...The U.S. Health Care System Catherine Wiley HCS531 September 12, 2011 Kenneth Feldman The U.S. Health Care System A health care system is a “network of agencies, facilities, and providers of health care within a specific geographic region” (Widipedia). The health care system is designed to meet the health care needs of a target population. According to Shi and Singh (2008), “A health care delivery system has two primary objectives: 1. Provide health care to all its’ citizens; 2. Services must be cost effective and meet standards of quality” (5). A system, “consists of a set of interrelated and interdependent components designed to achieve some common goals, and the components are logically coordinated (Shi & Singh, 28). As Shi & Singh (2008) state the health care system in the United States is a mixed market system. The source of coverage comes from the government, insurance from employers, and private payment. The health care system in the United States is not a system because there is no standardization, and is fragmented. Financing, insurance, delivery, and payment is from private and public sources. These four components creates the fragmentation of the system. These components compose the Quad-function Model and are necessary for the delivery of care in the United States. The components overlap to varying degrees in traditional insurance, government-run insurance...
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...policies from one country to the other. There is no such thing as a perfect finance model. There are many calls to move towards contemporary American free insurance and service market system6. It is argued that if there is no competition, the consumer will continue to be poorly served and second-class treatment will remain. However, many responses listed out the sophisticated problems that have arisen from the American healthcare system. Patient Choice One of the important justifications of the system in the US is greater patient choice. Under the concept of “money following the patient”, patients would not be constrained by cost considerations when choosing services between private sector providers and public sector providers6. Americans are free in the selection of doctors, standards of services as well as service providers. From the experience of the US, voluntary private insurance permits doctors to offer more expensive services beyond the basic provision. Patients are required to pay out-of-pocket for any extra charges. This kind of rigid payment system actually constrains rather than expands freedom of choice of patients6. Patient choice is expensive and thus is more likely to be restricted, especially when there is cost containment. It is the situation in the US that one of the main functions of HMOs was to introduce a gate-keeping role for GPs and limit the wide choices of specialists inherent in the traditional insurance mechanism11. Efficiency With free choice...
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...Economic in the U.S. healthcare system: The $765 billion price tag on wasteful spending Our country aims at continuing to increase the quality of patient care but medical services are being overused at an alarming rate causing great concern. The health spending of this country’s gross domestic product or GDP is 17.6% which is more than any other country (Feldstein). A report from CMS in 2010 states that the total health spending in the U.S. was roughly $2.6 trillion which is twice as much per capita of the average for any other nation yet delivers a lesser amount of care. These figures translate to $8,402 per person. (CMS) The Centers for Medicare and Medicaid Services predicts that this figure will reach $4.6 trillion by 2020 which translates to almost 20% of our GDP. Table 1. Health care spending as % of GDP in 2010 Source: OECD; The Economist, 2009 Out of the trillions of dollars spent in healthcare, the 2009 PricewaterhoseCooper’s report The price of excess: Identifying waste in healthcare spending estimates that $1.2 trillion is wasted. This is equivalent to more than half of what is allocated towards health spending in the U.S. and the figures are broken down in various categories. The report attributed health wastefulness in the following areas: 1. $765 billion towards issues related to healthcare reform debate (6 major areas...
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...Running Head: Fraud and Abuse Fraud and Abuse in the U.S. Healthcare System Tenisha Howard Keller Graduate Professor Cutspec June 12, 2011 Background People can be affected by healthcare fraud and abuse directly and indirectly. Fraud is defined as an intentional deception, false statement or misrepresentation made by a person with the knowledge that the deception could result in unauthorized benefit to oneself or another person. It includes any act that constitutes fraud under applicable federal or state law. Abuse is defined as practices that are inconsistent with professional standards of care; medical necessity; or sound fiscal, business, or medical practices. Intent is the key distinction between Fraud and Abuse. An allegation of waste and abuse can escalate into a fraud investigation if a pattern of intent is determined (B, Tom). Both, fraud and abuse can be committed by physicians, patients, and private insurers. Situations of fraud and abuse that occur in our healthcare system are billing for services that have not been provided, overbilling for services provided, and misdiagnosing health conditions in order to avoid financial responsibility for the proper treatment of illnesses. Define the Problem What can decrease the high costs of premiums and co payments? With the decrease of fraud and abuse, premiums and co payments would not be high. Who pays for fraud and abuse healthcare bill? Medicaid and Medicare are the two federal programs that are...
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...Project Comparison of Healthcare in US and Canada There are various differences between the healthcare systems in Canada and US. The differences were indelibly noted in 2004 after a policy analyst compared the two countries on the healthcare systems. According to the analysis, it was noted that US has an expensive healthcare system that doubles the Canadian healthcare systems. According to the percapita income expenditure on health report, the U.S spends $6,096 while Canada spends $3,038. On the other hand, other studies that were conducted later after the study was done indicate that the Canadian healthcare systems are better than the U.S healthcare systems. The reviews illustrated that the Canadian healthcare systems give the Canadians better and superior healthcare services as compared to the U.S (Pylypchuk&Sarpong, 2013). Pylypchuk andSarpong (2013) contended that various analysts have found that U.S is one of the countries whose spending on healthcare is big, but suffers the poorest healthcare for its people. Reports show that Canada has longer life expectancy than the US. The report on infant mortality in Canada shows that Canada is better than U.S by a great margin. Although analysts say that the comparative analysis do not give consistent differences between the healthcare systems, U.S is one of the countries that has been spot-lit of the idea of expensive healthcare. The actual reasons for the differences between the Canada and U.S are not yet determined;...
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...Healthcare in Germany vs. U.S.A Western Governors University Organizational Systems and Quality Leadership Germany’s and the United States’ healthcare systems compare and contrast in many ways. Germany has the third richest economy in the world and many categorize their healthcare system as socialized. Germany provides medical care to all of the citizens—young, poor, old, sick, and injured. Otto von Bismarck the Prussian chancellor in the 1880s in Germany invented the concept of healthcare systems, the notion that a government has to provide mechanisms so all its people can get medical care when they need it. In 1883, the Sickness Insurance Act was passed, representing the first social insurance program. Over the past 130 years the system has grown to the point where virtually all of the population is provided access to medical care. The Germans have what they call “Sickness Funds”, which are paid for by premiums based on income to one of 240 private insurers. A worker earning 60,000 would split a $750 family premium with their employer. It is more expensive than the U.K. but cheaper than the U.S. by about two thirds. It is a system where the rich pay for the poor and the ill are covered by the healthy (Saul, 2014). The United States healthcare system until recently has been mostly controlled by private industries and insurance companies, although we do have Medicare and Medicaid for the old and poor. Recently the Affordable Healthcare Act has been passed which requires...
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...Running Head: U.S. HEALTHCARE SYSTEM REFORM HS543 Health Services Finance Summer Term 2012 Instructor: Mary Black Course Project Outline U.S. Healthcare System Reform Submitted By Project Outline This project will explore the current state or our healthcare and where it is predicted to cost us in the future. We will also examine the overall health programs and how the uninsured will affect the system entirely. Universal healthcare would alleviate the financial burden on some of the population and provide access to almost all of the country's population; however, this system will cost more. Funding the program will be discussed as well as the taxes and other funding that will help pay for the coverage. Likewise, how this will affect hospitals and healthcare providers. Topic: U.S Healthcare System Reform Outline I. Abstract II. Introduce the Issue (Background) A. An analysis of our current healthcare system 1. A history of major events 2. Impact to healthcare organizations III. Defining the problem A. Political disagreements B. The increase of expenses IV. Literature Review A. Is U.S. Healthcare deteriorating? B. Effects on the profitability of local hospitals V. Analyze the Problem A. Raising insurance premiums B. The uninsured VI. Possible Solutions A. French Healthcare system B. A public option VII. Implementation Plan A. Financing VIII. Justification A. Access of...
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...Topic: U.S. HEALTHCARE SYSTEM REFORM Course Project T. Wise DeVry HSM 534 Health Service Finance February 23, 2013 Week 7 Professor Alison Williams Background The United States, being the most diverse society in the world, has a long and unsuccessful history of attempts at healthcare reform. We spend almost $2 trillion dollars per year on healthcare, yet not all American people have medical coverage (Barton, 2007). A huge percent of the population have to rely on outside sources, such as benefit health care from an employer or from government programs, such as Medicare and Medicaid. As compared to other nations, our society has people that are more overweight, live under more stress, and are less in physical activity. Additionally, our healthcare system underperforms compared to with other nations in critical areas such as, access, quality and efficiency (Davis). How did our system get this way? Why are we paying so much while other nations not so much? A history of major events - The U.S. healthcare system is trying to evolve with modern times; however, as time goes on, our current situation becomes more apparent: * In the 1950s, the price of hospital care was growing; however, more attention was diverted to the war in Korea. Many legislative proposals were made, but none could not be agreed on. * In the 1960s, hospital care expenses doubled, and despite over 700 insurance companies selling health insurance, a large percentage of the population...
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...Organizational Systems and Quality Leadership Task 3 Organizational Systems and Quality Leadership Task 3 Bronagh Paladino Western Governors University 1 Organizational Systems and Quality Leadership Task 3 A1. The country that I pick to compare to the U.S. healthcare system is Great Britain. According to the PBS Frontline program, “Sick Around The World”, by T.R. Reid, Great Britain uses a government run National Health Service (NHS), which seems too close to socialism for most Americans. For about half of what the U.S. pays per person for healthcare, the NHS covers all U.K. citizens and has better health statistics. (Palfreman, Reid, 2008). According to the World Health Organization (WHO), the total expenditure on health per capita is $3,311 in the U.K., whereas in the U.S., the total expenditure on health per capita is $9,146. (WHO, n.d.). In the U.K. the NHS’s proposition is that the citizens never have to pay a medical bill, no insurance premium and no co-pay. The British pay for their healthcare out of tax revenue as the government owns the hospitals and the doctors are salary government employees. The British pay much higher taxes than the Americans to cover their healthcare. (Palfreman, Reid, 2008). The U.S. healthcare system is based on a regulated market system as it is regulated by state or federal legislation. The U.S. healthcare is paid for by a combination of public and private sources by third-party private or public insurers and out-of-pocket...
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...The problem with the current healthcare system. There are many problems with the current healthcare system in the United States (U.S.). Most of these problems stem from the fact that it is not really a system in the proper sense of the word. The healthcare system is really a patchwork of entities with their own goals and priorities. The “system” is unequal in access, costs of services, and quality. One of the major problems with the healthcare system is that healthcare services are seen as a product under the market justice theory. Healthcare services are really not comparable to most products because they are a necessity for all people at some point in their lives. One thing that makes accessibility a difficult issue is that insurance is required for most to be able to achieve access. Insurance in turn requires a job that offers coverage that is worthwhile and affordable, however, many jobs do not offer worthwhile, affordable, or any coverage at all. This is also a problem when a person becomes unemployed. Another problem that inhibits access is the high cost of services for many people. While accessibility may not be an issue for some there is also the issue of inequality of the costs of services. Unlike many other countries where the prices of services are more transparent or equal in the U.S. many factors determine the cost of one particular service to an individual such as where the patient lives or what their insurance covers. This leads to the problem of those...
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...AND THE HEALTHCARE DELIVERY SYSTEM The Public and the Healthcare Delivery System September 11, 2009 The Public and the Healthcare Delivery System Thesis: Discuss the current American health care delivery system and provide recommended improvements. I. Discuss current healthcare delivery system A. Define concept of healthcare delivery system B. General public opinion regarding our current delivery system II. Examine the cost for the current healthcare delivery system A. Primary methods for funding B. Reforming cost III. What is the current role of the U.S. government in the healthcare delivery system? A. Medicare coverage B. Veteran’s hospitals IV. Insurance coverage for U.S. citizens A. Total number of U.S. citizens with no insurance coverage B. Reforming Insurance coverage for U.S. citizens V. Discuss changes we need to make in the healthcare delivery system A. Public option B. Offer low cost-coverage to individuals with pre-existing medical conditions VI. Who will absorb the cost for the changes needed in healthcare delivery? A. Insurance companies B. U.S. citizens References Bohmer, R. M., & Lee, T. H. (2009). The Shifting Mission of Health Care Delivery Organizations. The New England Journal of Medicine. Retrieved September 11, 2009. Retrieved from http://healthcarereform.nejm.org/?p=1347 Dove, J. T., Weaver, W. D., & Lewin, J. (2009). Healthcare Delivery System Reform:...
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...Healthcare in Germany By Nabil Fakhoury Florida Atlantic University Into to Healthcare Systems (HSA 6103) Dr. Shehadeh Fall 2014 Table of contents Abstract2 Introduction2 Access and Coverage2 Expenditures and Finance3 Advantages4 Drawbacks5 Hospitals and physicians6 Conclusion7 Introduction The German healthcare system can be traced back to the 1883, when Prince Otto Von Bismark passed a health insurance bill into a law. The German healthcare model is still known as the “Bismark Model” today (Khazan, 2014). There are many differences between the healthcare systems in the United States and in Germany. The German healthcare system does have some drawbacks; however, its many advantages rank it as one of top countries for providing accessible and quality healthcare. Despite all the controversy surrounding the many changes that the German system has undergone, Germany is still able to spend a fraction of what the United States spends on healthcare while still providing quality care that is accessible to everyone (Green & Irving, 2001). Germany spends $4,495 per capita while the U.S. Spends $8,508 per capita (Gopffarth, 2012). According to Dr. Dirk Gopffarth, Germany favors balancing its healthcare management over balancing the market competition (Gopffarth, 2012). Healthcare financing relies mostly on sick funds and government contributions. Germany is the only country in the European Union with a supplemental private health insurance (Riesberg & Worz...
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...leader in the healthcare services and an extraordinary trend-setter in medications and the diagnostics. US hospitals, clinics, health centers and research centers have given an extremely decently prepared innovative environment for the healthcare. The United States has the biggest healthcare services on the planet which speaks to an extraordinary allotment of the US economy. In the year of 2010, the healthcare industries utilized more than 14 million individuals or the nine percent of the aggregate US work industries. In 2010, healthcare industries represented around $1.75 trillion in incomes. The overview of the U.S. Bureau of Labor Statistics assesses that between 2008 and 2018, the healthcare industries...
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...Access to Healthcare in the United States Many would argue that here, in the United States, we have the best healthcare in the world. We benefit from the most up to date medical technologies, medications, and services. People come from every corner of the world to take advantage of our top notch physicians and facilities. One would questin is this reputation warranted, and if so, at what cost? These costs rank us among the highest of industrialized nations (Lundy, 2010). Does this high expenditure equate to better outcomes? According to the National Scorecard on US Health System Performance (2008), the US received a 65 out of 100 possible points. Compared with 19 other industrialized nations, the US came in last place in preventable mortality. Preventable mortality means just that, deaths which could have been prevented if “timely and effective care” could have been provided (The Commonwealth Fund on a High Performance Health System, 2008). In 2000, the World Health Organization performed their first ever comparison of the health systems of the world. They reviewed 191 different countries and ranked them on numerous parameters, the United States ranked 37th for overall health system performance (WHO, 2000). Is it that our healthcare system is truly that poor, or is it that our care is only excellent for those patients who can actually afford it? A universal healthcare system would not only provide healthcare for all, it could also decrease our healthcare spending and potentially...
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...have been debating healthcare for the last hundred years. Before the 1900s, doctors didn’t have much technology to diagnose and treat the sick, so it was more affordable to patients. Once new medicines were found, doctors started taking advantage of these new treatments, which increased cost. Therefore, as the cost went up, the public needed a way to pay for the treatments; this was the start of health insurance. Health insurance and healthcare came about during the time of the Great Depression. There are currently two main methods of providing healthcare: public and private. Public healthcare provides universal access and is funded through the government. Two forms of public healthcare are Medicare and Medicaid which President Johnson signed into law in 1965. Medicare, or public healthcare, was first enacted by the U.S. government to provide healthcare to the elderly. Medicaid provides insurance to anyone who has a disability or is in poverty. Private insurers are funded by premiums and cover clients while also making a profit. The first private insurer was the Baylor Hospital in the 1930s, which later became Blue Cross Blue Shield Health Insurance. The purpose of this report is to determine whether private healthcare coverage, as it currently exists in the United States, is more or less effective than a single payer system according to three criteria: cost, availability, and quality. Method: The Commonwealth Fund supports research on healthcare issues and helps to...
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