Understanding the US. Health Care Reform: Necessity, Challenges, and Implementation
The healthcare system is a complex of all organizations, institutions and resources whose primary purpose is to improve health. A good health system significantly improves the daily lives of people. Within the health system, services for the people should be provided. So, researching health services is a rationale and characteristic for the US health care reform in 2010. But the US healthcare system had several issues that affected and influenced the lives of people in the country. Because of this, the proposed research on the reform and health services problems is so substantial. It is confirmed by such studies as articles and reports of policy-makers involved in the preparation of the reform and implementation of pilot projects and data from the reports of experts of the 9th Annual World Health Care Congress, which was held on 16-18 April in 2012 in the United States, Washington DC. They are: Burritt, J., Steckel, C., Wallace, P., Edmonds, M. , Greenfield, S., Kaplan, S., Ware, J. Jr., Hsiao, W.C., Kappel, S., Gruber, J. , Orszag, P., Patel, K., Wells, K., Ralston, J. D., Carrell, D., Hereford, J., Ross, S. E., Chen-Tan, L., Samitt, C., Walters, B., Zucker, M., Smith, M., Halvorson, G., and Kaplan, G.
It is necessary to highlight the key issues that prompted the US government to begin health care reform and study the reform program in terms of its main sections: financing constraints of market relations and expansion of government regulation.
At the beginning of the 21st century, the US healthcare system faced two major challenges. The first one is a high rate of uninsured people (or 16% of the population) and, consequently, significant differences in the availability of medical care to uninsured citizens. The second challenge is the uncontrolled growth of the cost of the health care system. It is 17.5% of GDP (or $ 2.6 trillion per year), in contrast to the EU countries, where these costs are, on average, 8.3% of GDP. If healthcare costs in the United States continue to show growth at the average rate of 0.5% of GDP per year, in 70 years, the costs of healthcare in the United States will be accounted for 40% of GDP.
Public insurance programs Medicare and Medicaid, which are paid for medical assistance of pensioners and low-income citizens, constitute the largest part of expenditure for the federal government. It is 1,2 trillion US dollars per year.
If the US health care system costs would not restrained, the federal budget will require substantial additional funds in the next decade. This will lead to the need for taxes to increase, and, ultimately, it means that one-third of the total income of citizens will be given only to the health system.
The problem with uninsured people in the United States today has serious consequences, as about 20 thousand deaths (or 0.8% of all deaths) are related to the lack of citizens’ health insurance. The necessity of paying medical bills without health insurance is the leading cause of bankruptcy in the United States. Moreover, the rising cost of health care forces insurance companies to raise tariffs on voluntary medical insurance. In their turn, employers who have to pay these inflated prices either reduce the level of coverage of the insurance plan of their employees, reduce wages of employees to cover the cost of their health insurance, or deprive some workers of insurance. Thus, directly or indirectly, the shifting of the cost of health insurance on the workers or reduction of their wages occurs.
In their turn, healthcare providers guaranteeing medical assistance to those who cannot pay for it have to raise the rates for their services. So, cross-cost coverage of medical services for uninsured people from the funds of insured citizens occurs. It supports conditions for the continued growth of tariffs for medical care.
The disintegration process of patient care, which is associated with free choice of the patients of general practitioners and hospitals, as well as the lack of unified standards of care at all stages and levels of care, should be added to the problems mentioned above of the US health care. It leads to unnecessary and repetitive doctor appointments and complicates the efficient organization of the patient care process. All of these lead to the fact that the third part of the money spent on health is used inefficiently; from 3% to 10% of funds are wasted intentionally.
Thus, in addition to the general inefficiency, the US healthcare system has low access to healthcare for the population (16% uninsured), uncontrolled growth of healthcare costs and disintegration of the patient care process.
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