How İs America’s Healthcare System? American Health System Problems

How İs America’s Healthcare System? American Health System Problems. Like everything else in America, health insurance is something that varies from state to state. When Obamacare was introduced at the time, the biggest goal was to reduce the gap between states as much as possible and to reach a similar, standard and common health system throughout the country, but how successful this was is debatable.

How İs America’s Healthcare System?

First of all, let me say that if you came to America through a green card or in any other way, the first thing you should do as soon as you step into the country is to get health insurance. this is absolutely no joke. If you don’t have health insurance, an ambulance can take you to the hospital one street away, costing $2,000, a simple dressing in the emergency room is $800, and a simple doctor’s visit can cost you $400. I will not go into the details of these figures, but these figures are not an exaggeration.

We Turks generally have a “nothing will happen to me” mentality, but it’s not worth the risk. I personally have insurance even though I haven’t been to a doctor for 15 years because you never know what will happen tomorrow. There are people who get sick as soon as they get off the plane because of the weather change and have to go to the doctor and lose thousands of dollars with the dust of their feet.

However, one should not be too pessimistic. According to recent statistics, 92% of Americans have health insurance. Before Obamacare, this figure was 84%, and thanks to Obamacare, the rate of uninsured dropped from 16% to 8%. This rate is slightly lower than the insured rate in Germany and England, but after Obamacare, there was not much difference.

As I mentioned above, the healthcare system in America varies from state to state

While there are states such as Oregon, Washington, Minnesota, and California that apply the Scandinavian model exactly as a healthcare system, there are also states such as Alabama and Texas that apply the opposite model. For example, as always, let me give Oregon as an example. With a law passed last year, a health insurance system called “oregon health plan” was introduced.

Accordingly, single people with a monthly income of less than $ 1400, couples with an income of less than $ 1600 or families with children with an income of less than $ 2800 can have a completely free health insurance. This is the exact application of the Scandinavian model. The health insurance in this system covers almost all conceivable medical conditions (including giving birth, drug treatment, psychological treatment, external health).

Not every state is as generous as Oregon in this regard, but California has a more or less similar system. even a little bit more generous in california because you have to be at least a green card or citizen to get insurance in oregon, there are people who are illegal immigrants and get health insurance in california.

however, states’ own health insurance covers very few people. The vast majority (about 60%) of insured people in the United States are insured by the company they work for. Since the insurance policy and fees of each company are different, a complete unity has not been achieved here. For example, there are differences between the insurance provided by Nike to its employees and the insurance provided by Intel. In general, insurances of large and corporate companies are more comprehensive and cheaper.

While the insurance provided by the companies covers the family and children of the employee, the fee varies between 500-600 dollars per month. As a personal example: at my current company I don’t pay any money for health insurance covering myself and my spouse, but at the previous company I was paying $200 a month just for my own insurance.

When you go to the doctor without insurance, even the simplest procedure can cost hundreds or even thousands of dollars. There are several reasons for this.

1) when you go to the emergency room of a hospital, they have to accept you and give you the first response no matter what. legal obligation of these hospitals even if you do not have an identity card with you and you do not have money. That’s why the homeless and illegal immigrants often go to the doctor and hang out in the emergency room when there’s an emergency. Because they don’t pay, the squash goes to those who pay because the hospital is trying to subtract everyone’s expenses from those who pay.

2) Since emergency rooms are for emergencies only, hospitals want to reduce the use of emergency rooms and they do this by keeping the fees high. Since they cannot turn anyone away from the law, they do not want every person with a headache or a runny nose to be in the emergency room and use prices as a deterrent.

3) Since studying medicine in the USA is extremely expensive, doctors graduate with debts of 200-300 thousand and they pass this number on to the customer because they pay student loans of several thousand dollars a month.

4) If the doctors do wrong treatment and cause harm to the patient, the patient has the right to go to court and to seek compensation at a very serious rate (malpractice). Doctors buy special insurance just in case, which costs thousands of dollars each month. In the end, if the doctor is taken to court, the insurance company pays the compensation. This money is passed on to the customer.

5) Since the salaries of health personnel from nurses to caregivers are quite high and above world standards, this is also reflected in the prices. It’s not uncommon for a nurse in the US to earn $100,000 or more annually.

8 Major Problems with the U.S. Healthcare System Today

Quality of Care

According to The Commonwealth Fund, even though U.S. healthcare costs are the highest among comparable countries, it underperforms in most verticals. While the U.S. scores high on patient-centered care, it scores lower on safe and coordinated care, driving the U.S. quality score down. Here are some of the quality issues.

1. Preventable Medical Errors

A recent study by Johns Hopkins analyzed medical death rate data for eight years and found that medical errors are to blame for more than 250,000 deaths per year in the U.S. This accounts for 10% of all U.S. deaths and makes it the third leading cause of death after heart disease and cancer.

2. Poor Amenable Mortality Rates

The U.S. ranked last on the Healthcare Access and Quality (HAQ) Index in amenable mortality among eight other comparable countries. Amenable mortality measures premature death that is preventable and treatable by effective and timely care. The HAQ index is a scale from 0 (worst) to 100 (best) and measures preventable mortality rates for 32 causes of death. A higher rating suggests fewer deaths due to a higher standard of care and access.

3. Lack of Transparency

Fraud and cover-ups are rampant in the U.S. healthcare system. A significant problem is upcoding which becomes a tug-of-war between providers and insurance providers, with policyholders stuck in the middle. Providers “upcode” a procedure to get more money from insurance companies, but insurance may charge higher premiums to employers, and tighten its belt when paying consumers. Health consumers get stuck in the middle without any control over health outcomes and pricing.

4. Difficulty Finding a Good Doctor

With a lack of accessible information on doctor credentials and accomplishments, health consumers cannot easily find a good doctor. Consumers rely on uninformed online reviews that can help with assessing traits like staff friendliness and wait times. But, these platforms do not offer critical information such as information about health conditions consumers may be facing, the right doctors with skills treating those conditions, and how to assess a physician’s skill level in helping them with their health maladies.

Rising Expenditures

The U.S. ranks highest in healthcare costs among comparable countries. .

5. High Costs of Care

According to annual report data from the Health Cost Institute, average healthcare prices have increased year over year, with rates that were 15.0% higher in 2018 compared to 2014.

In 2018, U.S. firms and consumers spent 10% of GDP on healthcare—and this number has risen over the years. The Centers for Medicare & Medicaid Services (CMS) Office of the Actuary predicts that national healthcare spending in the U.S. (avg. annual rate of 5.4%) is expected to outpace GDP growth (avg. yearly growth rate of 4.3%) until the year 2023. Spending reached $3.81 trillion in 2019 and is predicted to reach $6.19 trillion in 2028 and account for 19.7% of the GDP.

The International Federation of Health Plans (iFHP) and member companies, in partnership with the Health Care Cost Institute (HCCI) in the United States, published the International Comparison of Health Prices Report. The report compares the median costs for health services in nine countries. Aside from two outliers (the cost of the drug Kalydeco in the UAE and cataract surgery in New Zealand), every drug and procedure surveyed cost substantially more in the U.S.

One example is hospital admission prices for a C-section, which costs $15.0K in the U.S. The country with the next highest cost for C-sections is Australia at $8.4K, and the lowest cost among the nine countries is $3.2K in South Africa.

Unfortunately, the situation is not any different for several other procedures examined, such as hip/knee replacement, appendectomy, childbirth and delivery, bypass surgery, and angioplasty. Aside from childbirth via normal delivery, which is only $2.2K more in the U.S. than the UK, other procedures are close to or more than 50% higher in the U.S.

Why is the cost of U.S. healthcare so high?

New Technology

The need for resources to train and manage new Electronic Health Records (EHR) and Electronic Medical Records (EMR) systems have increased due to the cost of operations and personnel needed to manage and operate the new systems.

Prescription Drugs and Diagnostics Tests

The U.S Department of Health and Human Services estimated that prescription drug spending topped $457 billion in 2015, which accounted for 16.7% of personal healthcare service expenditures. Diagnostic testing is also high as the fear of being sued can prompt physicians to prescribe more diagnostic tests, which increases costs. .

6. A Lack of Insurance Coverage

Uninsured Americans face more health hardship than insured Americans. As reported by healthypeople.gov, a division of the Office of Disease Prevention and Health Promotion, the uninsured may not seek medical care due to high cost and may forgo preventive care and regular health screenings, negatively affecting health. Children are also less likely to access preventive services or receive care for treatable conditions like asthma..

Shortages and Inefficiencies

7. The Nursing and Physician Shortage

It’s a supply and demand issue. Data published by the Association of American Medical Colleges (AAMC) postulates that the U.S. will experience a shortage of between 54,100 and 139,000 primary and specialty care physicians by 2033 as the demand increases.

The AAMC quotes AAMC President and CEO David J. Skorton, MD, as saying, “This annual analysis continues to show that our country will face a significant shortage of physicians in the coming years. The gap between the country’s increasing health care demands and the supply of doctors to respond adequately has become more evident as we continue to combat the COVID-19 pandemic. The challenge of having enough doctors to serve our communities will get even worse as the nation’s population continues to grow and age.”

The AAMC findings report that more than two in five active physicians will reach retirement age in the next 10 years, pushing the demand/supply ratio further. Physician burnout may also force providers to retire sooner. .

A different perspective on solving the shortage crisis

According to the Harvard Business Review, hiring more doctors does not solve the problem, although physician shortage remains a constant threat. The main issue involves the following:

  • Uneven care. Health consumers are receiving different levels of care determined not by a standardized level of quality but by their location, condition, or insurance plan. More rural areas may not have enough physicians, while urban areas may have more than needed.
  • Lack of insurance coverage. We discussed earlier in this article that many health consumers can’t afford the high cost of primary care due to high insurance costs.
  • Off-time. Many disciplines only serve patients on weekdays during regular office hours, with no availability on nights and weekends.
  • Inflexibility. Physician assistants and nurse practitioners can deliver primary care with the same quality as physicians but at a lower cost, yet they are underutilized.
  • Limited access. Some health consumers may be turned away from practices that limit access if they have Medicare or Medicaid. These patients aren’t as profitable a venture for providers.
  • Lack of efficiency. Compliance-related activities such as clinical documentation and electronic medical record administration limit a physician’s ability to offer more care.

8. Inefficiencies 

Preventable medical errors and hospital readmissions due to lack of quality care put consumers’ health at risk, but they also waste valuable time and resources, making healthcare inefficient.

A 2017 international healthcare comparison report published by The Commonwealth Fund reported that the U.S. ranks 10th among 10 comparable countries in Administrative Efficiency. Doctors spend unnecessary time updating EHRs and coordinating with insurance companies due to coverage restrictions (each plan differs in coverage options), which wastes money and resources.

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