As a first world nation, many would expect the United States to possess one of the best, if not the best healthcare system in the world. Sadly, they would be mistaken because even though the US spends the most on healthcare worldwide, in 2013, the World Health Organization(WHO), ranked the U.S. healthcare system at a dizzying 37th place (Pittman, 2012). According to the Commonwealth fund, 18% of our Gross Domestic Product(GDP) is spent on healthcare, this works out to be $2.9 trillion annually, $9,200 per person and for persons 65 and older this number doubles to $18,424 per person. In 2020, the Centers for Medicare and Medicaid estimate that the U.S will send an estimated $4.6 trillion. McLaughlin 2011 stated that: “U.S. public spending on …show more content…
When looking at the lack of coordination or integration in healthcare one needs to look towards the physicians providing the care, mainly the primary care physicians. Patients who have chronic illnesses that require long-term care lack someone to ensure that every aspect of their treatment makes sense, is adding value, and all alternatives are assesses. The Commonwealth Fund states …show more content…
The way in which physicians and other health care providers are compensated is not beneficial to the patients. The fee-for service method of payment, which according to Kongstevedt is one of the main forms of reimbursement in HMO’s, is more focused on quantity as opposed to quality and volume over value. In the fee-for service method payments are made per service, without considering if the treatment, referral, or prescription is effective. There is no limit on how services are prescribed to patients and so many services may not have been necessary in the first place. Many patients choose to do surgery when other less invasive procedures would have been equally if not more effective. The Florida Times Union states
It is generally accepted that the method of payment to physicians affect their professional attitude and behaviour. Consequently, health policy makers manipulate payment system in an attempt to achieve optimal health care for their citizens such as improve accessibility, quality of care, patient’s satisfaction and cost containment. In Ontario, there are a wide range of mechanisms that are used to pay physicians for their services that are funded by both federal and provincial government. According to Canada Health Act annual report (2013), the majority of primary healthcare physicians are funded using the fee for service payment arrangement but of that majority, only less than 30% are compensated exclusively according the fee for service plan. The remaining physicians are funded using one of the following mixed compensation models:
On a global scale, the United States is a relatively wealthy country of advanced industrialization. Unfortunately, the healthcare system is among the costliest, spending close to 18% of gross domestic product (GDP) towards funding healthcare (2011). No universal healthcare coverage is currently available. United States healthcare is currently funded through private, federal, state, and local sources. Coverage is provided privately and through the government and military. Nearly 85% of the U.S. population is covered to some extent, leaving a population of close to 48 million without any type of health insurance. Cost is the primary reason for lack of insurance and individuals foregoing medical care and use of prescription medications.
For decades, one of the many externalities that the government is trying to solve is the rising costs of healthcare. "Rising healthcare costs have hurt American competitiveness, forced too many families into bankruptcy to get their families the care they need, and driven up our nation's long-term deficit" ("Deficit-Reducing Healthcare Reform," 2014). The United States national government plays a major role in organizing, overseeing, financing, and more so than ever delivering health care (Jaffe, 2009). Though the government does not provide healthcare directly, it serves as a financing agent for publicly funded healthcare programs through the taxation of citizens. The total share of the national publicly funded health spending by various governments amounts to 4 percent of the nation's gross domestic product, GDP (Jaffe, 2009). By 2019, government spending on Medicare and Medicaid is expected to rise to 6 percent and 12 percent by 2050 (Jaffe, 2009). The percentages, documented from the Health Policy Brief (2009) by Jaffe, are from Medicare and Medicaid alone. The rapid rates are not due to increase of enrollment but growth in per capita costs for providing healthcare, especially via Medicare.
CBO Projects Total Healthcare Spending to Hit 26 Percent of GDP by 2035 [Healthcare Financial Management Association]. (2010, August). , 9. Retrieved from
Sarpel, U., Vladeck, B. C., Divino, C. M., & Klotman, P. E. (2008). Fact and Fiction: Debunking Myths in the US Healthcare System. Annals of Surgery, 247(4), 563-569. doi:10.1097/SLA.0b013e318159d566
To prove my thesis in this paper I will discuss how our senior citizens and the chronically ill have been hurt by recent cuts their HMOs have made. I will discuss the many reports of HMO negligence and the issues concerning the patient doctor relationship. I will also go into what actions, or lack thereof, our government has taken in response to HMO woes. All of these points will show that HMOs have lost the concept for caring for their patients including our elders who are one genre that are being hit hard by the actions these HMOs have taken.
The current health care reimbursement system in the United State is not cost effective, and politicians, along with insurance companies, are searching for a new reimbursement model. A new health care arrangement, value based health care, seems to be gaining momentum with help from the biggest piece of health care legislation within the last decade; the Affordable Care Act is pushing the health care system to adopt this arrangement. However, the community of health care providers is attempting to slow the momentum of the value based health care, because they wish to maintain their autonomy under the current fee-for-service reimbursement system (FFS).
In order to make ones’ health care coverage more affordable, the nation needs to address the continually increasing medical care costs. Approximately more than one-sixth of the United States economy is devoted to health care spending, such as: soaring prices for medical services, costly prescription drugs, newly advanced medical technology, and even unhealthy lifestyles. Our system is spending approximately $2.7 trillion annually on health care. According to experts, it is estimated that approximately 20%-30% of that spending (approx. $800 billion a year) appears to go towards wasteful, redundant, or even inefficient care.
The U.S. expends far more on healthcare than any other country in the world, yet we get fewer benefits, less than ideal health outcomes, and a lot of dissatisfaction manifested by unequal access, the significant numbers of uninsured and underinsured Americans, uneven quality, and unconstrained wastes. The financing of healthcare is also complicated, as there is no single payer system and payment schemes vary across payors and providers.
The demand of a constantly developing health service has required each professional to become highly specialised within their own field. Despite the focus for all professionals being on the delivery high quality care (Darzi, 2008); no one profession is able to deliver a complete, tailored package. This illustrates the importance of using inter-professional collaboration in delivering health care. Patient centric care is further highlighted in policies, emphasising the concept that treating the illness alone whilst ignoring sociological and psychological requirements on an individual is no longer acceptable. Kenny (2002) states that at the core of healthcare is an agreement amongst all the health professionals enabling them to evolve as the patient health requirements become more challenging but there are hurdles for these coalitions to be effective: for example the variation in culture of health divisions and hierarchy of roles. Here Hall (2005) illustrates this point by stating that physicians ignore the mundane problems of patients, and if they feel undervalued they do not fully participate with a multidisciplinary team.
spends about 15% of its gross domestic product on healthcare, thereby making it the largest sector of the economy” (Goldman, D., & McGlynn, E., 2005). “Americans are not healthier than some of the other developed nations, regardless of these extensive costs” (WHO, 2010). “Almost 40 million Americans are uninsured and about 18% of Americans under the age of 65 receive half of the recommended healthcare services” (Goldman, D., & McGlynn, E., 2005). “Though, quality of care was noted not to vary much in cities with respect to lack of insurance, poverty, penetration of managed care and availability of physicians and hospital beds” (Goldman, D., & McGlynn, E., 2005).
Health care expenditures is an increasing proportion of gross domestic product (GDP) in Organization for Economic Cooperation and Development countries as its share in GDP increased by an average of nearly 2 percent annually in last 40 years. Health care expenditures in the US increased 6.2 on average annually between 1991 and 2011. Health care spending consisted 17.9 percent of GDP in the US in 2011.
Rising medical costs are a worldwide problem, but nowhere are they higher than in the U.S. Although Americans with good health insurance coverage may get the best medical treatment in the world, the health of the average American, as measured by life expectancy and infant mortality, is below the average of other major industrial countries. Inefficiency, fraud and the expense of malpractice suits are often blamed for high U.S. costs, but the major reason is overinvestment in technology and personnel.
The chronic care model calls for an organizational change in the way individuals with illnesses are cared for, and the involvement of nurses, social workers and patients themselves. The challenge is moving in an effective way of improving quality from research carried out predominantly in health maintenance organizations to the mainstream of health care practice (Wielawski, 2006). Wagner’s explanation is to substitute the customary physician-centric office structure with one that supports clinical teamwork in association with the patient. The notion spreads outside the health care organization to collaborative associations in the community. Wagner et al. (2001) termed this approach the “chronic care model.” With this model, physicians, nurses, case managers, dieticians, and patient educators
As of 2013 data, the US per capita government expenditure was $4307 while total per capita expenditure on health spending was $9146, which is 17.1 percent of the GDP (2013) for the total expenditure on health. The annual rate of growth in per capita government spending on healthcare has been roughly 5.1 percent over the past thirty years (WHO, 2015). This rate of spending on health care growing faster than the economy for many years creates challenges ...