Care System WRC

The American Health Care System: International Perspective of Development

As a basis: Project for the implementation of German technology in the field of health with the involvement of specialists from Korea or Japan.

 


This table is about the beginning of common methods of development, is attributable, in part, to the high cost of health care in the U.S. Indeed, the U.S. spends considerably more on health care than any other – OECD country.

The Organization for Economic Co-operation and Development (OECD) is an international forum directional at global development that brings together 34 member countries to compare and discuss government policy in order to “promote policies that will improve the economic and social well-being of people around the world.” The OECD countries are advanced or emerging economies. Of the member states, the U.S. and Mexican governments play the smallest role in- overall financing of health care. However, public (government) spending on health care per capita in the U.S. is greater than all other OECD countries, except- Norway and the Netherlands.

The OECD found- in 2013, the U.S. spent $8,713 per person or 16.4 percent of its GDP on health care—far higher than the OECD average of 8.9 percent per person. Following the U.S. were the Netherlands, which allocated 11.1 percent of its GDP, then Switzerland also at 11.1 percent, and Sweden, which allocated 11 percent of its GDP to health care in 2013. In North America. Canada and Mexico spent respectively 10.2 percent and 6.2 percent of their GDP on health care. On a per capita basis, the U.S.- spends more than double the $3,453 average of all OECD countries.

The U.S., health care system is unique among advanced industrialized countries. The U.S. does not have a uniform health system, has no universal health care coverage, and recently enacted legislation mandating healthcare coverage for almost everyone. Rather than operational a national health service, a single-payer national health insurance system, or a multi-payer universal health insurance fund, the U.S. health care system can best be described as a- hybrid system.

In 2014, 283.2 million people in the U.S., 89.6 percent of the U.S. population had some type of health insurance, 66 percent of workers covered by a private health insurance plan. Among the insured, 115.4 million people, 36.5 percent of the population, received coverage through the U.S., government in 2014 through Medicare (50.5 million), Medicaid (61.65 million), and/or Veterans Administration or other- military care (14.14 million) (people may be covered by more than one government plan). In 2014, 32.9 million people in the U.S. had no health insurance.

This fact sheet compare the U.S. health care system to other advanced industrialized nations, with a focus on the problems of high health care costs and disparities in insurance coverage in the U.S., It will then outline some common methods used in other countries to lower health care costs, examine the German health care system as a model for non-centralized universal care Considering the participation of specialists and technologies from Korea or Japan, and put the quality of U.S. health care in an international context.

Visible spending on health care in the US

Prohibitively higher cost is the primary reason Americans give for problems accessing health care. Americans below-average incomes are much more likely than their counterparts in other countries to report not: visiting a physician when sick. receiving a recommended test, treatment, or follow-up care; filling a prescription; and seeing a dentist. Fifty-nine percent of physicians in the U.S. acknowledge their patients have hardship paying for care. In 2013, 31 percent of uninsured adults reported not getting or delaying medical care because of costs, compared to five percent of privately insured adults and 27 percent of those on public insurance, including- Medicaid/CHIP and Medicare.

While there is no agreement as to the single cause of rising U.S. health care costs, experts have identified three contributing factors.

The first is the cost of new technologies and prescription drugs. Analysts have argued “that the availability of more expensive, state-of-the-art medical technologies and drugs fuels health care spending for development cost and because they generate demand for more intense, costly services actually if they are not necessarily cost-effective.” In 2013, the U.S. spent $1,026 per capita on pharmaceuticals and other ephemeral medical care, more than double the OECD average of $515.

Second explanation for increased costs is the rise of chronic diseases, including obesity. Nationally, health care costs for chronic diseases facilitate huge proportions to health care costs, especially during end of life care. “Patients with chronic illness in their last two years of life account for about 32% in total Medicare spending, much of it going toward physician and hospital fees associated with repeated hospitalizations.” The National Academy of Sciences detected that among other high-income nations the U.S. has a higher rate of chronic illness and a lower overall life expectancy. Their findings suggest that this holds true even when controlling for socio-economic disparity. Experts are focus more on preventative care in an effort to improve health and reduce the financial burdens associated with chronic disease. One provision of the Patient Protection and Affordable Care Act, commonly referred to as simply the Affordable Care Act (ACA), implemented in 2013, provides additional Medicaid funding for states providing low costs access to preventative care.

Thirdly, high administrative cost are a contributing factor to the inflated costs of U.S. health care. The U.S., leads all other industrialized countries in the share of national health care expenditures devoted to insurance administration. It is tight to determine the exact differences between public and private administrative costs, in part because the definition of “administrative” varies widely. The government outsources some of its administrative needs to private firms. Larger firms spend a smaller percentage of their total expenditures on administration, and nationwide estimates suggest that as much as half of the $361 billion spent annually on administrative costs is wasteful. In January 2013, a national pilot program implemented under the ACA began. The aim is to improve administrative efficiency by permitting, doctors and hospitals to bundle billing for an episode of care rather than the current ad hoc method.

Health insurance in the USA: Division is not uniform across structures

While the majority of U.S. citizens have health insurance, premiums are rising and the quality of the insurance policies is fall. Average annual premiums for family coverage increased 11 percent between 1999-2005, but have since leveled off to increase five percent per year between 2005-2015. Deductibles are rising actually faster. Between 2010-2015, single coverage deductibles have risen 67 percent. These numeral outpace both inflation and workers’ earnings.

The shortage of health insurance coverage has a profound impact on the U.S. economy. The Center for American Progress estimated in 2009- the shortage of health insurance in the U.S. cost society between $124 billion and $248 billion per year. Whereas the low end of the estimate represents just the cost of the shorter lifespans of those without insurance, the high end represents both the cost of shortened lifespans and the loss of productivity due to the reduced health of the uninsured.

Health insurance coverage is irregular and often minorities and the poor are underserved. Forty million workers, two out of every five, do not have access to paid sick leave. Experts propose that the economic pressure to go to work even when sick can prolong pandemics, reduce productivity, and drive up health care costs.

1. There were 32 million uninsured Americans in 2014, nine million fewer than the year prior. Experts attribute this sharp drop in the uninsured to the full implementation of the ACA in 2014. Of American adults who had health insurance in 2014, 73 percent had one or more full-time workers in the family and 12,2 percent had one or more part-time workers in the family. Just 49,5 percent of American adults reported getting health insurance from an employer in 2014.

2. Envelopment by employer-provided insurance varies considerably by wage level. Firms with higher proportions in low-wage workers are less likely to provide access to health insurance than firms with low-proportions of low-wage workers.

3. In 2014,- 11.2 percent of full-time workers were without health insurance. The percentage of part-time workers without insurance was 17.7 percent, a significant decrease from 24 percent in 2013, thanks in to the Affordable Care Act. The uninsured rate among those who had not worked at least one week too decreased from 22.2 percent in 2013 to 17.3 percent in 2014.

4. Small firms are less likely to provide health benefits to full or part-time workers. Among all small firms (3-199 workers) in 2015, only 56 percent offered health coverage, compared to 98 percent of large firms.

5. After the Affordable Care Act allowed for many young adults (19-25) to remain on their parents’ health intention, there was a statistically significant increase in the percentage of insured young people from 68.3 percent in 2009 to 82.9 percent in 2014. Over the same time, the percentage of young people aged 26-34 with insurance increased from 70.9 percent to 81.8 percent.

6. Women in the individual market faced higher premiums than men for the same coverage. In 2014, the Affordable Care Act banned this practice, as well as denying coverage for pre-existing conditions.

7. In 2014, 19.3 percent of the population living below 100 percent of the poverty line ($23,550 a year for a family of four) was uninsured. Consequently, into the Kaiser Family Foundation, 90 percent of the uninsured have family incomes within 400 percent of the federal poverty level. This makes them appropriate for either subsidized coverage through tax credits or expanded Medicaid eligibility under the Affordable Care Act’s state health exchanges.

The Affordable Care – Act: Successes and Challenges

1. In March, 2010, President Obama signed the ACA into law that made hundreds of significant changes to the U.S. healthcare system between 2011-2014. Provisions included in the ACA are intended to expand access to healthcare coverage, increase consumer protections, emphasizes prevention and wellness, and help evidence- based treatment and administrative efficiency in an attempt to curb rising healthcare costs.

2. In January 2014, almost all Americans are required to have some form of health insurance from either their employer, an individual plan, or through a public program such as Medicaid or Medicare. Since the “individual mandate” took effect, the total number of nonelderly uninsured adults dropped from 41 million in 2013 on 32.3 million in 2014. The largest envelopment gains were concentrated among low-income people, people of color, and young adults, all of whom had high uninsured rates prior to 2014.

3. A major provision of the ACA was the creation of health insurance marketplace exchanges where individuals not yet covered by an employer-provided plan or a program such as Medicaid or Medicare can shop for health insurance. Individuals with incomes between 100 percent and 400 percent of the federal poverty line would be eligible for advance able premium tax credits to subsidize the costs of insurance. States have the options to create and administer their own exchanges or allow the federal government to do so. Now, only 14 states operate their own exchanges.

 


4. Designed to facilitate competition among providers and deliver choice transparency to consumers, the state-based exchanges appear to be doing just that. A analysis by the Commonwealth Fund found that the number of insurers offering health insurance coverage through the marketplaces increased from 2014-2015. moreover, there was generally no reported increase in average premiums for marketplace plans over that period. The analysis found only a modest increase in average premiums for the lowest costs plans from 2015 to 2016.

5. The ACA also included a majority expansion of the Medicaid program, although the Supreme Court ruled in 2012 that this expansion is a state option. As on November 2015, 30 states have chosen to expand Medicaid. As of 2014, adults with incomes at or below 138 percent of the federal poverty line are presently eligible for Medicaid in the states that have adopted the expansion.

6. Despite improvements to the U.S healthcare system under the ACA, a number of challenges keep. In 2014, 10.4 percent of Americans were still uninsured, and those with insurance still face high deductibles and premium cost. Moreover, in the 20 states that had not expanded Medicaid, an estimated three million poor adults fall into the “coverage gap” where their incomes are above current Medicaid eligibility limits but below the lower limit of premium credits on the healthcare exchanges. The bulk of people in the envelopment are concentrated in the South, with Texas (766,000 people), Florida (567,000), Georgia (305,000) and North Carolina (244,000) having among the highest number of uninsured.

7. The ACA included a number of other provisions to improve healthcare access and affordability. The law banned lifetime monetary caps on insurance coverage for all new plans and prohibited plans from excluding children and most adults with preexisting condition. Insurance plans are also prohibited from cancelling coverage except in the case of fraud, and are required to rebate customers if they spend less than 85 percent (80 percent for individual and small group plans) of premiums on medical services. Additionally, the ACA established the Prevention and Public Health Fund to allocate $7 billion towards preventative care such as disease screenings, immunizations, and pre-natal care for pregnant women and between 2010-2015. Moreover, $11 billion in funding for community health centers and $1.5 billion in additional funding for the National Health Service Corps was included in the law.

8. Amount of cost control provisions were included in the ACA in an attempt to curb rising medical costs. Amongst them is the Independent Payment Advisory Board, which will provide recommendations to Congress and the President for controlling Medicare costs if the costs exceed a target growth rate. The administrative process for billing, transferring funds, and determining eligibility is being simplified by allowing doctors to bundle billing for an episode of care rather than the current ad hoc technique. Moreover, changes were made to the Medicare Advantage program that would provide bonuses to high rated plans, incentivizing these privately-operated plans to improve quality and efficiency. Moreover, hospitals with high readmission rates will see a reduction in Medicare payments while a new Innovation Center within the Centers for Medicare and Medicaid Services was created to test new program expenditure reduction methods.

An International Case Study: how in Germany pays for health care

Germany has one of the most successful health care systems in the world in terms of quality and costs. Some 240 insurance providers collectively make its public version. Together, these non-profit “sickness funds” cover 90 percent of Germans, majority of the remaining 10 percent, generally higher income Germans, opting to pay for private health insurance. Average per-capita health care costs for this system are less than half of the cost in the U.S. The details of the system are instructive, as Germany does not rely on a centralized, Medicare-like health insurance plan, but rather relies on private, non-profit, or for-profit insurers that are tightly regulated to work towards socially desired ends—an option that might have more traction in the U.S. political environment.

1. The average insurance contributions to German sickness funds are based on an employee’s gross income, around 15.5 percent, income cap at $62,781, and employers and employees each pay about half of the premium. In total, an individual employee’s contribution is 8.2 percent and the employer pays the remaining 7.3 percent.

2. Premiums, not based on risk and are not affected by a person’s marital status, family size, or health, Germans have no deductibles and lowco-pays.

3. Doctors – private entrepreneurs and get a fee from insurers for each visit and procedure they perform. Procedure, they are tightly regulated. Groups of corps-based physicians in every region negotiate with insurers to arrive at collective annual budgets. Doctors should remain in these budgets, as they do not receive additional funding if they go over. This situation helps keep health care costs in check and discourages unnecessarily expensive procedures. The average German doctor makes about one-third less per year than in the U.S., around $123,000.

4. Government general revenues cover premiums for children, the next generation should be the entire nation’s fiscal responsibility, instead of just the responsibility of the parents.

5. Germany reformed its envelopment for prescription drugs in 2010 after costs for prescription drugs continued to rise. Prior to reforms, drug companies set the price for new drugs and were not required to show that the new drug was an betterment over previously available prescription drugs. Pursuant to the reforms effective in 2011, manufacturers could set the price for the first 12 months- new drug is on the market. “As the drug enters the market, a new process of benefit assessment begins.” Manufacturers must establish, through comparative effective research that the new drug has an “added benefit to the patient, compared to the previously existing standard treatment.” Drugs without added benefit will be reimbursed according to a government pricing. New drugs without added benefits are available to patients, but the patient has to pay the price difference. For drugs with added benefit, a price will be negotiated between health insurers and the fabricator.

Quality of U.S. Health Care in International Context

U.S. health care specialists are among the best in the world. However, treatment in the U.S. is inequitable, overspecialized, and neglects primary and preventative care.  The end result of the U.S. approach to health care is poorer health in comparison to other advanced industrialized nations.  According to the Commonwealth Fund Commission, in a 2014 comparison with Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the U.K., the U.S. ranked last overall.  In terms of quality of care, the U.S. ranked fifth, but came in last place in efficiency, equity, and healthiness of citizens’ lives. Comparing other health care indicators in an international context underscores the dysfunction of the U.S. health care system.

• Despite the relatively high level of health expenditure, in the U.S. there are fewer physicians per capita than in most other OECD countries. In 2013, the U.S. had 2.6 practicing physicians per 1,000 people — below the OECD average of 3.3.

• In the U.S., there are only about 1.2 primary care physicians per 1,000 people. Projections indicate that the U.S. will need 52,000 more primary care physicians by 2025 to meet demand. While population growth and aging make up a substantial proportion of this increased need, expanded access to insurance under the Affordable Care Act means more people will seek out treatment. Therefore, there are provisions in the legislation to increase the number of primary care physicians in the U.S.

• There is a significant spatial mismatch within the United States for physicians as well. While the U.S. averaged 225.6 doctors active in patient care per 100,000 people in 2014, there is a wide variance across states; Massachusetts ranks highest with 349.5 active doctors per 100,000 people, while Mississippi has only 170.3.

• In 2013, the U.S. infant mortality rate was 5.96 per 1,000 live births, while the OECD median was 3.8.

• The obesity rate among adults in the U.S. was 35.3 percent in 2013, down slightly from 36.5 in 2011. This is the highest rate among OECD countries. The average for the OECD countries was 19.0 percent in 2013.