The U.S Health Care System: System Outcomes, Essay Example

The U.S health care system provides treatment, prevention management of illnesses and the care of patients through the services offered by the nursing, medical and allied health professionals. The health care system consists of the providers (physicians and hospitals), payers (patients and insurers, both private and public) and regulators (state government and federal agencies). The U.S health care system has though been faced by challenges since the start of the 21^st century. Among these challenges, according to (Kao 2006), is the attacking of the rising costs of the health care system due to increased demand for health services and the improvement of the health care quality. Health care reforms has been an agenda for most the U.S political parties in their preparation for both the presidential and congressional elections. For instance, in 2006, the then president George Bush W. had featured the reforms as a priority in his agenda during the State of the Union address.

In the 1930s through early1980s, there were different sources that financed the U.S health care system unlike the “single-payer” system in other nations. The indemnity based system of both the public and the private insurance were responsible for medical expense of an individual. In the mid 1980s, a managed care system emerged in responding to the significant increases in the cost. The managed care system involved the use of organizations to act as insurers of groups of individuals. The organizations made contracts with specific providers in order to have control on the health care expenditures and the quality of health care. Most of the commercial health care insurance in 1990s was provided through this managed care system.

The managed care was divided into three main categories (Boimex 2007): Preferred Provider Organizations (PPOs), Health Maintenance Organizations (HMOs) and Point of Service (POS) system. In HMO, the insurer owned the organizations which delivered care. The PPOs were a network of health care providers who offered the insurer’s clients with services at reduced costs. The POS’s plans were to allow members to choose services from a network provider with a financial dispencentive since they went outside the network.

Through these plans, the employers subsidized the commercial health care costs by insuring their employees. For example, in 2004, the U.S businesses paid $6280 for an employee in his health care. Consequently, the increasing cost was shifted to the employees by the co-payments, deductibles and higher premiums for the employees. This employer based system left many people without health insurance. Being poor and due to the sharing of a household with a fully employed person who was ineligible made many to be uninsured. Though being uninsured didn’t automatically leave a person out of the care. They used such options of federal programs and emergence room.

In 2003, the federal government founded most of the hospitals. These hospitals were owned by local government of which some were regarded as nonfederal which were open to the public. Of these community hospitals most of them were non-profit with the others being profit making.  In addition to these hospitals, there were more nursing homes with employed nurses and medical officers.

There was therefore growing of high costs of the health care system with complexity of care processes. In the U.S health care, expenditures grew from $250 billion in 1980 to $1.4 trillion in 2003 with no sign of slowing. The health care spending was expected to rise to 17% of GDP in the U.S in 2011 with the expansion of Medicare drug coverage, reaching $9216 per capita (Emoly 2008). According to the PricewaterhouseCooper, the healthcare expenditure of the U.S was expected to top the Organization for Economic Cooperation and Development (OECD) to $10 trillion. It therefore rendered U.S as the highest among the OECD countries in spending for health care.

Nearly 34% of the $1.9 trillion spent on the U.S health care went to hospital care and 10% for prescription drugs in 2004. This expenditure was twice that of 1994. The movement to managed care in the 1980s and 1990s reduced the rate of cost increase with no additional savings (Mongan 2004). The health care cost was identified as the first priority for the U.S government by a survey study conducted by the Kaiser Family Foundation in December 2005. They found that health care access and insurance expenditure increased by 74.3% from 1994 to 2004 and that the costs rose at a triple rate of inflation from 2001 to 2006. The U.S employers paid $9950 and $3695 for family and individual health insurance coverage respectively with employees contributing a third of these costs, reduced competitiveness in accordance to obligations of some. The General Motors Health care obligations added about $1500 to the price of each vehicle they sold.

In the recent, any employer of the Maryland state with more than 10000 employees had to spend 8 % of the payroll on health care or paid the state. Most of the Americans at this time depended Marjory on employers for coverage. The Medicare trust fund was expected to be bankrupt by 2019 since the cost increase had strained the U.S government’s Medicare and medical budget.

The ground demand for health care and the rise of incidences of chronic diseases due to changes in demography and lifestyle has predominantly contributed to the increase of these health care expenditures. The aging population as life expectancy increased from 71 to 77 years, led to decrease in retirement age from 65 to 62. A retiree lived another 20 years with a high need of expensive and frequent health care services. This demographic bulge which was referred to as a baby boom generation resulted in doubling of population of the next thirty years (i.e. from 40m in 2005 to 80m). Lower expected mortality rates would lead to a larger elderly population which would increase in chronic diseases such as cancer, asthma and diabetes. The number of such people with chronic diseases is expected to increase to 134 million by 2020.

According to Boimex (2007), the increased costs are also as a result of complexity in the care given through the increase in the new specialists, medical knowledge and devices. In 1995 there were increased publications per year by the Medline database. In terms of organizations, the medical work became complex than before so as to coordinate diverse and bigger teams for treating patients. More health care providers and specialists were needed for cardiac interventions. There was also a need of integrating the health care system.

During the 2008 campaigns, the U.S the presidential candidates talked earnestly about covering 47 million uninsured individuals though there was a little of how to control rising costs of health care. A discussion therefore arose on how to implement a bigger policy of insuring the uninsured in a health care coverage design. It is a big challenge to lower the costs of health care at once since it is a longer term issue. As far much the political spin may underline the issue of uninsured, it doesn’t mean that the health care costs will ran reduce by having a health insurance. Most of the politician’s posture on the health care topic as to get elected though according to the panelists of 2008, there are no major changes in this health care system can be realized soon.

The Blue Shield and Blue Cross of Massachusetts plans to overhaul the way in which doctors and health care providers are paid i.e. these would like to pay hospitals and doctors a flat sum and bonuses to improve care by the providers rather than paying for each patient’s treatment. This although brings a fear that more problems may be created similar to those of managed care. If these efforts cut down the health care costs then other states may follow the suit.

Minnesota on the other hand has made efforts in trying to cut the health care cost and shift to quality outcomes. Its targets are that the health care providers must ensure that different measures are made available for the public online. They also form a Health Care Transformation Task in 2007 to assist in governing different activities so as to transform the health care systems. Panelists argue that there will be difficulties in providing information that regards to the quality despite the fact that the increased information may result in the improvement of efficiency. They also point out that the issue of health care costs does not correlate to the outcomes. They argued that, “Hospitals that treat patients more intensively and spend more Medicare dollars did not get better results.” and that “greater use of resources is, if anything, associated with worse outcomes, poorer quality and lower satisfaction with care.” (Emoly2008).

The health care system has therefore not developed an effective and efficient way of caring the individuals with chronic diseases who accounts 75% of all health care expenses in the U.S. Regardless on when and what changes are made, the U.S government should understand that the current health care system comprises of many different moving parts including both the health care quality and reduction in the rising costs in the health care system.

References

Boimex R. (2007). [Review of the book The Challenge Facing the U.S Health Care Delivery System]. Choice, 32(6), 145.

Emoly K. (2008). [Review of the book The Complex U.S Health Care System’s Challenges].Choice, 3, 26.

Kao P. (2006). Overview of the U.S Health Care System. Boston, MA: Allyn and Bacon

Mongan J. (2004). [Review of the book Transformation of U.S Health Care]. Choice, 2(3), 32.