Health system in U.S.A

Supervised by :Prof. Madi Aljagbeer

Submitted by:Mohammad Al-

Khateeb

Faculty Of MedicineFamily And Community Medicine Department

Outlines

IntroductionHealth care system overviewFinancingHealth System Reform in the united states

IntroductionThe United States is located on the North American continent in the Western Hemisphere. The contiguous 48 states that exclude Alaska and Hawaii are bordered by the Atlantic and Pacific Oceans on the east and west, respectively, by Canada on the north and by Mexico and the Gulf of Mexico on the south.

The country is highly varied in topography and climate, with regions well below sea level to mountains above 6100 m (20 000 ft) and average annual temperatures ranging from a high of 26°C (78°F) to a low of -13°C (9°F) in a part of Alaska and -3°C (27°F) in the contiguous states. Similarly, precipitation ranges from a desert climate to tropical rainforest.

The capital of the united state is Washington, D.C.

population317 million people, (2014) according to U.S. Census Bureau estimates. 

Median age total: 37.2 years male: 35.9 years female: 38.5 years (2013 est.)

ethnicityAmerican;, Hispanic Asian Amerindian native Hawaiian or pacific islander

languageEnglish (82%)Spanish (11%)Others(7%)

literacy99 %

Demographic Data

Gross national income per capita (PPP international $, 2012)52,610

Life expectancy at birth m/f (years, 2012)76/81

Probability of dying under five (per 1000 live births, 2012)7

Probability of dying between 15 and 60 years m/f (per 1 000 population, 2012)

130/77

Total expenditure on health as % of GDP (2012)17.9

Infant mortality rate (2012)5.98 deaths/1,000 live births

Maternal mortality rate (2012)28deaths/100,000 live births

Physicians Density24.2 physicians/10,000 population (2009)

Hospital bed density3 beds/1,000 population (2010)

General health profile

Health care system overview

The current American health care system consists of many types of privately and publicly funded health insurance plans, all of which offer various types of health care services. According to the New England Journal of Medicine, based on The World Health Report 2000, Health Systems: Improving Performance, the U.S. health care system was ranked 37 in the world.

Advantages:

1)The U.S. has one of the best medical research systems in the world.  Researchers from famous institutions like Harvard Medical School, the Cleveland Clinic and the Mayo Clinic are known all over the world for the advances that they are currently making in the world of medicine. 

2)For those who have jobs with great benefits or those who can afford it, some American insurance plans are some of the best in the world.

3) Another advantage of the current American health care system is that the taxpayers do not have to pay for the expense that is associated with providing medical care to the millions of people that need it. It seems that people in the US enjoy the fact that they do not have to pay for other people to benefit and will only have to pay if they fall victim to some kind of problem themselves. 

Disadvatages

1)One of the biggest disadvantages of the current American health care system is that people spend much more in the U.S. for health care, but Americans are not healthier than other nations that spend much less. The amount of money spent on health care in America is staggering. The U.S. spends more of its total GDP (gross domestic product) on health care than any country in the world.

2)A major disadvantage of the American health care system is the fact that many individuals are uninsured. 18 percent were without health insurance.

Health insurance coverage

Employer-sponsoredPrivate Inidividual

Medicaid/ OtherPublicUninsured

62%

5%

15%

18%

Uninsuredomany of Americans have probably experienced being uninsured argue that American health system is among the best in the world, especially in terms of the technology available and the advances made, and that having an uninsured population is the price we pay for such a system. oHowever, it is safe to say that most Americans see uninsurance as an injustice and recognize that reform is necessary to ensure coverage for all.

oSince 1 out of 6 Americans are uninsured, many of Americans have probably experienced being uninsured or have known people who have not had health insurance.

Employer-sponsored Insurance Offered by employers as part of benefits

package Administered by private insurance companies

(for-profit and non-profit) Employer pays bulk of premium & employee

pays remainder Erosion of employer-sponsored insurance in

recent years

Individual Insurance Purchased directly by people who do not get

coverage through their employers Non-group (individual) plans Premiums based on individual health risk More expensive per person compared to

employer-sponsored insurance

Medicare Covers the elderly (ages 65 and older)

and non-elderly with disabilities Administered by the federal government

(single-payer system) Financed through:

Federal income taxes Payroll taxes on employers and employees Out-of-pocket payments by enrollees

Medicare Four parts:

Part A – Hospital insurance Part B – Supplemental insurance Part C – Managed care Part D – Prescription drugs

Significant coverage gaps - most enrollees obtain supplemental, private insurance

Growth in the aging population and increased technology presents challenges for the future

Medicaid Covers certain low-income individuals

(pregnant, children, elderly, disabled) Not every poor person is covered! Administered by state governments Financed jointly by the state and federal

governments Benefits are fairly comprehensive, but many

providers won’t take care of Medicaid patients Low reimbursement rates

State Children’s Health Insurance Program (S-CHIP) The program was designed to cover uninsured

children in families with incomes that are modest but too high to qualify for Medicaid

Administered and financed similarly to Medicaid Similar problems to Medicaid:

Low reimbursement rates → some providers refuse to accept S-CHIP

Eligibility varies by specific populations and states

Other Public Insurance Programs

Veterans Health Administration Health benefits plan available to all veterans Services delivered through VA health care

facilities Financed by the federal government

Native American Indian Health Service

Financing

The financing of health care centers around two streams of money: the collection of money for health care (money going in), and the reimbursement of health service providers for health care (money going out). In the United States, the responsibility for these two functions is shared by private insurance companies as well as the government, both of which are known in policy terms as “payers.” As such, the United States can be thought of as a “multi-payer” system.

•Individuals and businesses

o Taxes: Both individuals and businesses pay income taxes to the government. In addition, there is a payroll tax on employers and employees to finance Medicare.

o Premiums: Businesses pay all or most of the premium for employer-based insurance for employees, and employees pay the remainder. Employer-based insurance premiums and individual insurance premiums are collected by private insurers .

o Direct or out-of-pocket payments: This is a direct payment to a provider for health care services (e.g. a co-payment) .

•Government

o Medicare, Medicaid, S-CHIP, and the VA: The government uses money generated from taxes to reimburse providers who take care of patients enrolled in these programs .

o Public employees’ premiums: The government also uses tax dollars to pay private insurers a health insurance premium for federal employees and other public employees .

•Private insurers o Private insurers accept premiums from individuals, businesses, and the government. In turn, they reimburse providers for taking care of patients with private insurance.

• Health service providers

o Providers (doctors, hospitals, and other health care facilities) take care of individuals. They are reimbursed for their services by

private insurers and the government .

Health System Reform

In March 2010, the United States enacted major health-care reform. The ACA expands coverage to the majority of uninsured Americans, through:

)1 (subsidies aimed at lower-income individuals and families to purchase coverage

)2 (a mandate that most Americans obtain insurance or face a penalty

)3 (a requirement that firms with over 50 employees offer coverage or pay penalty

)4 (a major expansion of Medicaid

)5 (regulating health insurers by requiring that they provide and maintain coverage to all applicants and not charge more for those with a history of illness, non-discrimination for pre-existing conditions, and conforming to a specified benefits package. Most of the major provisions are scheduled to go into effect in 2014.

For further information go to reference number one pages number 31 & 32

References1. Rice T, Rosenau P, Unruh LY, Barnes AJ, Saltman RB,

van Ginneken E. United States of America: Health system review. Health Systems in Transition, 2013; 15(3): 1– 431.

2. www.who.int3. Overview of the U.S. Health Care System, Written by

Kao-Ping Chua AMSA Jack Rutledge Fellow 2005-2006 February 10, 2006 .

4. http://www.ehow.com/list_5903455_advantages-disadvantages-american-health-care.html

5. Overview of the U.S. Health Care System, OU Pre-med Club/AMSA September 27, 2006 .

6. www.indexmundi.com