United States Health Care System Problems and Solutions

Paper Info
Page count 10
Word count 2801
Read time 10 min
Topic Health
Type Research Paper
Language 🇺🇸 US

Introduction

The US health care system is faced with myriad of challenges and problems, with increase in time, the problems will deepen and there will be developments of new challenges. It is assumed that advancement in technology will lead to enhanced efficiency but despite this, the costs of testing and treatment will still increase. It has been argued that the US health care system is one of the most expensive health care systems in the world; also the quality of the health care system has been doubted, these therefore leave many citizens unable to enlist in any health care scheme. There have been numerous calls to reform the system so as to make it affordable and expanded. The major problem has been however how to finance the expanded coverage. Several problems afflict the US health care system and these include the high number of the population that lack coverage, administrative costs and complexities, ineffective system of payment and the high cost of the medical care. Analyzing the problems critically presents a scenario that these problems are intricate and difficult to address hence making the potential solutions complex.

There has been unanimity that the health care system in USA is expensive, one that provides quality health care and also one that leaves a huge portion of the population without coverage. The major problem with the entire system is how to approach reforms in the system. The health system in the USA is faced with among other problems the large number of people that do not have health coverage, problems on the decision as to who will and who will not be covered, and the ineffectiveness in the payment of incentives, administrative costs and the complexities and under valued primary care. These three predominant concerns are more complicated than how they just appear and hence making it very difficult to come up with solutions for them. The solutions to these problems are often conflicting, for example, the expansion of coverage to the uninsured segment of the population has the tendency of increasing the costs and can elongate public budget, consequently cutting the costs of health care has the tendency of compromising on the quality of health care.

The United States of America spends a lot of money in health care than any other country in the world, the medical practitioners are paid well and the citizens with good medical care options get access to the modern medical technology. With the realization that the health care system was characterized with numerous problems, the year 1990s was considered the period to reform the health care system through the introduction of the universal health care insurance system but the attempt failed terribly hence left the private sector as the engine to drive health reform (Cutler, n.d.).

The health care system is also faced with myriad of social challenges like limited education, poor quality of health services, poverty and the emergence of marginalized class of individuals in the society. Racial discrimination also characterizes the health care system. The health care system is oriented towards the economic structure where the poor people have limited health care options. The lack of health care options and unavailability of insurance scheme providers has led to consumers looking for expensive services like urgent care and emergency rooms that may not necessarily meet their demands.

Problems and Solutions to US Health Care System

High Population of Uninsured Americans

Several debates on the health care systems both nationally and internationally virtually mention the concern over the large and ever increasing US population without health coverage. The American health care system however provides a safety-net care for the population that lack insurance cover; this is supported by the revenue from the tax related income from the public. This has elicited a lot of complains since it amounts to shifting the bills to other citizens and more so it is considered an inefficient scheme. Majority of the working class Americans are covered through a medical scheme by their employers; Medicare on the other hand is a program by the federal government to provide health insurance to a particular segment of American citizens particularly those with advanced renal diseases and those with disability and Medicaid on the other hand provides medical insurance for the American citizens of the low income level. Despite this medical cover schemes, there is a substantial American population that lacks health insurance cover completely. This substantial population may be low income earners and employees in small businesses whom the employer does not offer medical or insurance cover and they themselves may not afford it. It is however assumed that the uninsured American population can get medical care from the emergency rooms or through charity organizations (Orbelander, 2002).

It is estimated that approximately 47 million which translates to 15 percent of the American population do not have a health insurance scheme and majority of them are children. The medical bills in the USA are considered the leading cause of financial bankruptcy and majority of the American population more often have problems in footing their medical bills. This number is on the increase especially at this period when recession is hitting hard on the economy. Although coverage is confused with health care access, they may not be the same or apply in similar contexts since it is possible to have coverage and access or vice versa. The uninsured often access health care via the community health care clinics or from the doctors offering pro bono services; the hospitals with Medicare are often required to stabilize those people who need emergency care. Having medical insurance coverage is not mandatory that you will pay for health care since people who lose their jobs find it difficult paying for their health care and even the segment of the population with comprehensive health care plan often experience some difficulties in servicing the costs that might arise as a result of chronic health complications or also find it difficult in footing the costs resulting from serious health problems (Rushton, 2009).

It is this large mass of uninsured Americans that is considered the greatest undoing of the health care scheme. The only two options that are available have limited the ability of the Americans to acquire health cover; these two options are insurance by the employees and second one is the public health insurance scheme. The cases of medical coverage are often underreported. The inability to acquire insurance coverage may be largely due to job mobility or family matters. Also it has been known that majority of the uninsured Americans are people who are in position to pay for medical scheme but have opted not to. This is largely linked to the safety net in the name of the public hospital network which acts as an informal hospital insurance scheme. Lacking insurance cover is likely to cause problems; this is because the uninsured have the tendency of postponing or staying minus health care coverage and are also unlikely that they can have a regular health care.

Universal Coverage

There should be the adoption of universal coverage for all the American population. The plan that was adopted in the year 2010 was aimed at guaranteeing all the American citizens an enrolment in the basic health care scheme of their choice. The congress has debated this issue of having insurance mass coverage but there are certain emerging issues from this debate which include whether it is mandatory to have health coverage for every citizen, whether particular groups should be given priority in accessing health care or obtaining coverage or whether medical insurance coverage that is provided with subsidies should meet minimum standards of cost sharing.

Another solution is the proposed health care plans; policy analysts and health care providers have suggested that an alternative health care plan can be a viable option, these plans can be categorized as employer mandates, enlarging the current arrangements, the introduction of tax incentives and the nationalization of health care insurance. Since the Medicare emerged as one of the successful public program, there have been some calls to expand it so as to cover beyond the elderly population since its cost of administration is less than two percent.

Quality of Care

When determining whether or not medical practitioners should stick to providing the best care, it is imperative to analyze whether the service provided meet the satisfaction of the consumers and also if it is the care that the patient wants and furthermore if the health service is administered in a manner that the patient deems fit. The health care system in the United States of America is ranked by the world health organization (WHO) at position 37th in the world and is often characterized by overcrowding in all emergency and the urgent care circumstances, consequently the Center for Disease Control and Prevention ranked the USA at position 29th on the basis of infant mortality rate and the ranking with respect to the US has been on decline (Ameredes, 2008). This ranking is an indication that the American population does not receive the best value for their expensive health care coverage. Although a lot of money is spend on health care in the USA as compared to other developed countries, the quality of the health care is still below average or even deteriorating when analyzed based on certain indicators. There are often some cases of medication errors that inflict damage to many healthcare consumers and other cases at times result in death. These medical errors are linked to faulty medical systems, their processes and conditions which may be preventable (Luft, 2006).

Proper Quality System Checks

There should be the development of new measures that focus on the patient assessment of the health care like the Consumer Assessment of Health Plans (CAHPS) which precisely deals with the assessment of hospitals and the quality of care they offer. Among the things they assess are whether the patients are getting the desired care and also the assessment of how the doctors deliver their services. There have been several efforts to improve the quality of health care in USA. Among the suggested ways of improving the health care include the enhancement of the metrics that is used for estimating the quality and the attempt to publicly report relative information. Among the merging issues in the attempt to improving the quality of health care include; whether preventive care can aid in improving the quality of health care, whether or not it is possible to improve health care quality without necessarily restructuring the health care structure or whether the enhancement of the quality should be pursued irrespective of whether or not it will increase the costs (Lyke, 2009). Also there has been a consideration of the single payer system as a solution to this problem of cost since it is economically feasible.

Financing or Cost

A lot of money is spent on marketing and other administrative costs; this creates the possibility of increasing the cost of the health care scheme. Other costs also are incurred in the processing, reviewing and in benefit determination expenses which is considered a burden. The cost of financing the health care in the USA is estimated to currently cost approximately 15 % of the gross domestic product which is twice in per capita spending when juxtaposed with other developed nations. Large of this amount is used in insurance paperwork and system bureaucracy and not the patient. Cost and spending in the health care is coupled by the rising costs for virtually every party including the employees, retirees and the health care providers. This has emerged as a cause of anxiety to majority of the population especially those with the intention of retiring or when an individual is seriously ill. The spending in health care increased from 7% in 1970 to 12% in 1990 to the now 15% of the GDP (Cunningham, 2003)

The payment system also suffers from ineffective incentives; economic incentives have the ability to manipulate the individual demand for health care. The deductible amount sways the consumers’ decision to look for treatment. This tendency of relying on deductible amount results in the development of reluctance by the people to seek health care. To address the problem there should be a plan which will bear greatest responsibility for the cost of the care and the consumers should be fed with information about the medical needs in each health care system service. This increase in the health care spending is predicted to have an effect on the countries share of economic output and hence majority of the population will be faced with a lot of challenges especially in the making of choices between health care and other priorities. The high spending in the USA is linked to its high per capita in terms of GDP that make Americans spend more. The cost of the health care may be largely attributed to the third party payments which encompass private insurers, public insurers and also the public direct provision (Anon, n.d.).

Private health insurance is the most common in the US and majority of the population is covered by private health care plans. The cost of health care has been spiraling at an alarming rate and this has led to the tendency of hindering or limiting the ability of health care providers to shift the increase in premium cost to employees and also resulted in health care providers providing less generous plans and the cutting of the coverage for part time employees. The health care spending has emerged as the major problem for the public sector as in the case of Medicaid which increases with the increase in state budget. Health care spending is also the second increasing component of the federal budget, second to public debt. These surging costs might lead to fiscal pressures on the side of the government and hence limiting the ability of the government to respond to their demands which may encompass the reduction of budget deficits.

Solution to Problem 3

Raising Funds

There should be a redirection of revenue both current and new, paid as the expense for uninsured. Ensuring that all citizens access health care is an expensive task and it will demand a lot of money in financing it. This problem can be solved by raising revenue through the following proposed sources; revenue from the federal and state governments, raising money through two-third reduction in bad debt and charity care, money can also be raised through insurance premiums that are paid by employees and lastly revenue can be raised through automation and the elimination of preapproval demands together with other methods that are considered as viable source of revenue (Montreal Economic Institute, 2005).

The insurance plan that was developed in the year 2010 was aimed at ensuring that all patients are guaranteed access to enhanced health care plan. Regulating the costs or cutting the spending on health care may not be easy, this is because the fundamental factors that necessitate the increases in the spending may be technological and pharmaceuticals. The problem with the regulating of costs may result in the scenario of payers shifting the burdens to others. Among the issues that emanate from the debate on cutting health spending are; whether the regulation of the market in health care will reduce the health care spending, whether the cutting of spending for other individuals may result in the increase in cost for others and whether the reduction of costs will likely compromise the quality of health care (Garson, 2000).

Conclusion

Despite the numerous attempts to reform the health cares system, the step towards solving the problems especially problems concerning the cost regulation and the accessibility which are perceived to be the real problems bedeviling the health care system have often preoccupied the minds of policy makers. The real menace is the absence of an organization or an institution to take care of the uninsured after the government takes care of the already covered through the managed care protections and the expanded Medicare privileges.

The health care system in the USA is at a constant conflict with the economic reality and the needs of the clients or the consumers. Unless the entire system is reformed, the problems being experienced will be escalating; the increasing health care costs, the evidence on the quality of the health care and the ever insurmountable increase in the number of Americans who are uninsured will be imponderable and overwhelming. This problem in the US health system is not as a result of its private character but due to its immense regulation that is attached to the insurance functions. The high number of uninsured Americans is due to the tax treatment of the insurance system and the limited degree of direct involvement by the policy and stakeholders and the cases where the payments are made through a third party.

References

Ameredes, T. (2008). The US health care system. Web.

Anon. (n.d.). The US health cares system: best in the world, or just the most expensive. Web.

Cunningham, W. (2003). The Development of the U.S. Health Care System and its Problems. Web.

Cutler, D. (n.d.). The American Healthcare System. 2011. Web.

Garson, A. (2000). President’s page: the U.S. healthcare system 2010: problems, principles, and potential solutions. Web.

Luft, H. (2006). What works and what does not work well in the US health care system. Pharmacoeconomics 24(2): pp. 15-28.

Lyke, B. (2009). Health care reform: an introduction. Web.

Montreal Economic Institute. (2005). Two myths about the U.S. health care system. Web.

Orbelander, J. (2002). The US health care system: on the road to nowhere? Canadian Medical Association or its licensors 267(2): pp 163-168.

Rushton, F. (2009). US health-care crisis. Pediatrics International (51): pp 603–605.

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