The United States is a country with a developed health care, to the success of which the American economy contributes significantly. Increased life expectancy of the population is the most important social change since the establishment of the social security system. In 1935, when the law on social insurance came into effect, life expectancy for men was 62 years and 66 years for women (Frank, 2012). At present, the group of people aged 85 years is the fastest-growing population group. Infant mortality index (children up to one year) is quite low, which indicates the high quality of the country’s health. However, several critical issues determine the relative instability of this area. In order to understand the current concerns about the health care industry in the USA, it is crucial to consider the system’s core.
Health Care System in America
The country spends on health care two times more in comparison with other industrialized countries of the West (Frank, 2012). Nevertheless, millions of Americans have no insurance, which means no guaranteed access to health services. The essence of the problem lies in the fact that the mechanisms of state regulation that stimulate and guide the development of the social sector of the economy are embedded in market relations (Frank, 2012). Currently, there is a tendency to broaden and strengthen the distribution functions of the government.
America has the most expensive health care system in the world. It spends more money on health sector than any other country in the world. The main laws governing the industry have been taken with the presidency of Lyndon Johnson (1857-1861) (Healey & Evans, 2014). Johnson has greatly enhanced the social policy of the country fighting against poverty and racial segregation. During his presidency, Medicare program (national health insurance, which provides the elderly US population with the corresponding health care services) was introduced. Certain specific features are characteristic of the health care industry in the contemporary America (Healey & Evans, 2014).
First, it is a system of health insurance called Medicaid. This type of insurance protects the rights of the poor since 1965 (Bauchner, 2015). A person should collect the documents confirming the low level of income, as well as, to fill in a number of papers to take part in this program. The system provides medical assistance for large families and the disabled. Services that are covered by the Medicaid cover consultation of doctors, hospital stay, vaccinations, medication prescription, preventive care for children, long-term care and other.
Second, it is a system of health insurance called Medicare. It is a special federal health insurance program for people over 65 and for those perishing from end-stage renal illness or amyotrophic lateral sclerosis (Bauchner, 2015). The system requires Medicare cost sharing, but 90% of the participants of this system have other types of insurance (employer-sponsored private health insurance, Medicaid or Medigap plan). There is also an insurance plan Medicare Advantage, which costs the participants about 12% more than the traditional Medicare. This system provides a lot more options for treatment.
Third, there is the health insurance SCHIP aimed at children. State Children’s Health Insurance Program is a joint program of the state and the US federal government, which allows insurance of children from families that earn too much to join the Medicaid but not enough to buy private insurance (Healey & Evans, 2014). SCHIP programs are conducted by the authorities of each state in accordance with the requirements defined by the Centers for Medicare and Medicaid Services. Within this framework, SCHIP can be an independent insurance program for children and a part of the Medicaid program. In terms of the insurance of children, state authorities receive additional funds from the US federal government. It is crucial that the state determines itself, which services will be provided for children through this program, but each state shall include examinations of children, immunizations, hospital stay, dental care, laboratory tests, and diagnostic radiation.
Fourth, there is a private medical insurance. Private insurance can be purchased individually or as a group (for instance, a company buys insurance for their employees). Most Americans who have private health insurance get it from their employers. At present, active measures are being taken in the country to encourage employers to buy health insurance for their employees (Healey & Evans, 2014). Many colleges, vocational schools, universities also offer student health insurance paid by the educational institution. Some schools require students to participate in the sponsored insurance programs or to provide proof that the student already has a comparable health insurance.
Health Care Concerns
Despite the presence of various insurance programs, the organizational structure of medical support in the United States is characterized by its pluralistic nature, the diversity of medical institutions, and the lack of a single centralized control. In the US, there are three categories of health care institutions such as public, private, profitable (commercial), and private non-profit ones (Ross, Orenstein, & Botchwey, 2014). Private or commercial hospitals are ordinary private business enterprises with their typical characteristic features. Federal and state government fund public hospitals (through taxation). They furnish care for specific groups of the American population and for patients with mental or severe physical disorders. Local municipal bodies found private non-profit institutions with the assistance of public funds, personal donations, as well as various companies, and charities (Ross et al., 2014).
These hospitals are private corporations, the initial capital of which is formed by the founders and, as commercial organizations; they provide services for payment. The non-profit status is widely used in the United States by various foundations, organizations, institutions, and companies as it allows them to avoid paying taxes (Ross et al., 2014). It should be noted that the notion of being non-profit does not mean that these companies provide medical care free of charge. There is a fundamental difference between commercial and nonprofit hospitals; in particular, instead of paying dividends, the shareholders of nonprofit hospitals invest their profits in the new or improved facilities, in the creation of reserves for investments and funds to assist the poor, which is encouraged by the state through a preferential tax treatment (Schulte, 2012).
In conclusion, the interventional activities of the state are necessary in the field of health management. On the one hand, there is the urgent need for compliance with national priorities in the field of public health, and on the other, the need to combine the real possibilities of the state with sometimes opposing interests of individual layers and groups of society. Responding to these objective needs of the society in an adequate way should be the incentive for the activities of state bodies in the sphere of public health.
References
Bauchner, H. (2015). Medicare and Medicaid, the Affordable Care Act, and US health policy. JAMA, 314(4), 353-354.
Frank, R. (2012). Long-term care financing in the United States: Sources and institutions. Applied Economic Perspectives and Policy, 34(2), 333-345.
Healey, B., & Evans, T. (2014). Introduction to health care services. Hoboken, NJ: John Wiley & Sons.
Ross, C., Orenstein, M., & Botchwey, N. (2014). Health impact assessment in the United States. New York, NY: Springer.
Schulte, M. (2012). Healthcare delivery in the U.S.A. Boca Raton, FL: CRC Press.