Jan 12, 2018 in Health

Quality of US Health Care

To begin with it should be noted the national or general health care is a rather indistinct concept. In practice it is realized in various ways. The health system in each country is a product of its unique characteristics, history, political process, and national character of people; many of these systems endure large-scale reforms now.

Now it is possible to allocate three main essentially different health systems:

  • 1) mainly state (Great Britain);
  • 2) mainly insurance system presented in such European countries as Germany, France, Holland, Austria, Belgium, Switzerland, some states of Latin America, Japan and others; more than 1 billion people lives there, it is over a quarter of all world's population;
  • 3) mainly private (paid) system (USA).

Scientists have repeatedly undertaken attempts of the comparative analysis of health systems in different countries. According to the results the United States looks shaky lagging considerably behind other industrially developed countries in ratings.

The World Health Organization rated health systems in various states of the world last time in 2001. Then it came to a conclusion that quality of health system of the country do not always depend on its size, population and state of the economy. There is no certain universal model of the organization of health care which can bring success and prosperity to all states. According to this rating, at that time the best health system of the world existed in France. Italy, in its turn, took the second place, Spain - the sixth, Germany - the 12th, Great Britain - the 14th and the USA - the 35th.

Critics of the American health system often suggest reforming it having used foreign samples. They specify that expenses on health care are much less in many states while the efficiency of medical services is higher than in the USA. The skeptics insist the United States should add foreign experience to the arsenal and create the state health system.

Undoubtedly, the USA spends much money for health care in comparison with all other countries. The USA expenses make nearly 16 % of gross domestic product today. It is for 6, 1 % larger than an average value on other industrially developed countries.

However, large expenses are not always considered as the negative phenomenon. America spends money for medicine because it is a rich country. Economists think medical services to be "normal goods" and it means that its expenses have positive correlation with the level of income of the population. Growing of the mentioned income causes the increase of people's demand for these "goods" as well.

Nevertheless, due to the nature of distribution of these expenses medical services lay down as heavy burdens on consumers and corporations' shoulders. The annual medical insurance for a person costs 4479 dollars today, and 12106 dollars for a family. Contributions to medical insurance rose for 6 % in 2007. It means they have been grown quicker than an average salary has.

The majority of population believes that it is necessary to pass over to the system of state insurance as in France or in Canada in order to provide an acceptable health care for all people.

Many critics of the American health system want to create the state health care by a principle of "one payer". Within such system medical services should be financed at the expense of taxes instead of consumers' payments and private insurance. Direct payment from patients should be forbidden or sharply limited. If private insurance remains it will cover only small set of the additional services which will not be included in state insurance plan. The state will supervise expenses on medical care, developing the national budget of health system and compensation levels.

It should be noted the US government has held reforms in order to change the situation in its health care system. The health care reforms that President Barack Obama signed into law in March 2010 were seventy-five years in the making. Since Franklin D. Roosevelt, U.S. presidents have struggled to enact national health care reform; most failed.

Persisting through crisis Obama insisted on pursuing health reform despite the current economic crisis, surging deficits, and calls to wait for better times.

It is clear that reforms are inevitable. There is no free medicine in the USA and insurance companies pay for doctor's services which, in their turn, offer people annual medical insurances. Obama's initiative is urged to reduce cost of such insurance and to make medical aid more available. The law met rigid counteraction of insurance companies because it imposes strict restrictions. So, for example, it is forbidden to raise insurance cost for insurance companies in case the patient has a serious disease. This point deprives insurers of large profits.

The Market for Long-Term Care Insurance Expenditures on long-term care services in the U.S. is high and growing - they reached $135 Billion in 2004. Long-term care is extremely expensive - the average rate for a semi-private room in a nursing home was over $50,000 per year in 2002. Economic theory suggests that individuals should find it valuable to protect themselves against the risk of these large expenses by purchasing private long-term care insurance.

Physicians, in its turn, should cooperate and work in team. Team-oriented training approaches have resulted in improved interpersonal working relations, primary care staff members' better comprehension of each other's roles, and increased levels of job satisfaction and teamwork. Multidisciplinary care teams are common in many countries, particularly the United Kingdom, Germany, and the Netherlands.

The health system of the USA is presented by independent services at three main levels; it is family medicine, the hospital help and public health care. Medical services in the USA are accommodated by individuals and legal establishments. Various commercial, charitable and state organizations offer patients both out-patient and stationary services.

Many Americans do not have a private insurance. Therefore, the government of the USA pays expenses on health care by means of two main programs - Medicaid (for unemployed, deprived and some groups of disabled people) and Medicare (medical care for the elderly after 65 years) which allow the poor and needing inhabitants of the country to receive medical services free of charge or at low cost.

However, there are many Americans who have not been captured by any types of insurance. Many of them work but employers do not provide them with the medical insurance. At the same time these people are too young to correspond to the requirements of "Medicare" and do not refer to the category of poor so the "Medicaid" program does not extend on them as well. By different estimates, the number of uninsured Americans fluctuates from 20 to 50 million people (8-20 % of the population).

In the USA there is a harmonious system of relationship: the client - insurance company - the doctor. Insurance companies pay special attention to the list of medicines and treatment schemes. Effective legislation guarantees each doctor's step is under control in the country. American doctors do not prescribe preparations which are not included in the officially accepted list of medicines appointed at the level of Ministry of Health or insurance company. In case of presentation the claim to the doctor for a professional mistake the verification of all his instructions is carried out. The fulfilled and accurate schemes of treatment, regular updating of the list of preparations relieve insurance companies of a medical polipragmaziya, the client - from consequences of a medical error, and the doctor - from judicial proceedings.

Certainly, such medical thinking can be characterized as clamped by a narrow framework. Nevertheless, physicians avoid prescribing a large number of preparations if they are not sure in their compatibility. American insurance medicine with its voluntary medical insurance is on guard of their clients' health guaranteeing not only payment of the provided medical service but also high-quality treatment by traditional medicines. Any insurance company will not pay treatment cost with practicing hypnosis, acupuncture, homeopathic or phytopreparations. From the point of view of insurance medicine such therapy is nonconventional and its effect is disputable.

Therefore, on the one hand insurance companies protect the clients from nonprofessional medical care; on the other hand Americans trust the doctors and do not buy medicine without doctor's recommendation.

Still, very often physicians have to respond their patients' claims. Many of these claims are given for the most insignificant reasons. It should be noted, doctors won 91 % of all claims for inadequate medical practice (medical errors etc.) considered by juries in 2004. Doctor's protection of the reputation costs too expensively. Approximately 4,5 years pass from submission of the claim till the end of the trial passes and the average lawyer's fee made $94 284 in 2004 (according to the American medical association). Many states try to accept the law protecting doctors from unreasonable claims.

It should be admitted, quality of medical care is understood as a set of the characteristics confirming compliance of the rendered medical care to available needs of the patient (population), to its expectations, modern level of science and technology. Quality is a multidimensional concept. Nevertheless, its main characteristics are adequacy, availability, continuity, effectiveness, productivity, efficiency, safety, timeliness, stability of the process and the result, continuous improvement and improvement.

The ideas of improvement of medical care quality, consumers' satisfaction of medical service quality and protection of their rights are actively developed both in scientific researches and in practice in the USA. A great attention is given to these problems in lawmaking. American Congress specially founded Agency on researches in health care and quality for development efforts on a problem of improvement quality, efficiency and availability of medical care through carrying out basic scientific researches and advance of their results in clinical practice in 1989. The Advisory Commission on protection of consumers and quality of medical care (ACCP&QHCI) functions and the National Committee on ensuring quality (NCQA) are created.

Now scientific search in the field of health care quality and a choice of adequate methodical receptions for its assessment is conducted practically in all countries. The various international and national organizations on this problem began to be organized.

There is no doubt that the National Committee for Quality Assurance (NCQA) sets the standard for credentialing in managed care. Credentialing simply means making sure that a practitioner is qualified to render care to patients. Each managed care organization (MCO) is responsible for establishing the criteria for participation within the health plan, based on the needs of the members and the standards of the MCO. The basic elements for a physician are the following: valid and current licensure, clinical privileges at a hospital, Valid Drug Enforcement Agency (DEA) or Controlled Dangerous Substance (CDS) certificate, appropriate education and training - i.e., graduation from an approved medical school and completion of an appropriate residency or specialty program, board certification (if specified by the practitioner or required by the MCO), appropriate work history, malpractice insurance, history of liability claims.

Regardless of the standards set, the MCO must put a system in place that ensures that its practitioners meet these standards before they are accepted as an active provider within the health plan. This system or process is commonly referred to as credentialing. Credentialing is a necessary and critical first step in securing qualified practitioners to render and manage the care of MCO members. Failure to adopt and use effective policies damages the reputation of managed care and undermines the very principles upon which the industry was founded. More importantly, failing to devote sufficient attention and resources to credentialing means running the risk of providing substandard care to members who put their faith and dollars in MCOs that promise to provide quality care. On the contrary, taking the time to implement effective credentialing policies and procedures demonstrates an MCO's commitment to excellence and to securing only the most qualified practitioners for its members.

Credentialing is the process of review and verification of the information of a health care provider who is interested in participating with a managed care organization (MCO). Obviously, the entire credentialing process could be made easier if insurers use standardization of their format. This would allow physicians to hold up a database of all of their information in a standardized format and send the same information and application to each managed care organization. Physicians should accept this credentialing legislation system through their state and local agencies. This one decision could help the physicians to get rid of spending long hours for completing credentialing applications and compiling information.

The USA takes the first place on the volume of carried-out researches and the level of achievements in the sphere of medical technologies in the world. Undoubtedly, medical technology is obligatory for human health and better quality of life in some areas; and brings billions of dollars to the economy. Some would say that practical medicine depends on medical technologies greatly these days. It is probably based on supervision that clinical physicians use a big variety of technologies in diagnosing, consideration and assessment care of their patients. In the development of a new health care technology it is important to recognize its potential influence.

The purpose of the medical technologies' assessment in medicine is a formation of recommendations about rendering medical care on the basis of results of applied scientific researches. It is not enough to carry out an appraisal of only clinical aspects of efficiency means and ways of rendering medical care for realization this purpose. Carrying out the analysis of all sets of the clinical, economic, social and ethical problems arising in connection with application of medical technologies is essential for the development and choice of optimum decisions. Ethical and social aspects of technology application are considered from the point of view of providing equal opportunities in receiving necessary medical care for all members in society. The technology usage can be regarded as unethical in case of consumption considerable resources. Therefore, the rational use of technology is more appropriate as it will work for the benefit of many people. The process of assessment medical technologies should include features of organization health care and structure of rendering medical care.

The most qualified medical care becomes available to the growing number of people due to new information technologies around the world. Special clinic sites connect patients who need organ transplantation and potential donors in the USA. In rural areas of the poor states doctors can consult specialists of the medical centers and receive information which is necessary for treatment effective treatment.

New informational technologies make an essential contribution to the improvement of life quality of many people with limited physical or mental possibilities.

Within several centuries people, mainly inhabitants of the countries with high level of resources, used results of inventions which promoted the improvement of their health. Improvements of the state of people's health are connected with the possibility to predict, prevent, diagnose and treat many diseases and to facilitate functional violations due to the methods of treatment and technologies. It was hardly possible to imagine only several decades ago. Vaccines and medical devices are the most numerous among medical products which are usually applied at rendering medical help.

The rapid progress in carried-out researches allowed developing the complicated medical technologies such as genetic testing, genetic manipulations with living tissues, the robotics' use at carrying out surgeries and remote treatment. However, despite the reached progress the largest part of a world's population is almost deprived or at all has no access to many of these innovations.

The American health system is considered to be one of the best health care in the world market on equipment the latest diagnostic equipment, on high qualification of the medical personnel, on a high reserve of medical clinics, the centers and other establishments of medicine. The latest medicines are developed and used in the USA. The best medical educational institutions, the largest and equipped hospitals, strong research bases are situated there.

Making a conclusion, it should be noted that the health system in the United States of America takes a leading place in the world on scales of the resources concentrated in it. The United States takes a leading place on level and productivity of scientific researches in the world. The health care in the USA is provided with the most perfect medical equipment, drugs and expendables. According to the investigations the USA possess the stable medical system capable to fast reaction in changing conditions. America takes leading positions on confidentiality and respect for patients, on timeliness of assistance and satisfaction of patients' needs.

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