本文是医疗专业Essay范例，题目是“Comparison of Healthcare Systems: USA and Nigeria（医疗系统的比较:美国和尼日利亚）”，这项研究是为了比较美国和尼日利亚的卫生保健系统。本研究回顾了美国与尼日利亚的医疗保健体系。它还将比较两国的卫生保健筹资、卫生保健政策和卫生保健指标。使用谷歌、Yahoo搜索引擎、Govome、Civitas、Ebscohost、Pubmed搜索两国医疗保健系统的一些相关文章和书籍。使用哪种方法说明
ABSTRACT摘要
This study was to compare USA and Nigeria health care system. This research sets out review the USA health care system compare to Nigeria. It will also compare health care financing, health care policy, health care indicators of both countries. A search of some relevant articles, books on both countries health care system using the Google, Yahoo search engine, Govome, Civitas, Ebscohost, Pubmed. Which method used explained
INTRODUCTION介绍
The health care system consists of organizing which include health care providers and individuals whose their job is to meet health care needs of people in the society.
卫生保健系统由组织组成，其中包括卫生保健提供者和个人，他们的工作是满足社会上人们的卫生保健需求。
The health care system is among the most essential aspect of any country. A better health system must deliver services which are best for citizens in the society according to their plan of WHEN, WHERE they need the services. Health care system of a country differs with each other, for a country to have a good health care system they must have a good, quality, professional health care providers, well kept facilities and infrastructure and government must make sure enough money is spent on health which means the country’s financing on health must be strong.
A country health care delivery must be strong, especially primary health care delivery, delivery of health care depends on well trained professionals and paraprofessionals who join together as a team, which is consist of professionals in medicine, psychology, physiotheraphy, nursing, dentistry, midwifery, public health practitioners, community health workers who consistently provide preventive, curative and rehabilitative care services to the community.
一个国家的卫生保健提供必须强有力，特别是初级卫生保健的提供，卫生保健的提供取决于训练有素的专业人员和辅助专业人员，他们组成一个团队，由医学、心理学、理疗、护理、牙科、助产、公共卫生从业人员组成，社区卫生工作者，持续向社区提供预防、治疗和康复护理服务。
According to (Wikipedia) “Health care delivery is divided into three (1) Primary health care delivery (2) Secondary health care delivery (3) tertiary health care delivery.”
Primary health care delivery is the work of health professionals who is the first health care provider to consult by all patients in health care facilities such as primary care physician, general practitioner, family physician, physiotherapist, physician assistant, or nurse practitioner it depend on the community, in some locality patients may wish to see another health care professional first e.g. pharmacists or a nurse, especially in Africa patients may wish to see other traditional medicine professional depends on the type of condition, patients may then transfer to secondary or tertiary care for more treatment.
Primary health care sometimes can be used as an emergency care center which provide outpatient services and also attend to patients same day they make an appointment. Primary health care practitioners must good in many areas as some patients may want to consult the same practitioner for checkups, preventive care and health education and every time they come across new health problems.
初级卫生保健有时可被用作紧急护理中心，提供门诊服务，并在病人预约的当天为病人提供治疗。初级卫生保健从业人员必须精通许多领域，因为有些病人可能希望在体检、预防保健和健康教育以及每次遇到新的健康问题时向同一名从业人员咨询。
Sometimes both acute and chronic illnesses use to treat in primary health care out of those illnesses include, e.g., hypertension, asthma, diabetes, depression, anxiety, back pain, primary health care also provide maternal child health care services e.g. family planning and vaccinations. Primary health care services are financed by government, the money is generated through income taxes.
Secondary health care delivery is the health care provided by medical specialists who mostly do not have first contact with patients e.g. Urologists, dermatologists, cardiologist.
Secondary health care delivery includes acute care treatment for a short period of time, but serious illness, injury or other health problems, e.g. hospital emergency department, it also possess professional attendance when we are talking about childbirth, medical imaging and intensive care.
Secondary health delivery at times used with hospital care, nevertheless most of secondary health care providers do not need to work at hospitals, for example psychiatrists, clinical psychologists, physiotherapists or occupational therapists and some of primary health care are provided within hospitals depend on the national health care system of the country and policies or organization, in some country it is compulsory for patients to first see primary health care provider for test or medicine before they can be able to use secondary health care, for example in USA some physicians might reduce their practice to secondary health care by allow patients to see a primary health care provider first.
二级保健提供有时与医院护理一起使用，但大多数二级保健提供者不需要在医院工作，例如精神病医生、临床心理学家、医院内提供的物理治疗师或职业治疗师和一些初级保健取决于国家的国家保健系统和政策或组织，在一些国家是强制性的病人第一次看到测试或医学初级卫生保健提供者之前可以使用二级医疗保健,例如在美国一些医生可能会减少他们的实践二级医疗保健,让病人看到初级卫生保健提供者。
In some poor country secondary health care delivery may be very expensive because of some technology, mostly in some developing countries because their government is not supporting secondary health care delivery so some patients would prefer to stick with primary health care or traditional medicine which is dangerous to their health especially in Africa.
Tertiary health delivery is specialized advising health care, mostly for inpatients and on referral from both primary and secondary health care providers, for advanced medical treatment and investigation.
Tertiary care services include cancer management, neurosurgery, plastic surgery, cardiac surgery, and treatment for severe burns, Neonatology advance services, palliative and some other complex medical and surgical treatment. Tertiary health care delivery can be private no agreement with the government it is self-support or insurance, which make the services more expensive than other health care delivery.
This research is about a comparison of the health care system of two countries one developed country (USA) and the other one is developing country (NIGERIA). In this research I will compare both country’s health care system, health indicators, health financing, health spending and their health policy.
The Nigeria health sector尼日利亚卫生部门
The health in Nigeria is one of the superlative social sectors in the country, it’s simple to understand the organizational framework of the Nigerian.
尼日利亚的卫生部门是该国最好的社会部门之一，很容易理解尼日利亚的组织框架。
Health sector’s work on the implementation of its mandate. The Nigeria health care delivery system has gone through fantastic policy changes over the years.
The health sector of Nigeria was heavily subsidized with the introduction of the structural adjustment program which seen the massive pulling out of State subsidies from the health sector in 1986, health care delivery then became privatized.
The sources of Nigeria health care financing are coming from a free market economic system through the private sector, funding from the world bank, international monetary fund (IMF), donor agencies. There are other sources, e.g. government as public sector and voluntary organization.
The federal government role is to monitor the university teaching hospitals, federal medical centers( tertiary care) while the State government coordinate the several general hospitals (secondary health care) and the local government manages on the primary health care which are controlled by the federal government through the NPHCDA. Life expectancy in Nigeria, According to (United Nations 2012) “overall is 50.26, for male 49.50 and for females is 51.03. Nigeria had the highest “prevalence of accidents, sexual transmitted disease, injuries, disability, lung and cancer disease etc. Which see them ranked close to the bottom of life expectancy at birth.
Health care in United State is mostly provided by many several organizations. In United State private sector owned, most of health care facilities, according to, (WHO, 2011) “58% of US health care facilities are non- profit, 21% are for- profit while 21% are owned and controlled by government, the United States spent more on health care per capita ($8,608) and also on health care as a percentage of GDP (17.2%) more than any other country.”
The provision and spending on health care in United State comes from programs like Medicaid, Medicare, the veterans’ health administration and the children’s health insurance, few of the population are insured by themselves or by their family who are members of employer, while some are uninsured, people who are working under public sector are provided by the government.
Life expectancy at birth in the United State according to, (United Nation 2012) “overall is 77.97, for male 75.35 and female 80.51 that see United State in rank 40th”. US had the highest prevalence of heart and lung disease, injuries, adolescent pregnancies, homicides, obesity, infant mortality, sexually transmitted disease (STD). car accidents and disability, all this problem ranked US at 40th of life expectancy at birth.
LITERATURE REVIEW文献综述
According to World Health Organization (WHO 2015) a good health system delivers quality services to all people, when and where they need them. The exact configuration of services varies from country to country, but in all cases requires a robust financing mechanism; a well-trained and adequately paid workforce; reliable information on which to base decisions and policies; well-maintained facilities and logistics to deliver quality medicines and technologies.
根据世界卫生组织(世卫组织，2015年)的说法，一个良好的卫生系统可以在需要的时候和地点向所有人提供优质服务。服务的具体配置因国而异，但在所有情况下都需要健全的筹资机制;一支训练有素、薪酬充足的劳动力队伍;作为决策和政策依据的可靠信息;维护良好的设施和物流，以提供高质量的药品和技术。
Pao- Ping Chua and Jack Rutledge (2006) discussion about “the U.S. health care system” is the subject of much polarizing verbal confrontation. At one compelling are the individuals who contend that Americans have the “best health care system on the planet”, indicating the uninhibitedly accessible medicinal innovation and cutting edge offices that have gotten to be so exceptionally typical of the framework. At the other compelling are the individuals who criticize the American system as being divided and wasteful, indicating the way that America spends more on healthcare than some other nation on the planet yet still experiences gigantic uninsurance, uneven quality, and regulatory waste. Understanding the discussion above, America spend more on health care system but it does not make their system better than other nations. America health system still lack behind
M.C. Asuzu, (2004) discussion about “Nigeria health care system” The health system in Nigeria is organized along the now widespread three levels of the primary, secondary and tertiary levels of care. The system is run simultaneously such that all the three levels of government – local, regional/state and national/federal, despite the fact that they hold essential obligation regarding stand out level of the system each, can surpass it and give administrations at any of the other two levels of care. One of the impacts of this liquid system, even with the numerous social and infrastructural issues confronting the country, is that the quest for the politically alluring tertiary human services can remain the main appealing zone of the health system, to the disservice of alternate levels of care. The disregard of the primary health care system, its maldistribution and additionally the secondary health care system, will bring about a modified social insurance pyramid. This won’t deliver any health for the individuals yet will dependably have the risk to crumple on itself. According to discussion above Nigeria health system works on three levels of primary, secondary and tertiary health care.
Teitelbaum, J. B., & Wilensky, S. E., (2013 pg47), Said the United States has one of the most noteworthy characteristics of health care in the world. The US insurance system lessens the danger of money related destroy in case extravagant administrations are required, gives scope to preventive administrations increases care and influences results positively.Teitelbaum, J. B., & Wilensky, S. E., (2013 pg53) also said while the health system (National Health Insurance Scheme and the Community Based Health Insurance Scheme) in Nigeria have a few breaches. It is overseen by health upkeep associations which allocate care relying upon month to month capitations paid by customers.
Okolo C, (2013), noticed that the US Medicaid health system and insurance agencies in the US have entry to better subsidizing from its customers and the administration individually. They are not degenerate and give quality healthcare. Healthcare buyers in the US can pick the level of healthcare they need or require, Okolo C, (2013) Also perceived that the Nigerian Health Maintenance Organizations are exploitative and degenerate; they don’t transmit stores paid to them via healthcare suppliers which restricts the nature of healthcare customers get subsequently. The Nigeria’s Universal healthcare system does not permit purchasers to pick. Now and again Nigerians in need of complex circumstances are sent to another country. Customary pharmaceutical is noiselessly joined in Nigeria’s healthcare system. Nigerians belittle customary restorative professionals notwithstanding all advising accordingly, conventional medicinal experts are prepared by the administration are prepared in safe practices. This is a major contributory figure the weakness health indices of Nigeria. Okolo let us know that Nigeria health organization are corrupt they do no remit the fund paid to them by health care providers which affect the quality of health in the country, Unlike United State
David A. Squires (2012) The U.S. Spends much more on health care than whatever other nation. However, this high spending can’t be credited to higher wages, a more seasoned populace, or more noteworthy supply or use of doctor’s facilities and specialists. Rather, the discoveries recommend the higher spending is more probable because of higher costs and maybe all the more promptly available innovation and more noteworthy stoutness. Health care quality in the U.S. Fluctuates and is not prominently better than the far less lavish systems in the other study nations. Of the nations contemplated, Japan has the most minimal health spending, which it accomplishes essentially through forceful value regulation. As past studies have indicated, health care spending in the U.S. Smaller people that found in some other industrialized nation. In 2009, U.S. Spending came to about $8,000 per capital.
David A. Squires(2012)美国在医疗保健上的花费比其他任何国家都要多。然而，这种高支出不能归功于更高的工资，更有经验的民众，或更值得注意的供应或使用医生的设施和专家。相反，这些发现认为，更高的支出更有可能是因为更高的成本，或许是所有更迅速可用的创新和更值得注意的坚固性。美国的医疗质量起伏不定，并不比其他研究国家的医疗体系好多少。在考虑的国家中，日本的医疗支出最少，这主要是通过强有力的价值监管实现的。正如过去的研究表明，美国的医疗保健支出比其他一些工业化国家要小。2009年，美国人均支出约为8000美元。
Rachael Burke & Devi Sridhar (2013) said definite data was accessible for the Federal Government spending on the Federal Ministry of Health only. There was no information for spending at the state or commonplace level. The aggregate spent was $1037 million, give or take $6.70 every capita. The World Bank records that $18.70 every individual was spent from open sources on health. Decentralized spending at state and neighborhood level presumably clarifies the $12 distinction between these figures. In 2005 (the latest year for which a financial plan breakdown is accessible) the WHO National Health Accounts record for Nigeria demonstrate that government financed 13% of all healthcare spending, and state and neighborhood governments supported a further 13%. In the event that this example held in 2009, that would represent a portion of the disparity between the monetary allowance record figures and the World Bank report.
It can be seen that the U.S. healthcare system is a superior system with less death, despite the fact that it is more expensive however it spares more lives. In any case, it is still exceedingly censured by the natives and even the government. Shortly, there is a level headed discussion about health care changes in the U.S. Government, around a change of the healthcare system to a universal healthcare system much the same as that of Nigeria. One may inquire as to why the U.S. healthcare system on a par with it looks still has a great deal of issues as I would like to think. Sum up the qualities/weakness of Nigerian system.
可以看出，美国的医疗保健系统是一个优越的系统，死亡率更低，尽管它更昂贵，但它节省了更多的生命。无论如何，它仍然受到当地人甚至政府的强烈谴责。简而言之，有一个关于美国政府卫生保健改革的冷静的讨论，围绕着卫生保健系统向全民卫生保健系统的改变，就像尼日利亚一样。有人可能会问，为什么美国的医疗体系和它看起来一样，仍然有很多我想要思考的问题。总结尼日利亚制度的优点/缺点。
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