Patient Outcomes and Sustainable Change: Identifying Leadership Roles for Doctors of Nursing Practice Today, the United States spends more taxpayer monies on healthcare services than virtually any other industrialized country in the world, yet Americans still pay more out-of-pocket expenses and receive fewer physician visits per year compared to nations that spend less. Moreover, the demand for already scarce healthcare services is expected to increase concomitantly with the rapid growth being experienced in the elderly demographic, and these demands will likely continue to expand as the baby boomer generation retires in greater numbers and lives longer lives compared to past generations. Against this backdrop, determining how and why the United States ranks alone among dozens of other countries – many of them still in their developmental stages – in terms of the lack of universal healthcare. To determine the facts, the purpose of this paper is to provide a review of the relevant literature concerning the provision of universal healthcare services in Canada, including its health outcomes and how they compare to the U.S. In addition, an assessment concerning whether universal health care should be a concept supported by a doctor of nursing practice (DNP) and supporting rationale is followed by the results of a health care quiz and an analysis of its implications for the U.S. health care system. Finally, a review of selected articles and the DNP’s leadership role in promoting optimal health care outcomes is followed by a summary of the foregoing research and relevant findings in the conclusion.

1. Explore a country that provides universal health care. What are its health outcomes? How do these outcomes compare to those in the United States? Should universal health care be a concept that the DNP should support? Why or why not?

Today, the United States is the only major industrialized nation that treats access to health care services as a privilege rather than a fundamental human right. One country that is routinely cited as being superior to the U.S. in terms of health care coverage is Canada, which has offered some level of government-subsidized health care services to all of its population since the mid-20th century (The birth of Canadian Medicare, 2018). This trend was reinforced by the passage of the Canada Health Act of 1984 which transformed the disparate components of the provincial health care system into a true nationwide resource that are currently free to all Canadian consumers at the point of care (Martin & Miller, 2018).

Although the universal health care coverage offered in Canada is a laudable objective, the services that are offered are limited compared to other countries including the United States and lengthy wait times for elective care are the norm (Martin & Miller, 2018). In addition, access to universal health care services in Canada is restricted by geographic proximity to available clinicians, and access for the country’s large rural population, including most especially its diverse indigenous peoples, is especially limited. In this regard, Martin and Miller (2018) emphasize that, “Profound health inequities experienced by Indigenous populations and some vulnerable groups require coordinated action on the social determinants of health if these inequities are to be effectively addressed” (p. 1719). In addition, the health care system in Canada has limited access to new medical technologies (Roy, 2015)

Notwithstanding these constraints, though, the outcomes achieved by Canada’s universal health care system are enviable, with an infant mortality rate ranked 180th lowest and the 21st highest longevity rate in the world today (Canadian people, 2018). Nevertheless, Canadian health care consumers still suffer from some of the same levels of health care problems as their U.S. counterparts, including obesity levels that are ranked the 26th highest in the world (Canadian people, 2018). In order to improve these suboptimal health care outcomes, Martin and Miller (2018) advise that, “Expansion of the publicly funded basket of services and coordinated effort to reduce variation in outcomes will hinge on more engaged roles for the federal government and the physician community than have existed in previous decades” (p. 1720). Taken together, it is reasonable to conclude that the Canadian universal health care system remains a work in progress, but the treatment of the access to health care services as a right rather than a privilege is a concept that all DNPs should support for the United States given its potential to extend the lifespan and improve the quality of life...

The Commonwealth Fund provides an international review of health care systems. Read the Commonwealth Fund report, International Profiles of Health Care Systems, 2014, and take the associated quiz. Discuss what knowledge you gained from the quiz and describe any changes you would apply to the U.S. health care system.
The results of the administration of this quiz are presented in Table 1 below, followed by a summary of the knowledge gain and how it should be applied to the U.S. health care system.

Table 1

Results of International Profiles of Health Care Systems quizs (selected answers are BOLDED)

Question

Results

Description

In which two countries are adults least likely to get a doctor’s appointment for the same or next day when they need care?

Germany and the Netherlands 

Australia and New Zealand 

Canada and the U.S.

Correct! Yes, only 48 percent of people under 65 in the U.S. and 41 percent of people in Canada are able to get a same- or next-day appointment. However, U.S. residents do, on average, have relatively fast access to specialists.

About how much does the U.S. spend annually on health care per person?

Less than $4,000

$4,000 to $6,000

$6,000 to $8,000

More than $8,000

Correct! You got it! The U.S. spends $8,745 per person on health care annually, which is more than any other nation and $5,000 more than Japan, a low-spending country. Despite this high rate of spending, U.S. health outcomes are not superior.

In which countries do people have the longest life expectancy?

Germany and the U.S.

Japan and Switzerland

The Netherlands and Sweden

Correct! Japan and Switzerland have the longest life expectancy, at 83 years. In the U.S., it is 79.

What country other than the U.S. has a large uninsured population?

Germany

England

Neither

Correct! But it isn't just Germany and England who [sic] have smaller uninsured populations than the U.S. No other industrialized country has a large uninsured population.

In which countries are most hospitals publicly owned?

Denmark and New Zealand

The U.S. and Japan

New Zealand and the Netherlands

That’s partly correct!

Partly right. The majority of hospitals are publicly owned in New Zealand, but in the Netherlands the majority of hospitals are privately held. Australia, England, France, Italy, Norway, and Sweden are other countries where the majority of hospitals are publicly owned.

Health spending growth has slowed in the U.S. in recent years. How has health spending been growing in other industrialized countries?

Faster than in the U.S.

Slower than in the U.S.

About the same as in the U.S.

Sorry. That’s incorrect!

Wrong. Health spending is growing at about the same rate in other industrialized countries as it is in the U.S. However, the U.S. still spends much more on health care – 16.9 percent of the GDP compared to the median rate of 9.3 percent of GDP for all industrialized countries.

About how much more, on average, does an orthopedic surgeon earn in the U.S. than in France?

$114,000 more

$288,000 more

$362,000 more

Sorry! That’s incorrect!

No, think higher. Think $288,00 more. In the U.S., orthopedic surgeons on average earn $442,450, while in France they earn $154,380.

Where do adults age 65 and older have out-of-pocket health care costs on par with those paid by older adults in the U.S.?

Switzerland

Germany

The U.K.

Sorry, that’s incorrect!

Nope. In Germany, only 7 percent spent $2,000 or more on health care. Twenty-two percent of older adults in Switzerland and 21 percent of older adults in the U.S. spend that much.

In which areas of care does the U.S. perform well relative to other countries?

Patients talk with health care professionals about diet and exercise

Patients with chronic conditions have treatment plans that can be carried out in daily life

Patients have enough time with their regular doctors

All of the above

Correct! The U.S. does well in all of these areas. Fifty-eight percent of chronically ill older adults in the U.S. reported they had discussed their treatment goals with their…