can be determined by comparing countries’ healthcare practices, procedures, and outcomes.
The similarities and differences between the organization, practices, and procedures of the U.S. and Norway healthcare systems create attention to the advantages and disadvantages of the U.S. system over the Norwegian system concerning older adults’ health care. Leveraging various policy evaluation criteria, a needs assessment of the U.S. healthcare system’s relative advantages and disadvantages reveals the need for policy changes or new policy development to improve elderly Americans’ healthcare coverage. The new policies or policy changes must uphold equity as opposed to equality in health care coverage to promote humanistic and economically, legally, and politically viable health care coverage for Americans.
Similarities and Differences in the American and Norwegian Health Care Coverages
Both the American and Norwegian elderly health care coverages are non-universal since in both countries. Universal health coverage is the equitable accessibility of quality health care at any time, regardless of socioeconomic status and geographic location (WHO, n.d.). The conditional administration of elderly adults’ health care coverage in the U.S. underscores WHO’s definition of universal health coverage. For instance, in America, individual inclusion in elderly health care coverage depends on the personal adult’s Medicare eligibility criteria, while inclusion in Norwegian older adults’ health coverage depends on the elderly individuals’ municipality (KFF, 2019; Saunes, 2020). These conditions suggest that individual older adults’ access is determined by their socioeconomic and geographic locations, such as age in both countries, social security status in America, and time-specific geographic location in Norway.
Another similarity between healthcare coverage for elderly Americans and Norwegians is that funding is a shared responsibility between private and public schemes in both nations. In countries, public funding generated through the general and payroll taxes covers significant portions of older adults and general population health care spending. For instance, America’s approximate annual public and private health coverage spendings are $ 4993 and $ 1122 per capita, while Norway’s public and out-of-pocket healthcare coverage spending are $ 5, 289 and $ 877, respectively (Tikkanen & Abrams, 2020). Therefore health coverage for older adults and the general population relies more on government funding than individual spending in both countries.
Whereas the elderly adults’ health care coverage is a federal government’s jurisdiction in the U.S., the administrative authority of older adults’ health care coverage in Norway rests on the local/municipal government. These differences result from different laws and statutes governing the country’s health coverage. For instance, health coverage for the overall U.S. population is governed by the 1965 Social Security Act 1965 and the comprehensive healthcare reform law, the 2010 Affordable Care Act (ACA), also known as Obama Care (KFF, 2019). The Social Security Act established the Medicaid and Medicare plans to promote equitable access to quality health care by recognizing and supporting marginalized and vulnerable groups to obtain affordable health insurance. The Norwegian Municipal Health and Care Service regulates the country’s health care for older adults (Sánchez et al., 2019). The Municipal Health and Care Act of 2012 mandates that municipal governments provide comprehensive health coverage to all elderly citizens (Schönfelder et al., 2020). Thus, one can deduce that the U.S. older adults’ healthcare coverage is a subject of a uniform or centralized decision-making process. Norway’s older adults’ health coverage is based on decentralized and non-uniform municipal healthcare practices and procedures.
Additionally, elderly adults’ healthcare coverage in Norway is mandatory and a constitutional right. In contrast, it is obtained through application and eligibility to the different parts of Medicare in the U.S. Being a Norwegian citizen guarantees an older adult comprehensive health and social care coverage under the 2012 Municipality Health and Care Act of 2012 (Schönfelder et al., 2020). On the contrary elderly Americans have different levels of accessibility to health depending on their socioeconomic histories, which predict their eligibility for different healthcare coverage options. For instance, healthcare coverage requires an individual to be 65 years and above or meet the Medicare illness and disability qualifications (KFF, 2019). Also, for Americans aged 65 and above, their employment status and preferences determine their level of coverage depending on the Medicare sections in which the status and choice place them (KFF, 2019).
The Advantages and Disadvantages of the U.S. Healthcare System
The Relative Advantages of the American Health Care System in Serving Older Adults
The U.S. elderly adults are centralized under the federal Medicare plan resulting in uniformity and flexibility. The uniformity eliminates regional disparities in administrative policies, practices, and procedures, thus simplifying the decision-making processes regarding accessibility, payment, and oversight (Medicare, n.d.). Also, Medicare’s centralization promotes flexible access as older adults are legible for Medicare services in any region within the country. On the contrary, the decentralized older Norwegians’ health care coverage promotes individual municipality bias in policies, practices, and procedures concerning older adults’ care. It promotes regional outcomes in older adults’ care (Saunes, 2020). Also, the decentralized Norwegian older adults’ health care coverage limits the access of older adults’ health care to an individual’s municipality (Strand, 2019). Thus, the U.S. health care coverage for older people is more flexible than the Norwegian’s regarding geographical location and less vulnerable to geographical barriers to accessing older adult health care.
Furthermore, the American older adult health coverage provides more proportionate health and social care than the Norwegian’s, thus promoting relatively better outcomes for older people’s well-being. For instance, the U.S. older adults’ health care coverage is an interprofessional area of healthcare and social work, thus ensuring a balance between addressing the population’s overall needs in a balanced manner. Compared to the care for elderly Americans, the Norwegian older adults health care plan overemphasizes health care and disproportionately addresses senior citizens’ social needs (Schönfelder et al., 2020). For instance, Thus, the American elderly care setting is more representative of older peoples’ overall needs than its Norwegian counterpart.
The Relative Disadvantages of the American Healthcare System in Serving Older Adults
The elderly Americans’ health care coverage plan is limited relative to the inclusivity of the elderly Norwegian’s health care coverage. For instance, for an American to be eligible for Medicare, they must be eligible for social security retirement benefits or registered for social security. Consequently, only about 96% of elderly adults can access Medicare services (National Center for Health Statistics, 2023). The rest 4 percent are uninsured or under private medical plans. On the contrary, health care coverage for older adults in Norway is a mandatory human right and automatic, implying that 100% of the elderly population is guaranteed medical coverage as a right (Saunes, 2020). The Norwegian government mandates the local governments to ensure every elderly adult in their particular municipality is fully covered under the Municipality Health and Care Act of 2012 (Schönfelder et al., 2020).
Furthermore, U.S. health care coverage results in unsatisfactory outcomes for the healthcare system and stakeholders. For instance, the U.S. imposes a higher medical cost to its citizens than other top 11 OECD countries, with about 40% higher out-of-pocket annual healthcare expenditure against the 0.3% to 15% private spending in the other ten countries (Tikkanen & Abrams, 2020). Also, the U.S. spends about 16.9% of its GDP, the highest rate among the OECD countries, on health care, while Norway spends only 10.2% of its GDO on health care, making it the fifth least spender in health care (Tikkanen & Abrams, 2020). Ironically, the U.S. has the lowest life expectancy at an average of 78.6, relative to Norway’s second-highest average life expectancy of 82.7 (Tikkanen & Abrams, 2020). Also, Norway’s emphasis on home-based care, also known as aging in place, is associated with more health benefits than the U.S. residential facilities (Sánchez et al., 2019).
Assessing the Need for Change in the Health Care Coverage for Elderly Americans
The relative disadvantages of the U.S. elderly adults’ health care coverage create the need for policy changes concerning Medicare administration based on the efficiency criterion of policy evaluation. According to Bardach & Patashnik (2019), the efficiency criterion assesses the validity of a policy based on the net utility of its actual or projected outcomes. This criterion is the most humanistic approach for judging health care policies as it accommodates diverse value judgments. For instance, cost-effectiveness promotes a quantitative policy validation based on the economic or financial implication of a policy outcome (Bardach & Patashnik, 2019). Also, the efficiency evaluation promotes qualitative measures of policy outcomes’ value allowing a broad scope of philosophical concepts for judging policies such as equality, equity, and diversity (Bardach & Patashnik, 2019). An efficient healthcare policy must produce sustainable quantitative and qualitative net utility for healthcare stakeholders. Thus the contribution of Medicare to poor healthcare outcomes, such as socioeconomic disparities in elderly adults’ health coverage and excessive spending, and high mortality rates relative to the Norway system, defy the qualitative and quantitative predictors of an effective policy. Thus, the ACA guidelines for Medicare administration must be revised to promote economically viable and equitable coverage for older adults.
The differences between the older adults’ health coverage in America and Norway revealed that Medicare poses more disadvantages than advantages to the elderly adult’s health care access and the healthcare system’s outcomes. The relatively high cost of healthcare funding, socioeconomic differences in accessibility and utilization of Medicare, and the low life expectancy invalidate ACA’s Medicare administration provisions because of its quantitate and qualitative inefficiency. Thus lessons from the Norwegian systems, such as the guarantee of automatic coverage of universal health insurance plans for older adults and a shift from private funding to public funding, can inform Medicare policy reforms to realize more humanistic and economically viable outcomes for elderly Americans’ health care services.
Universality in the administration of Medicare can be promoted by adopting the principles of social justice and acknowledging human dignity. Social justice enables the recognition of the social injustices embedded in the Medicare administration that policy changes must seek to eliminate. For instance, complex Medicare structure and eligibility criteria fail to acknowledge elderly adults’ needs, especially those elderly adults below 65 that are equally vulnerable to aging health risk factors. Also, the employment history limits health coverage access for socioeconomically deprived older adults.
Therefore Medicare administration should make elderly adults’ coverage a human right and extend Medicaid inclusion age to 60. Also, the out-of-pocket premium contributions should be removed in all Medicare parts for people aged 60 and above, regardless of socioeconomic status. Younger high-income employees and employers should fund the elderly adults’ medical coverage in return for their comprehensive coverage by succeeding generations in the future.
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