United States Versus Honduras Health Care Delivery System

United States Versus Honduras Health Care Delivery System

UnitedStates Versus Honduras Health Care Delivery System


UnitedStates Vs Honduras Health Care Delivery System

Tableof Content

Abstract 3

Introduction 3

Underpinningsof Health Care Delivery Systems 4

Beliefsand Values 5

EconomicPerspectives (Economic Theories) 7

Accessand Utilization 8

Costand Financing 9

Qualityand Outcomes 10

HealthcareDelivery System Analysis 11

Strategiesfor Improvement 12

Conclusion 12

References 14


Ahealth care delivery system refers to the organization of people,institutions, and resources used to deliver health care services to acertain population with the aim of maximizing its health. The exactstructure of health care delivery systems varies from country tocountry. In 2000, World Health Organization (WHO) classified healthcare systems in its 191 member states based on five performanceindicators. These indicators were disability adjusted, lifeexpectancy, responsiveness of the health delivery system in terms ofspeed of service and confidentiality, financing of the health caresystem, overall quality of health, and accessibility of health by thepopulation (WHO, 2000). From these parameters, the United States wasranked 37 while Honduras was ranked 131 out of the 191 countriesclassified. This paper analyses the health care delivery system inboth the United States and Honduras, and comparison between the twostates in terms of the systems, affordability, and effectiveness aswell as in terms of effectiveness to deliver quality health care toits citizens. Every country’s has its key player, how it operates,as well as who participates, both legal and ethical concerns, and theproblem that faces the system.


Thehealthcare sector has become one of the key sectors that make anation be defined as developed, developing or underdeveloped. Withthis idea, countries have embarked on providing the best-suitedsystem for all its healthcare concerns, and in turn the reason whydifferent countries have different models or systems for healthcareprovision, and delivery to its people. Honduras is a country inCentral America, which is defined as an underdeveloped due tonumerous vices that have faced it over time since independence in1821. The country has been referred as one of the poorest in theregion of the western hemisphere. On the other hand, the UnitedStates is one of the developed nations globally and is made of 50states. The two countries have diverse governing systems, as well ashealth delivery systems. The Honduras health sector is comprised ofthe public sector, steered by the ministry of health, and it’s thekey player within the health delivery system of the country. In theUnited States, the health care delivery and health sector is uniqueas the majority of the care is given by largely operated andprivately owned organizations. In simple statistics, in the UnitedStates, only an estimated 21% of the hospitals are owned by thegovernment while 58% are comprised of non-profit making, and theremaining number is made by profit-making healthcare providingorganizations.

Underpinningsof Health Care Delivery Systems

Countrieshave the responsibility to design and develop their own health caredelivery systems in accordance with their health needs and theavailable resources. As a result, health care delivery systems arediverse depending on the country. However, despite the differences,all health systems should be able to provide primary health careservices, public health services, and generate resources forfinancing (Yih, 2011). According to the WHO (2000), the goals of allhealth care delivery systems are to provide quality healthcareservices to all citizens, to respond swiftly to the health needs ofthe population, and to ensure fair distribution of health financingpromoting affordability among the population

Therefore,all health care delivery systems are underpinned on a robustfinancing strategy and a well-trained and competent workforce that isadequately paid to render health services (Yih, 2011). Health caredelivery systems also require good and reliable information systemsto base decisions and policies on, well maintained facilities andlogistics to deliver quality care and research to promoteevidence-based care and discovers new technologies that improvepatient care. Finally, they also require a good organization foreffective coordination and inter-sectoral collaboration between thevarious players in health delivery. Therefore, a good healthcaredelivery system should provide high-quality services to the wholepopulation, at the right time and place. The health services in agood health care delivery system are accessible, affordable, andcomprehensive. The system should provide various coverage optionsdeliver timely, efficient and effective patient-centered care that isequitable to all. The health delivery system should also make healtha shared responsibility between the individual, healthcare providers,and the society (WHO, 2000).

Inthe United States, the health care delivery system is made ofsubsystems, which acts as the foundation of the countries caredelivery system. These entail subsystems such as managed care,military, vulnerable population, and integrated delivery. On theother hand, the system used in Honduras is defined by the role ofgovernment, non-governmental organizations as well as NGO’s, andhence vary from the basic such as the case of the United States.

Beliefsand Values

Thebeliefs and values of a country are evident in its health caredelivery system. The US has long held beliefs and values onindividual independence in all aspects of life including health care.Therefore, an individual is responsible for his or her health. Thishad led to disparities in the health care service delivery among therich and the poor. Health care is delivered privately in the US withan estimated 23% of American having problems paying since theAmerican health delivery system does not incorporate income levelsinto the healthcare costs.

Onthe other hand, Honduras, believes in equity and fairness in thehealth care delivery system to provide health services to the poorand the rich. The country enjoys a collective value ofinterdependence in the health care delivery system where the ministryof health regulates the health sector and provides health coverage toall citizens (`Health Systems Profile Honduras`, 2009). Small ruralhospitals are built so as to provide care to the rural population andthe poor. These hospitals charge fees based on the income levels,signifying the interdependence on each other. Various teams alsovisit remote areas twice a month to offer comprehensive care to thecommunities for free.

TheAmerican and Honduras health care delivery system has similar beliefsregarding the quality of care in different facilities. In bothsystems, quality of care is believed to be better in privatehospitals than in public hospitals, though it is more expensive inthe private hospitals. Users in both countries consider optimalmedical and personal attention to be offered in the privatefacilities despite their limited experience as compared to publichospitals which have been in existence for long. However, costs deterthem from attending the private facilities, leaving them for thewealthy. Hondurans prefer small rural hospitals for inpatient caredue to physical and social proximity to the large ones in theprovincial headquarters (`HEALTH SYSTEMS PROFILE HONDURAS`, 2009).The urban hospitals are visited for emergency and specialized careservices that are not available in the rural hospitals. The Americansprefer urban hospitals as opposed to the rural ones (Ridic et. al,2012).

EconomicPerspectives (Economic Theories)

Applyingeconomic theories in healthcare delivery are complex because healthymarkets do not have the characteristics to determine the marketprice. Factors distinguishing health care economics from othereconomies include government intervention, uncertainty, high barriersto entry, and the existence of a third party. Such as a doctor whomakes the purchase decision, such as surgery on behalf of the patientwho is the buyer (Scott et. al., 2001). In all the healthcaredelivery systems, economics, the resources are also insufficient tomeet the health needs. Therefore, the priority health needs are metfirst, leaving the others. The US healthcare delivery system isinfluenced by the competition in setting the costs of healthcareservices. The high demand for healthcare has led to increased costs.In Honduras, the government provides and regulates the healthservices preventing an increase in cost.

TheUS and Honduras health delivery system utilize the pooling of risks,economic model to minimize the health risks by ensuring the riskassociated with healthcare financing is borne by all members in alarge pool and not by each member individually. The federal and stategovernments have created risk pools through health insurance to lowerthe cost of healthcare in the US (Scott et. al., 2001). In doing so,the healthy enrollees help in subsidizing the care for the very sick.The Ministry of Health has lowered the cost of healthcare in Hondurasthrough the taxes collected by the government. The taxes enable theMOH to create a pool of funds to provide healthcare to all ataffordable costs, thus, reducing the individual cost in Honduras.

Boththe US and Honduras health systems utilize the economic theory ofregulation developed by A. C. Pigou. The theory states thatregulation is important for benefiting the public through solvingcollective action problems and providing solutions where the privatemarkets fail to equally allocate resources (Scott et. al., 2001). Inboth systems, the government intervenes by delivering healthcare inareas where the private system does not invest in since they cannotyield better profits. The government also applies the public interesttheory by correcting such failures through regulations to push themarkets to an optimal social equilibrium for all people to enjoy.

Accessand Utilization

TheAmerican healthcare delivery system is highly accessible to most ofthe citizens. Hospitals are easily accessible due to their favorablegeographical location in the US. The US also enjoys a betterinfrastructure, making it easy to reach the hospitals. Ruralhospitals in America provide comprehensive services and emergencycare with very little referral cases to the major urban hospital. Thefacilities in America also have adequate physicians (2.8 in 1000persons) that provide care (Ridic et. al, 2012). An estimated 10% allhealth workers in America work in the rural area unlike in Honduras,where only 3% of the total number of physicians are located in therural clinics.

Onthe contrary, Honduras lacks adequate access to healthcare services.83% of Hondurans are reported to lack health insurance as compared to13.4% of Americans. Honduras also has an inadequate number ofphysicians (0.8 in 1000 persons), gaps in infrastructure, financialconstraints, and variable supply of medicines (Pearson et. al.,2012). Rural areas have limited healthcare infrastructure promptingmedical teams from the urban areas to visit them twice a month toprovide essential health services. Patients also complain of longqueues and wait times in health facilities after having traveled forlong distances. Finally, large facilities in Honduras have onlylocated provincial headquarters and are normally are visited in caseof emergency and specialized care services that are not available inthe rural hospitals.

Utilizationof healthcare is better in the US than in Honduras. A study conductedin found that 70% of people in Lomitas had no contact with healthcareproviders in a year, 43% in La Hicaca, and 28% in Coyoles with 80%waiting for 1-3 hours. Only 53% of people had contact with healthcareproviders in the previous year in Honduras as compared to 82.1% ofpeople in the US. 95% of Hondurans visit the hospital when sick withthe remaining 5% utilizing herbal remedies, 51% for preventive care,including vaccination, 43% for medications, 17% for prenatal, and 8%for screening tests (Pearson et. al., 2012). In the US, 98.3% ofpeople visit the hospital when sick and an astounding 90% utilizepreventive services. 77.8% of mothers utilize prenatal services inthe US health delivery system and 60% visit hospitals for screeningtests (HealthCare. gov, 2015). Therefore, the utilization of healthcare is better in the US than in Honduras.

Costand Financing

TheUS health care delivery system lacks a single nationwide healthinsurance system. The system is, therefore, financed from manysources. Health insurance is provided by the government to specificgroups or purchased from the private market. Funds to insuranceproviders come from three sources which are money paid by employerson behalf of their employees (61%), individual purchase of healthinsurance cover, and government funding of health insurance to covergovernmental programs that are designed for low-income people and theelderly above 65 years (HealthCare. gov, 2015). Public insuranceplans (26%) in the US are Medicare, Medicaid, and the StateChildren’s insurance program. Medicare receives its funds from thefederal government Medicaid receives from state governments throughgeneral taxes. Medicare is meant for the disabled and the aged whileMedicaid funds economically disadvantaged groups. The uninsured group(13%) receives care from public clinics. The US spends 17% of the GDPon health (Ridic et. al., 2012).

InHonduras, the public health care system is financed by the centralgovernment. The public sector is divided into the Ministry of Healthwhich plays the regulatory role in health and the Honduran SocialSecurity Institute (HSSI) which collects fiscal resources andcontributions to health by workers (Madriz, 2011). The private sectoris financed by out of pocket funds from the patients who visit them.88.3% of the people are covered by the MOH, 2.7% of privateinsurance, and 9% by the HSSI. The public spending on health is 6.7%of the GDP (Gillespie, 2004).

Qualityand Outcomes

TheUS healthcare system is more advanced than the Honduras system, thus,has better outcomes. For example, premature babies have a higherchance of survival in the US than in Honduras due to moderntechnology. The infant mortality rate is less in the US at 5.96 per1000 live births as compared to Honduras which is at 25 per 1000 livebirths. Maternal mortality in the US is lower than in Honduras at17.8 deaths per 100,000 as compared to 100 per 100,000 in Honduras.The high life expectancy of 78.74 years in the US is also anotherproof of quality healthcare delivery system in the US in relation toHonduras whose life expectancy is 73 years (Cdc.gov, 2015).

TheUS healthcare delivery system provides a higher accessibility tohealth services than Honduras leading to better health outcomes. Thequality of training for healthcare providers is also higher in the USthan in Honduras. In addition, the US is leading in pharmaceuticalinnovation worldwide producing safe drugs that extend and improvelife accounting for the high life expectancy.

HealthcareDelivery System Analysis

Thehealthcare delivery system of the US lacks a national insuranceprogram, unlike the Honduras system. As a result, the Americans lackuniversal access to healthcare because the US healthcare deliverysystem is unable to provide a basic package that is universally andequally accessible to all Americans due fragmentation (Ridic et. al.,2012). On the other hand, the Honduras healthcare delivery system iscentrally financed and run by the MOH and HSSI making healthcareuniform to all the citizens (Madriz, 2011). Nevertheless, the USsystem where there is fragmentation promotes the development ofbetter policies which are responsive to the needs of the variousgroups, unlike the national system. Policies are also easilyimplemented in a fragmented system rather than a national system.

However,the US healthcare system enjoys robust financing with 17% of the GDPfrom the federal and state government as compared to the Hondurassystem which gets 6.7% of the GDP. As a result, accessibility isbetter in the US than in Honduras. The funding improves the qualityof services by allocating the required resources for quality care,for example, employing more healthcare providers to reduce the waittimes and improve utilization (Ridic, et. al., 2011). Proper fundinghas also promoted research in the US leading to the discovery ofimproved technologies and drugs which lead to better health outcomesand improve the quality of life. Proper funding is also required inthe development and implementation of health policies.

TheUS system proves to be better at meeting the health needs of thepopulation than the Honduras system. The fragmentation of servicesenables communities to discover their priority health needs duringpolicy development and implementation, unlike the national Honduransystem. It also promotes accessibility of healthcare by people in therural areas as well unlike the Honduran system where crucial hospitalinfrastructure is located in the provincial cities only denying thosein the rural areas some health services.

Strategiesfor Improvement

Thereare various strategies that can be used to improve both systems ofhealthcare delivery. The Honduras system can benefit from setting upthe proper infrastructure in the rural areas and building bighospitals there to prevent long distance travels in search ofhealthcare. The breaking down of the ministry of health into countieswould also go a long way in promoting responsiveness to priorityneeds of each community. It would also promote equality in allocatingresources between the national government and the counties.

Onthe other hand, the US healthcare delivery system could be improvedby restructuring the organization of the healthcare system from asupply-driven system to a patient-centered system. Shifts should bemade from the profitability of the players in health such asinsurance companies and private practice doctors to promoting betterpatient outcomes. Creating a non-profit insurance mechanism can helpto lower the cost of healthcare in the United States and promoteproper allocation of the available resources. Investing in researchand information technologies can help the system to discover betterevidence-based practices.


Everycountry’s healthcare system is determined by the health needs ofthe population. The system should meet these needs in a timely mannerat the least expense. It should also decrease disparities among thediverse populations. The government, insurance companies, workers,and healthcare providers should, therefore, work together inpromoting a safe, reliable, efficient, and effective healthcaresystem. Continuous monitoring and evaluation should also be done toassess the extent to which the system meets the needs of thepopulation. Comparison with other country’s health systems shouldalso be done so as to learn from each other and improve the overallhealthcare delivery system. It’s clear that different factorsimpact the success as well as the type of system for care deliveryadopted by every country. Some of the factors entail economic andpolitical stability, population/demographic of a country as well asavailable resources. Both the United States and Honduras havediffered in almost every aspect and in turn, the difference in theirhealth care delivery system.


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