Essay Note Cards/Ajeetha M.
Although employer-provided health insurance is voluntary, it is encouraged by tax policy. Employer-paid contributions to employee health costs are basically a substitute for cash wages. This substitution has increased in recent years.
"A layman's guide to the U.S. health care system" www.ncbi.nlm.nih.gov
Despite these efforts, health care costs continue to escalate. The resulting pressure on public, private, and individual budgets keeps the issue of control of health care costs high on the public agenda.
"A layman's guide to the U.S. health care system" www.ncbi.nlm.nih.gov
Health services are provided by a loosely structured delivery system organized at the local level. Hospitals can open or close according to community resources, preferences, and the dictates of an open market for hospital services. Also, physicians are free to establish their practice where they choose.
"A layman's guide to the U.S. health care system" www.ncbi.nlm.nih.gov
In recent years, health reform in the United States has focused on controlling rapidly rising health costs and increasing financial access to health care. A variety of cost-control strategies have been attempted at the Federal, State, and local levels of government and by private payers.
"A layman's guide to the U.S. health care system" www.ncbi.nlm.nih.gov
Nevertheless, persons without health insurance are not entirely without health care. Although they receive fewer and less coordinated services than those with insurance, many of these "uninsured" individuals receive health care services through public clinics and hospitals, State and local health programs, or private providers who finance the care through charity and by shifting costs to other payers.
"A layman's guide to the U.S. health care system" www.ncbi.nlm.nih.gov
Prepared for a 15-nation comparative study for the Organization for Economic Cooperation and Development (OECD), the article summarizes descriptive data on the financing, utilization, access, and supply of U.S. health services; analyzes health system cost growth and trends; reviews health reforms adopted in the 1980s; and discusses proposals in the current health system reform debate.
"A layman's guide to the U.S. health care system" www.ncbi.nlm.nih.gov
The majority of those with private health insurance are covered for inpatient hospital services and physician services; the breadth and depth of coverage of other services vary.
"A layman's guide to the U.S. health care system" www.ncbi.nlm.nih.gov
There are more than 1,000 private health insurance companies providing health insurance policies with different benefit structures, premiums, and rules for paying the insured or medical care providers.
"A layman's guide to the U.S. health care system" www.ncbi.nlm.nih.gov
There is no health planning at the Federal level, and State planning efforts vary from none to stringent review of hospital and nursing home construction projects. In areas without sufficient private providers (e.g., inner cities and remote rural areas), Federal-and State-funded programs provide some primary care to populations not otherwise served by the fee-for-service (FFS) system.
"A layman's guide to the U.S. health care system" www.ncbi.nlm.nih.gov
These expenditures are financed by a complex mixture of public payers (Federal, State, and local government), as well as private insurance and individual payments: There is no single nationwide system of health insurance. The United States primarily relies on employers to voluntarily provide health insurance coverage to their employees and dependents
"A layman's guide to the U.S. health care system" www.ncbi.nlm.nih.gov
Affordable Care Act. In 2010, the passage of the Patient Protection and Affordable Care Act, or ACA, represented the largest expansion to date of the government's role in financing and regulating health care. Components of the law's major coverage expansions, implemented in 2014, included:
"International Health Care System Profiles United States" https://www.commonwealthfund.org/
Children's Health Insurance Program. In 1997, the Children's Health Insurance Program, or CHIP, was created as a public, state-administered program for children in low-income families that earn too much to qualify for Medicaid but that are unlikely to be able to afford private insurance. Today, the program covers 9.6 million children.5 In some states, it operates as an extension of Medicaid; in other states, it is a separate program.
"International Health Care System Profiles United States" https://www.commonwealthfund.org/
Employer-sponsored health insurance was introduced during the 1920s. It gained popularity after World War II when the government imposed wage controls and declared fringe benefits, such as health insurance, tax-exempt. In 2018, about 55 percent of the population was covered under employer-sponsored insurance.
"International Health Care System Profiles United States" https://www.commonwealthfund.org/
In 1965, the first public insurance programs, Medicare and Medicaid, were enacted through the Social Security Act, and others followed.Medicare. Medicare ensures a universal right to health care for persons age 65 and older. Eligible populations and the range of benefits covered have gradually expanded. In 1972, individuals under age 65 with long-term disabilities or end-stage renal disease became eligible.
"International Health Care System Profiles United States" https://www.commonwealthfund.org/
Medicaid is largely tax-funded, with federal tax revenues representing two-thirds (63%) of costs, and state and local revenues the remainder.7 The expansion of Medicaid under the ACA was fully funded by the federal government until 2017, after which the federal funding share gradually decreased to 90 percent.
"International Health Care System Profiles United States" https://www.commonwealthfund.org/
Medicaid. The Medicaid program first gave states the option to receive federal matching funding for providing health care services to low-income families, the blind, and individuals with disabilities. Coverage was gradually made mandatory for low-income pregnant women and infants, and later for children up to age 18.
"International Health Care System Profiles United States" https://www.commonwealthfund.org/
Medicare is financed through a combination of general federal taxes, a mandatory payroll tax that pays for Part A (hospital insurance), and individual premiums.
"International Health Care System Profiles United States" https://www.commonwealthfund.org/
Movement toward securing the right to health care has been incremental.
"International Health Care System Profiles United States" https://www.commonwealthfund.org/
Public and private insurers set their own benefit packages and cost-sharing structures, within federal and state regulations.
"International Health Care System Profiles United States" https://www.commonwealthfund.org/
Role of private health insurance: Spending on private health insurance accounted for one-third (34%) of total health expenditures in 2018. Private insurance is the primary health coverage for two-thirds of Americans (67%). The majority of private insurance (55%) is employer-sponsored, and a smaller share (11%) is purchased by individuals from for-profit and nonprofit carriers.
"International Health Care System Profiles United States" https://www.commonwealthfund.org/
Role of public health insurance: In 2017, public spending accounted for 45 percent of total health care spending, or approximately 8 percent of GDP. Federal spending represented 28 percent of total health care spending. Federal taxes fund public insurance programs, such as Medicare, Medicaid, CHIP, and military health insurance programs (Veteran's Health Administration, TRICARE). The Centers for Medicare and Medicaid Services is the largest governmental source of health coverage funding.
"International Health Care System Profiles United States" https://www.commonwealthfund.org/
The U.S. health system is a mix of public and private, for-profit and nonprofit insurers and health care providers.
"International Health Care System Profiles United States" https://www.commonwealthfund.org/
The federal government provides funding for the national Medicare program for adults age 65 and older and some people with disabilities as well as for various programs for veterans and low-income people, including Medicaid and the Children's Health Insurance Program. States manage and pay for aspects of local coverage and the safety net.
"International Health Care System Profiles United States" https://www.commonwealthfund.org/
Today, Medicaid covers 17.9 percent of Americans. As it is a state-administered, means-tested program, eligibility criteria vary by state. Individuals need to apply for Medicaid coverage and to re-enroll and recertify annually. As of 2019, more than two-thirds of Medicaid beneficiaries were enrolled in managed care organizations.
"International Health Care System Profiles United States" https://www.commonwealthfund.org/
Access, Quality, Cost, Equity, and Population Health are the five pillars of healthcare system.
"Overview of the American Healthcare System" https://sphweb.bumc.bu.edu/
As we move through the readings and better understand the foundations of the American health care system, we are reminded that social and institutional values and beliefs that emphasized disease more than health and prevention contributed to our astronomical costs and slowed down our progress toward attainment of a manageable and affordable system.
"Overview of the American Healthcare System" https://sphweb.bumc.bu.edu/
Explore the infograph about US Health Care Costs by reviewing "Visualizing Health Policy" from the September 2012 issue of Journal of the American Medical Association. As you read, note the following: Increase in health care spending exceeds growth of US economy Small proportion of population uses most of resources Burden of health care costs on families Health care spending per capita in US compared to other countries
"Overview of the American Healthcare System" https://sphweb.bumc.bu.edu/
If shopping were like health care, product prices would not be posted, and the price charged would vary widely within the same store, depending on the source of payment.
"Overview of the American Healthcare System" https://sphweb.bumc.bu.edu/
The United States is among the wealthiest nations in the world, but it is far from the healthiest. Although Americans' life expectancy and health have improved over the past century, these gains have lagged behind those in other high-income countries. This health disadvantage prevails even though the United States spends far more per person on health care than any other nation.
"Overview of the American Healthcare System" https://sphweb.bumc.bu.edu/
"In 2014, 283.2 million people in the U.S., 89.6 percent of the U.S. population had some type of health insurance, with 66 percent of workers covered by a private health insurance plan."
"The U.S. Health Care System: An International Perspective" https://www.dpeaflcio.org/
A multi-payer health insurance system, or all-payer system, which provides universal health insurance via "sickness funds," used to pay physicians and hospitals at uniform rates, thus eliminating the administrative costs for billing. This method is used in Germany, Japan, and France.[66]
"The U.S. Health Care System: An International Perspective" https://www.dpeaflcio.org/
A national health insurance system, or single-payer system, in which a single government entity acts as the administrator to collect all health care fees, and pay out all health care costs. Medical services are publicly financed but not publicly provided. Canada, Denmark, Taiwan, and Sweden have single-payer systems.
"The U.S. Health Care System: An International Perspective" https://www.dpeaflcio.org/
A national health service, where medical services are delivered via government-salaried physicians, in hospitals and clinics that are publicly owned and operated—financed by the government through tax payments. There are some private doctors but they have specific regulations on their medical practice and collect their fees from the government. The U.K., Spain, and New Zealand employ such a system. [65]
"The U.S. Health Care System: An International Perspective" https://www.dpeaflcio.org/
A universal mandate for health care coverage defines these systems. Such a mandate eliminates the issue of paying the higher costs of the uninsured, especially for emergency services due to lack of preventative care.[67] Other methods for reducing costs may include:
"The U.S. Health Care System: An International Perspective" https://www.dpeaflcio.org/
Another explanation for increased costs is the rise of chronic diseases, including obesity. Nationally, health care costs for chronic diseases contribute huge proportions to health care costs, particularly during end of life care.
"The U.S. Health Care System: An International Perspective" https://www.dpeaflcio.org/
By taking an international perspective and looking to other advanced industrialized countries with nearly full coverage, much can be learned. While methods range widely, other OECD countries generally have more effective and equitable health care systems that control health care costs and protect vulnerable segments of the population from falling through the cracks. Among the OECD countries and other advanced industrialized countries, there are three main types of health insurance programs:
"The U.S. Health Care System: An International Perspective" https://www.dpeaflcio.org/
Fifty-nine percent of physicians in the U.S. acknowledge their patients have difficulty paying for care.
"The U.S. Health Care System: An International Perspective" https://www.dpeaflcio.org/
Finally, high administrative costs are a contributing factor to the inflated costs of U.S. health care. The U.S. leads all other industrialized countries in the share of national health care expenditures devoted to insurance administration.
"The U.S. Health Care System: An International Perspective" https://www.dpeaflcio.org/
Funding health care costs in relation to income rather than risk or people's medical history
"The U.S. Health Care System: An International Perspective" https://www.dpeaflcio.org/
Germany has one of the most successful health care systems in the world in terms of quality and cost. Some 240 insurance providers collectively make up its public option. Together, these non-profit "sickness funds" cover 90 percent of Germans, with the majority of the remaining 10 percent, generally higher income Germans, opting to pay for private health insurance. The average per-capita health care costs for this system are less than half of the cost in the U.S.
"The U.S. Health Care System: An International Perspective" https://www.dpeaflcio.org/
In 2014, 48 percent of U.S. health care spending came from private funds, with 28 percent coming from households and 20 percent coming from private businesses. The federal government accounted for 28 percent of spending while state and local governments accounted for 17 percent.[1] Most health care, even if publicly financed, is delivered privately.
"The U.S. Health Care System: An International Perspective" https://www.dpeaflcio.org/
Negotiating the price of prescription drugs and bulk purchasing of prescription medications and durable medical equipment is a method used in other countries for lowering costs. This has been effectively used by the U.S. Department of Veterans Affairs, Medicaid, and Health Management Organizations in the U.S. Yet, it has been prohibited by law from traditional Medicare. Savings of up to five percent of total health care expenditures could result from the full adoption of these practices.
"The U.S. Health Care System: An International Perspective" https://www.dpeaflcio.org/
Of the member states, the U.S. and Mexican governments play the smallest role in overall financing of health care.[4] However, public (i.e. government) spending on health care per capita in the U.S. is greater than all other OECD countries, except Norway and the Netherlands.[5]
"The U.S. Health Care System: An International Perspective" https://www.dpeaflcio.org/
Prohibitively high cost is the primary reason Americans give for problems accessing health care. Americans with below-average incomes are much more likely than their counterparts in other countries to report not: visiting a physician when sick; getting a recommended test, treatment, or follow-up care; filling a prescription; and seeing a dentist.
"The U.S. Health Care System: An International Perspective" https://www.dpeaflcio.org/
Rather than operating a national health service, a single-payer national health insurance system, or a multi-payer universal health insurance fund, the U.S. health care system can best be described as a hybrid system.
"The U.S. Health Care System: An International Perspective" https://www.dpeaflcio.org/
The Organization for Economic Co-operation and Development (OECD) is an international forum committed to global development that brings together 34 member countries to compare and discuss government policy in order to "promote policies that will improve the economic and social well-being of people around the world."[3] The OECD countries are generally advanced or emerging economies.
"The U.S. Health Care System: An International Perspective" https://www.dpeaflcio.org/
The details of the system are instructive, as Germany does not rely on a centralized, Medicare-like health insurance plan, but rather relies on private, non-profit, or for-profit insurers that are tightly regulated to work toward socially desired ends—an option that might have more traction in the U.S. political environment.
"The U.S. Health Care System: An International Perspective" https://www.dpeaflcio.org/
U.S. health care specialists are among the best in the world. However, treatment in the U.S. is inequitable, overspecialized, and neglects primary and preventative care.[77] The end result of the U.S. approach to health care is poorer health in comparison to other advanced industrialized nations. According to the Commonwealth Fund Commission, in a 2014 comparison with Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the U.K., the U.S. ranked last overall. In terms of quality of care, the U.S. ranked fifth, but came in last place in efficiency, equity, and healthiness of citizens' lives.[78]Comparing other health care indicators in an international context underscores the dysfunction of the U.S. health care system.
"The U.S. Health Care System: An International Perspective" https://www.dpeaflcio.org/
While there is no agreement as to the single cause of rising U.S. health care costs, experts have identified three contributing factors. The first is the cost of new technologies and prescription drugs.
"The U.S. Health Care System: An International Perspective" https://www.dpeaflcio.org/
