Healthcare in the United States is provided by many different organizations. Health care facilities are mostly owned and operated by private sector businesses. 58% of US community hospitals are non-profit, 21% government-owned, and 21% for profit. According to the World Health Organization (WHO), the United States spends more on per capita health care ($ 9,403), and more on health care as a percentage of GDP (17.1%), compared to other countries in 2014. between the world's top economic powers, the US remains the only industrial country in the world without universal health care coverage.
By 2013, 64% of health spending is paid by the government, and is funded through programs such as Medicare, Medicaid, Children's Health Insurance Program, and Veterans Health Administration. People under the age of 67 obtain insurance through their employer or family members, by purchasing their own health insurance, or not having insurance. Health insurance for public sector employees is primarily provided by the government in its role as an employer.
The life expectancy of the United States is 78.6 years at birth, up from 75.2 years in 1990; this ranks 42th among 224 countries, and 22 of 35 industrialized OECD countries, down from 20 in 1990. In 2016 and 2017, life expectancy in the US fell for the first time since 1993. Of the 17 high-income countries studied by the National Institutes of Health, the United States in 2013 has the highest or closest obesity prevalence, car accidents, infant mortality, heart and lung disease, sexually transmitted infections, teenage pregnancies, injuries, and homicides. On average, US men can be expected to live almost four years less than in top-ranked countries; although in particular, 75-year-old Americans live longer than those who reach that age in other developed countries. A 2014 survey of health care systems from 11 developed countries found that the US health care system became the most expensive and the worst performing in terms of access, efficiency, and equity of health.
Costly fees are the main reason Americans have trouble accessing health care. Gallup consulting firm notes that the uninsured rate among US adults is 11.9% for the first quarter of 2015, continuing to decrease interest rates that are not insured by the Patient Protection and Affordable Care Act (PPACA). At more than 27 million, higher than the entire population of Australia, the number of people who do not have health insurance in the United States is one of the main concerns raised by health care reform advocates. The lack of health insurance is associated with an increase in mortality, about sixty thousand preventable deaths per year, depending on the research. A study conducted at Harvard Medical School with the Cambridge Health Alliance showed that nearly 45,000 annual deaths were associated with a lack of patient health insurance. The study also found that Americans who do not have insurance and work have a 40% higher risk of death compared to American workers who are uninsured personally.
In 2010, Patient Protection and the Affordable Care Act (PPACA) became law, enacting major changes in health insurance. Under the law, major hospitals and physicians will change their practices financially, technically and clinically to encourage better health outcomes, lower costs, and improve their distribution and accessibility methods. The Supreme Court upheld the constitutionality of most laws in June 2012 and affirmed the insurance exchange subsidies in all states by June 2015.
Video Health care in the United States
History
Maps Health care in the United States
Statistics
Hospitalization and health insurance
A study by the Healthcare Research and Quality Agency (AHRQ) found that there were 38.6 million permanent hospitals in the US in 2011, up 11% since 1997. As the population also grew, hospitalization remained stable at around 1,200 per 10,000 population during this period. Information from 2012 indicates that there is a slight decrease in fixed hospitals compared to 2011, 36.5 million. Hospitals remain in 2011 an average of 4.5 days and are calculated to cost an average of $ 10,400 per stay.
A study by the National Institutes of Health reported that lifetime expenditure per capita at birth, using 2000 dollars, showed a big difference between women's health care costs ($ 361,192) and men ($ 268,679). Most of these cost differences are in short-term men, but even after adjustment for age (assuming men live as long as women), there is still a 20% difference in lifetime healthcare costs.
The US Census Bureau reported that 49.9 million people, 16.3% of the population, were not insured in 2010 (up from 49.0 million inhabitants and 16.1% of the population in 2009). A 2009 study in five states found that medical debt accounted for 46.2% of all personal bankruptcies, and 62.1% of bankruptcy filers claimed high medical costs in 2007. Since then, healthcare costs and the number of uninsured and underprivileged patients insurance has increased. A 2013 study found that about 25% of all senior citizens declare bankruptcy due to medical expenses.
US. health care and expenses
World Health Organization (WHO), in 2000, ranked the US health care system as the highest in cost, first in responsiveness, 37 in overall performance, and 72 by overall health level (among 191 member states included in this study). In 2008, the Commonwealth Fund, an advocacy group seeking greater government involvement in US health care, led by former Carter Administration official Karen Davis, rated the United States the last in health care quality among similar countries, and noted that the cost of US care is greatest.
According to WHO, the United States spends more on per capita health care ($ 9990), and more on health care as a percentage of GDP (17.8%), compared to other countries in 2008. In 2013, the US spent 17, 1% of total GDP for health care, 50% greater than France's second highest spending country (11.6%). In 2014, the US spends $ 2.6 trillion (5.0% increase from 2013) on personal healthcare spending, by 2015 the US spending $ 3.2 trillion of about 17.8%. Per capita spending is $ 8,054 in 2014 - up from $ 7,727 in 2013. In 2011, the US paid almost twice as many Canadians lagging behind other rich countries in sizes such as infant mortality and life expectancy. In 2009, the US had a higher infant mortality rate than most industrialized countries in the world. Diseases such as Diabetes and heart disease are among the most expensive conditions to treat due to their chronic nature, and eat about 85% of health care costs. This condition has increased recently and is one of the factors that led to an increase in health care spending.
Health care debates
The active debate on health care reform in the United States involves the question of the right to health care, access, justice, efficiency, cost, choice, value, and quality. Some argue that the system does not provide an equivalent value for the money spent. According to the 2004 Institute of Medicine (IOM) report: "The United States is one of the few industrialized nations in the world that does not guarantee access to health care for its population." The OECD report 2004 says: "With the exception of Mexico, Turkey and the United States, all OECD countries have achieved universal or nearly universal coverage (at least 98.4% of the coverage) of their populations in 1990." The IOM 2004 report also observes that "a lack of health insurance causes approximately 18,000 unnecessary deaths annually in the United States," while a 2009 Harvard study conducted by the Doctors founder for the National Health Program, a pro-single payer advocacy group, estimates that 44,800 deaths occurred every year due to lack of health insurance. The group's methodology has been criticized by economist John C. Goodman for not seeing the cause of death or tracking changes in insurance status from time to time, including death. Furthermore, a 2009 study by former Clinton policy advisor Richard Kronick found no mortality due to uninsured after certain risk factors were controlled and specifically criticized the methodology used by IOM.
Between 2004 and 2013, the trend of high levels of underinsurance and wage stagnation contributed to lower consumption of health services for low-income Americans. This trend is reversed after the implementation of the main provisions of the Affordable Care Act (ACA) in 2014. Lack of insurance or higher cost sharing (user fees for patients with insurance) creates barriers to accessing health care: the use of care decreases by increasing liabilities cost sharing of patients. Before the ACA was enacted in 2014, 39% of below-average reported earnings Americans no longer visit doctors for medical problems (whereas 7% of low-income residents in Canada and 1% of low-income UK residents report the same). Forgetting medical care because of the large cost sharing can ultimately increase costs due to downstream medical issues; this dynamic can play a role in the US international rank as having the highest healthcare expenditure despite significant patient cost sharing.
By 2017, the possibility that ACA may be revoked or replaced has raised interest in the question of whether and how health insurance coverage affects health and death. Several studies have shown that there is a relationship with the expansion of ACA and factors associated with better health outcomes such as having regular source of care and ability to pay for treatment. A 2016 study concluded that approximately 60% improvement in the ability to pay for care can be attributed to the provisions of Medicaid expansion that are enacted by the Patient Protection and Affordable Care Act. In addition, an analysis of post mortality change Medicaid expansion suggests that Medicaid saves lives at a relatively more cost-effective rate of social cost of $ 327,000-867,000 per life-saving compared to other public policies that cost an average of $ 7.6 million per life.
Health in the US in a global context
The United States is within the American Territory or AMRO (World Health Organization classification). In AMRO, the US has the third lowest mortality rate (U5MR) by 2015. By 2015, the under-five mortality rate is 6.5 deaths per 1000 live births, less than half the regional average by 14.7. The US has the second lowest maternal mortality rate in AMRO, 14 per 100,000 live births, well below the regional average of 52. The life expectancy at birth for children born in the US by 2015 is 81.2 (women) or 76.3 ( male) years, compared with 79.9 (female) or 74 (male) years (estimated AMRO area). Globally, the average life expectancy is 73.8 for women and 69.1 for men born in 2015.
The 2015 global average for underfive mortality is 42.5 per 1000 live births. Underfive under-five mortality rate is 6.5 times more than 6 times less. The 2015 global average for maternal deaths is 216, an average of 14 maternal deaths in the United States 100,000 live births are over 15 times less, but Canada has half as many (7) and Finland, Greece, Iceland and Poland respectively only has 3. Although not as high as in 2015 (14) as in 2013 (18.5), maternal deaths associated with labor have shown recent improvement; in 1987, the mortality ratio was 7.2 per 100,000. By 2015, the American rate is twice the maternal mortality rate in Belgium or Canada, and more than triple the rate in Finland as well as some other Western European countries.
According to the World Health Organization, life expectancy in the US is 31 in the world (out of 183 countries) by 2015. The average life expectancy of the US (both sexes) is over 79. Japan ranks first with an average life expectancy of nearly 84 years. Sierra Leone ranks last in life expectancy of more than 50 years. However, the US is ranked lower (36) when considering health-adjusted life expectancy (HALE) in over 69 years. Another source, the Central Intelligence Agency, showed that life expectancy at birth in the US was 79.8, ranked 42 US in the world. Monaco was the first on this 224 list, with an average life expectancy of 89.5. Last Chad with 50.2.
The Aa 2013 National Research Council study states that, when considered as one of 17 high-income countries, the United States is at or near the peak in infant mortality, heart and lung disease, sexually transmitted infections, teenage pregnancies, injuries, and disability rates. Together, such problems put the US at the bottom of the list for life expectancy in high-income countries. In 2007, US men could be expected to live nearly four years less than in Switzerland, and US women could be expected to live more than 5 years less than women in Japan. Women born in the US by 2015 have a life expectancy of 81.6 years, and men are 76.9 years old; more than 3 years less and more than 5 years less than people born in Switzerland (85.3 F, 81.3 M) or Japan (86.8 F, 80.5 M) by 2015.
Cause of death in US.
The three leading causes of death among both sexes and all ages in the US consistently remained cardiovascular disease (rank 1), neoplasms (2) and neurological disorders (3), since the 1990s. Lower chronic respiratory diseases. [53] By 2015, the total number of deaths from heart disease is 633,842, by cancer is 595,930, and from chronic lower respiratory disease 155,041. By 2015, 267.18 per 100,000 deaths are caused by cardiovascular disease, 204.63 by neoplasms and 100.66 by neurological disorders. Diarrhea, lower respiratory tract infections and other common infections are ranked sixth overall, but have the highest infectious disease mortality rate in the US at 31.65 deaths per 100,000. There is evidence, however, that most health outcomes and early deaths can be attributed to factors other than infectious or non-communicable diseases. As a study of the National Research Council of 2013 concluded, more than half of men who died before 50 died of murder (19%), traffic accidents (18%), and other accidents (16%). For women, the percentage is different. 53% of women who died before 50 died of illness, while 38% died from accidents, murders, and suicide.
Provider
Healthcare providers in the US include individual health care personnel, health care facilities, and medical products.
Facilities
In the US, ownership of health care systems is primarily in private hands, although federal, state, county, and municipal governments also have certain facilities.
By 2018, there are 5,534 registered hospitals in the United States. There are 4,840 community hospitals, defined as non-delivery, short-term, or special public hospitals. Non-profit hospitals share total hospital capacity remained relatively stable (around 70%) for decades. There are also private profit and income hospitals as well as government hospitals in several locations, mainly owned by district and city governments. The Hill-Burton Act was passed in 1946, which provides federal funds for hospitals in exchange for care for poor patients.
There is no national system of government-owned medical facilities open to the general public but there are local government-owned medical facilities that are open to the general public. The US Department of Defense operates field hospitals as well as permanent hospitals through the Military Health System to provide military-funded care to active military personnel.
The federal Veterans Health Administration operates VA hospitals open only to veterans, although veterans seeking medical care for conditions they do not receive while serving in the military are charged for services. The Indian Health Service (IHS) operates an open facility only for Native Americans of a recognized tribe. These facilities, plus IHS-funded private tribal facilities and services to enhance the capacity and capabilities of the system, provide medical care for tribes beyond what can be paid by personal insurance or other government programs.
The hospital provides outpatient care in emergency rooms and special clinics, but is primarily available to provide inpatient care. Emergency departments of hospitals and urgent care centers are a source of care that focuses on sporadic problems. Surgicenters are an example of a specialized clinic. Hospital services for severely ill people estimated to live six months or less are generally subsidized by charities and government. Prenatal, family planning, and dysplasia clinics are government-funded obstetric and gynecological specialty clinics, and are usually administered by nurse practitioners. Services, particularly urgent care services, can also be remotely telemedicine by service providers such as Teladoc.
In addition to government and private health care facilities, there are also 355 free clinics registered in the United States that provide limited medical services. They are considered part of a social safety net for those who do not have health insurance. Their services can range from more acute care (ie STD, injury, respiratory disease) to long-term care (ie dentistry, counseling). Another component of the health safety net is a federally funded public health center.
Doctors (MD and DO)
Doctors in the US include those trained by the US medical education system, and those who are international medical graduates who have progressed through the steps required to obtain a medical license to practice in the state. This includes through the three steps of Medical License Exam (USMLE). The first step of USMLE examines whether medical students understand and are able to apply scientific scientific basis for medicine after the second year of medical school. Topics include: anatomy, biochemistry, microbiology, pathology, pharmacology, physiology, behavioral science, nutrition, genetics, and aging. Step 2 is designed to test whether medical students can apply their medical skills and knowledge to actual clinical practice during the fourth year of medical school. Step 3 is performed after the first year of residency. It tests whether students can apply medical knowledge to unchecked medical practice.
The American College of Physicians, uses the term doctor to describe all medical practitioners who hold a professional medical degree. In the US, most doctors have a Doctor of Medicine (M.D.) degree. Those with Doctor of Osteopathic Medicine (D.O.) received similar training and underwent the same MLE steps as MD and were also allowed to use a "doctor" degree.
Medical, research and development products
As in most other countries, the manufacture and production of medicines and medical equipment is done by private companies. Research and development of medical and pharmaceutical equipment is supported by public and private funding sources. In 2003, research and development spending of approximately $ 95 billion with $ 40 billion came from public sources and $ 55 billion came from private sources. This investment in medical research has made the United States a leader in medical innovation, as measured by the revenue or the number of new drugs and devices introduced. By 2016, research and development spending by pharmaceutical companies in the US is estimated at about 59 billion dollars. In 2006, the United States accounted for three quarters of world biotechnology revenues and 82% of the world's R & D spending in biotechnology. According to some international pharmaceutical trade groups, the high price of patent drugs in the US has prompted substantial reinvestment in such research and development. Although PPACA, also known as Obamacare or ACA, will force the industry to sell drugs at cheaper prices. Because of this, perhaps budget cuts will be made on research and development of human health and drugs in America.
Healthcare provider workers in the United States
A major demographic shift in the United States puts pressure on the medical system because "baby boomers" reach retirement age. The demographic shift to the older population is projected to increase medical expenditure in North America by at least 5%, creating funding challenges that governments (through medical and other social services), insurance companies, and individual savings accounts will be hard to absorb. Health care spending for people over 45 is 8.3 times greater than those under 45. Finally, the older population is rapidly increasing the demand for health services despite tight budgets and reduced workforce. All of these factors put pressure on wages and working conditions, with the majority of health care jobs looking at salary reductions between 2009 and 2011.
Alternative medicine
Beyond the standard health care system, more and more people are looking for alternative treatment options. This treatment is defined as a therapy that is generally not taught in medical schools or is not available in hospitals. They include herbs, massage, energy healing, homeopathy, and more. A national survey found that from 1990 to 1997, the use of at least one alternative therapy has increased from 33.8% to 42.1%. More recent studies suggest that about 40% of adults in 2007 used some form of Alternative and Complementary Medicine in the past year. Their reasons for seeking this alternative approach include improving their well-being, engaging in transformational experience, gaining more control over their own health, or finding better ways to relieve symptoms caused by chronic illness. They aim to treat not only physical ailments but improve the underlying nutritional, social, emotional, and spiritual causes. Most users pay for this service outside the pocket, because insurance tends to provide some or even do not cover most services. Total pocket costs in 1997 were estimated at approximately $ 27.0 billion.
Expenditure
The cost of aggregate US hospitals was $ 387.3 billion in 2011 - a 63% increase since 1997 (adjusted for inflation). Cost per stay increased 47% since 1997, averaging $ 10,000 in 2011.
According to the World Health Organization (WHO), total health care spending in the US is 18% of GDP in 2011, the highest in the world. The Department of Health and Human Services expects that the share of GDP health will continue its historical trend, reaching 19% of GDP by 2017. Of every dollar spent on health care in the United States, 31% go to hospital care, 21% for doctors/clinical services , 10% for drugs, 4% for teeth, 6% for nursing homes and 3% for home health care, 3% for other retail products, 3% for government public health activities, 7% for administrative costs, 7% for investment, and 6% for other professional services (physical therapist, optometrist, etc.).
In 2007, about 85% of Americans had some form of health insurance; either through their employer or the employer of their spouse or parent (59%), individually purchased (9%), or provided by the government program (28%, there is some overlap in these figures).
Among those whose employers are paying for health insurance, the employee may be required to donate some of these insurance costs, while the employer usually chooses an insurance company and, for large groups, negotiates with an insurance company. Direct government programs cover 28% of the population (83 million), including the elderly, the disabled, children, veterans and some poor people, and federal law mandates public access to emergency services regardless of ability to pay. Public spending accounts for between 45% and 56% of US health care spending.
Health care administration accounts for 30 percent of US health care costs.
Rules and supervision
The organizations and institutions involved
Health care is subject to broad legislation at both the federal and state levels, many of which are "arbitrary". Under this system, the federal government handed primary responsibility to the state under the McCarran-Ferguson Act. Important regulations include state-level healthcare provider licensing and testing and approval of medicines and medical equipment by the US Food and Drug Administration (FDA), and laboratory testing. These regulations are designed to protect consumers from ineffective health or fraud. In addition, the state regulates the health insurance market and they often have laws that require health insurance companies to cover certain procedures, even though the state mandate in general does not apply to self-financed healthcare plans offered by large employers, who are exempt from state-invited under the preemption clause of the Employees Retirement Income Law.
In 2010, the Patient Protection and Affordable Care Act (PPACA) was signed by President Barack Obama and includes new regulations, with one of the most important being the health insurance mandate which requires all citizens to purchase health insurance. Although there are no regulations per se, the federal government also has a major influence on the healthcare market through its payments to providers under Medicare and Medicaid, which in some cases are used as reference points in negotiations between medical providers and insurance companies.
At the federal level, the US Department of Health and Human Services oversees the various federal agencies involved in health care. The health agency is part of the US Public Health Service, and includes the Food and Drug Administration, which certifies the safety of food, the effectiveness of medicines and medical products, the Centers for Disease Prevention, which prevent illness, premature death and disability. , The Agency for Healthcare Research and Quality, the Agency for Toxic Substances and the Disease Registry, which regulates dangerous spills from toxic substances, and the National Institutes of Health, which conducts medical research.
State governments maintain state health departments, and local governments (districts and municipalities) often have their own health departments, usually branches of state health departments. State council regulations may have executive and police powers to enforce state health laws. In some states, all members of the state council must become health care professionals. Members of the state council may be assigned by the governor or elected by the state committee. Local council members may be elected by the mayor's council. The McCarran-Ferguson Act, which rules out regulation to the states, does not regulate insurance, nor does it mandate that the state organize insurance. "Acts of Congress" that are not explicitly meant to regulate the "insurance business" will not precede state laws or regulations governing the "insurance business". The law also stipulates that federal anti-trust laws will not apply to "insurance businesses" as long as the state regulates in the region, but federal anti-trust laws will apply in cases of boycotts, coercion, and intimidation. In contrast, most other federal laws will not apply to insurance whether the state regulates in that area or not.
The self-policing of the provider by the provider is a major part of the oversight. Many health care organizations are also voluntarily subject to inspection and certification by the Joint Commission Accreditation Organization Hospital, JCAHO. The providers also undergo testing to obtain board certification that proves their skills. A report released by Public Citizen in April 2008 found that, for the third year in a row, the number of serious disciplinary measures against doctors by the state medical board declined from 2006 to 2007, and called for more oversight of the council.
The federal center for Medicare and Medicaid Services (CMS) publishes an online performance data search database at home care.
In 2004, the libertarian think tank, the Cato Institute, published a study that concluded that regulation benefits $ 170 billion but costs the public up to $ 340 billion. The study concludes that most of the cost differences arise from medical malpractice, FDA regulations, and facility regulations.
"Certificate of need" for the hospital
In 1978, the federal government required all countries to apply the Certificate of Needs (CON) program for cardiac care, which meant that hospitals had to file and receive certificates prior to implementing the program; the goal is to reduce costs by reducing the double investment in the facility. It has been observed that this certificate can be used to increase costs through weakened competition. Many countries abolished the CON program after the federal requirements expired in 1986, but some states still have this program. Empirical studies that look at costs in areas where these programs are stopped do not find a clear effect on costs, and the CON program can lower costs due to the construction of reduced facilities or increased costs due to reduced competition.
Provider license
The American Medical Association (AMA) has lobbied the government for severely limiting physician education since 1910, currently at 100,000 doctors per year, which has led to a shortage of doctors and the salary of doctors in the US is doubling in Europe, the main reason for health care more expensive.
The bigger problem may be that doctors are paid for the procedure, not the result.
The AMA is also aggressively lobbying for many restrictions that require doctors to perform operations that might be performed by cheaper labor. For example, in 1995, 36 countries prohibited or restricted obstetrics despite providing equally safe care by doctors. AMA's lobbying rules have lowered the number and quality of health care, according to economists' consensus: restrictions do not add to the quality, they lower the supply of care. In addition, psychologists, nurses and pharmacists are not allowed to prescribe drugs. Previously nurses were not even allowed to vaccinate patients without direct supervision by a doctor.
36 countries require health care workers to undergo a criminal background check.
Emergency Medical Treatment and Active Employment Act (EMTALA)
EMTALA, authorized by the federal government in 1986, requires the hospital emergency department to deal with all patients' emergency conditions regardless of their ability to pay and is considered an important element in the "safety net" for the uninsured, but does not establish a direct payment mechanism for such treatment. Indirect payments and reimbursement of costs through federal and state government programs never provide full compensation for public and private hospitals for the full maintenance cost mandated by EMTALA. More than half of all emergency care in the US is now not compensated. According to some analyzes, EMTALA is an unfunded mandate that has contributed to financial pressures on hospitals in the last 20 years, causing them to consolidate and close facilities, and contribute to emergency room density. According to the Institute of Medicine, between 1993 and 2003, emergency room visits in the US grew by 26%, while in the same period, the number of emergency departments decreased by 425.
The mentally ill patients present unique challenges to emergency departments and hospitals. In accordance with EMTALA, psychiatric patients entering the emergency room are evaluated for emergency medical conditions. Once the patient is mentally ill mentally stable, the regional mental health agency is contacted to evaluate it. Patients are evaluated whether they endanger themselves or others. Those who meet these criteria are treated in mental health facilities for further evaluation by psychiatrists. Usually, the mentally ill patient can be detained for up to 72 hours, after which a court order is required.
Quality assurance
Health care quality assurance consists of "activities and programs intended to ensure or improve the quality of care in either prescribed medical settings or programs.These concepts include assessment or evaluation of the quality of care, identification of problems or deficiencies in delivery of care, designing activities to address these deficiencies , and follow-up monitoring to ensure the effectiveness of improvement measures. "Private companies like Grand Rounds also release quality information and offer services to companies and plan to map the quality in their networks.
One of the innovations in promoting the quality of health care is the public reporting on the performance of hospitals, professionals or health care providers, and health care organizations. However, there is "no consistent evidence that public releases of performance data change consumer behavior or improve care."
The overall system effectiveness
Measures of effectiveness
US unparalleled health care delivery systems provide quality medical care for residents. In a highly effective health care system, individuals will receive reliable care that meets their needs and is based on the best available scientific knowledge. To monitor and evaluate system effectiveness, researchers and policy makers track the size of systems and trends over time. The US Department of Health and Human Services (HHS) fills a publicly available dashboard called the Health Systems Measurement Project (healthmeasures.aspe.hhs.gov), to ensure a robust monitoring system. Dashboard captures access, quality, and maintenance costs; the health of the population as a whole; and the dynamics of the health system (eg, labor, innovation, health information technology). Includes steps parallel to other system performance measurement activities including HHS Strategic Plan, Government Performance and Results Act, Healthy Person 2020, and National Strategy for Quality and Prevention.
Access to care: cost, affordability, coverage
The US health system does not provide health care to the entire population of the country. Individuals get health insurance to offset health care expenses. However, a lack of adequate health insurance persists and is a known barrier to accessing health care systems and receiving timely and appropriate care. Measures of accessibility and affordability tracked by national health surveys include: having a regular source of medical care, visiting dentists annually, preventable hospitalization rates, reporting difficulty seeing specialists, delaying treatment due to costs, and health insurance coverage rates.
- As a country, the rising cost of health care has raised concerns among the public and private sectors. Between 2000 and 2011, health care spending nearly doubled, growing from $ 1.2 trillion to $ 2.3 trillion [CDC Health, USA, 2013]. Evidence suggests the rate of growth has slowed in recent years. Other measures of costs captured by the national survey include: health insurance premiums, high pocket costs (eg, deductibles, copayments), and national health expenditures including individual, employer and government expenditures.
Population health: quality, prevention, vulnerable population
Population health is also seen as a measure of the overall effectiveness of the health care system. The extent to which the population lives a healthier live an effective system signal.
- While life expectancy is one measure, HHS uses combined health measures which predict not only the average length of life, but also, the expected part of life expectancy becomes "in health good or better, and free from activity restrictions. "Between 1997 and 2010, the number of years of high-quality life is expected to increase from 61.1 to 63.2 years for newborns.
- Lack of preventive measures, preventable disease rates and the prevalence of chronic diseases suggests that the US health system is not sufficiently improving health. Over the past decade teenage pregnancy rates and low birth rates have dropped significantly, but have not disappeared. Obesity rates, heart disease (high blood pressure, high cholesterol controlled), and type 2 diabetes are the areas of major concern. While chronic diseases and some comorbidities are becoming increasingly common among a population of elderly Americans living longer, the public health system also finds itself fending off the emergence of chronically ill young people. According to the US Surgeon General "The prevalence of obesity in the US more than doubled (from 15% to 34%) among adults and more than tripled (from 5% to 17%) among children and adolescents from 1980 until 2008. "/li>
- The concern for the health system is that health benefits do not increase equally for the entire population. In the United States, disparities in health care and health outcomes are widespread. Minorities are more likely to suffer from serious illnesses (eg, type 2 diabetes, heart disease and colon cancer) and are less likely to have access to quality health care, including preventive services. Efforts are being made to close the gap and to provide a fairer care system.
Innovation: manpower, health care, R & amp; D
Finally, the United States tracks investments in the health care system in terms of skilled health care workers, the use of meaningful IT health, and R & D outputs. D. Aspects of dash performance of this health care system are important to consider when evaluating the cost of care in America. That's because in many policy debates about the high costs of US health, highly sophisticated technological advocates are showing innovation as a marker of an effective health care system.
Compared to other countries
A 2014 study by the American private foundation The Commonwealth Fund found that although the US health care system is the most expensive in the world, it ranks last in most performance dimensions when compared to Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway , Sweden, Switzerland and the UK. The study found that the United States failed to achieve better results than any other country, and last or last in terms of access, efficiency and equity. The study dates from an international survey of patients and primary care physicians, as well as information on health care outcomes from The Commonwealth Fund, World Health Organization, and the Organization for Economic Cooperation and Development.
The US is ranked 50th in the world with a life expectancy of 78.49. CIA World Factbook ranking the 174 worst United States (out of 222) - which means 48 best - in the world for infant mortality rate (5.98/1,000 live births). Americans also undergo cancer screening at a significantly higher rate than people in other developed countries, and access MRI and CT scans at the highest level of any OECD country.
One study found that between 1997 and 2003, preventable deaths declined more slowly in the United States than in 18 other industrialized countries. A 2008 study found that 101,000 people a year died in the US that would not be if the health care system was as effective as France, Japan, or Australia.
The Organization for Economic Cooperation and Development (OECD) found that the US ranks poorly in terms of years of potential life loss (YPLL), a statistical measure of years of life lost under the age of 70 that are willing to be saved by health. Among OECD countries where data are available, the United States ranks third for women's health care (after Mexico and Hungary) and the last fifth for men (Slovakia and Poland also rank worse).
Recent studies have found a growth gap in life expectancy based on income and geography. In 2008, a government sponsored study found that life expectancy declined from 1983 to 1999 for women in 180 districts, and for men in 11 districts, with most of the decline in life expectancy occurring in Deep South, Appalachia, along the Mississippi River, at Southern Plains and in Texas. The difference is as high as three years for men, six years for women. The gap grows between rich and poor and with educational levels, but narrows between men and women and by race. Another study found that the educated and low educated mortality gap expanded significantly between 1993 and 2001 for adults aged 25 to 64 years; the authors speculate that risk factors such as smoking, obesity and high blood pressure may be behind this difference. In 2011, the US National Research Council estimated that deaths attributed to smoking, to a decrease in the US, would drop dramatically, increasing life expectancy; it also shows that one-fifth to one-third of life expectancy differences can be attributed to obesity which is the worst in the world and has increased. In the analysis of breast cancer, colorectal cancer, and prostate cancer diagnosed during 1990-1994 in 31 countries, the US had the highest relative five-year survival rates for breast cancer and prostate cancer, although survival was systematic and much lower in the US black. man and woman.
The debate about US health care concerns the question of access, efficiency, and quality purchased by the large amount spent. The World Health Organization (WHO) in 2000 ranked the first US health care system in response, but 37 in overall performance and 72 by overall health level (among 191 member states included in the study). The WHO study has been criticized by free market advocate David Gratzer because "fairness in financial contributions" is used as a valuation factor, marking countries with private health care or paying high per capita costs. The WHO study has been criticized, in an article published in Health Affairs , due to its failure to include public satisfaction ratings. The study found that there is little correlation between WHO ratings for health systems and satisfaction that citizens declared using the system. Countries like Italy and Spain, ranked highest by WHO are ranked poorly by their citizens while other countries, such as Denmark and Finland, are scored low by WHO but have the highest percentage of citizens who report satisfaction with health care their system. WHO staff, however, say that the WHO analysis does reflect a "responsive" system and argues that this is a superior measure for consumer satisfaction, which is influenced by expectations. Furthermore, the relationship between patient satisfaction and utilization of health care, spending, and outcomes is complex and not well defined.
A report released in April 2008 by the Child Development Foundation, which studied the period from 1994 to 2006, found mixed results for the health of children at US death rates for children aged 1 to 4 fell by one-third, and the percentage of children with blood lead levels rising by 84%. The percentage of mothers who smoked during pregnancy also declined. On the other hand, both obesity and the percentage of low birthweight babies increase. The authors note that an increase in infants born with low birth weight can be attributed to women who delayed birth and increased use of fertility drugs.
In a sample of 13 US developed countries was the third in the weighted drug-usage population in 14 classes in 2009 and 2013. The drugs studied were selected on the basis that the condition being treated has a high incidence, prevalence and/or death, due to significant long-term morbidity and excretion high levels of spending and significant developments in prevention or treatment have been conducted in the last 10 years. The study noted considerable difficulties in cross-border comparison of drug use.
System efficiency and equity
Variations in the efficiency of health care delivery can lead to variations in results. The Dartmouth Atlas Project, for example, reports that, for over 20 years, a clear variation in how medical resources are distributed and used in the United States is accompanied by clear variations in results. Doctors' willingness to work in the region varies with regional income and the facilities it offers, the situation is aggravated by the shortage of GPs in the United States, especially those who offer primary care. The Affordable Care Act, if implemented, will result in additional demand for services that primary care physicians can not meet, especially in economically depressed areas. Additional doctor training will take several years.
Lean manufacturing techniques such as value stream mapping can help identify and then reduce waste associated with health care costs. Other product engineering tools such as FMEA and the Fish Bone Diagram have been used to improve efficiency in health care delivery.
Efficiency
Preventable death
In 2010, coronary artery disease, lung cancer, stroke, chronic obstructive pulmonary disease, and traffic accidents caused most of the years of life lost in the US. Lower back pain, depression, musculoskeletal disorders, neck pain, and anxiety cause most of the year to disappear due to disability. The most damaging risk factors are poor diet, tobacco smoking, obesity, high blood pressure, high blood sugar, physical activity, and alcohol use. Alzheimer's disease, substance abuse, kidney and cancer diseases, and falls cause the most extra years of life to disappear above the 1990 levels per capita that is adjusted for their age.
Between 1990 and 2010, among 34 countries in the OECD, the US fell from 18 to 27 in the standard age mortality. The US fell from 23 to 28 for the age of the lost age standard. Decrease from 20 to 27 in life expectancy at birth. Decrease from 14 to 26 for healthy life expectancy.
According to a 2009 study conducted at Harvard Medical School by the founders of the Physicians for the National Health Program, a pro-single paying lobbies group, and published by the American Journal of Public Health, the lack of coverage coverage was associated with nearly 45,000 deaths can be prevented every year. Since then, since the uninsured amount has increased from about 46 million in 2009 to 49 million in 2012, the number of preventable deaths due to lack of insurance has risen to about 48,000 per year. The group's methodology has been criticized by economist John C. Goodman for not seeing the cause of death or tracking changes in insurance status from time to time, including death.
A 2009 study by former Clinton policy advisor Richard Kronick published in the journal Health Services Research found no mortality increase due to uninsured after certain risk factors were controlled.
Value for money
A study of international health care spending rates published in the Healthcare Policy journal Health Affairs in 2000 found that the United States spends more on health care than any other country in the Organization for Economic Cooperation and Development (OECD) and that the use of health care services in the US is below the OECD median by most measures. The study authors concluded that the price paid for health care services is much higher in the US than elsewhere. While the next 19 richest countries based on GDP all pay less than half of what the US does for health care, they all earn about six years life expectancy over the US since 1970.
Suspension in seeking care and increased use of emergency care
Uninsured Americans are less likely to get regular health care and use prevention services. They are more likely to delay seeking treatment, resulting in more medical crises, which are more expensive than ongoing treatments for conditions such as diabetes and high blood pressure. A 2007 study published in JAMA concluded that an uninsured person is less likely than the insured to receive medical treatment after an accidental injury or a new chronic condition. Those who are not insured with injuries are also twice as likely because those who have insurance do not receive the recommended follow-up care, and similar patterns are performed for those with new chronic conditions. Uninsured patients are twice as likely to visit the hospital emergency room as those who have insurance; burdening systems intended for true emergencies with less urgent care needs.
In 2008, researchers from the American Cancer Society found that people who did not have personal insurance (including those covered by Medicaid) were more likely to be diagnosed with end-stage cancer than those who had such insurance.
The cost of uninsured care should often be absorbed by the service provider as a charity treatment, passed on to the insured through the transfer of fees and higher health insurance premiums, or paid by taxpayers through higher taxes. However, hospitals and other providers will be paid back for the cost of providing care without compensation through the federal counterpart program. Each country enacts laws governing reimbursement of funds to providers. In Missouri, for example, provider valuations of $ 800 million are matched - $ 2 for each $ 1 assessment - to make up about $ 2 billion. Under federal law, these funds are transferred to the Missouri Hospital Association to be disbursed to the hospital for expenses incurred by providing unattended treatment including Inappropriate Stock Payments (to hospitals with large numbers of uninsured patients), Medicaid Shortfalls, Medicaid managing maintenance payments for insurance companies and other expenses incurred by the hospital. In New Hampshire, under the law, maintenance costs that are not compensated for damages should include: the cost of charity care, any part of the Medicaid patient's medical expenses not paid by Medicaid payments, and any part of the cost of bad debt determined by the responsible person will meet the criteria under 42. USC Section 1396r-4 (g) sets the hospital-specific limits on disproportionate share hospital payments under Title XIX of the Social Security Act.
A report published by the Kaiser Family Foundation in April 2008 found that the economic downturn puts significant strain on the country's Medicaid and SCHIP programs. The authors estimate that a 1% increase in the unemployment rate will increase Medicaid and SCHIP registration by 1 million, and increase the uninsured amount by 1.1 million. State spending on Medicaid and SCHIP will increase by $ 1.4 billion (total spending on these programs will increase by $ 3.4 billion). This increase in spending will occur at the same time as government revenues decrease. During the last recession, Jobs and the Growth Tax Relief Reconciliation Act of 2003 (JGTRRA) included federal assistance to the state, which helped countries avoid the tightening of Medicaid and SCHIP eligibility rules. The authors conclude that Congress should consider similar assistance for the current economic downturn.
Variations in provider practices
The care provided to patients can vary significantly depending on the health care provider they use. Research shows that some cost-effective treatments are not used as often as they should, while overutilization occurs with other health care services. Unnecessary care increases the cost and can cause patients not to worry. The use of prescription drugs varies significantly based on geographic area. Excessive use of medical benefits is known as moral hazard - the insured individual is then more likely to consume health care. The way health care systems try to eliminate this problem is through cost-sharing tactics like co-pay and deductibles. If patients face more economic burden then they will only consume health care when they feel the need. According to RAND health insurance experiments, individuals with higher Coinsurance levels consume less health care than those with lower rates. The experiment concludes that with little care consumption there is generally no loss in social prosperity but, for a group of poor and sick people there must be a negative effect. These patients are forced to abort the necessary preventative care measures to save money leading to a late diagnosis of easily treated diseases and a more costly procedure later on. With fewer preventive treatments, patients are financially wounded by an increase in expensive visits to the ER. Health Care Costs in the US will also increase with this procedure as well. More expensive procedures result in greater costs.
One study has found significant geographic variation in Medicare spending for patients in the last two years of life. This level of expenditure is related to the amount of hospital capacity available in each region. Higher spending does not result in patients living longer.
Care coordination
Primary care physicians are often the entry point for most patients in need of care, but in a fragmented health care system in the US, many patients and their service providers experience problems with care coordination. For example, Harris Interactive's survey of California doctors found that:
- Four out of every ten doctors report that their patients have problems with their care coordination in the last 12 months.
- More than 60% of doctors report that their patients "sometimes" or "frequently" have long waiting times for diagnostic tests.
- About 20% of doctors report their patients repeat the test because of the inability to find results during the scheduled visit.
According to an article in the New York Times, the relationship between doctors and patients worsens. A study from Johns Hopkins University found that roughly one in four patients believe their doctors have exposed them to unnecessary risks, and anecdotal evidence such as self-help books and web posts indicates an increase in patient frustration. Possible factors behind a deteriorating doctor/patient relationship include the current system for training doctors and differences in how doctors and patients view medical practice. Doctors may focus on diagnosis and treatment, while patients may be more interested in health and listen to their doctors.
Many primary care physicians no longer see their patients when they are in hospital; instead, hospitals are used. The use of hospitalists is sometimes mandated by health insurance companies as a cost saving measure that is disliked by some primary care physicians.
Administration fees
The health care system in the US has a large number of players. There are hundreds, if not thousands, of insurance companies in the US. This system has a considerable administrative overhead, much larger than a single nationalized paying system, such as Canada. A study frequently quoted by Harvard Medical School and the Canadian Institute for Health Information provides that about 31% of US health care dollars, or more than $ 1,000 per person per year, go to health care administration costs, almost double the cost of administration in Canada. , by percentage.
According to the American Health Insurance industry insurance group, the administrative costs for private health insurance plans have averaged about 12% of the premium over the past 40 years. There was a shift in the type and distribution of administrative costs during the period. The costs of prosecuting claims have fallen, while insurance companies have spent more on other administrative activities, such as medical management, nursing assistance lines, and discounted fee negotiations with healthcare providers.
A 2003 study published by Blue Cross and Blue Shield Association (BCBSA) also found that health insurance administration costs were about 11% to 12% of the premium, with Blue Cross and Blue Shield planning to report slightly lower administrative costs, on average , rather than commercial insurance companies. For the period 1998 to 2003, the average cost of insurance administration decreased from 13% to 12% of the premium. The largest increase in administrative costs was in customer service and information technology, and the biggest decline was in service providers and contracts and in general administration. The McKinsey Global Institute estimates that excessive spending on "administration and health insurance" accounts for 21% of total over-estimated spending ($ 477 billion in 2003).
According to a report published by CBO in 2008, administr fees
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