The U.S. health care system is a complex network of organizations and programs, both public and private, that aim to provide medical services to the population. These include government-run programs such as Veterans Healthcare and Medicare, as well as various charitable and professional organizations. However, one major issue within the system is the affordability of health insurance, with millions of Americans lacking coverage and unable to afford basic services.
Over the years, the U.S. health care system has undergone significant changes in its organizational structure and delivery of care. One notable trend has been the consolidation of medical service providers through mergers and acquisitions, resulting in larger corporate models. Additionally, managed care has become a popular form of health care delivery service. This approach focuses on coordinating and managing the care of individuals to improve quality and control costs (Maurer & Smith, 2013).
Despite these changes, the U.S. health care system still faces challenges in terms of accessibility and availability. Compared to other developed countries, the delivery network in the United States appears disorganized and confusing. According to data from the Centers for Medicare and Medicaid Services, health care spending in the U.S. increased to $3.2 trillion in 2015, reaching $9,990 per person. This rise in spending is partly attributed to the expansion of coverage resulting from the implementation of the Affordable Care Act (CMS, 2015).
Several factors contribute to the growth in health care costs in the U.S. these include the predominant fee-for-service payment system, extensive third-party insurance coverage, a fragmented multipayer system, and a robust biomedical research establishment. The fee-for-service payment system, where providers are reimbursed for each service rendered, can incentivize the provision of additional services and billing for higher levels of care, leading to increased revenues. The fragmented structure of the U.S. health care system, with multiple payers and lack of coordination, further exacerbates cost pressures (De Lew, Greenberg & Kinchen, 1992).
Moreover, the fact that health insurance in the United States is primarily employer-based adds to the cost burden. Employers must prioritize cost containment in order to provide affordable coverage for their employees. Additionally, the high cost of medical malpractice premiums and the practice of defensive medicine, where providers order unnecessary tests and procedures to protect against malpractice claims, are often cited as sources of excessive health care spending.
The need for health care reform stems from these issues. One of the main objectives is to make Medicare more efficient, ensuring that tax dollars are effectively used to provide care for seniors. Reform also aims to bring skyrocketing health care costs under control, benefiting both families and businesses. Lastly, reform is expected to create a system that offers choice and access to high-quality, affordable care.
In conclusion, the U.S. health care system is comprised of a diverse array of organizations and programs, but the issue of affordable insurance remains a significant challenge. Changes in the organizational structure and delivery of care have occurred over the years, including mergers and acquisitions and the rise of managed care. However, the system still faces inefficiencies and fragmentation, contributing to high costs and limited accessibility. Health care reform is necessary to address these issues and achieve a more efficient and affordable system for all Americans.
References:
Center for Medicare and Medicaid Services (CMS). (2015). National Health Expenditure Data. Retrieved from https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/index.html
De Lew, N. K., Greenberg, W. M., & Kinchen, K. S. (1992). The causes of escalating health care costs. The American Economic Review, 82(2), 57-61.
Maurer, F. A., & Smith, C. M. (2013). Community/public health nursing practice: Health for families and populations. Elsevier Health Sciences.
