Private and public payers buy health-care services from health care providers subject to regulations by local, state and federal governments and also by other private regulatory organizations. The private and public regulators, as well as the providers, insures and the government, have important roles in the health-care system in the US. The state and federal governments have judicial, legislative and executive branches. The Department of Health and Human Services (HHS) is the largest administrative department in the US health-care system. Government’s role in the US healthcare system is quite complex and continues to evolve. Coverage of insurance in the US is highly segmented with many public and private sources, but there exist very wide gaps in insurance coverage as far as healthcare is concerned in the US.
The Medicare program, Medicaid, as well as the Children's Health Insurance Program, are administered by the Centers for Medicare and Medicaid services (CMS). In Canada, the Canadian provinces and territories are the ones mandate with organizing health service delivery. They are also in charge of education, accreditation and licensing of the healthcare providers. Regional health authorities have been established by the provinces. These authorities fund plan and fund the delivery of health services at the local level. Of late, some jurisdictions have consolidated some of these authorities to form bigger bodies. In Canada, the private sector almost entirely covers the provision of healthcare services although the federal government helps in financing of territorial/provincial health insurance programs.
Financing the healthcare system in the USA is divided into two categories: publicly financed health care and privately financed health care. According to the 2011 statistics, public spending in the country accounted for 48% of the total healthcare expenditure. For publicly funded health care, Medicaid is financed by health insurance in a joint federal-state program and also through taxes. The states receive money from the federal government at a rate that matches her per capita income (50% - 70.4% the state’s Medicaid expenditure. In privately financed health care, the private insurers can either be nonprofit or for-profit organizations. These companies are regulated the insurance commissioners of the state which are subject to the prevailing state and federal conditions.
Individuals can purchase a private health insurance but is mostly funded by tax exempted premium conditions whose contribution is made by the employee and the employer. Similar to the US healthcare system, the Canadian healthcare system is both publicly and privately funded. Public funding exceeds the proportion of the US counterpart and stands at about 70% of the total healthcare expenditure. Public funding is funded by taxation. The privately financed healthcare represents about 15% of the total healthcare expenditure in Canada. Among the services that the private health insurance covers are private rooms, home care, rehabilitation services, prescription, dental care and vision. Healthcare providers set their rates for the private insurance covered patients, and the government does not intervene in most cases.
Healthcare Reform in America
Streamlining the healthcare scheme in the US is not close to being over. The task of reducing medically and economically wasteful methods of treatment, reducing healthcare expenditure and attaining universal coverage has scarcely been scratched. Some of the proposals for the health system in America suggest that the healthcare system needs to pay close attention to the four Cs (choice, coordinated care, cost control and coverage). In the current America, there is a lot that is yet to be done especially pertaining the cost control aspect in healthcare. This is because cost control is an imperative aspect, not limited to the federal government but also to the state government. The first part of doing this is to make a government-funded health program which will end the open-ended entitlements. To occasion this conceivable, there is a demand for a dedicated tax system that will enable the federal government to control the cost of healthcare. The second part involves evaluation of old and new healthcare technologies and contrasting and comparing the outcomes and costs.
Reason Health Reform is so difficult
Healthcare reforms are hard to be realized in America because of a number of reasons. First, United States has a complicated healthcare system. It has hundreds upon hundreds of payment points. The many care providers like PPOs, HMOs, the Mayo Clinic, The VA, Medicaid, Medicare and Kaiser together with their many employees make it difficult to establish a universal health plan. Second is that America lacks a universal health system and, therefore, focus on quality improvement is hard. Third is that the political system in America simply makes it hard for reforms to be made. It is extremely difficult for the president to win votes in both houses of the American congress. Still in politics, campaigning in the US is very difficult and; therefore, most politician lack that interest to focus on their professional fields making it hard for any reforms to be brought to the legislature.
America has been experiencing for some time now a steady 1.5% increase in the cost of healthcare. In 2006 United States ranked first in terms of the cost of healthcare, but ranked 43rd in adult mortality and 39th in infant mortality. Currently, the statistics are even more worrying with the country falling behind even further each year. The cost is constantly increasing while the quality is remaining constant. It is evident that US healthcare system is far much expensive and complicated. We ought to gain knowledge of from other countries like France that have made considerable strides universal, affordable healthcare.
References
Thompson, S. (2013). International Profiles for Health Care Systems, 2013. London: Commonwealth.
