A Look Into The American Health Care System - Essay Example

? U.S. Health Care Delivery System Introduction The American health care system is the only system in the industrialised world without a universal health care for all citizens through government funded coverage. In America, there is a flexible system that is an amalgamation of government programmes and private players. Though it is normal to have both public and private players in the field, what is startling about America is the dominance of private players. According to records (as cited in Chua, 2006), in the year 2003, only 15 percent Americans had public insurance coverage through programmes like Medicaid. 62% of the non-elderly people relied on employer-sponsored insurance, and 5% had to depend on private individual insurance; and the remaining 18% of the population was uninsured. Thus, in the year 2009, there were 50 million Americans who did not have any insurance coverage. Admittedly the mixed health care system of America is full of pitfalls and loopholes that are analysed here. A Look into the Public Health Insurance Medicare- Medicare, started in the year 1965, is intended to cover those individuals aged above 65 and some disabled individuals. In this programme, the reimbursement is directly handled by the government. The fund for the Medicare system comes from federal income taxes, payroll tax shared by employers and employees, and individual enrollee premiums. However, there are various issues identified as associated with this Medicare system. As described in the Official U.S Government Medicare Handbook 2012, Medicare and You, the main issue is that despite the presence of Medicare coverage, people are forced to have supplemental insurance to meet their health needs. This is so because there are many issues in Medicare coverage. First of all, it does not offer complete coverage for skilled nursing facilities. In addition, there is no coverage for dental, vision and hearing issues. Thus, what happens in practice is that the people above 65 who are covered under Medicare are forced to spend more than one-fifth of their income on health care costs. Medicaid- It is designed to cover the low-income and disabled people. In addition, states are directed to modify their plans to include pregnant women, children, elderly, disabled, and parents. The program is jointly funded by state and federal governments. Presently, there are 51 Medicaid programmes in the nation, and the federal government meets 57% of the total expenses. Admittedly, Medicaid offers a lot of benefits including prescription drugs (“The Basics of the..”). However, as Kovner et al point out, the problem with the Medicaid programme is that it is difficult to get health care providers that accept Medicaid because it offers only low reimbursement rate (30). Another important public system is the State Children’s Health Insurance Programme (S-CHIP) which covers those children who do not qualify for Medicaid because of their income but are not financially strong enough to afford private health insurance. A Look into Private Health Insurance Employer-sponsored insurance- Majority of Americans has their insurance through employer-sponsored insurance. It is provided as part of the benefits package for the employees. Such insurances are administered by private insurance companies like Aetna and Cigna. In addition are the self-insurance plans where the company directly pays all the health care costs of their employees. Normally, large companies resort to such self-insurance plans. Admittedly, such employer-sponsored programmes are financed by the employer and the employee. In this case too, there is inconsistency regarding the coverage obtained. While some cover prescription drugs; others do not. Private non-group insurance- These are administered by private companies, and such insurances often go to all those who are not able to obtain insurance under other public and employment-based insurance. While the annual payment for such insurance is usually more than two thousand dollars for an individual, for a family of four, the amount is above ten thousand dollars. The Present Situation- Pros and Cons of the System In the U.S, health care cost is collected and reimbursed by both government and private insurance providers. According to statistics, in the year 2003, the nation spent 15% of its total GDP on health care, while the average in Organization of Industrialised Countries (OECD) was just 8.6%. In addition, it becomes evident that the per capita health spending in 2003 in the U.S was $ 5635 while the OECD average was just $ 2307. However when the government share of the total health expenditure of the nation is considered, the picture is different. As Gill points out, while other OECD nations met an average of 72% of their respective health costs, America met only 44% of the total health spending. Also, there is the startling information that one-third of the people below poverty line in U.S are still uninsured; and as a result, nearly 18,000 people die in America because of insufficient insurance coverage. According to the findings of American Medical Association, despite the considerably higher health care costs and disparities in the system that leave many people unprotected, as compared to other OECD nations, America still has higher levels of infant mortality and obesity. In addition, life expectancy in America is much lower than many of its industrialised counterparts like Japan, Canada, Spain, Switzerland and Australia. If one makes an intentional effort to find something positive, one can get some points that support the U.S health care system. Firstly, it allows patients to choose from the vast cornucopia of drugs, treatment options and surgical procedures that are available only with higher-paid doctors and hospitals. In addition is the benefit that the present system ensures the confidentiality of patient information which is in the danger of getting jeopardised in the case of centralisation. Another point that supports such a system is the fact that increased government involvement and funding will make people be extravagant in their health costs as government fully meets the burden. Conclusion- the way out Evidently, it is time for the government to think about a fully centralised system that ensures equality in receiving benefits and treatments. In addition, there should be unified and clearly defined rules defining what is included and what is not included in the insurance coverage. In addition, those with adequate economic power can be allowed access to more sophisticated and expensive treatment options. Another vital step to come out of the present jargon is to improve the medical education system. Instead of the prolonged 8 year study followed by internship and residency, there should be a system of compulsory community service with stipend along with study after four years of study. In addition, routine tasks can be given to other less qualified professionals, thus giving doctors more time and less workload. Also, it is highly necessary to cancel the rule that insurance companies should not sell policies outside their own states. This will help increase competition among insurance companies that will lead to better services, packages, and low premiums. With the above steps, it is possible to improve the American health care system. Works Cited “The Basics of the Federal/State Medicaid Program”. CSH White Paper: April 2003, web Nov 2011 http://documents.csh.org/documents/policy/Med/MedicaidBasics.pdf Chua, Kao-Ping. “Overview of the U.S Health Care System”. AMSA Jack Rutledge Fellow 2005-2006, February 10, 2006. Web 20 Nov 2011 http://www.amsa.org/AMSA/Libraries/Committee_Docs/HealthCareSystemOverview.sflb.ashx Gill, Kathy. The Health Care System in the U.S. web 20 Nov 2011 http://uspolitics.about.com/od/healthcare/tp/health_care_overview.htm “Improving the U.S health care system”. American Medical Association, April 2009. Web 20 Nov 2011 http://www.ama-assn.org/ama1/pub/upload/mm/-1/hsr-fly.pdf Kovner, Anthony R. Knickman, James & Jonas, Stevan (Eds.) Jonas & Kovner’s health care delivery in the United States. Springer Publishing Company, 2011. Print. “Medicare and You”. Official U.S Government Medicare Handbook, 2012, web 20 Nov 2011 http://www.medicare.gov/publications/pubs/pdf/10050.pdf Read More