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Increasing national healthcare spending due to an aging population is a rising burden on society and the economy. Under pressure to improve healthcare systems, it is important to evaluate different healthcare systems including the national healthcare system in China, the universal healthcare system in Japan, and the mixed healthcare system in the USA. In the different health insurance frameworks, it is imperative to shift from a cost-based fee-for-service system to a capitation system. Health insurance is generally designed to mitigate financial burden, which leads to equality of healthcare service access and thus prevent health inequality. From a public health perspective, health education improves health knowledge and skill which is profoundly associated with an improvement of health literacy. An increase in health literacy levels is related to a healthy lifestyle, and then an increase in the health of the population and sustainable notional outputs. This research attempts to address the problems that arise when changing health policies, i.e. healthcare system, on health considering the effects of difference in income, educational level, and health behaviors on health and health disparity. Objective: The purposes of this study are: (1) to empirically identify decision-making preferences about preventative behaviors, i.e. breast cancer prevention by different health insurance framework; (2) to evaluate disparity of health outcomes, i.e. different healthcare financing; and (3) to investigate health outcome disparity based on income and education in the different healthcare systems among China, Japan and the USA. Methodology and data: A Bivariate Probit model is used by controlling for socio-economic, demographic and healthcare financing factors to investigate health outcomes by different healthcare programs in China, Japan and the USA. The data comes from the China Economic, Population, Nutrition, and Health Survey 2011 Adult Questionnaire [about 30 thousand samples]; The Global Centers of Excellence (COE) Survey [about 5.5 thousand samples] conducted in 2011 by Osaka University in Japan; and Behavioral Risk Factor Surveillance System 2013, US [about 50 thousand samples]. Logit and OLS regression analyses were conducted to examine health and healthcare prevention behaviors and income and health disparity. Results: The findings suggest that there is clear-cut evidence about behaviors of preventive care by different health insurance frameworks among the three countries; an objective measure of health behavioral outcomes (breast cancer prevention) is significantly influenced by different healthcare financing and policy; A nation with health disparity (general health) is based on income inequalities and different educational level causes health disparity. Healthy lifestyle stems from higher health knowledge and depends on involvement by a modern and market-oriented healthcare delivery among the three countries. Conclusions/implications: A development of human capital, i.e. health stock, will reduce government healthcare spending. Insurance coverage is an important factor to increase the health of the population, i.e. longevity. Managed healthcare financing is a strategic policy to constrain ever-rising healthcare costs.

hsoa journal of community medicine and health care

Global Perspectives of Different Healthcare Systems and Health: Income, Education, Health Disparity, Health Behaviors and Public Health in China, Japan and USA