Universal Health Care System

The adoption of a universal health care system in United States is one of the major issues surrounding the health policy arena. Findings show that U. S. is the only industrialized country which does not have a health care service accessible to all its citizens. This research paper shows the current health care system in the United States as well as data from the Organisation for Economic Co-operation and Development (OECD) on the health indicators that assess the health care systems of the countries especially the developed ones.

It also highlights the single-payer and the multi-payer systems which are important schemes linked to universal health care and also the economic and cultural dimensions of the health policy. This paper shows the health reforms that were introduced in the Clinton administration which pertains to having a universal health care scheme. It also describes the role of nursing in enhancing the quality of health care in the United States. II. THE UNIVERSAL HEALTH CARE The Universal Health Care is a system which provides health care services on all citizens.

Kao-Ping Chua (2008) defines universal health care as a “basic guarantee of health care to all of its citizens” (p. 1). This program implies that the health care access is a basic right of every citizen in a country where it is applied. This system values equality among the citizens in accessing health services despite of income. The ability of a citizen to pay is not the measurement for the quality of health care in a universal health care system. One main feature of the universal health care is providing health insurance to all citizens.

Erin Ruth (2006) mentions the two (2) significant functions of health insurance: (1) health insurance protects the insured against high costs of health care, and (2) health insurance also assists in providing subsidies for the health care cost of the sick. Single-Payer and Multi-payer System The health care system is subdivided into two other systems based on the provider and financer of health care. These are the single payer system and the multi-payer system. Single-payer system according to John Battista, M. D. (1999) is financed by the public through government taxation. The health care insurance system is also administered publicly.

On the other hand, the multi-payer system as described by Battista (1999) is a system in which health care access is provided and financed by public and private institutions. Countries with single payer and universal health care systems are the industrialized countries in the world with the exception of Germany and United States. (Battista, 1999) Sussane Grosse-Tebbe and Josep Figueras (2004) cite that United Kingdom, Sweden, Italy, France, and Denmark have both universal health care and single-payer systems. On the other hand, Germany uses a multi-payer system accompanied by its universal health care program.

The United States uses a multi-payer system but the coverage is not universal. (Battista, 1999) Public and Private Expenditures Ashley McDougall et al. (2003) illustrated the data gathered from the Organisation for Economic Co-operation and Development (OECD) in 2002 regarding the total expenditure on health care as a percentage of Gross Domestic Product (GDP) for 10 countries . As seen in Figure 1, the health care expenditures as proportioned to GDP are varied from 7. 3 (Japan) and 13 (United States). These figures have an average of 8. 9 percent as shown in the graph by the blue horizontal line.

United Kingdom is the lowest among its European counterparts but according to the British government, government spending on health care will increase to 9. 4 approximately in 2008. It also shows that public expenditures (light colored bars) are dominant in the nine comparator countries with Sweden having the largest public health care spending of 84 percent followed by United Kingdom with 81 percent. United States is the only country in the graph with the lowest public spending on health care with 45 percent. (McDougall et al. , 2003) Figure 1 (Health Care Expenditures as proportioned to GDP) III.

HEALTH CARE SYSTEM IN THE UNITED STATES Chua (2006) describes the dominance of private health care providers from the public health care. As shown in Figure 2, 62 percent of the nonelderly Americans have health insurances sponsored by private employers. 15 percent of the nonelderly American population is insured via public insurance programs like Medicaid while the other 18 percent are uninsured. Other public insurance program is Medicare which provides access to health care for elderly people aged 65 years and above. Ruth (2006) describes the private health insurance from the employer sponsored and the private non-group.

This health insurance has two types: (1) “self-funded employee benefit plans, and state-licensed health providing organizations” (p. 2). The self-funded employee benefit plans are provided by the employers who pay directly all health care costs of their employees and contract with an administrator for the management of health plan. The state-licensed health providing organizations are of four (4) types: (1) commercial health insurers, (2) blue cross/blue shield, (3) Health Maintenance Organizations (HMOs), and (4) Blended Health Maintenance Organizations.

These differ in the “freedom of provider choice by enrollees, the method of provider reimbursement, and the cost of premiums. ” (Ruth, 2006, p. 2) Figure 2 (Health Insurance Coverage of the Nonelderly Population, 2003) The financing of health care in U. S. according to Chua (2006) is centered on two flows of money: (1) one is the collection of money for health care or the money going in, and (2) the other is the reimbursement of health service providers for health care or the money going out.

In a multi-payer system like in United States, the responsibility of financing health care rests on both the government and the private insurance companies. Figure 3 illustrates the inflow of money from the private institutions to the government through taxes and premiums, and the outflow of money from the government through the health service providers through provider payments and Medicare, Medicaid, etc. (Chua, 2006) Figure 3 (Flow of Money in the U. S. Health Care System) Need for Universal Health Care Scheme

Chua (2008) reports that United States experienced a severe increase in health care costs. In the past five years, health insurance premiums in United States have increased by double-digit percentages or 2-3 times its rate of inflation. This resulted to the rise in number of Americans who have no health insurances (reaching 45 million excluding the millions who are underinsured ). The middle-class American citizens are also affected by the rising health care cost which is manifested by the drop in the percentage of employers offering health insurance from 69 percent in 2000 to 60 percent in 2005.

Chua (2008) notes that the employers who provide health insurance benefits are not coping up with the high health costs. This is the reason why most of the middle-class, employed Americans have limited access or no access to health care. (Chua, 2008) John Battista and Justine McCabe (1999) present the perceived reasons why the United States does not have universal health care as a right of citizenship. First, the United States is regarded to have the best health care system in the world.

However, their findings on life expectancy (see Figure 4) and infant mortality (see Figure 5) , as illustrated by McDougall et al. (2003) suggest that United States is lagging behind the other industrialize nations when it comes to health care despite the best trained health care professionals it has. As shown by the two charts, United States ranks 10th on life expectancy on both male and female and has the highest infant mortality ratio of around 9 deaths per 1000 live births as compared to the other nine countries.

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