The American Health Care System Description

 

Table of contents:

 1.  Evolution of the U.S. health care policy

2.  Structure of the  U.S. health care system

3.  State health care programs

4.  Types of insurance

5.  Regulation and supervision in public health services system

 

1.Evolution of the U.S. health care policy

The fact that the U.S. health care police is among the best in the world, is a commonly accepted fact. Many countries work hard on this issue in order to create a health care system that would in whatsoever way resemble the system implemented by the United States. The United States of America is the owner of the most expensive health care system in the world. This is primarily due to the fact that U.S. spends on the health care system more than any other country both in absolute figures and as related to the GDP per capita. For instance, in 2007 U.S. spent approximately 7439 USD on the health care of its each citizen (Roehr,2008).

According to CIA World Fact book, the level of the child death rate and life expectancy in the USA both occupy the 40^th positions in the world. Despite all the financial support, historically the period of 1997-2003 revealed that the reduction of death rate in USA was the slowest as compared to other industrially developed countries. At the same time in 2006 the US statistics center after analyzing the information from the annual national public inquiry of a state of health, stated that about 70% of the US population referred to their health as “excellent” or “very good” (Mahar,2006). Such subjective evaluation of the national health is a very impressive and very important.

At the present moment US uses around sixteen percent of its GNP and it is expected that by the year of 2017 this percentage will reach the level of twenty percent. The main source for such potential growth is a set of state programs, which in its turn made lead to the destabilization of the national economy. Correspondingly, this issue needs further analysis and the implementation of a larger percentage of the privet sector of health care(Roehr,2008).

A spite all the impressive figures and numbers, the history has proved that USA is the only country in the world which does not have a universal system of health.  64% out of the 84% of the US citizens that have health insurance, are insurances covered by the employer. Only 9% acquire the health insurance as an individual private order; 27% of the US population obtains its insurance owing to various state programs (Roehr,2008). Certain state programs provide the invalids, elderly people, veterans and low-income groups with medical aid, and emergency health care for all US citizens notwithstanding their ability to cover it. Almost the half of the expenses of the country are the expenses of such state programs, therefore the US government is the largest insurer of the nation.

 

2.Structure of the  U.S. health care system

The US health care system is represented on three major levels: family medicine, hospital help and public health services. Medical services within the territory of the United States are provided both by private or legal establishments. Various commercial, charitable and state organizations offer patients both out-patient and stationary services (Mahar,2006).

About 47 % of all expenses on public health services of the USA, are expenses for hospitalization, about 2 % are house service, 10 % are medicamentous treatment and 10 % are the maintenance at geriatric homes. The remained 11 % cover services of dentists, ophthalmologists and other experts of narrow background(Roehr,2008).

Family medicine is considered to be a rather developed structure in the USA. Family doctors examine and observe patients and if necessary, direct them to narrow experts or to a hospital. Such doctors receive payment directly from patients. As a rule, the family doctor has his own office or cooperates with other experts. Hospitals make the largest component of the general amount of medical services of the USA(Wangsness,2009).

Hospitalization is the most expensive and most important component of the industry of public health services of this country. However, recently there are appreciable shifts towards other establishments, mainly polyclinics, points of first aid and geriatric homes. Out-patient services are slowly, but confidently replaced by hospitalization, and home visiting service by staying in geriatric homes.

In the USA there are two types of hospitals: the ones having property rights but frequently operated by big private corporations, and the hospitals that are non-profitable hospitals which are controlled by district and state authorities, religious communities or independent public organizations (Mahar,2006). US hospitals render a certain volume of the out-patient help in the ERs and in specialized clinics, but basically they are intended for rendering the hospitalization of the patients. A vast amount of attention is given to emergency aid. Besides, USA has a network of hospices for terminal patients with expected life expectancy of six month and less. Such hospices are usually subsidized by charitable organizations and the government.

However, in the USA, as well as in other countries, the concept of the out-patient help includes rendering of medical services without hospitalization of the patient. This makes a big share of rendering of medical aid to the population. Treatment in-home basically is made at the expense of the sisterly organizations and usually is ordered by the doctors. The private sector of out-patient medical aid is presented by personal doctors (experts in internal and family medicine, pediatricians), narrow background experts, for example gastroenterologists, cardiologist, nurses and other medical personnel(Roehr,2008).

3. State health care programs

Those American citizens, who do not have private insurance, are eligible for the action of such state programs as Medicare, Medicaid, and also other programs for the needy population offered by different states and local authorities. One of the researches showed that 25 % of none-insured US population can participate is such state programs, but nevertheless for certain reasons have not got under their action(Roehr,2008).

One of the major purposes of the US government is the expansion of the sphere of action of these programs on all levels of the population and especially for those US citizens, who truly need them. For example, the Tricare program is a program for the veterans and their families. In 1997 the federal government has introduced the program of the state insurance for children from families that have an income which is higher than the Medicaid admission rate but nevertheless is not sufficient in order to purchase insurance(Mahar,2006). By 2010 this program has helped millions of children, but in many states it has already faced the problem of insufficient financing.

The government of the USA pays the expenses of the public health services by means of two basic programs – Medicaid and Medicare. These two programs allow providing medical services which are either free of charge or at a very low cost, to poor or indigent citizens of the country. Medicaid annually provides medical aid to over 40 million Americans with low level of incomes, and Medicare provides medical aid to a similar amount of elderly patients and people with limited physical possibilities (Roehr,2008).

Medicare is a famous insurance state program for senior people who are older than 65 years which was implemented in 1967. Before its implementation almost the half of the elderly population of the United States did not obtain the required volume of medical services. This program coordinates the insurance of all the American citizens who are older than 65 years old and also of those citizens, who are approaching this age and have serious health pathologies. Thus, at the present moments more than 97% of the elderly population, citizens with serious kidney pathologies and about 4 million of invalids are insured by the Medicare program.

This insurance program covers medical aid during acute conditions right up to hospitalization, various diagnostic procedures, medical services at home and short stay in geriatric homes. Besides, patients can receive some preventive services, for example vaccination against hepatitis B, flu, pneumococcus and other. Such services as long hospitalization, nurse visiting service, hearing aids and prescription drugs are not covered by this program. Medicare is a rather effective program. It is partially financed from the special tax on workers: part f it is paid by the worker and the other part by the employer. As a whole, this tax is about 15 % of the income of working Americans. The other Medicare part is financed from the general proceeds of surtax.

The Medicaid state program was introduced in 1966 and is aimed at insuring American citizens from low-income families. Elderly people, people with severe injuries, invalids, pregnant women and children are also eligible for this program. This program also covers up to 40% of the newborns, about 30% of children of all age groups and about 40% of the HIV positive individuals(Cunningham, 2006).

 Medicaid deals with five basic services: stationary and out-patient treatment, consultations of various experts, stay in geriatric homes, laboratory diagnostics and radiological methods of research. This program pays for geriatric homes for aged people who require permanent care and cannot do anything without outside help.

Staying in such establishments is very expensive: up to 100 dollars a day, therefore, the amount of savings of the majority of such people is not sufficient for this purpose. Patients in geriatric homes get the largest portion of the Medicaid money (Cunningham, 2006).

The Medicaid program is financed both by the federal government and the states. The federal government pays the share of the Medicaid expenses from the proceeds from the general tax. That makes approximately half of all the expenses and the rest is paid by the government of each state.

In 1966 the Congress of the USA has passed the law which reformed the system of social security in the USA(Cunningham, 2006). Since then, each state of the country submits to the federal government a plan of the required medical services for different groups of the state population covered by Medicaid. After the approval of this plan the states began to use federal money along with their own incomes for financing medical services. There is a different Medicaid program in each state which converts this program into a system that is difficult to manage.

4. Types of insurance

Payments for health services are made by each person individually at the expense of his/her own means, as well as for any other rendered service. The insurance model provides division of financial risks according to which, each individual or its employer brings the established monthly payment (Wangsness,2009). Such mechanism of division of means frequently allows paying a full spectrum of necessary medical services. Nevertheless, sometimes it is necessary to pay a certain sum for rendered services – the so-called franchise, or to pay extra for each given procedure (Mahar,2006).

 Today the majority of employers use the so-called “management insurance organizations” which organize the rendering of medical services at a price that is considerably lower than the one paid by the worker in case of private individual appellation. The basic feature of such organizations is the conclusion of selective contracts which is basically a contact with several suppliers of medical services that allows achieving lower prices. Besides, these organizations often offer schemes of the decrease of the excessive medical expenses for the employer. In order to minimize the expenses, the patient needs to be preliminary examined the broad specialist before obtaining specialized aid. “Management insurance organizations” include health maintenance organizations and preferred provider organizations. The first ones cover only the medical services provided by the hospitals with which they have a contract. The second ones allow getting medical aid not only within the network of its hospitals but also outside the “contracted” hospitals. Modern employers give preference to health maintenance organizations(Roehr,2008).

 Though the American system of public health care is the most expensive in the world still it has certain “defects”. Many US citizens cannot receive adequate medical aid, the number of diseases in the country does not decrease, and preventive actions frequently do not bring expected result. However USA constantly take steps in the direction of the elimination of such “defects” and the system in generally directed to the improvement of the health of the population. Considering the close interrelation between the system of financing and the organizations providing medical services it is possible to say, that new mechanisms of financing lead to changes in the system of rendering of medical services and simultaneously become one of determinatives on the way to the improvement of the national health.

 

Bibliography:

 

1.  Mahar, M.(2006). Money-driven medicine: The real reason health care costs so much.Harper:Collins.

 

2.  Cunningham P., May J.(2006). Medicaid patients increasingly concentrated among physicians. Track Rep, Aug;(16):1-5.

 

3.  Roehr, B. (2008). Health care in US ranks lowest among developed countries. BMJ.

 

4.  Wangsness, L. (2009). Health debate shifting to public vs. private. Boston Globe. Retrieved February 04,2010. 2009.

http://www.boston.com/news/nation/washington/articles/2009/06/21/healthcare_debate_shifting_to_public_vs_private/?page=full.