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Almost every country that has a publicly funded health care system
also has a parallel private system, generally catering to private insurance
holders. While one goal
of public systems is to provide equal service to all, this egalitarianism
is often partial. Every nation either has parallel private providers
or its citizens are free to travel
to a nation that does, so there is effectively a two-tier healthcare system
that reduces the [social equality equality] of service. Private hospitals
often get newer and
better equipment and facilities, and since private providers are typically
better paid, so medical professionals motivated by money concerns migrate
to the private sector.
Publicly funded medicine, also called "socialized healthcare" or "universal healthcare", is a healthcare system that is financed entirely or in majority part by citizens' tax payments instead of through private payments made to insurance companies or directly to health care providers (health care premiums, co payments or deductibles). Medicare is a federal government program providing coverage to people age 65 or older. Medicaid is a federal and state program providing coverage to low-income and disabled persons. The Department of Veterans Affairs directly provides health care to U.S. military veterans through a nationwide network of government hospitals. However, a significant number of people exist who do not obtain health insurance through their employer, are unable to afford individual coverage or elect not to purchase it, and are not elderly or poor enough to qualify for Medicare or Medicaid coverage. Currently, it is estimated that 17% of the U.S. population is uninsured. A few states have taken serious steps toward universal health care coverage, most notably Minnesota. Other states, while not attempting to insure all of their residents, cover large numbers of people by reimbursing hospitals and other health-care providers using what is generally characterized as a charity care scheme; New Jersey is perhaps the best example of a state that employs the latter strategy.
The United States has been virtually alone among developed nations in not implementing a universal healthcare system. However, the U.S. health system does have significant publicly funded components. Medicare and Medicaid coverage is financed from taxation, but care is generally provided by privately owned hospitals or physicians in private practice.
Aspects of the United States health system
Whether publicly funded healthcare can adequately deliver health care
more cost effectively than the free market is a matter of much debate.
Of all developed nations, the healthcare system of the United States
has the highest degree of privatization. Consequently, it is frequently
cited by those favoring or opposing universal healthcare.
The cost and quality of care in the United States are frequently the
two major issues of discussion. Although the United States is below
the average for developed countries in health measures such as infant
mortality, maternal death, life expectancy, or cancer survival rates,
relevant statistics include people not covered by any insurance and
those covered by the system get what is arguably the best health care
in the world. Access to advanced medical treatments and technologies
is greater than in most other developed nations and waiting times are
substantially shorter for treatment by specialists. Also many foreign
citizens visit the U.S. to obtain treatments unavailable or available
only with long waiting lists in their home countries.
The United States does spend more on health care, as an absolute dollar
amount and per capita, than any other nation. It also spends a greater
fraction of its national budget on health care than Canada, Germany,
France, or Japan.
In 2001 the United States spent $4,887USD per person on health care,
more than double the rate of any other G7 country except Japan, which
spent $2,627 per capita annually. Risk factors specific to the U.S.
population, such as a relatively high prevalence of obesity, may partially
explain increased health care spending; however, many other industrialized
nations do share these problems to some extent. Although the U.S. Medicare
coverage of prescription drugs is scheduled to begin in 2006, most patented
prescription drugs are significantly more costly in the United States
than in most other countries. Factors involved are the absence of U.
S. government price controls, enforcement of intellectual property rights
limiting the availability of generic drugs until after patent expiration,
and the monopoly purchasing power seen in national single-payer systems.
Many U.S. citizens obtain their medications, directly or indirectly,
from foreign sources, to take advantage of lower prices.
The United States system does have substantial public components. Of
every dollar spent on health care in the United States, 44 cents comes
from some level of government. The elderly are covered by Medicare,
the poor (those with assets of less than $2,000) are covered by Medicaid,
merchant seamen are covered by the Public Health System, and retired
railway workers and military veterans are also covered by the government.
Government also affects private sector medicine through licensing and
regulatory barriers to entry into health professions.
Most experts believe that the U.S. system is best described as exhibiting
greater inequality than others, with covered people receiving a very
high quality of care and the uninsured and underinsured receiving a
lower standard of care. It is not clear that the lower standard of care
received by the uninsured and underinsured in the United States is actually
lower than that of other nations that provide complete publicly funded
health care. Facilities, such as emergency rooms, hospitals, and urgent
care facilities are often required to treat everyone by law.
Cost-cutting in the private sector
Some health economists assert that traditional private plans are not
very good at limiting spending to cost-effective procedures and schedules,
and that consumers exploiting this would view the transition to a public
system as a reduction in their compensation or benefits.
Other health economists believe that with the growth of health maintenance
organizations and other cost-cutting entities, private plans now limit
spend, with consequences for paperwork and some needed treatments. A
number of high-profile instances of Medicaid fraud have been uncovered
among health care providers and medical device suppliers.
[edit]
Market failure issues
Various healthcare analysts have asserted that market failure occurs
in healthcare markets , but some have suggested that it is result of
too much government involvement rather than too little.
The consumers of health care often lack basic information compared to
the medical professionals they buy it from, and fully informed choices
(particularly in emergencies) are often not plausible. Demand is likely
to be inelastic. The medical profession potentially may set rates that
are well above ideal market value, and they are controlled by licensing
requirements, with some degree of monopoly or oligopoly control over
prices. Monopolies are made more likely by the variety of specialists
and the importance of geographic proximity. Private insurance has been
perhaps the only stabilizing force as they pay a contractually fixed
cost for a given procedure. With no more than one or two heart specialists
or brain surgeons to choose from, competition for patients between such
experts is limited so contractually pre-arranged pricing helps reduce
supply-limited pricing.
[edit]
Preventive medicine issues
There is much conflicting information about the role of preventive medicine
in controlling medical costs and the improving the health of citizens.
Advocates of publicly funded medicine claim that preventive care saves
money and prolongs life, but opponents assert that it does neither .
[edit]
Difficulties of analysis
Cost-benefit analyses of various health care systems are frequently
mentioned by advocates and opponents of publicly funded healthcare programs.
Others caution that these analyses are difficult to do accurately due
to the multifactoral nature of health, healthcare delivery, and healthcare
financing, as well as the lack of consensus on what is "best" for a
nation or its people.
www.healthfinder.gov,
a great starting point!
U.S. Department of Health and Human Services
Health Resources and Services Administration
CDC's School
Health program
Health Insurance Sites listed by category:
HRSA HIV/AIDS Services
AIDS Advice
The Body: A Multimedia
AIDS and HIV Resources
JAMA AIDS-Related
Homepage
Journal of AIDS/HIV
American College Health
Association
Agency for Healthcare Research and Quality (AHRQ)
Alaska Primary Care Association
American Medical Association
American Public Health Association (APHA)
Association of Asian Pacific Community
Health Organizations (AAPCHO)
Association of American Medical Colleges
Bi-State Primary Care Association
California Primary Care Association
Community Health Care Association of
New York State
The Commonwealth Fund
Connecticut Primary Care Association
Denver Health Organization
The Florida Association of Community
Health Centers
Health on the Net Foundation - a nonprofit
organization in Geneva
Illinois Primary Health Care Association
Kansas Association for the
Medically Underserved
Louisiana Primary Care Association
Medical Group Management Association
Michigan Primary Care Association
National Association of Community Health
Centers
National Health Care for the Homeless
Council
National Committee on Quality Assurance
New Jersey Primary Care Association
New York Primary Care Association
Ohio Department of Health
Ohio Primary Care Association
Oklahoma Primary Care Association
Pan American Health Organization
PCAweb.org - Primary Care Associations website
Public Hospital Pharmacy Coalition (PHPC)
- PHPC represents the DSH hospitals and provides advice on how to maximize
use of the 340B program and ensure compliance with federal drug pricing
laws.
Texas Association of Community Health
Centers, Inc.
Virginia Primary Care Association
VHA Health Foundation
Wisconsin Primary Health Care Association
Cancer.gov
Cancerfacts.com
Oncology.com
American Academy of Family Physicians
Clinical Directors Network (CDN)
Health Affairs, the health care
journal
Midwest Clinicians Organization
Health Care for the Homeless Clinicians'
Network
COMMUNITY HEALTH CENTER AND OTHER HEALTH NETWORKS
Access to Care - a model primary
health care program serving low-income uninsured individuals in suburban
Cook County, Illinois.
Community
Health Connect is a nonprofit agency in Utah County, UT
Community Voices: HealthCare
for the Underserved is an initative of the W.K. Kellogg Foundation.
Eric B. Chandler Health Center - New Brunswick, NJ
The Family Health Center of Worcester
Family Health - a
community health center in Greenville, Ohio
Family Care Health Center
Healthreach Community Health
Centers - a network of 11 health centers in central and western
Maine providing family health care that is affordable and close to home.
Hudson River Community Health -
a network of community health centers throughout the Hudson River Valley
in New York State.
Kaiser Family Foundation
G.A. Carmichael Family Health Center
- in Central Mississippi
Greater Philadelphia Health Action
Manchester Health Center - Manchester,
New Hampshire
Morris Heights Health and Birthing Center
The Massachusetts League of Community
Health Centers
Terry Reilly Health Services - a heath
center in Idaho
Sixteenth Street Community Health Centers
- providing quality health care services to residents of Milwaukee,
Wisconsin
Southern Ohio Health Services Network
SouthEast Lancaster Health Services
A free New Jersey guide about health coverage for individuals is available by calling 1-800-838-0935. A similar guide for small employer coverage is available by calling 1-800-263-5912. The New Jersey health insurance reform programs in the individual and small employer markets are also described described under the Department of Banking and Insurance Web Page at its www.state.nj.us/dobi Internet address