Comparison between American and Indian Health Care System - Research Paper Example

?Running head: Comparison between American and Indian Health Care System Comparison between American and Indian Health Care System Date Introduction Many Americans have access to high-quality health care although at high costs. Nevertheless, the uninsured and the spiraling population of the underinsured, the poor, and the minority groups have inadequate access to health care, with effects of poor health outcomes, sometimes worse than developing country residents do. The provision of affordable health care to every American citizen remains an uphill task. Increasing health care access, while managing overall expenses and maintaining high-quality health is still a daunting challenge. Currently, the US health sector faces serious shortfall of primary care physicians. The Indian health care system comprises of several levels from national down to village levels. Unlike the non-real American system, the Indian system permits universal access healthcare for all its citizens through the national Rural Health Mission Program. India’s referral system underscores the Primary Health Care (PHC). This paper will compare US health care system with that of India by examining the factors affecting access to health care services, current health care financing, and the health care delivery system of both countries. The American Health Care System The American health care delivery is a non-real system comprised of four aspects, including financing, delivery, insurance, and payment mechanisms that are nonstandard, with loose coordination rather than a standard linear system consisting of interrelated components designed to operate in a coherent manner. It is unnecessarily fragmented. The financing component entails finances used to buy insurance or payment of consumed health care services. Insurance is necessary for guard against disastrous situations. Delivery involves provision of health care services. The payment aspect concerns reimbursement to providers for services consumed (Shi & Singh, 2012). Accessibility to health care in US depends on an individual’s ability to pay, availability of service, implementation of restrictions, and payment. This entails the person’s ability to procure health care services. The people eligible for health care services include those who have employed-based insurance, those under the health care program of the government, those able to purchase insurance out-of-pocket, and those capable of paying for private services. This implies that the insurance is the primary mechanism of health care service access (Shi & Singh, 2012). The groups that may be eligible for these programs include the poor, elderly, children, disabled, uninsured, military workforce, and the veterans. However, the fiscal planning for public insurance are made through private organizations such as the HMOs, with private physicians and hospitals rendering health care services. Out of 250 million Americans, having some form of insurance coverage, 174.5 million have privately purchased insurance coverage, while those under Medicare are approximately 42 million, with almost the same number being the beneficiaries of Medicaid. According to the 2006 US Census Bureau, 15.8 % Americans lacked insurance for that year (American College of Physicians, 2008). At least 1,300 corporations provide insurance services, with 64 Blue Shield/Blue Cross programs being in existence. A multitude of government agencies provide health care finances, research on medical and health provision, and supervision of the various components of the health care delivery system (Shi & Singh, 2012). The US financing of health care The health care expenditure at national level was about $ 2.0 trillion, constituting 16 % of US GDP in 2005. The expenditure is expected to hit $ 4.0 trillion in 2015, representing 20 % of GDP (American College of Physicians, 2008). The mechanisms of financing, payment, insuring, and delivery functions are a blend of private and public sources. However, the four key operational functions are majorly private. The employer-based insurance or privately owned insurance make up private financing, while the Medicare and Medicaid constitute the public funding. The private sectors driven by the desire to make profits are the primary players in performing the chief operational functions of health care delivery in the market-driven US economy. The employer-purchased insurance comes from private sources, while the private health care providers render health care services to people. The Medicare, Medicaid, the State Children’s Health Insurance Program (SCHIP) programs run by the US government finance insurance coverage that target specific groups of people, who fulfill the programs’ approved eligibility criteria (Shi & Singh, 2012). The US health care delivery The system comprises components that are interrelated and interdependent whose blueprints integrate mutual goals. It is unique in the sense that it lacks a centralized body to manage and control. The management and control of the system is almost impossible for a centralized body. The hugeness of the system underscores its complexity. There exists market imperfections, and existence of third-party insurers and multiple stakeholders. The US is among the key developed nations that do not have the program for national health care. The various health delivery settings employ roughly 10 million staff, of which 744,000 are practicing medical doctors, 168,000 dentists, 2.2 million nursing workforce, over 220,000 pharmacists, at least 700,000 medical and health care administrators. The US has approximately 325,000 therapists that render rehabilitation services in the physical, speech, and occupational areas. There are at least 5000 hospitals, approximately 4000 hospitals, and around 16,000 nursing homes in the US. The medical schools number at least 150, while dental schools total 56, with 91 pharmacy schools, and at least 1500 schools of nursing dispersed throughout the US (Shi & Singh, 2012). Market imperfections may be ascribed to pricing items through procurement of charged fees for rendered services (Shi & Singh, 2012). Package pricing through health bills bundled for a group of services that are related, and capitation, whereby the entire set of health care services comprise individual bills that tend to be more comprehensive. Capitation is an amount approved or flat rates that cover the health care for a particular period, usually per month. Phantom providers also characterize imperfect markets. Such ghost providers separately bill for range of services including supplies for pathology, use of health facilities, and anesthetics. The relationship between suppliers and health care providers tend to influence demand for health services (American College of Physicians, 2008). The physicians tend to engender market demands for private financial gains. The receipt of care by physicians, including follow-up visits, unnecessary surgeries, and tests tend to be superfluous. The presence of the third-party payers and insurers has the implications for first party patients, with health care providers being second party, whereas the intermediaries form the third party. There exists a dichotomy between financing and delivery at the intermediary level, whereby the provision of high quality care is not the primary concern. Furthermore, the primary care physicians tend to practice defensive medicine, an action, which entails the procurement of procedures, tests, and consultations whose clinical worth is questionable such that the physician prescribing such medications is immune from malpractice litigation (Shi & Singh, 2012) Shi and Singh (2012) observed that referring to the US health care delivery as system would be misleading because in real sense it is not a system although called a system when referred to its salient components, features or services. The multiple components of the US health care delivery can easily be decoded when viewed from the framework perspective. The five aspects of health care delivery framework include the foundations, resources, outcomes, outlook, and processes of the system. The system is characterized by overlap, defects, irregularities, superfluity, , complexity, fiscal manipulation, fragmentation, and lack of efficiency. The escalation of costs of managed care has been influenced significantly by the problem of increasing health care costs. The managed care system is an aspect of health care delivery that integrates the primary health care delivery functions in order to increase efficiencies. The system employs utilitarian approach to medical service provision and charges for rendered services. The hospitals and physicians are not the only providers of health care. Other health care providers include the sub-acute units of care, and surgery facilities for outpatients have emerged according to the evolving circumstances of economic opportunities. Concerns for access, costs, and quality have stimulated periodical changes in the delivery system (Shi & Singh, 2012). The system cornerstones may include the tenets of culture, values, and historical developments. The system resources comprise the human resources such as medical professionals, and nonhuman resources such as medical technology and financing of health services, whereas the system processes may include the care continuum, including curative, preventive, and restorative services for outpatient and primary care, inpatient services and facilities, managed care and integrated facilities, long-term care and health services for special populations. The system outcomes include the issues concerning health care costs, quality, and access. There is the need for health care reforms and change of health policy. The system outlook encompasses the future prospects of the health service delivery (American College of Physicians, 2008). The Health Care System of India The India’s system is comprised of several tiers cascading from the national level down to village level. Such levels range from the national, state, district, community, Primary Health Care (PHC), health sub-centers, and village levels. The national tier comprises the Union Ministry of Health and Family Welfare, of which fact has the Family Welfare Department and Health Development technical departments. The State Department of Health and Family Welfare in every state govern the state level structure. The technical department at this level is the State Directorate of Health Services (SDHS) and coordinates with the office of the State Department of Health and Family Welfare. However, SDHS’s organizational framework is uneven across India. Each State Directorate comprises supportive categories made up of technical and administrative personnel. In spite of incorporation of Directorate of Medical Education and Research (DMER) into SDHS, it still manifests the tendency to exist as a distinct entity. DMER exists in Kashmir, Jammu, Maharashtra, Tamil Nadu, Punjab, Karnataka, and Haryana states. The Madhya Pradesh, Andhra Pradesh, Karnataka, Bihar, and Uttar Pradesh states have established regional set-ups between the SDHS and the District Health Administration. The regional setups each contain three to five districts (Kamalam, 2005). The district level framework harmonizes the state structure and regional structure on one side with peripheral level PHC frameworks and sub-centers on the flip side. The information received from the state level is conveyed to the peripheral PHC through appropriate modifications in order to address local needs. In this way, the district structural tiers act as managers and conjure up various kinds of general, organizational, and administrative issues with regard to the management of health care. The district health administration undertakes preventive health promotional activities in harmony with state health programs and Multipurpose Health Workers Scheme (MPHWs). This body is also responsible for ensuring that medical care and welfare services for families are freely accessible across the communities in the district via the Primary Health Services and below (Kamalam, 2005). Furthermore, the district health administration provides other statutory services, including medico legal process, medical examination, accreditation, jail oversight, hospitals, and post mortem. This entity provides entry pre-service training for para-medicals and professionals as well as health staff in-service training at the PHCs and sub-centers of the respective districts. At the community level, the single Community Health Center (CHC) ensures provision of effective referral services to a population of between 80,000 to 120,000 people. Such centers offer continuum of primary care services, including general medicine, surgery, obstetrics, gynecology, and pediatrics. The establishment of CHCs implies upgrade of sub-centers or Taluk level hospitals or a number of PHCs at block level. Hospitals at Taluk level and Community Health centers can be regarded as the First Referral Units (FRUs). Each PHC serves a community population of approximately 30,000. There are ongoing efforts to refurbish the various rural dispensaries in order to generate auxiliary health assistants. There are sub-centers managed by one male and one female health care worker. Each sub-center can serve up to 10,000 people. The India’s government 7th Five Year Plan aims at reducing the population served by one sub-center to 5000 people. Currently, one male health care worker serves approximately 7,000 people, whereas the female worker serves an average of 5,000. The village level is more peripheral than sub-centers. A community often selects a single healthcare worker who can either be a nutritionist, health guide, traditional birth attendant (TBA) or a skilled Dai that serves about 1000 people in the village. These workers procure their skills from the sub-centers and PHCs. Rather than being government employees, the skilled staff work on voluntary basis. The community health workers receive technical support and further education from the multipurpose health care workers stationed at the sub-centers. The Panchayat or the village health committee is often charged with oversight and support (Kamalam, 2005). India’s Referral System The referral system comprises sequential tiers of referral support existing at the secondary and tertiary tiers supporting the health care delivery system at the national level, and PHC operations within the local community. In fact, the World Health Organization regards referral system as a key pillar in promoting PHC. The system is organized such that specialized health institutions form the links to referrals. The PHC comprise the primary point of reference within the sequence health system (Kamalam, 2005). Factors affecting accessibility to health care The India’s health care system is an amalgam of private and public subsidized healthcare services, with the private sector accounting for at least 80 % of spending on healthcare. Following decades of underfunded health care, there are insufficient health infrastructures, of which many offer primary care. There is mismanagement and ill equipment of public health facilities (Bairu & Chin, 2012). According to the 2007 Price Water House Coopers report, public health facilities are inefficient, understaffed, improperly maintained medical equipment and mismanaged except the All India Institute of Medical Studies (AIIMS). Moreover, there is shortage of public health facilities and more than eleven states of India lack laboratories for drug testing, with existing ones being either poorly equipped or understaffed. Both private and state hospitals usually provide treatment that is subsidized and charitable to the poor. Nevertheless, the majority of patients privately pay for health care services. Furthermore, the vast majority of Indian population lacks insurance coverage. The available public insurance schemes are usually basic and inaccessible by the majority. Only 11 % of Indian population is insured although there is greater expansion of access to insurance coverage due to burgeoning middle class. The government through the General Insurance Company (GIC), in addition to its four subsidiaries, the Oriental Fire & Insurance Co., the National Insurance Co., the New India Assurance Co., and the United India Insurance, chiefly provides insurance. Private insurance coverage in 2004-2005 constituted 1 %, with group insurance accounting for 35 % of total health insurance. About a quarter of Indian population have access to Western (allopathic) medicine, mainly practiced in 67 % of India’s hospitals and health facilities located in the urban areas (Price Water House Coopers, 2007). The vast majority of Indian population lives in rural areas. Many of the rural populations depend on alternative forms of treatment, including the unani, acupuncture and ayurvedic medicine. Approximately 67 % of India’s 15,393 hospitals were public in 2002. The inadequate health care infrastructure in India, especially within the context of primary care, blended with high poverty, diverse cultural and linguistic backgrounds, and illiteracy levels in the dense rural population, has underlain high morbidity and mortality rates in India relative to countries of same economic status (Bairu & Chin, 2012). The Rural Health Mission Program of 2005-2012 targets India’s rural populace in the 18 worst developed states in terms of public health indicators and poor infrastructure. This would improve accessibility of at least the government-run medical facilities by the rural poor. The urban poor are much worse off than rural poor because of the thriving private facilities that they cannot afford (Price Water House Coopers, 2007). Current Health Care Funding The state governments of India bear the brunt for funding public health, constituting 80 % of public funding. The national health programs are run by the federal government and constitute 15 % of funding. Nonetheless, the private sector financing dwarfs the public healthcare spending. Out of $ 30.5 billion health care expenditure of India, private corporations charging fees constitute 82 % of the total health care spending. This ratio is extremely high when graded on international scale. Approximately 60 % of the total outpatient care is provided by the private sector, while providing nearly 40 % of inpatient services. Nearly 70% of all Indian hospitals and 40 % of hospital beds are in private hands (Price Water House Coopers, 2007). Conclusion To summarize, many Americans have access to health care having some form of health insurance. On the contrary, only a small Indian population is insured. The public funding of insurance by the US are organized through the private insurers, whereas in Indian, government is the chief provider of insurance through GIC and its four subsidiaries. India tends to underscore PHC through the referral system. Just like the US, India’s private insurers constitute the bigger proportion of health care spending. Unlike India and other key developed nations, the US lacks national health program that ensures universal accessibility to health care. Accessibility to health care in US depends on an individual’s ability to pay, availability of service, implementation of restrictions, and payment. Unlike US, India mainly offers basic care although it is characterized by underfunding, mismanagement, and ill equipment of public health facilities. The American system has four complex aspects including financing, delivery, insurance, and payment mechanisms. References American College of Physicians. (2008). Achieving a High-Performance Health Care System with Universal Access: What the United States Can Learn from Other Countries. Annals of Internal Medicine , 148 (1), 55-75. Bairu, M., & Chin, R. (2012). Global Clinical Trials Playbook Management and Implementation When Resources Are Limited. New Delhi: Academic Pr. Kamalam. (2005). Essentials in community health nursing practice. New Delhi : Jaypee Brothers Medical Publishers. Price Water House Coopers. (2007). Healthcare in India:Emerging market report 2007. USA: PricewaterhouseCoopers. Shi, L., & Singh, D. A. (2012). Delivering health care in America : a systems approach. Sudbury: Jones & Bartlett Learning. Read More