State of the U.S. Healthcare System

Introduction

The healthcare system in the United States is unique, especially when compared to that of other countries. The healthcare system, in this case, means the combination of facilities, agencies, and care providers in specific geographical areas. The United States healthcare system, being in a free market state is thus, not entirely controlled by the government. This system, therefore, presents a great limitation with regard to how much doctors and other patients are able to charge their patients. Forces of demand and supply dictate the prices charged.

This system has however attracted lots of criticism especially from practicing physicians who argue that it is very bureaucratic. It is also thought that free trade system in healthcare together with many deliberate attempts to cut cost have succeeded in causing unhealthy competition reducing the effectiveness of health services provided. Despite the challenges generated by the system over time, it is agreeable that the healthcare system in the United States had successfully progressed; ensuring that standards of quality are not compromised and, that, citizens get reasonable care. This paper will discuss in a very broad manner, the aspect of healthcare systems in the United States.

Facilities

The discussion of the state of the healthcare system in the United States is virtually incomplete without the mentioning of the state of the facilities. Most healthcare facilities in the United States are held by private individuals, although the state; both federal and state command some ownership of some facilities. It is worth noting that ownership between the federal governments and privately owned is currently split at 30-70. Government hospitals in the United States are under the ownership and management of the city and county governments. In as early as 1946, the passing of the famous Hill-Burton Act in ensuring that the federal government fund hospitals in exchange for treatment for poor patients (Christensen, 2009). Worth noting is that to date there are no nationwide medical facilities owned or controlled by the government open for access to the public. On their behalf, medical facilities owned by local governments are in operation throughout the republic.

Additionally, the Department of Defense under the federal government operates field hospitals all over the country together with permanent hospitals, known as, Military Health Systems. These hospitals are dedicated to the provision of military-funded healthcare to all active and serving military personnel (Christensen, 2009). Veterans Health Administration under the federal government also operates Veteran hospitals, which are accessible only to veterans. In veteran hospitals, conditions that are treated for free are those where one was injured while in active duty.

There also exist the Indian Health Service facilities that only admit patients who are Native Americans from specific tribes. These Indian Health Service facilities, together with other tribal facilities increase the efficiency of the health system in terms of capacity and quality of services offered to Americans. These facilities assist in offering healthcare services to Native Americans, who do to their economic status cannot afford to pay the high premiums charged by insurance companies. They are also not in a position to pay high charges charged by private hospitals.

In America, there are hospitals, which specialize in both outpatient and in inpatient services care to patients. In hospitals, there are urgent care units and emergency departments, which often used as centers for sporadic problems and emergencies such as road accidents or infernos (Morrisey, 2008). Hospitals are also characterized by unique clinics including surgical centers, mother and child health clinics among others. Additionally, there are hospice facilities that mainly target individuals with a terminal illness and are likely to live for not more than six months. These facilities often get subsidies and other financial aids from governments and non-governmental charitable institutions.

There are also facilities that offer family planning, prenatal, obstetric, and gynecologic services. These are government-funded and are usually staffed by nurses who are on the state payroll. Healthcare facilities in the United States are thus not utterly adequate but can serve the needs of sick nationals without strain. Hospitals and health centers are equipped adequately with pharmaceutical products and machines relevant for the diagnosis and treatment of various diseases.

Medical personnel

The United States boasts of well trained, though, not adequate numbers of professionals serving in the healthcare system. The United States has an intensive medical education system that successfully trains medical professionals. Additionally, there are those individuals who are trained internationally but are issued with medical licenses that make them eligible to practice in the states.

The medical education system uses the word physician to imply to all medical practitioners in whichever area of specialization plus also those who hold a professional medical degree. In the United States, these individuals often are holders of either a masters or doctoral degrees in their different areas of specialization in the field of medicine. Only individuals with the right academic qualifications are allowed to practice in the provision of healthcare services to U.S nationals.

Research and development in the healthcare system

The United States healthcare system relies on medical devices and pharmaceutical products manufactured by private companies. Issues of research and development in the health sector equally receive massive funding from both the government and private financiers. For instance, in 2003, expenditures incurred on research and development was funded in almost a 50- 50 basis between the state and private financiers. In fact, out of the approximately $95 billion used, $40 billion was provided from public sources while $55 billion was raised from private sources.

The United States has invested heavily in medical and by extension healthcare research. This makes it a world leader gauged by the number of innovations of new and better drugs together with the introduction of new devices. In 2006, the United States healthcare system alone accounted for 75% of the world's biotechnology revenues and well over 82% of world spending in biotechnology and research. A number of pharmaceutical groups argue that the high cost charged on patented drugs in the United States has attracted more investments from several quotas on research and development. The sector is profitable and hence individual investors, as well as the government, find it worthwhile to put in money in carrying out further research in the field.

However, it is expected that the flagging of the ObamaCare healthcare will make drugs in the industry cheaper. This by extension is likely to mean that investment on research and development in the health sector is expected to reduce (White, 2009). This may not be a positive stride in the area of medicine in the United States of America.

Regulation and oversight of the healthcare system in the United States

The healthcare system is subject to comprehensive regulation by both the state and the federal governments. It is, however, the primary responsibility of the federal government to offer oversight to healthcare providers. The regulation essentially occurs in areas such as the issuance of licenses to healthcare providers, granting certificates of approval of new medical devices and pharmaceutical products and overseeing laboratory testing.

The main aim of the regulation is to protect patients from fraudulent practitioners and ineffective healthcare providers (Morrisey, 2008). Although not a form of regulation in the strict sense, the federal governments in the United States influence the healthcare sector by making payments to care providers through Medicare and Medicaid schemes. These two often act as a reference point while negotiating for the most reasonable premiums that insurance companies, as well as medical providers, can charge.

The government through the United States Department of Health and Human Services is responsible for overseeing of all federal agencies that have a part to play in healthcare. Health agencies in the United States include the Food and Drug Administration charged with certifying food safety and that of medical products and drugs (White, 2009). The Centers for Disease Prevention is also an agency and deals with disease prevention, prevention of premature deaths and disability. There are other healthcare agencies such as the Agency Toxic Substances, Disease Registry and Agency of Healthcare Research and Quality, supervised by the federal government.

It is worth noting that healthcare providers also have their own self-policing mechanisms that act as a major step in oversight. Additionally, most healthcare providers voluntarily submit themselves for comprehensive inspection and subsequent certification by the relevant body, The Joint Commission on Accreditation of Hospital Organizations.

Healthcare providers and professionals go through a series of test with a view of confirming their skills; most individuals willingly go through this testing. Reports compiled in the past have indicated a declining trend of the number of physicians that have faced disciplinary actions before the state medical boards. This decline shows the positive result of having functional oversight bodies. Regulation and oversight of operations in the healthcare sector remain paramount if the sector is to progress and deliver quality to the country citizens.

Healthcare in the U.S compared to other countries

The United States healthcare system is among the world leaders with the life expectancy being 78.49. The United States ranks 50th best in the world. Cases of infant mortality in the United States have declined over time to the current 5.98 for every 1000 live births. This again puts the U.S healthcare system at position 48 out of the possible 222. The major questions that come to people's minds when comparing united states healthcare systems with others in the world are around issues of efficiency, access and the quality of output given the high amount of spending dedicated to healthcare sector.

In 2000, the world health organization ranked the United States healthcare system number one in terms of responsiveness but was positioned number 37 with regard to overall performance. Although WHO rankings are highly disputed by some individuals, the information they provided was out of research and hence to a big extent credible. The rate of decrease of preventable deaths in the United States is however slow when compared to other countries such as France and Finland, with over 101,000 deaths witnessed annually which could have otherwise been avoided. The United States has also made major strides in reducing the mortality gap between the rich and educated and the poor in this society. With regard to this, the United States beats many other countries.

Challenges facing the United States Health System

Although the United States healthcare system is rated among the best in the world, there are a number of challenges that this system faces. Some of these challenges include a disparity in access to healthcare. There is a disparity in access as well as treatment methods between the whites and the blacks. Research has found that the white has better access to quality health services as compared to the blacks and other minorities in the United States such as Hispanics and African Americans. These minority groups have a higher incidence of diseases such as cancer and other chronic diseases (Gans. 2005). This has in effect resulted in higher cases of mortality amongst these groups as compared to the whites. This group is at a higher risk of developing lifestyle related diseases such as obesity and diabetes. The prevalence of HIV/AIDS is also high amongst minorities as compared to whites.

The overall effect of this disparity is that the minority group has a relatively lower life expectancy as compared to the whites. This disparity has a negative impact on the economy of the United States in that the government spends a lot of money proving healthcare services for this group as compared to the amount of money invested in the provision of healthcare services for their white counterparts (Gans, 2005).

A study conducted to determine the cause of the disparity revealed several reasons for this disparity. Education was identified as one of the major causes of this disparity. The research found that there was a big difference between the education levels of the minorities as compared to the education levels of the whites. The differences in education levels have been associated with the historical issues that left the minority groups disadvantaged as compared to the whites.

There is a high correlation between the level of education and quality of healthcare. People with a high level of education are more conscious about their health and hence they are more likely to lead a healthy lifestyle as well as access the best quality healthcare services. Due to the low level of education, this group is not able to secure quality jobs and thus their level of income is relatively low. This renders them unable to access quality medical services since they cannot afford it.

Drug safety issues

In the United States, the responsibility of ensuring that drugs are up to standard is under the Food and Drug Administration. This institution ensures that both the human as well as veterinary drugs are efficient and safe. The Food and Drug Administration is responsible to disseminate all information pertaining to drugs to the public to help them in making informed decisions when it comes to buying these drugs (Shi & Singh 2013). All medical devices together with all the drugs produced for use in the United States must pass through the Food and Drug Administration for approval. During the approval process, the Food and Drug Administration examines whether the set standards have been maintained in the production process of either the drug or the equipment.

However, there is a major challenge that faces the safety of drugs and medical facilities. The Food and Drug Administration gives protection and immunity to pharmaceutical companies making them immune to any form of prosecutions because of any problem that may result from the use of their products. The approval that is offered to the pharmaceutical products by the Food and Drug Administration are superior to any claim that may result from the use of these products.

This means that if a patient suffers from the use of the drugs approved by the Food and Drug Administration, it would be hard for such a person to claim damages for the adverse effects suffered (Shi & Singh 2013). In the event that such a patient is awarded damages in compensation by the court of law, the Food and Drug Administration has the power to overrule the court decision.

The problem with this immunity is that some pharmaceutical companies have exploited it to their advantage. Some pharmaceutical companies have used unethical ways to get their drugs approved. Such companies on several occasions use false trial data in a quest for having their drugs approved. The effect is that this body, based on the false clinical test data, has passed substandard drugs. This situation poses a lot of danger to all patients who use these drugs.

High cost of prescription drugs

Starting from the 1990s, the prices of pharmaceutical drugs started to rise in the United States. This placed a high burden to the consumers since the government and the medical insurers could not pay for the high cost of the drugs. This has forced individuals to make their own arrangements for buying these drugs. This has placed great financial stress on these individuals in that they spend more than a third of their earnings on these drugs.

The fact that the government of the United States does not purchase drugs for its citizens leaves the citizens exposed to exploitation from the manufactures. This also denies US citizens an opportunity to benefit from the economies of scale. When the government buys drugs directly from the manufacturers, it is able to negotiate for cheaper prices. This in effect makes the drugs to be cheap to the consumers.

Reforms in the healthcare system in the United States

The challenges that face the American healthcare system have prompted the government to institute a number of reforms in an attempt to address these challenges. These reforms aim at facilitating the access of health services to the Americans at affordable costs. A report released in 2004 by the Institute of Medicine showed that the United States is one of the few developed countries that do not invest in enhancing that its citizens get access to quality healthcare services (White, 2009). It is based on these shortcomings that these reforms have been instituted.

Plans are underway to introduce a comprehensive medical program that would guarantee access, quality, efficiency, and sustainability. This comprehensive healthcare system aims at putting in place structures that would enhance the provision of universal healthcare to all citizens. Although this healthcare system can benefit many Americans, a lot of politics revolve around the issue, compromising its implementation.

Americans have been divided based on their party affiliation over the implementation of this health system. Those who are in favor of the system argue that if it were implemented, the cost of accessing healthcare would fall significantly and lead to improved quality (White, 2009). Those who are against this system mostly basing their arguments on the economic impact that is associated with this system. If implemented, many people will opt out of the insurance companies and this will adversely affect their business.

Some states such as Vermont have formulated healthcare systems that would facilitate easy access of healthcare services. These systems involve only one provider of all healthcare services. The act that established this system recognizes quality healthcare as a human right that must be provided to all citizens.

The United States has as well instituted policies aimed at promoting access to healthcare services for all including the non-citizens such as visitors and immigrants. This has been done through the provision of medical insurance covers for these two groups of people.

Conclusion

The provision of quality healthcare services is among the goals that many countries have encompassed in their strategic plans and development agenda. For a nation to realize its economic goals, it must have a healthy population that will work toward achieving the goals. The country should, therefore, ensure that there are adequate medical facilities with qualified medical personnel to take care of the patients.

There should also be a regulatory body entrusted to enhance fair practices in the medical field. Despite the high level of development that the United States has realized, a number of challenges face its healthcare system. This has prompted a number of reforms in an attempt to streamline the system and make the healthcare services to be accessible to all citizens. The healthcare system in the United States has made major strides in ensuring that this is achieved.

References

Christensen, C. (2009). The Innovator's Prescription, New York: McGraw Hill.

Gans. D. (2005). The cost of health insurance administration in California: estimates for insurers, physicians, and hospitals. Health Affairs (Millwood), 24(6): 1629–39

Morrisey, A. (2008). Healthcare.New York, Morrow publishers.

Shi, L. & Singh, D. (2013). Essentials of the U.S. Healthcare System; Burlington MA: Jones & Bartlett.

White J (2009). The Obama administration's options for healthcare cost control: hope versus reality. Annals of Internal Medicine, 150(7): 485–9