The US Health Care Industry - Case Study Example

Discussion of the U.S. health care industry Formalization of health care, in the years 1880-1930, in the United s of America has led to the evolution of medical career. This is due to the upgrading of physician education, increased duties of the physician and the steady uplift of the health system. During this time, Americans had little access to health services. They were treated at home. Good health services only accessed by the wealthiest in the society (Reid 100). Whenever any poor person was sick, he would have difficulty because he would not receive better health care. The wealthy people could access the best health care services because they could afford it (Reid 101). Health services in the United States have progressed. At the beginning of the twentieth century, health insurance was emerged (Reid 128). The health insurance prepaid the health care expenses. The growth of the American Medical Association, AMA, took control over medical practices. AMA formed a coalition with the insurance firms, hospitals and business organizations in order to provide better health care for the American people. This ensured better and easier accessibility of health care by all the Americans regardless of their social and financial capabilities (Reid 132). Health care in the US has also met a lot of challenges over the years. High care costs and health insurance covers bring headache to all US citizens. Even when one wants to change employment, they have to consider the effects in their health covers. Many people do not have insurance covers. They cannot afford it, while some cannot get it due to certain reasons. Patients are not fully satisfied with the physicians at the hospitals. The patients always sue the physicians for any mistake done. The medical doctors have loads of work from the government and the insurance firms, hindering their work (Reid 96). American health care is of high quality, readily available but at high cost. Despite this, the uninsured, underinsured and the underserved minorities have limited access to health services. America has one of the best trained health personnel but still has health workers shortage. About 84.2%, 250 million Americans are insured while 15.8% were not (Reid 187). Without insurance, one is likely to receive less of the preventive services. They have little access to personal physicians and cannot get the required health services. They succumb to even preventable disease and develop complications that may even lead to death (Reid 187). The health service in the states is offered by different legal health entities. Private sector owns and operates large health sector. The government provides health insurance. Organizations like Tricare, Medicare, Veteran Health Administration, Medicaid and Children’s Insurance Programme provide 65% of health care spending (Reid 133). Employers insure most people less than 65 years. Some people buy health insurance personally while others are totally uninsured. United States spent a lot on health services than any other country in 2008. It is the fourth highest spending country on health. The number of underinsured, the health cost and the uninsured has increased due to the medical debt of 2007 (Reid 138). The USA infant mortality rate is one of the highest in the world. Life expectancy is 42nd worldwide. The USA pays very hugely for health services yet still does not cope with other nations in terms of life expectancy and infant mortality. At birth life expectancy stands at 78.5, 50th worldwide. Health care in the US is the costly than any other nation. USA is ranked the best health care provider in responsiveness, 72nd in overall health and 37th in performance. 98.4% people in USA are insured. In 2009, 44800 patients died for lack of health insurance (Reid 139). The private firms own the health care systems. The state, federal and city governments also run the health sector. Local government health facilities are open to the public. Field hospitals are operated by the federal. Federal VA, Veteran Health Administration, is only for veterans (Reid 116). Native Americans operate in the Indian Health Services, IHS. IHS funds these facilities increasing the capacities of the systems. The hospitals provide outpatient, specialty clinics and inpatient care services. Charities and government subsidize the health costs of the terminally ill, hospice services and the sporadic illness (Reid 118). The United States medical education trains their physicians. The physicians may also receive certification from the international medical schools that are internationally licensed to provide trainings. The private companies manufacture and produce the medical and pharmaceutical services. The public and private sectors fund the health sector. The health research and expenditures bills were settled by the public and private sectors. The medical research has made US one of the leading research centers in the world. Costs of patented medicine have improved reinvestment in health development and research (Reid 165). Many US citizens accuse the health providers of being concerned about the expense of providing health care service than the quality of services offered. The MCOs have poor methods of measuring the health performance in the States (Reid 120). Medical reports are not easily accessible, patients are not provided with the full information they need. Therefore, the MCOs should work on their service provision in that information may be accessible. Patient’s confidentiality maintained and proper methods and procedures of measuring performance established (Reid 124). About 45% of the US population has a chronic condition. Sixty million have multiple chronic situations. In the Medicare program, 83% of the patients have more than 1 chronic condition. 23% have more than 5 medical chronic conditions. It is estimated that in 2015, 150 million American citizens will be diagnosed with at least 1 medical chronic condition (Reid 98). The insurance plans and the patients pay the hospital and doctors services. The individuals with government or private insurance have limited access to health facilities. They are only allowed to use their insurance in specific health centers (Reid 99). Emergency treatment is accessible by all patients, despite their ability to pay. Emergency care is more expensive than the normal care. Emergency rooms are usually full hence some ER patients are directed to other health facilities. The state and federal level takes responsibility of the health care facilities. Under the McCarran-Ferguson Act, they provide license for the health facilities and approve the operations of the pharmaceuticals through the food and Drug Administration. The regulations protect the consumer from ineffective healthcare. They also control the health care insurance market under the stipulated insurance laws and procedures. This enables fair and perfect competition (Reid 107). The health standard of the United States needs to improve. Several factors hinder the smooth running of the health sector. Getting health facilities is one of the major problems that makes US lag behind. Patients have limited access in seeing the physician and obtaining medical attention. The number of people with health insurance in US is less than in other leading country. The US has the longest waiting time on appointment. It has also one of the largest numbers of patients with pending medical bills (Reid 120). The USA should provide universal health insurance coverage that is affordable for the citizen. The US can practice cost saving. It can use the government to negotiate prices of services to obtain revenue that can be diverted into paying of health insurance. Global budgeting may also improve provision of health insurance. This is through restraining health care costs and provision of health care incentives. Provision of universal health coverage will ensure that the US citizens have access to health services without financial constraints (Reid 114). This will enhance faster access to health care which will save a lot of lives. United States has poor health information technology and the EMRs. The minimal cost for these tools lowers the effectiveness of health services provided. Physicians waste a lot of time doing paper work instead of attending patients. The relationship between the physician and insurers is not good. Additional of physicians to curb the paper work pressures the available facilities. To improve efficiency and reduce administrative expenses, the US health sector must adopt an electronic method of processing claims and improve on technology by getting a uniform billing system across the payers. Automating payments and health transactions will reduce rely on paper and fasten all processes in the health sector and reduce errors at the hospital (Reid 135). One of the major factors that hinder the health service sector in the US is the equity factor. The differences based on sex, ethnicity, insurance status, income, and geography have led to the decline in the health sector. Minimal differences in terms of provision of health services should be avoided to improve the health sector in the States. Wide gaps exist between the uninsured population and the insured. There is a difference in service provision along the ethnic ties. Provision of services should be open to everyone irrespective of race, sex, financial income or ethnicity. Overcoming this obstacle will see the health service greatly improve (Reid 178). Quality of US health sector is in question. The health care system in the US is not fully providing effective clinical services. The care coordination, handling of chronic diseases, inadequate admission of nurses, medical errors and high incapability of death prevention in the US health is of low quality. The quality of services of health sector will be noticed when there is adequate provision of prevention services, minimal errors and effective clinical processes. Financial incentives to the physician and monitoring of health performance will improve the quality of health services provided (Reid 180). The physicians’ payment system should be reviewed so that better payment methods like Medicare should be used. Supporting the patient – physician relationship will improve service provision in the health sector. The technological prowess of the USA health sector is lagging behind compared to major nations. Investing in research and having up to date infrastructure that encourages innovation will greatly improve the technological factor in the health system. Relying on outdated technology will result in low quality health results that would lower the health standards. A sufficient number of trained physicians and health care personnel ensure appropriate research hence improvement in the United State’s health sector. Public and the private investors should highly invest in medical researchers. The public will greatly benefit from the discoveries that promote a development in the health sector. This, therefore, will advance the health sector and encourage innovation thus improvement in the US health sector (Reid 185). Many lessons are got from the innovations and experience of other countries health system. The US is indeed improving its health care. The improvement of the patient centre primary care and trained physician has really seen the health care climb great heights. The adoption of the reimbursement methods improves the service provision and the quality of health care. Expansion of health technology, infrastructure and government investments will see the US health care improve even more. Works Cited Reid, T. R. The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care. New York: The Penguin Press, 2009. Print. Read More