Healthcare financing and delivery systems

Health Care Financing / Delivery Systems

The United States is the richest, most powerful nation in the world with the most expensive health care yet, the World Health Organization (WHO) ranked the U.S. 37th in the world for quality and fairness of health care (Reid, 2008). Over 47 million people are without health care, and thousands of individuals file medical-related bankruptcy every year. The U.S. is the only developed country in the world without universal health care. Many health care reforms have been proposed, but state health reforms over the past two decades have failed (Woodhandler & Himmelstein, 2002). Other nations have accomplished universal health care coverage in different ways, however, most have achieved this through legislation and regulation of healthcare companies. Some countries with universal health coverage have banned private insurance companies, while others allow private insurance companies to exist as competition, or as supplementation to the national plans to provide additional coverage. In some cases, private insurance companies exist to cover medical services that aren't covered under the government health plan such as cosmetic procedures.

Citizens of these nations seemingly benefit, medically and financially, from universal health coverage not just because these nations typically have significantly lower infant mortality rates, longer life spans, and reduced per capita healthcare cost. Yet, in the U.S., many are adamantly opposed to any kind of government regulation for health plans or for-profit healthcare corporations. Much of this opposition is based on misinformation leading to arguments that may not necessarily make sense.

One of the main reasons that people oppose universal healthcare is because of the belief that free markets provide superior results and cost controls. Less government involvement means that there are more organizations allowed to compete resulting in more affordable products for the consumer. Organizations competing for consumer business theoretically means higher quality at lower cost. However, for-profit, investor-owned healthcare facilities have higher costs and measure-of-quality scores are lower than non-profit healthcare facilities. In addition, the U.S. has higher healthcare administrative costs than other nations; 31% of U.S. healthcare spending is due to administrative costs (Woolhandler, Campbell, & Himmelstein, 2003).

Another opposing argument to universal healthcare in the U.S. is that healthcare quality would be reduced. Many people believe that the best healthcare in the world is in the U.S. In fact, the U.S. is often ranked as the lowest of the developed nations for healthcare (Mahon, 2010). WHO rates France as having the best healthcare ("World Health," 2000). In addition to universal healthcare, France also has non-profit supplementary providers, which means that the government subsidizes 70% of regular expenses but pays 100% of more expensive or long-term treatment plans (Sandier, Paris, & Polton, 2004). Money for subsidies comes from mandatory earnings contributions such as 5.25% salary, capital income, and gambling winnings (Sandier, 2004).

An argument that often arises is that people say they don't want the government deciding what medical procedures they can have. However, decisions regarding what procedures are covered by a particular health plan are made by the healthcare insurance companies, which are for-profit ("Insurance Verification," n.d.). Many people are denied treatment regardless of the illness. As already mentioned, some of the other nations with universal healthcare have supplementary plans in addition to the government plans that allow the patient more choice.

There are many arguments against, yet different methods for establishing universal healthcare coverage in the U.S. In fact, in the U.S., taxes already pay for more than 60% of U.S. health spending (woodhandler, 2002). Americans pay the highest health care taxes in the world. Citizens actually do pay for universal health coverage but don't receive it (woodhandler, 2002). Clearly, there is no reason why a universal health care system cannot work in the U.S.

References:

Carrasquillo, O., Himmelstein, DU.,Woodhandler, S., Bor, DH. (1999). A Reappraisal of Private Employers' Role in Providing Health Insurance. NEJM, 340(1), 109-114.