The United Kingdom, Israel and the USA: The impact of healthcare systems on health.

Background: To gain additional insight on health outcomes, this presentation explores health systems in three industrialized, high income countries located on three different continents, United Kingdom (UK), Israel, and United States (US). The UK, Israel and the US differ in size, population structure, and have very different health care systems. The purpose of this presentation is to describe the healthcare systems of the countries, discuss health outcomes in vulnerable populations, and propose a more proactive approach to health care delivery. Methods. Utilizing three factors of the Behavior Model of Utilization (health system environments, characteristics of the population, and health outcomes), this presentation examines healthcare accessibility for each of the countries. Results. Health systems and populations in the three countries differed dramatically, but many similarities surfaced. Most importantly, all countries' health systems had issues addressing the health needs of socioeconomically low income individuals, immigrants, and minorities which was reflected in unmet needs and inadequate health promoting behaviors. Conclusions. Philosophies of "health is a right" or "health is a benefit to be purchased" have not altered the level of health outcomes or nature of gaps in providing care to several vulnerable population groups. High income countries must take an active approach to address gaps in health care delivery. Relevance to clinical practice. Nurses comprise the largest health-care workforce in the world and must take the lead in reaching out to engage high risk population groups worldwide to provide them information on the use of health care systems and the importance of preventive care with the goal of reducing poor health outcomes and decreasing health disparities