The Importance Of Health Care In The United States

Health care is one of the most important amenities the world acquires. Without health care, where would the population be? The human species would gradually decline tremendously if the world lacked health care, health care systems, and health insurance. The main goal of a health care system is to provide people with health care services at a logical and efficient rate while also maintaining a level of quality for the patient. Each country has its own advantages and disadvantages to its health care system including the way it chooses to finance health care. What works for one country may not necessarily be efficient for another country. Some believe that if reform took place, health care systems around the world will be more efficient if they

each implemented principles from each other. Through a voluntary system, The United States’ health care financing options consist of insurance plans, programs and government funding for specified groups while France acquires a universal health care system for everyone in which its insurance is funded partly by the taxes collected by the government and partly paid by citizens directly. The result of these options causes the expenditures of each country to either rise or fall.
Each country’s health care insurance options are an important mechanism to determine who is deemed to obtain health care, how much extensive care they can receive, and how much it will cost them. Generally, insurance aims to give patients the ability to pay lower out of pocket costs for health care services. As the number of citizens that have insurance rise, the demand for medical facilities and physicians will follow that trend as well. Patients are therefore more apt to go to the doctor to get a check up and get treated for their illnesses. Specialized services also expand when insurance covers them, which then coincides with a demand and rise for sub-industries. More physicians and facilities will have to receive pay for their service provided. Therefore, the method of financing options in each country affects their total health expenditures.

The United States Private Financing Options
In the United States, there are private financing options that consist of group insurance, self-insurance, and individual private insurance.

Group insurance has tax advantages when the employee’s employer provides them with insurance. People also may choose to insure themselves with “self-insurance” by paying directly out-of-pocket and managing their money to prepare for risk. Employers take on great risk to insure employees by providing them with the health care benefits. However, there is no insurance premium tax on employers (Self-Insurance Institute of America, 2012). So if all goes well, employers do not lose money. There is also individual private insurance where the cost is based on the individual’s health (Shi & Singh, 2015). Individual private insurance plans provide people with a variety of plans to choose from with many options of types of care able to be received. Usually when a person has private insurance he or she has to pay minimum co-payments to his or her provider while the rest is covered at the time of visit. However, some plans do not have co-payments and deductibles, but the person may be paying a higher annual cost for insurance. All of these options give the United States citizens freedom to choose what type of health insurance plan they want, without being automatically assigned to

one.
The United States Public Financing Options
Medicare serves as one of the public financing options that acts as a categorical program in the United States. Medicare provides select groups with health care coverage. Medicare is Title XVII of the Social Security Act. People who are qualified are entitled to this program regardless of income (Shi & Singh, 2015). Medicare provides for people who are sixty-five years or older, disabled, or have end-stage renal disease. Medicare part A (Hospital Insurance) is financed by mandatory payroll taxes demanded by the government. This insurance program generally covers inpatient hospital care, skilled nursing facilities, home health, and hospice (Health Care in America). Medicare part B (Supplemental Medical Insurance) is paid partly by general tax revenue on top of a premium. This part of Medicare covers outpatient services such as occupational therapy, physical therapy, rehab centers, and many more. Medicare is essentially beneficial for the elderly and the disabled because they ultimately receive funds from the government who is collecting taxes in order to receive the care they need.
Medicaid is another public health care insurance categorical program for the United States. Medicaid also aims to provide health care to particular groups, like Medicare. Medicaid is Title XIX of the Social Security Act. Medicaid finances health care for the “indigent” who cannot afford to contain wellness when they are ill (Shi & Singh, 2015). These people would normally just remain sickly. Each state individually determines who is considered to be the poor, or the needy. People have automatic eligibility under federal law if they are TANF (Temporary Assistance for Needy Families) and SSI (Supplemental Security Income) recipients, children and pregnant women below 133 percent of the Federal Poverty Level, and the “medically needy” designated by a state (Shi & Singh, 2015). Without Medicaid, there would possibly be a lower demand for specialty care. Medicaid allows the poor, TANF and SSI recipients, children and pregnant women below the federal poverty level to receive inpatient, outpatient, physician, labs, x-rays, nursing facilities, home health care, pediatrics, medical and surgical dentistry, vaccinations, family planning, obstetrics, and post-partum care (Shi & Singh, 2015). People that qualify for Medicaid have an immense access to these services because the federal government and state government jointly finance Medicaid. Overall, Medicaid is extremely beneficial and generous towards the medically needy who are in search of maintaining health.

Americans With No Health Care
Among all of the private and public insurance options and programs, some people in the U.S remain without health care. People who do not receive insurance plans from their employer and who do not fall within the categories of Medicare or Medicaid are at a loss of receiving healthcare. American citizens do not usually choose to have no health insurance especially when they are susceptible to risk. Unfortunately, all Americans do not qualify for coverage by private or government health insurance (Shi & Singh, 2015). At this point, if the person is sickly they have to pay out-of-pocket costs for every procedure or decide not to receive treatment.
United States Reimbursement Methods
The U.S also has reimbursement methods to help lower costs, such as fee-for-service, bundled charges, cost-plus reimbursement, and prospective reimbursement. The amount and extent of medical attention needed drives these methods to be more favorable for the patient. Fee-for-service is set by the provider in which the individual service is billed and then insurers determine a reasonable charge for the patient to pay (Shi & Singh, 2015). Bundled charges allow for a number of similar services be combined into one standard price. This function attempts to solidify provider-induced demand because fees of all of the health care given are included (Shi & Singh, 2015). Within cost-plus reimbursement patients are required to pay a per diem rate or per patient day rate. There is no incentive to control costs or limit services (Shi & Singh, 2015). The prospective reimbursement method aims to calculate the amount of reimbursement in advance to determine whether or not a person wants to actually receive the care. It therefore removes incentives to be inefficient (Shi & Singh, 2015). With this method, the payer can plan future health care spending if they are determining an expensive long-term care treatment. All of these methods try to help Americans pay the least they possibly can while getting the quality care they need.
The French Government’s Role in its Health Care System
In France, health care financing options differs from the United States in that their government plays a higher role in negotiating prices with providers. The French government bargains with hospitals, doctors, and pharmaceutical companies. According to Ed Dolan, France ultimately spends half as much on administration and marketing than the seven percent of health care costs reported by the U.S. (Dolan, 2011). The government has a larger role in “giving out” health care in France while in the U.S the government only chooses to assist certain groups through Medicare and Medicaid. Through this method, France is able to spend less on expenditures while providing higher care to a tremendous amount of people without discriminating.
France Uses “Public-Private” Mixture
The French health care system uses a mixture of “public-private” financing to provide a higher level of care for a more reasonable price. According to the NCBI, the French use this mix for hospital and ambulatory care, higher levels of resources, and a higher volume of service provision than in the United States (Rodwin, 2003). The French have a barrier between their hospital and ambulatory care because of their country’s overall earnings of wealth per year. The French only earn one third of what U.S medical doctors earn in the U.S. (Dolan, 2011). The reason for this gap is that the French do not have to pay for medical school, which leaves health care professionals without debt once they begin their careers as health professionals. The numbers could be skewed since the French earn less money to begin with. The per capita is almost twenty percent less than the United States, which serves as a pure reason for the gap in total expenditure costs (Dolan, 2011). There is a debate whether France is really providing health care financing options that are actually more beneficial than the United States since their costs appear to be lower. France manages to provide high quality services that cause their GDP to be lower than that of the U.S.
The French Use “Fee-For-Service” with NHI
France uses the fee-for-service function to provide patients with specialized care. Fee-for-service reimburses the payer with the help of National Health Insurance. Since France has a universal system, citizens do not have control over their enrollment in this system. The French are automatically assigned regardless of their social status—unemployed or employed (Rodwin, 2003). Some people may believe that the French lack freedom of choice while others may disagree and feel that they are at the peak of economic health care financing gains. The advantage of fee-for-service for the French makes it easier to acquire other benefits that are not covered under NHI and about ninety percent of people choose to pay for “supplementary insurance” (Rodwin, 2003). Some people in the U.S. are not able to afford the procedure or treatment, even with an insurance plan. With France’s fee-for-service option, the French are able to receive more acute care than Americans.
Indemnity Model Used for Reimbursement
The French contradicts American insurance plans for ambulatory care and inpatient care. France uses the indemnity model for people in need of urgent care. The indemnity model reimburses the insured a predetermined amount per service (Shi & Singh, 2015). The patient is therefore responsible for paying the provider, the physician or institution where service has taken place. For hospital services where patients stay for longer periods of time there are per diem reimbursements (Rodwin, 2003). These costs are based on the actual treatment and a portion of capital costs. Reimbursement essentially tries to fully benefit the payer as much as it can instead of charging absurd costs for care that requires immediate attention and is out of the person’s control.
French National Health Insurance
The French NHI resembles Medicare in the United States through its allowance of patient choice. The French NHI covers more of the costs of service as they become more expensive and harder for the patient to pay (Rodwin, 2003). Medicare does not provide such a great coverage for all. All health care and medication is all inclusive in the French NHI (Rodwin, 2003). There are also no deductibles that the insured must pay. At this wide range of amenities, the French have an advantage over the people who are currently under the United States’ Medicare program.
American and French Expenditures
The U.S and France’s health care financing options are both unique and contrast each other and many of these costs cause the United States’ expenditures to rise significantly.

The United States spends twice as much on health care than France through expenditures according to Ed Dolan who says that the French spend “11.2% on GDP, compared with 16% in the United States” (Dolan, 2011). Expenditures are increased by expansion of health insurance and increase in health insurance premiums (Shi & Singh, 2015). People in the United States make more profit than in France, but it is still imperative that the U.S tries to solidify its expenditures for the

future.