GLECKMAN STUDY
HEALTH CARE SYSTEM IN AMERICA
Health care system in America is unique compared to those of the advanced industrialized countries. It does not have a uniform health system, has no universal health care coverage, and recent legislation mandating coverage is not yet implemented fully. U.S. health care system can be best described as a hybrid system. Rather than operating as a national health service, it operates as a single-payer national health insurance system, or a multi-payer universal health insurance fund. Programs such as Medicare, Medicaid, TRICARE, Children’s Health Insurance Program and Veterans Health Administration contribute almost 60-65% of the health care provisions and spending. The government for public sector employees primarily provides health insurance. Their employer or one of the family member’s employers insures people under the age of 67. Some people get themselves insured, while the rest remain uninsured. U.S. Census Bureau has reported that, 17.3% i.e. 49.9 million residents are uninsured. The Organization for Economic Co-operation and Development (OECD) estimated that in 2010, U.S spent $8233 per person, which is nearly 8% higher than OECD average of 9.5%.
COST TO INDIVIDUAL PATIENT
Cost is the primary reason for lack of health insurances and access to cares among Americans. Citizens with below-average income in America are more likely to report not: visiting a physician while sick, getting a recommended test, treatment or follow-up when compared to their other counterparts. Some of the important contributing factors to the high prices of medical care in U.S. are:
- Availability of more expensive, state-of-art medical technologies and drugs are the reason for expensive health care since they generate demand for more intense, costly services even if they are not cost-effective.
- Rise of chronic diseases including obesity also contributes to expensive health care insurances. This is because, health care costs for chronic diseases consumes large proportions of health care costs, particularly during end of life care.
ACCESS OF CARE
The Patient Protection and Affordable Care Act (PPACA) or more commonly known as the “Obamacare” is a United States federal statute, into force from March 23, 2010. It represents the most significant regulatory overhaul of the U.S. health care system. It enacts with the goal of increasing the quality and affordability of health insurance by reducing the uninsured rate, increasing public and private insurance coverage, reducing health care costs for individuals and the government. It introduced a number of mechanisms to increase coverage and affordability. This law also requires insurance companies to cover all applicants within new minimum standards and offer same rates regardless of their pre-existing conditions or sex. The PPACA includes a combination of measures to reduce healthcare costs, expansion of coverage through private and public insurance.
LIMITATIONS TO CARE
The main causes for limitation in access to health care are because the payers must try to deliver most care to a lot of people at least rates.
- Formularies or commonly known as drug prescription list that are covered by an insurance plan and available to people are at low costs. Medicines not on the list are available, but at a very high cost. This hinders the access to healthcare.
- Insurance co-pays and coinsurance are the tools used by many health insurance plans to discourage people in seeking unnecessary medical care. This can limit the access for people with less income or chronic diseases.
- Social, economic, cultural and financial barriers may hinder people’s ability to access the most effective treatments.
- On-going shortage of health care professionals eventually increases the waiting time for patients and result in lack of effective health care services.
COST EFFECTIVENESS
The US healthcare system is one of the least cost-effective in reducing mortality rates according to a recent study published in Journal of the Royal Society of Medicine Short Reports. Cost-effectiveness was determined by considering the nation’s GDP health expenditure (GDPHE). It was known from the investigation that, United States had the highest current and average GDPHE which were 15.3% and 12.2% respectively. It was also found that, other nations had significantly greater mortality rate reductions than the United States in relation to both ‘adult’ and ‘older’ people. However, several cross sectional studies that have shown association between spending and outcomes have showed that more spending leads to better outcomes.
PATIENT SATISFACTION
A survey conducted by marketing research and consulting firm reveals the different perceptions of patients from United States and their future outlook. The findings were that, U.S. patients expressed more contentment with their country’s healthcare system, at the same time worried about the system in the next 5 to 10 years. U.S. patients’ perceptions about the doctors, nurses, pharmacists and hospitals are the most positive. Many patients believe that the cost of health care is the major burden. Despite of the negative perceptions, people from United States are very content with their healthcare system, rate doctors the highest on the survey’s temperature scale and government rating was low.
PRIMARY CARE vs. SPECIALIST CARE
Though primary care is a critical component of any health care system, there is a considerable imbalance between primary and specialty care in United States. Current specialty physician population in US is more than sufficient to meet the demands for treatments which all physicians agree on its necessity. The reason for requirement of more primary care is the demographics of the general population. Major driving force behind the specialists is the growing medical technologies and lot more allowances and flexibilities compared to that of primary care physicians. One consequence of having too many specialists is that, they have been regarded as the major force for increase in intensive, expensive health care services. To achieve a better balance in the proportion of primary health care and specialists, continual efforts are required to improve the geographic and specialty distribution of physician labor forces.
SUSTAINABILITY OF THE SYSTEM
The United States health care system is unsustainable. It is failing because of the substandard quality of services, high prices and inaccessibility to care services. Political leaders have also failed to address this issue for many years. However, health care system of 21st century has shown early signs of sustainability with Obamacare in effect. First, under ACA, employers will be incentivized to provide a healthy work environment. Second, ACA’s Medicare Hospital Value-based Purchasing program will grade hospitals on the quality of their service delivery, including patient satisfaction.
REFERENCES
iBerning, M. (2013, June 19). How will 'Obamacare' impact hospital sustainability? Retrieved Jan 11, 2014, from greenbiz: http://www.greenbiz.com/blog/2013/06/19/how-will-obamacare-impact-hospital-sustainability
FamiliesUSA. (2010, Sep 23). The Patients' Bill of Rights: Ending Annual and Lifetime Limits. FamiliesUSA.
Formulary Staff. (2011). US healthcare system among least cost-effective in reducing mortality. Formulary Journal.
Jr., M. L. (2012, Mar 21). American patients satisfied but worried about healthcare. Medical Economics.
Limitations To Access. (n.d.). Retrieved from JNJ: http://www.jnj.com/sites/default/files/pdf/limitation-to-access.pdf
National Association of Insurance Commissioners. (2010). "Patient Protection and Affordable Care Act of 2009: Health Insurance Exchanges".
Shi, L. (1995). Balancing Primary versus Specialty Care. Journal of The Royal Society of Medicine, 428-430.
Weinstein, M. C., & Skinner, J. A. (2010). Comparative Effectiveness and Health Care Spending — Implications for Reform. The New England Journal of Medicine.
Wikipedia. (2014, Jan 6). Health care in the United States. Retrieved Jan 9, 2014, from wikipedia: http://en.wikipedia.org/wiki/Health_care_in_the_United_States#Spending
