Reform of the Law on Affordable Health Care


Even though ACA has accumulated several accomplishments, some of its approaches appeared to be ineffective. In reforming ACA, the US can learn from health care policies implemented by other countries to improve its current health care system. Analyzing relevant experiences from abroad, especially existing policies that work, may help policymakers examine current health policy and gain insights into why some approaches are counterproductive and how to modify them.

If successfully transferred and adapted to local circumstances, foreign ideas and techniques may significantly contribute to reforming ACA. The purpose of the given memo is to evaluate the differences between health systems used in other countries and identify which lessons from abroad would be most relevant in implementing ACA.

Differences between NHS and NHI

It is important to differentiate between health system models in which countries operate when reflecting on their experiences. National Health System (NHS) refers to the government-funded medical and health care services. In NHS systems, such as those in the UK, Norway, Finland, Spain, and Portugal, 76% of funding comes directly from taxation and approximately 20% comes from payroll tax (Gusmano & Rodwin, 2015, p. 54).

National Health Insurance (NHI) systems, such as those in France and Canada, are characterized by payroll-tax based financing and private providers handling most of the care. Currently, in comparison to NHI, the NHS system is considered to be more impressive in terms of safe care, efficiency, and patient-oriented care (“About the NHS,” 2016). The US has neither an NHI nor an NHS system, and exhibits pluralism in its means of financing, as they include revenue through the fiscal tax system, social security system, private insurance, and out-of-pocket payments.

China’s Problems and Aspirations in Health Policy

At first glance, China does not seem to offer a useful health care lesson to the US and other countries. This may be explained by the country’s geopolitical position, especially its large population and huge and diverse territory, as well as the authoritarian rule. Over the last decades, China has become a more powerful country as it has shifted from a third-world to a first-world economy; and it now demands access to state-of-the-art medical care (Lwin, Xu, & Zhang, 2015).

However, despite its flourishing economy, Chinese government investments in health care are smaller than those of OECD nations, and the bulk of funding is represented by out-of-pocket payments (Gusmano & Rodwin, 2015). It is thus important to understand issues that diminish China’s preparedness to care for one of the largest world’s populations.

Even though China achieved universal health insurance and the majority of Chinese residents have at least basic insurance coverage, it does not cover half of the medical costs (Sun, Gregersen, & Yuan, 2017). Not all Chinese people have equal access to health care, and there are economic disparities between those who live in wealthier coastal areas and those living in poorer rural provinces. The Chinese government’s reduction of its share in health care spending and transition to the market mechanism in health care only contributed to income-based inequities in the health care system of the country. Despite an effort made by the central administration to increase the affordability of health services by expanding health insurance coverage, out-of-pocket payments still account for a great part of revenue for Chinese health care providers.

To reduce urban-rural disparities, the central government and local governments aim to create incentives for medical graduates to work in rural-based hospitals (Lwin et al., 2015). This is because currently, people living in rural areas of China do not have adequate access to health care. Another aspiration in the health policy of China relates to development support of Routine Health Statistics Information System (RHSIS).

This is particularly important for western areas of the country, which have poor infrastructure. One more goal is associated with an improvement of the overall level of quality of care in China by creating a trusted and professionalized physician workforce.

Lessons from Abroad That Would Be Relevant in Reforming ACA

Reflecting on the experience of NHI and NHS systems, it is crucial to consider the following lessons in reforming ACA. Firstly, making affordable health insurance available to more people is impossible without legislation making the coverage compulsory. Secondly, it is important to rely not on estimated risk when setting insurance premiums but on ability-to-pay criteria. Such an approach has been incorporated by England’s NHS, which resulted in healthier and wealthier people paying for the care of economically disadvantaged individuals. When applying this experience to the US, it would be feasible to consider cutting benefits for high-income beneficiaries of Medicare and Social Security (Elmendorf, 2016).

Thirdly, it can be stated that price regulation and budget targets should be viewed as tools for reducing health care costs. Drawing on China’s health system experimentation, it should be noticed that pure reliance on market forces may put a financial burden on people and lead to social disparities. Finally, health care is inequitable in the US, contrary to OECD countries, where people are not restricted to obtaining health care within certain provider networks.

Should you need more information about the recommendations discussed above, do not hesitate to contact me.


About the NHS. (2016). Web.

Elmendorf, D. (2016). Recommendations for federal fiscal policy. Harvard Kennedy School. Web.

Gusmano, M. K., & Rodwin, V. G. (2015). Comparative health systems. In J. R. Knickman & A. R. Kovner (Eds.), Jonas and Kovner’s health care delivery in the United States (11th ed., pp. 52-73). New York, NY: Springer.

Lwin, M. K., Xu, M., & Zhang, X. (2015). Comparative study on health care system between Myanmar and China according to World Health Organization (WHO)’s basic health blocks. Science Journal of Public Health, 3(1), 44-49. Web.

Sun, Y., Gregersen, H., & Yuan, W. (2017). Chinese health care system and clinical epidemiology. Clinical Epidemiology, 9, 167-178. Web.