American Health Services

The United States of America has one of the most expensive Health Care system in the whole world. The country spends on the health system more than any other country – just in the year 2007 the US spent on the health care 2,26 billion dollars, which is 7439 dollars for one person. According to the latest data there are nearly 16% of GDP spent on the medical treatment in the US and according to the prognosis it will grow toll 2017 up to 19,7%. What will be important to note that during the last 30 years the growing expenses for these services for the last 30 years descend from government programs and this fact could seriously damage financial stability of the country.

According to the data of the Institute of Medicine of the National Academy of Sciences, the United States is the "only wealthy, industrialized nation that does not ensure that all citizens have coverage" (Battista, McCabe, 1999).

Nearly 84% of US citizens have medical insurance, 64% received it from the employer, 9% - got it themselves, 27% of citizens get it according to the government programs. Certain government programs provide medical service for invalids, oldsters, children, veterans, and people with low income. Such programs also provide emergency aid for every citizen of the country despite the reason they could pay for it or not. More than 45% governmental expenses in the sphere of health services is financing such government programs, that is why US government is most insurer of the nation.

In the year 2006 nearly 16% from general population of the US did not have insurance and that was nearly 47 million people. That main reason is the high price for the insurance policy, which grows quicker than wages and inflation. In 2001 from the expenses paid for health service, nearly 50% of corporations were bankrupted in the US. And it is not surprising that in such a situation lot of arguments and debates are holding on around the American system of health service as well as its effectiveness, quality and accessibility and also about f=great deal of money which is spent on its support
In the year 2000 WHO analyzed health service systems of 191 countries in the world and the US health care received first place in the rate of the most stable systems, able to react quickly in the changing facilities. The same time the USA took the first place among the most expensive health service and just 37th of the quality of medical care level and 72nd on the general health level in the country. But this WHO investigation could be criticized for its methodology and absence of consumer’s satisfaction of the health system analysis

According to CIA WORLD Factbook the USA obtains 41st position for the children’s death rate level and 45th place according to the life longevity. Resent researches showed that during the period from 1997 till 2003 lowering the rate  of deaths that could be prevented occurred in the USA slowly than in other 18 industrial countries. From the other side , the results of held on 2006 annual National questionnaire of health state, performed by the Center of Controlling Disease of National Statistic Centre in the field of Health care system showed that nearly 66% of respondents consider their health to be “excellent”  or “very good”

Health service system in the United States is represented by independent service on three main levels: family medicine, hospitality aid and public health care. Medical service is provided by private institutions. Different commercial, charity and governmental organizations offer the patients as out patient  as well as stationary services.

Nearly 47% of all the expenses on the health service in US are provided for stationary service, nearly 2% home service, 10% - medical treatment, 10% - for retirement homes. The last 11% are spent on the service of dentists, ophthalmologist and other particular specialists.

Family medicine service is quite a developed structure in the USA. Family doctors are treating the patients and if it is necessary they send them to the particular specialists or to the hospital. Payment for the service such doctors get directly from the patient. Family doctors usually have their own office or co-operate with the other specialists.

Hospitals are without any doubts the biggest part of US medical service. In-patient treatment is the most expensive and important component of Health Care System of this country. But during the last time there exists noticeable changes into the side of the other institutions, mainly out-patients clinics, emergency aid stations and retirement homes. Out-patient treatment slowly, but rapidly replaces in-patient treatment, and home service – staying in retirement homes.

In the US there mainly exists two types of hospitals: privately owned for-profit hospitals, mainly ruled by great corporations and non-profitable hospitals ruled by government, religious community and independent non-government organizations. The structure of hospital service is quire typical: there you could get out-patient treatment at emergency aid departments and some specialized clinics, but mainly they are providing in-patient treatment. Great attention is paid to the emergency aid department. In the departments of emergency aid and centers of emergency therapy is provided sporadically, focused on the problem service. Surgical center – is an example of specialized clinic. Besides, hospice network is a well developed structure in the US. Hospice is a clinic for the terminal patients with supposed life longevity 6 months and less, which are usually financed by charity funds and government.

In the US, as well as in the other countries, the definition of out-patient service means providing medical service without hospitalization, which is the pain part of providing medical service for the patients. Home service is mainly provided for mainly sisterly organization and mainly is ordered by doctors. The private sector of out-patient service is represented by personal doctors (Specialist on inside and family medicine, podiatrists), particular specialists, for example, gastroenterologist, cardiologist, and others, also  hospital nurses  and other medical personnel. In 1996 there has appeared so called concierge medicine service – providing wide range of service by personal doctor on the prepaid

Many Americans who do not have personal insurance policy are under the activity of such government programs as Medicare and Medicaid  and also other programs of different states and local government for the people with low income.

One of researches showed that nearly 25% of uninsured citizens of the USA (nearly 11 million people) could take part in one or another governmental program, but for some reason did not use it. One of the government aims is widening of activity sphere of this programs for all the social levels of the people who need it.

For example there exists the program TRICARE for veterans and their families. In 1997 government involved the program of children state insurance, providing medical insurance for children from the families which income is higher than possible for using Medicaid, but they could not still aloow themselves to buy insurance policy. In 2006 the program helped for 6,6 mln children but in many states it met the problem – lack of finances.
Yet in the 1986 there was submitted an Act about Emergency aid service, that proclaimed on the national level the ability of emergency aid service for every citizen despite the presence of insurance or not.

The US government pay off the expenses on the health care service with the help of two programs – Medicaid and Medicare, which help to provide medical service for poor and indigent citizens of the country free or by low price.

In 2006 Medicaid program provided medical service for 38,3 millions of Americans with low income, Medicare – 40,3 million  aged patients and people with limited physical abilities

Financial system of Health Care service is the US has incomplete public financing and gets financial support from the governmental and private funds.
In 2004 for the private insurance policies there were paid off 36% of health care service expenses, 15% paid by private persons, 34% federal government, 11% - local governments of the states or local governments, 4% - other private funds.

The major part of Americans get medical insurance from the employer (59,7%). Besides the medical insurance there exist payments in the case of disability and life insurance and others.

But in fact employer is not obliged to provide insurance for the employee, even he is working full time, big corporations have such insurance in practice. From 2001 the payment for such insurance grew on 78%, when the wages grew only at 19% and inflation at 17%. The same time, employees who have insurance provided by the employer sometimes have to pay for health care service for themselves like some additional payments and deductibles.
The employers offer different types of medical insurance. One of the most widely spread types of medical insurance is compensative insurance or so called insurance “payment for service”. In this type of insurance employee pays a fee to Insurance Company for the every employer who has certain insurance policy. Than insurance company pays for the receipts given by medical institution or doctor. Usually insurance company pays 80% of expenses on the medical service and the left sum the patient should pay himself.

The government support employers in providing employees medical insurance and do not tax funds spend on this aim. General sum of such tax grants is nearly 150 billion dollars per year.

According to different data, the amount of uninsured Americans is nearly from 20 to 50 million people (8-20% of country’s population). In 2006 this amount was nearly 47 million people (15,8% of population). It is quiet a bit problem, as many people could not pay for health care service and postpone it, in the end that causes increasing expenses for medical care. And providing health care service for the great number of uninsured patients could cause bankrupts of the hospital or a doctor. Among the uninsured people there are 38 million of able-bodied adults and more than 27 million have partial work. Nearly 37% people have family annual earnings more than 50 thousand dollars per year.

According to the data of Census Bureau 36,7 million of uninsured – are legal residents of the USA, another 10,2 million – illegal inhabitants of the country. There was made a conclusion that nearly fifth part of the uninsured could themselves an insurance policy, nearly fourth part could take part in government programs and 56% need financial help.

Sources:

1. World Health Organization assess the world's health system. Press Release WHO/44 21 June 2000.

2. Gatta, G. (February 2006). "Survival from rare cancer in adults: a population-based study". The Lancet Oncology 7 (2): p.132–140.

3. Brown, D. (May 14, 2008)"The Less the Education, the Higher the Risk of Dying Early," The Washington Post

4. Schultz H. (2005) Health Care USA: Understanding Its Organization And Delivery.

5. Williams A (1987) "Health economics: the cheerful face of a dismal science" in Williams A (ed.) Health and Economics, Macmillan: London

6. Marc L. Berk and Alan C. Monheit

7. Battista J., McCabe J. (1999) The Case for Universal Health Care in the United States, retrieved November 9th 2009, from Connecticut Coalition Universal Health Care

8. California HealthCare Foundation (2007) Uncoordinated Care: A Survey of Physician and Patient Experience, retrieved November 9th 2009 from California Health Care Foundation

9. Anderson G., Reinhardt U., Hussey P. and Petrosyan V. (2003) "It's The Prices, Stupid: Why The United States Is So Different From Other Countries", Health Affairs, Volume 22, Number 3, May/June 2003.

10. Kaiser Family Foundation (2007),Health Insurance Premiums Rise 6.1 Percent in 2007, Less Rapidly than in Recent Years Bat Still Faster Than Wages and Inflation, retrieved November 9th 2009 from Kaiser Family Foundation

11. Gina Kolata (2009, August 11) Survey Finds High Fees Common in Medical Care,  The New York Times

12. Selden T and Sing M.(2008), The Distribution Of Public Spending For Health Care In The United States, 2002, Health Affairs 27, no. 5

13.U.S. Department of Health & Human Services, Centers for Medicare and Medicaid Services (2009), Overview The Children's Health Insurance Program, retrieved November 9th 2009 from U.S. Department of Health & Human Services Web Site

14. Wangsness L. (June 21, 2009), Health debate shifting to public vs. private, Boston Globe.

15. Mahar, M. (2006), Money-Driven Medicine: The Real Reason Health Care Costs So Much, Harper/Collins, 2006.