Introduction
For the most part, the health care system in the US is primarily market-driven and privatized. It requires the medical care of US people is a commodity in the market, affected by supply and demand. The government’s Medicare and Medicaid programs, employers’ insurance, and private payments support US healthcare funding. The country began its efforts to provide critical health care (universal health care) many decades later than most Western industrialized countries. Still, they are more advanced than many other countries on the path to value orientation. However, various reforms and funds are aimed at developing and strengthening an affordable healthcare system for all US citizens.
The Affordable Care Act
The Affordable Care Act (ACA) has allowed millions of people to receive insurance coverage and is expected to improve access to health care. However, the Affordable Care Act has generated a lot of controversies since it was passed in 2010 (Health care 2022). The strengthening of the health care system has enabled millions of citizens to receive insurance, saving thousands of lives. The introduced law affected the lives of previously uninsured people who could not afford insurance due to lower incomes. In general, the improvement in health status is attributed to the adoption and private expansion of the ACA. However, citizens are still required to have insurance to access health services.
Before the introduction of the law, insurance organizations used medical supporting to choose whether to offer individual coverage, at what cost, and with what exclusion or limitation based on the individual’s medical condition. The main goal was to enable people to pay premiums to prevent health risks that would cover expected medical expenses (Health care 2022). Due to the preservation of medical prescriptions at individual enterprises, the remaining population groups found themselves without insurance coverage (Health care 2022). In contrast, the ACA was initially introduced to encourage more stable and healthy people to buy insurance, which would help reduce insurance risks and premiums for everyone.
The ACA led to one of the most significant developments in health care coverage in US history. By 2022, the uninsured rate had fallen to 8 percent, which is a record low given that in 2010, when the program was introduced, there was about 16 percent of uninsured people in America (National uninsured rate 2022). Accordingly, after the adoption of the ACA, about 20 million Americans received health insurance (National uninsured rate 2022). As early as 2019, 11.4 million people across the country were enrolled through the ACA health insurance markets. Increases in enrollment have occurred for all income levels, both among children and adults, and disparities in enrollment between races and ethnic groups have reduced but remain an important problem.
Comparison of Developed Nations
Hospitalization due to various chronic diseases, which include asthma, diabetes, and others, is a pressing public health problem in the United States. The hospitalization rate in the United States is higher than in comparable countries, primarily due to complications from diabetes or congestive heart failure. Adequate primary care can significantly reduce this level and improve the US ranking among other countries. For example, more than a quarter of American adults report having been diagnosed with two or more chronic diseases, compared with 22 percent or less in all other countries (U.S. health care 2020). This figure is twice as high as in the UK and the Netherlands.
Various complications, such as postoperative complications such as deep vein thrombosis or pulmonary embolism, are more common in the US than in most countries. The prevalence of postoperative complications for many complex procedures is higher in the US than in the Netherlands, the UK., Sweden, and Belgium. Overall, this is because the US has a higher rate of informed treatment and therapy errors than most comparator countries (U.S. health care 2020). It reduces the overall safety of patients being treated in the hospital. Due to the lack of preparation of hospitals to accept many people because of priority home treatment in the United States, the death rate of the population has significantly increased: by 16% higher than in other developed countries (U.S. health care 2020). However, recently the country has been able to adapt to new conditions and has reduced this figure by 43% (U.S. health care 2020). The United States maintains the lowest life expectancy among countries with a high standard of living.
In the US, life expectancy masks ethnic and racial differences. Life expectancy for non-Hispanic whites is 3.5 years higher, at 78.8 years, compared to non-Hispanic blacks, who have an average life expectancy of 75.3 years (U.S. health care 2020). Hispanic Americans have a life expectancy of 81.8 years, higher than whites and similar to life expectancy in Canada, New Zealand and the Netherlands (U.S. health care 2020). According to researchers from the UK and Denmark, the coronavirus pandemic has led to the most significant decline in life expectancy since the Second World War. The largest drop in life expectancy was observed in American men – it decreased by 2.2 years (U.S. health care 2020). This sharp decline in life expectancy was mainly due to high mortality from COVID-19 in older age groups.
Economic Comparison
Comparing health care spending in the US to other countries is difficult because each country has unique political, economic, and social characteristics that affect its spending. In general, this depends on many economic factors, which include gross domestic product, per capita health spending, spending priorities, and cost sharing. Wealthy countries, including the US, spend more per person on healthcare and related costs than lower-income countries (Amadeo, 2022). The majority of the US’s budget, approximately 65%, goes to mandatory spendings such as Social Security, Medicare, and the Supplemental Food Assistance Program (Amadeo, 2022). In addition, the military is still a priority area as well. Healthcare is a big industry in the US economy, it accounted for 18% of GDP ($2.7 trillion) in 2019 (Global industry market sizing). That makes the US medical services sector the sixth economy in the world, in which the gross product exceeds the GDP of Brazil, Great Britain, Italy, and Russia. US health care spending per person in 2020 was $11,945, $4,000 more than any other high-income country (Global industry market sizing). Due to the pandemic, health care costs have increased in recent years in all countries.
However, despite this, spending levels vary widely around the world. The US local, state and federal governments are ranked 24th out of 29 countries for which comparable data is available, with a score of 38.0% (Global industry market sizing). Mandatory and discretionary spending makes up more than ninety percent of all federal spending and pays for all public services and programs that society relies on (Amadeo, 2022). High-spending countries spend much on social protection, while low-spending countries spend less.
Current Issues and Sustainability
In 2020, the number of newborns in the US fell to an all-time low. 3.6 million babies were born between January and December, according to the Washington government (Tavernise, 2021). According to the New York Times, that is about 4% less than a year earlier and mainly caused by the COVID-19 pandemic (Tavernise, 2021). The pandemic has also affected the frequency of childbirth among teenagers. Girls and young women aged 15 to 20, who mostly attended online courses due to school closures, gave birth to only about 15 children per 1,000 women of childbearing age. The birth rate, measured as the number of children per thousand women aged 15 to 44, has lowered by about 19 percent from a fixed peak in 2007 (Tavernise, 2021). The federal government reported that the birth rate was declining for the sixth year in 2020 (Barone, 2021). The coronavirus pandemic has also reinforced the postponement of pregnancy among American women.
In fact, wealth is the main reason for the declining birth rate in the US. Today more women are graduating than ever, making up most of the college students (Hanson & Checked, 2022). Scientists emphasize that women who have children by the middle of their 20s are more likely to avoid long-term education. Careers cause women to postpone having children, offering them less time to give birth while productive as well. Along with the increase in the number of women in the labor market, women’s ambitions have changed.
Environmental issues also influence the decision to have children. According to an Amnesty International human rights survey, four out of ten young people believe climate change is one of the most urgent global issues (Amnesty International UK, 2019). The United States is ready to play a leading role in building resilience. It means integrating sustainable practices into national policies, creating green jobs, and educating the public about how they can help make America more resilient. The ‘green’ economy’s creation and development are critical aspects of sustainable development. That means developing new industries and jobs that are environmentally friendly and sustainable. The United States has already taken necessary steps toward sustainable development, but much remains to be done to make the country a world leader in this area.
U.S. Health Disparities
Ethnicity and race are the leading measures of difference in the health care system of different countries, but they manifest themselves in different ways. For example, differences arise in socioeconomic status, geographic location, citizenship status, disability status, gender, age, language, sexual identity, and orientation (The root causes of health inequity 2017). Differences appear during life, from birth to middle age and among the elderly. Federal efforts to reduce inequalities are focused on specific priority populations, including people of color, children/teens, seniors, women, those with special health care needs, and those living in urban and rural areas. These groups are not equally complete and often overlap in meaning. Inequalities arise within population smaller group as well. For instance, there are differences in medical and health care among Hispanics based on duration of stay in country, immigration status and even in primary language. Additionally, data for Asians often mask underlying differences between subgroups of the Asian population.
In the United States, socio-economic inequality is associated mainly with racial characteristics. According to the Census Bureau, in 2019, the median income of Asian Americans was $98,000, whites $76,000, Hispanics $56,000, and African Americans $46,000 (Inequalities persist 2021). Tax filing and census statistics show increased wealth inequality in the United States in recent decades. Differences in access to health insurance among racial groups, stemming from income disparities, put the United States among the leaders in the number of deaths from a new coronavirus infection.
One of the critical problems facing the American healthcare system at the beginning of the pandemic was the lack of beds for patients with a new coronavirus infection. The American government has encouraged the transfer of treatment from hospitals to outpatient settings over the past decades to save money. The main tools for this are Medicaid and Medicare. Hospitals rely on program funding to cover the cost of most hospital admissions or improve their medical workforce’s skills, to compensate for the cost of treating uninsured patients. Accordingly, the slightest change in the rules for reimbursement negatively affects hospitals that operate at the level of 1-2% of profit per year (Disparities 2022). The situation that arose in 2019 around the world pointed to all the shortcomings of the healthcare system in the United States and all other countries.
Conclusion
The United States does not have a uniformly regulated healthcare system. There is a wide range of private and public health insurance providers, and the rules regarding insurance are constantly changing. As in other aspects, freedom is a valuable asset, and everyone can decide for himself whether he wants to insure or not. After that, a law gave new food for thought and opened up another era. The dimensions of the main segments of the healthcare system are so significant that understanding the mechanisms of their functioning is essential for the entire sphere of medical services and for the economy. The US healthcare reform is built into the existing system and is aimed at developing competition in specific segments, for example, between insurance companies that sell medical policies in state-regulated markets. The reform sets the task of adjusting the motivation for the activities of insurance companies and medical institutions. In addition, the health system faces other challenges, such as combating the high rate of chronic diseases and increasing the birth rate. It can be influenced by focusing on sustainable development and creating a green economy.
References
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