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The U.S healthcare system is the most elaborate healthcare system in the world. Healthcare reforms in the U.S are always under thorough scrutiny by the political class and always form a basis of almost all presidential campaigns. The complexity of the system is what generates a lot of interest in trying to understand its mode of operation (Hulse, 2008). The U.S is an economic powerhouse and therefore its healthcare system is expected to be among the best in the world. The U.S healthcare system has got a lot of interconnected components that lead to a quality and effective system. In order to understand the U.S healthcare system, its components have to be analyzed in detail. Roemers model of a healthcare system clearly demonstrates how a socialist healthcare system operates. This paper will explore the entire U.S healthcare system in relation to Roemers model.
The U.S healthcare system has got three categories of healthcare providers. These three categories include private healthcare providers, hospitals and other centers that provide medical products (Shi, 2010). The federal and state hospitals provide subsidized healthcare services with less emphasis on making profits. The privately owned hospitals are pro-profits but play a significant role in healthcare provision. The hospitals have specialty clinics and emergency rooms that offer emergency services to accident victims and other emergency cases. The hospitals and clinics provide outpatient services including prenatal care. All practicing healthcare providers are trained by the U.S medical education system and must possess a practicing license in order for them to practice in any American state (Shi, 2010). Medical devices and pharmaceutical products are manufactured by private companies which supply most of their products to federal and state owned healthcare facilities.
Medical research and development are very essential in the provision of quality healthcare facilities. The U.S government in collaboration with private sponsors has invested heavily in medical research with annual investment being estimated to be around $ 100 billion (Shi, 2010). The U.S healthcare spending is among the highest in the world with current spending being close to 20 percent of Americas GDP. The American healthcare system is the most innovative and sustainable in the world due to the heavy spending by the Government on research and provision of healthcare facilities (Niles, 2010). Physicians and government hospitals take a substantial amount of the healthcare budget with almost 10 percent of the healthcare budget going to prescription drugs. Disease prevention is among the many proactive measures taken by the U.S government in an effort to protect its citizens from various diseases. The disease prevention initiatives are normally funded by the U.S federal government.
Healthcare insurance plans and payments made by patients are the main sources of funds for hospitals and doctors (Niles, 2010). Health insurance is very popular in America with almost 85 % of Americans having a health insurance cover. Health insurance policies are normally organized by the government and employers while other people prefer to have personal covers. Vision and dental care policies are purchased separately under the regular health insurance program (Niles, 2010). The needy in the society are normally helped by the charity care programs that are funded by government subsidies and non-profit foundations. The Emergency Medical Treatment Act stipulates that all patients that require emergency room care must be treated even if they are unable to afford the services. This act applies specifically to emergency cases and only caters for the poor citizens. The veterans, the disabled, the poor, the elderly and children are all covered by government programs. Health insurance covers provided at the workplace are non-taxable and therefore the most attractive way of increasing an employees salary (Niles, 2010).
The uninsured Americans have a problem in accessing quality healthcare services. This group of people relies on well wishers to cater for their medical bills (Hulse, 2008). Healthcare programs funded by the government do not reach all those who are disadvantaged in the society. This problem has made policy makers in the healthcare industry to recommend a universal healthcare system in order to help the marginalized groups. The universal healthcare system advocates for subsidized health insurance policies that enable those with low income to access quality healthcare services (Hulse, 2008).
The U.S healthcare system is regulated by the federal government in conjunction with the state governments. The McCarran-Ferguson Act allows the federal government to give powers to individual states which enables them to manage healthcare issues and regulations (Niles, 2010). Licensing of healthcare providers and approval of healthcare facilities is done at the state level. Healthcare regulations are very important in ensuring that consumers are well protected from ineffective and poor quality healthcare. It is also the responsibility of states to ensure that the health insurance market is strictly regulated (Niles, 2010). Some of the federal laws regarding insurance are not applicable in individual states irrespective of a states healthcare policies. The U.S government introduced the certificate of need program in 1978 since most healthcare facilities were being duplicated and therefore wasting resources. The certificate program is no longer operational in some states because its cost saving advantage was not viable (Dougherty, 2008).
The number of doctors in the U.S is very small and therefore their salaries are very high. The high salaries paid to physicians are one of the reasons why healthcare services are very expensive in the U.S compared to Europe. The U.S healthcare system is organized in such a way that doctors are paid according to the procedures they perform and not according to the results delivered (Dougherty, 2008). The regulations in the U.S healthcare system are strictly followed but some of them are a hindrance to the provision of quality healthcare to the people. Overdependence on doctors is an example of the limitations brought about by the American healthcare regulations. In order to assess the U.S healthcare system in the best way possible, it is important to look at a sample model of a healthcare system. Roemers model of a healthcare system is a perfect model that can be compared with the U.S system.
Roemers model of a healthcare system advocates for a social healthcare system that promotes equal distribution of healthcare resources and services. The U.S healthcare system focuses on regulations and other interventions but the system is still not as effective as it should be (Wennberg, 2011). Roemers model recommends for a free healthcare market that is competitive as the only solution to the problems being experienced in many healthcare systems. Despite advocating for a free market, Roemers system calls for extensive regulations in order to protect the free healthcare market from fraudulent activities (Wennberg, 2011). Social planning is key to bringing equitable and efficient healthcare services. Conditions necessary for effective competition must exist for Roemers model to be fully effective. Roemers system considers healthcare services among the fundamental human rights that should be provided by the government (Hulse, 2008). According to Roemers model, healthcare should not be a profit making venture but a basic social right provided by the government to its people.
Roemers healthcare model encourages insurance covers that are socialized so that all citizens are covered regardless of their financial status. Insurance plans are funded by the public but all the regulations and guidelines are set by the federal government. Citizens under the socialized health insurance plan access hospitals for both primary and specialized medical care (Hulse, 2008). The most notable advantage that Roemers healthcare model is that it provides medical insurance cover for all citizens irrespective of their social and economic status. Roemers model is universal in nature and advocates for a comprehensive medical cover for all citizens. The public authority must ensure that health insurance administration is fair to all citizens (Wennberg, 2011). The system should ensure that all hospitals and physicians that provide healthcare services to the citizens are fully compensated for their services.
In conclusion, The U.S healthcare system has been performing well over the years irrespective of the numerous challenges that all healthcare systems face. The U.S system requires a few adjustments for it continue being relevant and effective. Suggestions from Roemers model of a healthcare system should be considered when planning for healthcare reforms in the U.S. Roemers model advocates for a socialist approach in healthcare provision. Roemers model has been applied in countries such Canada and Cuba with the end results being very impressive.
References
Dougherty, D. (2008). The 3Ts roadmap to transform U.S health care. The Journal of the American, 299 (19), 38-64.
Hulse, N. (2008). Toward an on demand peer feedback systems for a clinical knowledge base: A case study with order sets. Journal of Biomedical Informatics, 41 (1), 152-164.
Niles, N. (2010). Basics of the U.S health care system. New York, NY: Jones & Bartlett Learning.
Shi, L. (2010). Essentials of the U.S healthcare system. New York, NY: Jones & Bartlett Publishers.
Wennberg, J. (2011). Tracking medicine: A researchers quest to understand health care. American Journal of Epidemiology, 174 (2), 252.
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