The US medical system is among the largest and most sophisticated mechanisms in the world. It is also the most expensive in comparison with other developed nations. The medicines used in the treatments are also costly, which can be attributed to the time and capital invested in research, development, approval and marketing of the pills. Even though the Affordable Care Act (ACA) has changed many things concerning the health insurance plan and the system in the whole, the medical services remain a real burden for the sufficient part of the population, especially for representatives of numerous ethnic groups, who live below the poverty line.
Racial and gender bias is another issue that affect the US healthcare system, especially toward the people of color. There is a tendency to consider such patients as less responsible for their health than white patients, therefore, in some specialists’ eyes, they do not deserve proper treatment. Females often do not receive relevant diagnosis compared to men.
It is a common thing for hospitals nowadays to request compensation for some manipulations made to nonexistent patients. In other cases, physicians receive a part from their diagnostic bills, which shows evident fraud and incompliance with medical ethics.
Another issue is HMOs (Health Maintenance Organizations) that have approved list of specialists to use by the citizens, which is very popular among employers. Such attractive service for companies, in fact, cuts the opportunities of common people to receive convenient medical treatment and may even refuse in their application to their family doctor.
Therefore, the is a crucial need in further development of the relevant legislation and policies to improve the existing problems.
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Introduction
The United States (US) healthcare system is to a great extent unique among other industrialized nations. Despite it being among the top world economic powers, the US has no universal healthcare coverage, lacks a unified health system and have recently passed legislation authorizing health care coverage for almost every person. Rather than having a national health service, multi-payer universal or a single-payer insurance system, the government finances the US healthcare services. As a result, the health sector is majorly operated by various distinct organizations with healthcare facilities being owned and operated mainly by the private sector. As of 2014, about 48 percent of the healthcare expenditure came from private funds (Department for Professional Employees, 2016). This paper aims to consider the problems that surround the US healthcare system such as high cost, gender and racial biases and concerns related to private insurance among others.
Lack of Insurance and Private Health Insurance
The expenses of health research, health care services, and other related items have drastically increased in the last few decades. Currently, health expenditure exceeds 2.6 trillion US dollars per year (Ketsche, Adams, Wallace, Kannan " Kannan, 2015). Despite such spending, the US healthcare system lags behind as compared to other industrialized countries in a couple of essential health indicators. Its system of private health insurance has majorly contributed this issue. In contrast to the US, other western countries have a national health insurance and health care system (Khemani, 2018). The US uses a direct-fee system, in which patients are expected to settle their hospital bills through the aid of private health insurance (Medicare covers for individuals aged 65 and above).
High Cost of Health Care
The US spends a lot of money health care as compared to any other industrialized country. Its per capita health expense reached approximately 7,900 US dollars as of 2009 (Cuckler et al., 2011). This amount was 50 percent greater than those of the next two highest spending nations, Switzerland and Norway, twice as high as France expenses, 80 percent higher than the expenditure of Canada and 2.3 times greater than the cost in the UK. This vast expenditure by the US may be justified if its health and medical services quality outranked all of these other nations in a couple of indicators. However, it is evident that the US spends more than it should on care delivery. The reason behind this include:
First, the administrative cost for healthcare tops as compared to other industrial countries. Since the US health insurance covers are private, record keeping and billing task are immense that they cost about 360 billion US dollars annually. Second, the country depends on a “free for service” private insurance model. As a result, the medical institutions and specialists are may not be controlled in setting up the charges for the services. Other nations have been known to regulate the prices of the medical industry. This distinction between the US and other industrial country helps explain why the healthcare services cost more in the US.
Medical Fraud and Medical Ethics
Various groups of healthcare providers such as the dentists, nursing homes, physicians and medical equipment companies engage in multiple forms of health care fraud. For instance, it is common to find hospitals billing Medicaid, Medicare or private insurance firms for laboratory tests examinations that were never conducted and even creating ghost patients. All of these forms of fraud combine to an estimated cost of 100 billion US dollar per annum. Other practices are ethically questionable, but legal (Barkan, 2016). For instance, a physician may refer a patient for a test to a laboratory that he owns or which he has invested. This practice is referred to as self-referral, and although legal, it raises the concern of whether or not the tests are in best interest of the patient or the physician. In other practices, physicians have collected thousands from their patients to undertake a part in the drug test. For instance, a doctor may receive 1,000 US dollars from every patient that sign up.
HMOs and Managed Care
As an advancement, the establishment of HMOs (Health Maintenance Organizations) will enroll subscribers through their workplaces. This innovation means that patients should visit physicians that are included on the HMO’s approval list or employed by the HMO. Therefore, if a patient's physician is not approved, he should either seek an authorized physician or see his own with no insurance cover. This trend is becoming popular with the employers since it is less expensive than the traditional insurance coverage. However, managed care tends to be very controversial due to two reason.
First, HMO creates restrictions on the physician’s choice as well as other healthcare providers. Families that have had a family doctor, who is currently not under the HMO list of approved physicians, are forced to look for another specialist or risk going with no coverage. Patients are similarly not guaranteed that they can see the same physician repeatedly (Khazan, 2018). Second, HMOs restrict the type of medical tests and procedure that a patient may undergo, an issue described to as Denial of Care, which also limits patients’ prescriptions choices since they have to use those allowed by their cover, even though physicians may recommend differently. However, HMO claims that the restrictions are crucial in keeping the cost of medical down.
Racial and Gender Bias
Race and gender biases are another issue affecting the US healthcare system, especially toward the people of color. For instance, an African American with the same health condition as a white person is less likely to receive similar or relevant medical procedures. According to a survey conducted on why this disparity exists, physicians rated a white patient as more likely to adhere to the recommended treatment as compared to the people of color, since most believed that patients of color are less responsible for their health than white patients (Crowley, 2010). This biases also seem to affect the quality of care. For instance, women are less likely to be recommended for a particular procedure, diagnostic tests and medication similar as to men, including kidney transplant or dialysis, cardiac catheterization, knee replacement for osteoarthritis and lipid-lowering medications (Hoffmann " Tarzian, 2001). Moreover, Hoffmann and Tarzian (2001) found that unlike male patients, women do not receive respective treatment for their pain and are just recommended sedatives instead.
Conclusion
The above-noted problems are not new in the US healthcare system, and there is a need to resolve these issues. For instance, the majority may be avoided by reducing costs and improving quality. Moreover, some of these issues can be solved by creating awareness among the physicians and health professions on the damage that they are causing the society; for instance, gender and racial disparity is creating mistrust between the affected people and the physicians. Others will require government intervention. For example, expenditure is something that can only be resolved in Congress. However, apart from these issues, US hospitals have state of the art technology, which makes their treatment of quality standard.
References
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