Healthcare Utilization and Finance


The following paper compares the US and England healthcare systems, the access to care, major services, and financial aspects. The second country is selected because of the high level of the sector’s evolution, its effective work, and specific approaches to financing. At the same time, there are radical differences between these two approaches to delivering care. Comparing the given two frameworks, it is possible to acquire an enhanced vision of how they work and the problems that might emerge.


Starting the comparison, it is vital to focus on the fundamental aspects of both systems’ work. Thus, the USA does not have universal healthcare coverage as all citizens of the USA have a chance to select the method they view as the most beneficial for them. Individuals might have the insurance coverage offered by their employers to have the necessary healthcare (Cherry & Jacob, 2019). There are such programs as Medicaid, Child Health Insurance, and Veteran Benefits that help to address and cover vulnerable population groups, such as retired people, children, and unemployed individuals (Cherry & Jacob, 2019). Medicaid is a program designed and supported by the government to support low-income households or people with limited capabilities and provide them with the necessary healthcare (Shi & Singh, 2018). However, the high cost of insurance plans serves as a barrier to improved coverage as numerous people cannot afford it (Shi & Singh, 2018). In such a way, the US healthcare system has several critical problems that should be addressed to improve its work.

England has another system that radically differs from the approach used in the USA. Health coverage in the state is universal, which means that every individual benefits from access to the demanded care (Cohen, 2021). The National Health Service Act of 1946 became the central document establishing the framework and introducing the major patterns for the cooperation between care providers and patients (Buswell, 2020). As a result, an effective system was created and integrated at the state level. Nowadays, all residents of England are entitled to the NHS and can enjoy mainly free services (Cohen, 2021). These include children, unemployed, or retired people who have health issues and need assistance (Cohen, 2021). Moreover, children and young people are viewed as the priority to contribute to the improvement of the nation’s health (Cohen, 2021). In such a way, England differs from the USA because of the existence of a national healthcare system and the reduced importance of insurance plans.

Coverage of Medications

England and the USA have different approaches to the coverage of medications. The US system offers access to medicines via health insurance exchange plans, state-supported programs, such as Medicare and Medicaid, or health plans designed to meet various population groups’ needs (Cherry & Jacob, 2019). Following the given plans and regulations, clients have to pay around 14% of the costs to get access to prescribed medicines (Shi & Singh, 2018). The government is the primary regulator of the price of drugs and treatments as it offers policies to determine price setting and distribution (Shi & Singh, 2018). However, medicines are offered in terms of health insurance programs, while those who cannot afford them might consider drugs too expensive. It is one of the significant issues affecting the healthcare system of the USA.

England has another set of rules regulating the given aspect. Regarding the current approach, all citizens should pay for medications, services, and procedures viewed as necessary by a health provider working within the NHS (Buswell, 2020). However, some groups can enjoy specific benefits because of their unique status. First, pregnant women, clients from low-income groups, and individuals with war pensions can be provided with free medicines (Cohen, 2021). Moreover, all children and students under 18 have free access to necessary drugs (Cohen, 2021). Finally, older adults can be provided with medications for free (Cohen, 2021). This approach supports the effectiveness of the healthcare system and its stable work.

Referral to See a Specialist

The US healthcare system implies specific demands to a person who wants to see a specialist. To avoid unnecessary visits, a client should have a referral from the primary care physician (Cherry & Jacob, 2019). His/her examination will help to determine whether additional consultation is needed. Thus, the situation is different for emergent cases as an individual can ask for assistance and treatment without any referral (Shi & Singh, 2018). The insurance programs and care plans regulate the given aspect. Clients with a PPO plan do not need a referral and can address any specialist they want, while for individuals with HMO, the referral from a primary care physician is critical (Shi & Singh, 2018). This system regulates the workload and ensures the system can provide care to all individuals.

In England, the approach to visiting a specialist is similar. The NHS designed a set of recommendations asking patients to acquire a referral letter from a general practice practitioner before addressing a specialist (Cohen, 2021). Moreover, a case can be considered by a general practice practitioner if he/she thinks no additional consultations are required (Cohen, 2021). He/she can use various tests, analyses, or drugs to address the health issue and improve the patient’s state (Cohen, 2021). If no progress is observed, a referral can be provided.

Coverage for Preexisting Conditions

The government of the USA also regulates the coverage of preexisting conditions. Following its rules, all health insurance companies in the state cannot use preexisting conditions as the cause for refusal of coverage (Cherry & Jacob, 2019). Moreover, no additional charges can be used because of the health problem of a person (Shi & Singh, 2018). It helps to ensure that numerous clients will be involved and benefit from stable access to the demanded care. The given approach is not relevant for England as it has the NHS, which guarantees that all citizens can use healthcare services regardless of their preexisting conditions (Cohen, 2021). In such a way, their previous issues and health statuses do not influence the amount and quality of care provided to them.


The aspects of the US system outlined above introduce some financial concerns that should be discussed. First, the current system is viewed as one of the most expensive in the world (Shi & Singh, 2018). The price of necessary services and medications is higher than in any other state (Shi & Singh, 2018). For this reason, the financial state of citizens is linked to their chances of being treated effectively. Low-income families might fail to afford the necessary care, which means that government should focus on improving this aspect.

Financial implications for England are different as for citizens, access to all care services is guaranteed. It means they can benefit from the reduction of spending on this aspect (Cohen, 2021). However, financing the given sector requires a constantly growing amount of money because of the increasing number of patients (Cohen, 2021). Chronic diseases and the Covid 19 pandemic introduce new challenges and require significant costs. As a result, the government looks for a more effective model of cost distribution and the involvement of sponsors to resolve the problem.


Buswell, G. (2020). Healthcare in the UK: A guide to the NHS. Expatica. Web.

Cherry, B., & Jacob, S. (2019). Contemporary nursing: Issues, trends, and management (8th ed.). Mosby Elsevier.

Cohen, S. (2021). The NHS: Britain’s National Health Service, 1948–2020. Shire Publications.

Shi, L., & Singh, D. (2018). Essentials of the U.S. Health Care System. Jones & Bartlett Learning.

Removal Request
This essay on Healthcare Utilization and Finance was written by a student just like you. You can use it for research or as a reference for your own work. Keep in mind, though, that a proper citation is necessary.
Request for Removal

You can submit a removal request if you own the copyright to this content and don't want it to be available on our website anymore.

Send a Removal Request