Topic: Functions of Health Care System
Write a 2 page essay discussing the3 basic Characteristics of the US Health Care System differentiate the US healthcare delivery system from that of other countries:
- No central agency governs the system.
- Access to health care services is selectively based on insurance coverage.
- Health care is delivered under imperfect market conditions.
The American healthcare specialists feel that their healthcare system is one of the best in the World, because the country spends the highest per capita on health. In spite of these efforts, the morbidity rates, fatality rates and undesired medical prognosis remain to be high. This suggests that the healthcare system may be inefficient. Studies were conducted in the US and several other developed nations (such as Germany, Canada, UK, Australia and New Zealand) on patients having similar health problems. Several environmental factors such as political (laws, policies and regulations), economic (general market situation), technological (biotechnology and information technology), social (ethnic, cultural and social), physical (public hygiene and environmental problems) and characteristics specific to the population (demography, health needs, social diseases, etc) affect the manner in which the healthcare services are being provided.
The healthcare system is the US is distinctive compared to other healthcare systems. Governments of several other countries organize national health insurance programs by which citizens automatically receive services. Most of the services are provided free of cost, which tends to disrupt the entire system. A common or a global budget is set up at the national level, from which resources are allocated. Availability and quality of the services depends on this budget. As the Government tends to control the healthcare delivery system and the budget being limited, introduction of new technology may take a while.
The situation is different in the US, where insurance does not automatically cover the healthcare needs of the people. The government or its agencies significantly do not maintain the healthcare delivery system, and both financing and delivery segments are controlled mainly by the private sector. Most of the hospitals and physicians in the US belong to the private cadre. Only 45% of the healthcare expenditure in the US is met by the Government. Unlike other countries, a central agency is not set up which monitors the expenditure of the common budget, and to control the accessibility and utilization of the healthcare services. However, the government plays a role in the US healthcare industry by developing certain standards or norms in the healthcare delivery, and determining the reimbursements that should be provided to the patients through insurance. The government ensures that the healthcare organizations maintain these standards.
Other countries provide access of the healthcare services to all the citizens, whereas in the US access is restricted to employers having health insurance packages, those covered under government healthcare programs, those who can privately chose an insurance package and those who cannot afford to pay for insurance privately. A significantly larger percentage of people in the US do not subscribe to insurance packages, and have to access healthcare services after paying. Following the implementation of certain laws, the uninsured people need not pay for emergency services obtained in a hospital. However, the basic limitation of the US healthcare system seems to be arising from the absence of a comprehensive access plan for primary healthcare services for the uninsured proportion of the population. Often, the patients in the US had to wait for several days to meet the physician.
People in the US have a number of choices before selecting the healthcare service providers. However, true competition is not really present in the healthcare system, because the healthcare industry does not fulfill all the criteria re needed to meet the needs of a ‘free market’. The prices of the healthcare packages under managed care and insurance services are not governed by competition, but by certain external agencies. Many of the smaller healthcare service providers are merging and providing their services under a common platform. Hence, the quality and the cost of services provide by these companies are not controlled much by competition. As the number of uninsured people is greater in the US, they may seek only emergency services. Hence most of the patients do not have knowledge of the services being provided to them. The health insurance packages in the US do not cover minor illnesses, unless subscribed by the patient. They only cover basic and routine services required by the patient.
The US healthcare system may not be totally patient friendly. Compared to other countries the US system was more effective, but the other dimensions of care such as equitability, safety, timeliness, efficiency and a user-friendly approach, was deficient. The other countries tend to spend less on healthcare compared to the US. Hence, it suggests that there is space for the US system to improve performance and quality.
References:
- A Distinctive System of Health Care Delivery. 2003. 11 Jan. 2007 http://publichealth.jbpub.com/shi/3e/samplechaps/ShiChapter1.pdf
- Davis, K., Schoen, C., Schoenbaum, S. C., Audet, A. J., Doty, M. M., Holmgren, A. L., and Kriss, J. L. “Mirror, Mirror on the Wall: An Update on the Quality of American Health Care Through the Patient’s Lens”, The Commonwealth Fund, 2006. 11 Jan. 2007 http://www.cmwf.org/publications/publications_show.htm?doc_id=364436