10.1.4: Health Care in the U.S.
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Health Care in the U.S.
Healthcare in the United States is provided by separate legal entities, often private facilities with governmental insurance for citizens.
Learning Objectives
Outline the problems with American health care, primarily due to privatization
Key Points
- Healthcare facilities are largely owned and operated by the private sector.
- The United States is alone among developed nations with the notable absence of a universal healthcare system.
- Publicly-funded insurance is provided to the public through programs, such as Medicare, Medicaid, TRICARE, the Children’s Health Insurance Program, and the Veterans Health Administration.
- Active debate about healthcare reform in the United States concerns questions of a right to healthcare, access, fairness, efficiency, cost, choice, value, and quality.
- Many of the uninsured are the working poor or are unemployed. Although some are healthy and choose to go without it, others have been rejected by insurance companies and are considered “uninsurable”.
Key Terms
- the Children’s Health Insurance Program : The Children’s Health Insurance Program (CHIP) is a program administered by the United States Department of Health and Human Services that provides matching funds to states for health insurance to families with children. The program was designed to cover uninsured children in families with incomes that are modest but too high to qualify for Medicaid.
- private insurance : Private insurance refers to health insurance provided by a non-governmental organization, usually a privately owned or publicly traded corporation.
- TRICARE : is a health care program of the United States Department of Defense Military Health System. TRICARE provides civilian health benefits for military personnel, military retirees, and their dependents, including some members of the Reserve Component.
Healthcare in the United States is provided by many separate legal entities. Healthcare facilities are largely owned and operated by the private sector. Health insurance is now primarily provided by the government in the public sector, with 60-65% of healthcare provision and spending coming from programs, such as Medicare, Medicaid, TRICARE, the Children’s Health Insurance Program, and the Veterans Health Administration.
The United States is alone among developed nations with the notable absence of a universal healthcare system. Current estimates put U.S. healthcare spending at approximately 16% of GDP, second highest to East Timor (Timor-Leste) among all United Nations member nations. The U.S. system is primarily one of private insurance, with governmental insurance provided for citizens on the healthcare fringe. Insurance is provided by large-risk bearing corporate entities, which organize healthcare delivery by negotiating pricing and services with provider (physicians and hospitals) organizations. Most Americans under age 65 (59.3%) receive their health insurance coverage through an employer (which includes both private, as well as civilian public-sector employers) under group coverage, although this percentage is declining.
Debates about Healthcare in the United States
Active debate about healthcare reform in the United States concerns questions of a right to health care, access, fairness, efficiency, cost, choice, value, and quality. Some have argued that the system does not deliver equivalent value for the money spent. The United States pays twice as much, yet lags behind other wealthy nations in such measures as infant mortality and life expectancy. Currently, the United States has a higher infant mortality rate than most of the world’s industrialized nations. Around 84.7% of Americans have some form of health insurance; either through their employer or the employer of their spouse or parent (59.3%), purchased individually (8.9%), or provided by government programs (27.8%; there is some overlap in these figures).
Furthermore, the number of persons without health insurance coverage in the United States is one of the primary concerns raised by advocates of healthcare reform. According to the United States Census Bureau, in 2009, there were 50.7 million people in the United States (16.7% of the population) who were without health insurance. Some Americans who do not qualify for government-provided health insurance are not provided health insurance by an employer, and are unable to afford, cannot qualify for, or choose not to purchase private health insurance. Many of the uninsured are the working poor or are unemployed. Although some are healthy and choose to go without it, others have been rejected by insurance companies and are considered “uninsurable.”
Physicians, Nurses, and Patients
The interactions between physicians, nurses, and patients are central to healthcare.
Learning Objectives
Evaluate the importance of positive interactions between physicians, nurses and patients, in terms of satisfaction with health care services
Key Points
- Physicians in the United States include both physicians trained by medical education in the United States, and physicians that are international medical graduates who have progressed through the necessary steps to acquire a medical license to practice in a state.
- Patient’s satisfaction is favored by a good doctor-patient relationship.
- Nursing is a healthcare profession focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life.
Key Terms
- patient’s satisfaction : Patients’ satisfaction with an encounter with health care service is mainly dependent on the duration and efficiency of care, and how empathetic and communicable the health care providers are.
- doctor-patient relationship : The doctor-patient relationship is central to the practice of healthcare and is essential for the delivery of high-quality health care in the diagnosis and treatment of disease.
- medical education : Medical education is education related to the practice of being a medical practitioner, either the initial training to become a doctor (i.e., medical school and internship), additional training thereafter (e.g., residency and fellowship), or Physician Assistant education.
Physicians
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments. They may focus their practice on certain disease categories, types of patients, or methods of treatment; such physicians are known as specialist medical practitioners. They may also assume responsibility for the provision of continuing comprehensive medical care to individuals, families and communities; these physicians are known as general practitioners.
Medical practice properly requires both a detailed knowledge of the academic disciplines (such as anatomy and physiology) underlying diseases and their treatment, and also a decent competence in its applied practice. Physicians in the United States include both physicians trained by medical education in the United States, and physicians that are international medical graduates who have progressed through the necessary steps to acquire a medical license to practice in a state. The U.S. physicians are an important part of the health care in the United States. Currently, the American College of Physicians uses the term physician to describe all medical practitioners holding a professional medical degree.
Nurses
Nursing is a healthcare profession focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. There are a number of educational paths to becoming a professional nurse, which vary greatly worldwide, but all involve extensive study of nursing theory and practice, and training in clinical skills. Nursing Science is a field of knowledge based on the contributions of nursing scientists through peer-reviewed scholarly journals and evidenced-based practice. Nurses care for individuals of all ages and cultural backgrounds, who are healthy and ill, in a holistic manner based on the individual’s physical, emotional, psychological, intellectual, social, and spiritual needs. The profession combines physical science, social science, nursing theory, and technology in caring for those individuals.
Patients
A patient is any recipient of health care services. The patient is most often ill or injured and in need of treatment by a physician, advanced practice registered nurse, or other health care provider. Patients’ satisfaction with an encounter with health care service is mainly dependent on the duration and efficiency of care, and how empathetic and communicable the health care providers are. It is favored by a good doctor-patient relationship. Also, patients that are well informed of the necessary procedures in a clinical encounter, and the time it is expected to take, are generally more satisfied even if there is a longer waiting time.
Alternatives to Traditional Health Care
Alternative medicine is any practice claiming to heal “that does not fall within the realm of conventional medicine.”
Learning Objectives
Break down the various types of alternative medicine and how they fit into the health care system
Key Points
- Alternative medicine is frequently grouped with complementary medicine or integrative medicine, which, in general, refers to the same interventions when used in conjunction with mainstream techniques, under the umbrella term complementary and alternative medicine, or CAM.
- Whole medical systems cut across more than one of the other groups; examples include traditional Chinese medicine, naturopathy, homeopathy, and Ayurveda.
- Mind-body medicine takes a holistic approach to health that explores the interconnection between the mind, body, and spirit.
- Biology-based practices use substances found in nature such as herbs, foods, vitamins, and other natural substances.
- Manipulative and body-based practices feature manipulation or movement of body parts, such as is done in chiropractic and osteopathic manipulation.
- Integrative medicine is the combination of the practices and methods of alternative/complementary medicine with conventional medicine.
Key Terms
- mind-body medicine : Mind-body medicine takes a holistic approach to health that explores the interconnection between the mind, body, and spirit.
- manipulative and body-based practices : Manipulative and body-based practices feature manipulation or movement of body parts, such as is done in chiropractic and osteopathic manipulation.
- integrative medicine : Integrative medicine is the combination of the practices and methods of alternative/complementary medicine with conventional medicine. It may include preventive medicine and patient-centered medicine.
Non-Conventional and Conventional Medicine
Alternative medicine methods are diverse in their foundations and methodologies, and they may be based on historical or cultural traditions, rather than on scientific evidence. Methods may incorporate or base themselves on traditional medicine, folk knowledge, spiritual beliefs, or newly conceived approaches to healing. Alternative medicine is frequently grouped with complementary medicine or integrative medicine, which, in general, refers to the same interventions when used in conjunction with mainstream techniques, under the umbrella term complementary and alternative medicine, or CAM.
There is no clear and consistent definition for either alternative or complementary medicine. In Western culture, it is often defined as any healing practice “that does not fall within the realm of conventional medicine,” or “that which has not been shown consistently to be effective. ” There is a debate among medical researchers over whether any therapy may be properly classified as “alternative medicine. ” Some claim that there is only medicine that has been adequately tested and that which has not. They feel that healthcare practices should be classified based solely on scientific evidence.
The U.S. National Center for Complementary and Alternative Medicine (NCCAM) has developed one of the most widely used classification systems for the branches of complementary and alternative medicine. It classifies complementary and alternative therapies into five major groups, which have some overlap. Whole medical systems cut across more than one of the other groups; examples include traditional Chinese medicine, naturopathy, homeopathy, and Ayurveda. Mind-body medicine takes a holistic approach to health that explores the interconnection between the mind, body, and spirit. Biology-based practices use substances found in nature, such as herbs, foods, vitamins, and other natural substances. Manipulative and body-based practices feature manipulation or movement of body parts, such as is done in chiropractic and osteopathic manipulation.
Integrative medicine is the combination of the practices and methods of alternative/complementary medicine with conventional medicine. It may include preventive medicine and patient-centered medicine. It may also include practices not normally referred to as medicine, such as using prayer, meditation, socializing, and recreation as therapies. Its academic proponents sometimes recommend misleading patients by using known placebo treatments in order to achieve a placebo effect.
The Role of Government
Publicly funded health care is a form of healthcare financing designed to meet the cost of healthcare needs from a publicly managed fund.
Learning Objectives
Analyze the role of the government in the provision of health care
Key Points
- Most developed countries, with the exception of the United States, have partially or fully, publicly funded health systems.
- Publicly funded healthcare systems are usually financed in one of two ways: through taxation or via compulsory national health insurance.
- In compulsory insurance models, healthcare is financed from some combination of employees’ salary deductions, employers’ contributions, and possibly additional state funds. Insurance may cover other benefits, as well as health.
- When taxation is the primary means of financing healthcare, all eligible people receive the same level of cover regardless of their financial circumstances or risk factors.
- Most western industrial countries have a system of social insurance based on the principle of social solidarity covers eligible people from bearing the direct burden of most healthcare expenditure, funded by taxation during their working life.
- A range of measures, such as better payment methods, has improved the microeconomic incentives facing healthcare providers.
Key Terms
- social solidarity : Most western industrial countries have a system of social insurance based on the principle of social solidarity covers eligible people from bearing the direct burden of most healthcare expenditure, funded by taxation during their working life.
- compulsory insurance models : In compulsory insurance models, healthcare is financed from some combination of employees’ salary deductions, employers’ contributions, and possibly additional state funds. Insurance may cover other benefits as well as health.
- Publicly funded health care : Publicly funded healthcare is a form of healthcare financing designed to meet the cost of all or most healthcare needs from a publicly managed fund.
Government and Healthcare
Publicly funded health care is a form of healthcare financing designed to meet the cost of all or most healthcare needs from a publicly managed fund. The fund may be a not-for-profit trust, which pays out for health care according to common rules established by the members or by some other democratic form. In some countries, the fund is controlled directly by the government or by an agency of the government for the benefit of the entire population. This distinguishes it from other forms of private medical insurance. In the private model, the rights of access are subject to contractual obligations between an insurer and an insurance company. The latter seeks to make a profit by managing the flow of funds between funders and providers of health care services.
Publicly funded healthcare systems are usually financed in one of two ways: through taxation or via compulsory national health insurance. In compulsory insurance models, healthcare is financed from some combination of employees’ salary deductions, employers’ contributions, and possibly additional state funds. Insurance may cover other benefits as well as health. When taxation is the primary means of financing healthcare, all eligible people receive the same level of cover regardless of their financial circumstances or risk factors.
Most developed countries, with the exception of the United States, have partially or fully publicly funded health systems. Most western industrial countries have a system of social insurance based on the principle of social solidarity covers eligible people from bearing the direct burden of most healthcare expenditure, funded by taxation during their working life. Many OECD countries have implemented reforms to achieve policy goals of ensuring access to healthcare, improving the quality of healthcare and health outcomes, allocating an appropriate level of public sector other resources to healthcare, while at the same time ensuring that services are provided in a cost-efficient and cost-effective manner (microeconomic efficiency). A range of measures, such as better payment methods, has improved the microeconomic incentives facing providers. However, introducing improved incentives through a more competitive environment among providers and insurers has proved difficult.
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