Healthcare in the USA
The obvious drawback of the US healthcare system is the lack of free medical care, but the average price of insurance per year is around $1,000, which is quite acceptable for the majority of the employed population.
The United States is the only industrialized nation that does not guarantee its citizens a universal and comprehensive health insurance system.
Health system structure
Responsibility for national health rests with the US Department of Health and Human Services, led by a secretary (minister) who reports directly to the president. The ministry includes 10 official representatives in the regions (directors). It should be noted that the Department of Health plays a very modest role due to the small share of government participation in the industry. The main tasks are control over the medical system and the implementation of social programs, control over medical science, monitoring and reporting to the authorities the situation in the field of health, welfare and social security of the population. The following departments within the Ministry are directly solving the problems of medicine – the Public Health Service and the Office for the Financing of Medical Assistance. In addition to the Ministry of Health, some of the functions in the field of health are carried out by special units of the Ministry of Labor, the Environmental Protection Agency and other government departments.
US medicine operates at the following levels:
- family medicine – doctors conduct a general examination of patients, referring them, if necessary, to a narrower specialist;
- hospital care occupies a central place in the medical system, although in recent years its importance has been reduced and replaced by the activities of
- clinics, ambulances and nursing homes. Hospitals are divided into commercial and non-profit;
The health care system consists of numerous services that vary in type of funding and function, including:
- Services of public health and preventive medicine – they are engaged in the prevention of diseases, the monitoring of the ecological state, quality control of food, water, air, etc.;
- Outpatient non-emergency services;
- Simple inpatient care – specializes in short-term hospitalization;
- Sophisticated inpatient care – the provision of long-term, highly qualified and technically sophisticated inpatient care.
The US health care system is pluralistic, resulting in a lack of a single centralized management and numerous types of medical facilities. But absolutely all institutions provide medical services exclusively for a fee. For a number of categories of citizens that are treated free of charge, the costs are compensated by the state or special funds.
Hospitals in America are divided into three types:
- State – funding is provided by the federal and state governments. They provide services for veterans, the disabled, civil servants, patients with tuberculosis and mental illness;
- Private profitable (commercial) (up to 30% of all hospitals) – a typical business enterprise, forming its capital on an individual, group and joint-stock basis;
- Private “nonprofit” – created on the initiative of religious or ethnic groups or local residents, they account for up to 70% of the total final fund. The main difference from the previous type is that the income received does not go to shareholders in the form of dividends, but is invested in a hospital, which improves the quality of service, technical equipment, etc.
The state supports such activities in the form of preferential taxation. Despite the institution’s “nonprofit” status, treatment, like in a commercial hospital, remains paid. The popularity of this hospital status can be explained by the desire to avoid paying taxes.
The US government provides two special programs for the needy citizens of the country – Medicaid and Medicare.
- Medicaid, designed to help people with low incomes, is funded by both the federal and state governments;
- Medicare aims to help people over 65, as well as pre-retirement citizens who have health problems. The sources of financing are: payroll tax, progressive income tax and corporate income tax.
Tricare provides insurance for veterans and their families.
There is no compulsory health insurance in the United States. The costs of medicine are borne by each individual person. It should be noted that insurance does not cover everything, but only a clearly limited list of medical services.
This does not include, for example, the services of a dentist, ophthalmologist, pediatrician or psychiatrist, etc. All-inclusive insurance can be afforded only to very wealthy people. As a result, a serious injury or illness can severely undermine the family budget – medical bills cause half of the bankruptcy of individuals in the United States.
Insurance usually covers the cost of drugs, most of which are only available on prescription.
Most large companies provide insurance for their employees, although this is not necessary for the employer.
In many organizations, you can take out collective insurance for several people. This type of insurance, as a rule, is cheaper than individual. However, in the event of a serious illness of one of the members of the labor collective, the cost of the total insurance price for the next year may increase, which may cause hostility towards people of pre-retirement age or people with disabilities.
There are two types of insurance provided by the employer:
- “Service fee”: payment of money for actually provided services; usually the insurance company reimburses 80% of the costs, the rest fall on the shoulders of the patient;
- “Managed services”: payment of a fixed amount for each insured, excluding additional services.
In the case of a “service fee”, the employer is interested in lowering medical costs, for which purpose special management organizations are involved, collaborating with several providers of medical services, thereby reducing their cost. Before going to a specialist, the patient is examined by a general practitioner. If it becomes possible to prescribe an expensive treatment, it is necessary to obtain the conclusion of another specialist.
The high cost of medical care pushes many Americans to go abroad for treatment in “cheaper” countries (the so-called “medical tourism”) – most often to Canada, England, Italy, the Caribbean and Cuba.
US Health Care Reform
US health care reform was initiated by US President Barack Obama, who took office in 2009. This is the first attempt to reform the US medical system since the 1960s.
Over the past 30 years, America has disproportionately increased health care spending, although there were no objective reasons for improving the quality of services.
The insurance market provided by employers is extremely monopolized, which impedes labor mobility and creates conditions for discrimination of patients both before and after the conclusion of an insurance contract, including in the form of denial of payments. The ever-increasing cost of Medicare and Medicaid is one of the reasons behind the prohibitive US budget deficit.
The authors of the reform aimed at creating a universal system of medical support, which is designed to cover 50 million currently uninsured citizens. The reform is designed to improve the conditions of medical insurance for citizens who already have a policy. Exchanges for insurers will be created, thanks to which it will be possible to obtain a policy for those who could not get insurance from the employer. For insurance premiums, in this case a “ceiling” will be set at 3-9.5% of the client’s income. Private insurance companies will be denied the right to refuse insurance for sick people. Citizens will be able to purchase insurance without the assistance of employers in specially created centers for this. There will be an administrative liability for those who refuse to purchase and companies that refuse to sell the policy. Starting in 2014, such fines for citizens will amount to $95 or 1% of income and gradually increase to $695 or 2% of income. The supply system for senior citizens with essential medicines will be improved.
On January 13, 2017, 6 days before the inauguration of Republican Donald Trump, the U.S. House of Representatives voted in favor of a resolution that would initiate the process of canceling Obamacare.