A Case-Oriented, Cross-Country Comparison of Three High Income Countries’ Health Systems and Health Care Accessibility of Vulnerable Populations

Authors: Zlotnick, C., Anderson, S. and Heaslip, V.

Start date: 27 July 2017

Background. Located on different continents, the United Kingdom (UK), Israel and the United States (US) are high income countries differing in size, population size, and type of health care systems; yet, their general population's health outcomes are similar. This study used qualitative and quantitative information to gain insight on the health care systems and health care accessibility of vulnerable groups in the general populations of these three industrialized countries. Methods. Using a case-oriented, cross-country comparison, this study uses the three factors of the Behavioral Model of Utilization (i.e., health system environments, population characteristics and health behaviors/outcomes) to examine health care accessibility for selected vulnerable groups in each of the three countries (i.e., Israel, UK, US). Results. The health system environments and population characteristics differed dramatically. All health systems showed features indicating their adaptation to the dominant or majority group of the country’s general population. However, all three high income countries' health systems were inadequate at addressing vulnerable population groups (i.e., socioeconomically low income individuals, minorities, immigrants, non-citizens) as demonstrated by unmet need and inadequate health behaviors. Discussion. Despite the diversity of health system philosophies and approaches, none of the health systems were effective at addressing health care inaccessibility and or unmet need for vulnerable population groups. Health systems in high income countries lack strategies that proactively engage, reach-out to and facilitate health care access for vulnerable populations.

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