America has the finest health care money can buy but most Americans can't buy the superior health care Dick Cheney, Congress or the wealthy have because of the cost. In other, more socially responsible nations health care is a right of all citizens and in many cases visitors to these countries as well.............Leonard
Health care in the United States is provided by many separate legal entities. Health care facilities are largely owned and operated by the private sector. Health insurance is now primarily provided by the government in the public sector, with 60-65% of healthcare provision and spending coming from programs such as Medicare, Medicaid, TRICARE, the Children's Health Insurance Program, and the Veterans Health Administration.
The U.S. Census Bureau reported that a record 50.7 million residents (which includes 9.9 million non-citizens) or 16.7% of the population were uninsured in 2009.[1][2] More money per person is spent on health care in the USA than in any other nation in the world,[3][4] and a greater percentage of total income in the nation is spent on health care in the USA than in any United Nations member state except for East Timor.[4] Although not all people are insured, the USA has the third highest public healthcare expenditure per capita, because of the high cost of medical care in the country.[clarification needed][5][6] A 2001 study in five states found that medical debt contributed to 46.2% of all personal bankruptcies and in 2007, 62.1% of filers for bankruptcies claimed high medical expenses.[7] Since then, health costs and the numbers of uninsured and underinsured have increased.[8]
Active debate about health care reform in the United States concerns questions of a right to health care, access, fairness, efficiency, cost, choice, value, and quality. Some have argued that the system does not deliver equivalent value for the money spent. The USA pays twice as much yet lags behind other wealthy nations in such measures as infant mortality and life expectancy, though the relation between these statistics to the system itself is debated. Currently, the USA has a higher infant mortality rate than most of the world's industrialized nations.[nb 1][9] In the United States life expectancy is 42nd in the world, after some other industrialized nations, lagging the other nations of the G5 (Japan, France, Germany, UK, USA) and just after Chile (35th) and Cuba (37th).[10]
Life expectancy in the USA is 42nd in the world, below most developed nations and some developing nations. It is below the average life expectancy for the European Union.[11][12] The World Health Organization (WHO), in 2000, ranked the U.S. health care system as the highest in cost, first in responsiveness, 37th in overall performance, and 72nd by overall level of health (among 191 member nations included in the study).[13][14] The Commonwealth Fund ranked the United States last in the quality of health care among similar countries,[15] and notes U.S. care costs the most.[16]
The USA is the "only wealthy, industrialized nation that does not ensure that all citizens have coverage" (i.e., some kind of private or public health insurance).[17] In 2004, the Institute of Medicine report observed "lack of health insurance causes roughly 18,000 unnecessary deaths every year in the United States."[17] while a 2009 Harvard study estimated that 44,800 excess deaths occurred annually due to lack of health insurance.[18]
On March 23, 2010, the Patient Protection and Affordable Care Act (PPACA) became law, providing for major changes in health insurance.[19]
Contents
[hide]
1 Health care providers
1.1 Facilities
1.2 Medical products, research and development
2 Health care spending
2.1 Impact on U.S. economic productivity
3 Health care payment
3.1 Private
3.2 Public
3.3 The uninsured
3.4 Role of government in health care market
4 Health care regulation and oversight
4.1 Involved organizations and institutions
4.2 "Certificates of need" for hospitals
4.3 Licensing of providers
5 Overall system effectiveness compared to other countries
6 System efficiency and equity
6.1 Efficiency
6.2 Third-party payment problem and consumer-driven insurance
6.3 Overall costs
6.4 Equity
7 Drug efficacy and safety
7.1 The impact of drug companies
8 Political issues
8.1 Prescription drug prices
8.2 Health care debate
9 Health Care Reform
10 Health Insurance Coverage of Immigrants
11 See also
12 Notes
13 References
14 Further reading
15 External links
[edit] Health care providers
Health care providers in the United States encompass individual health care personnel, health care facilities and medical products.
Physicians in the United States include both ones trained by the US medical education system and ones that are international medical graduate who have progressed through the necessary steps to acquire a medical license to practice in a state.
[edit] Facilities
Main article: Medical centers in the United States
In the United States, ownership of the health care system is mainly in private hands, though federal, state, county, and city governments also own certain facilities.
The non-profit hospitals share of total hospital capacity has remained relatively stable (about 70%) for decades.[20] There are also privately owned for-profit hospitals as well as government hospitals in some locations, mainly owned by county and city governments.
There is no nationwide system of government-owned medical facilities open to the general public but there are local government-owned medical facilities open to the general public. The federal Department of Defense operates field hospitals as well as permanent hospitals (the Military Health System), to provide military-funded care to active military personnel.
The federal Veterans Health Administration operates VA hospitals open only to veterans, though veterans who seek medical care for conditions they did not receive while serving in the military are charged for services. The Indian Health Service operates facilities open only to Native Americans from recognized tribes. These facilities, plus tribal facilities and privately contracted services funded by IHS to increase system capacity and capabilities, provide medical care to tribespeople beyond what can be paid for by any private insurance or other government programs.[21]
Hospitals provide some outpatient care in their emergency rooms and specialty clinics, but primarily exist to provide inpatient care. Hospital emergency departments and urgent care centers are sources of sporadic problem-focused care. "Surgicenters" are examples of specialty clinics. Hospice services for the terminally ill who are expected to live six months or less are most commonly subsidized by charities and government. Prenatal, family planning, and "dysplasia" clinics are government-funded obstetric and gynecologic specialty clinics respectively, and are usually staffed by nurse practitioners.
[edit] Medical products, research and development
As in most other countries, the manufacture and production of pharmaceuticals and medical devices is carried out by private companies. The research and development of medical devices and pharmaceuticals is supported by both public and private sources of funding. In 2003, research and development expenditures were approximately $95 billion with $40 billion coming from public sources and $55 billion coming from private sources.[22][23] These investments into medical research have made the United States the leader in medical innovation, measured either in terms of revenue or the number of new drugs and devices introduced.[24][25] In 2006, the United States accounted for three quarters of the world’s biotechnology revenues and 82% of world R&D spending in biotechnology.[24][25] According to multiple international pharmaceutical trade groups, the high cost of patented drugs in the U.S. has encouraged substantial reinvestment in such research and development.[24][25][26]
[edit] Health care spending U.S. healthcare costs exceed those of other countries, relative to the size of the economy or GDP. Total U.S. healthcare spending as a percent of U.S. GDP (gross domestic product).[27]
Current estimates put U.S. health care spending at approximately 16% of GDP, second highest to East Timor (Timor-Leste) among all United Nations member nations.[4] The Health and Human Services Department expects that the health share of GDP will continue its historical upward trend, reaching 19.5% of GDP by 2017.[28][29] Of each dollar spent on health care in the United States, 31% goes to hospital care, 21% goes to physician/clinical services, 10% to pharmaceuticals, 4% to dental, 6% to nursing homes and 3% to home health care, 3% for other retail products, 3% for government public health activities, 7% to administrative costs, 7% to investment, and 6% to other professional services (physical therapists, optometrists, etc).[30]
The Office of the Actuary (OACT) of the Centers for Medicare and Medicaid Services publishes data on total health care spending in the United States, including both historical levels and future projections.[31] In 2007, the U.S. spent $2.26 trillion on health care, or $7,439 per person, up from $2.1 trillion, or $7,026 per capita, the previous year.[32] Spending in 2006 represented 16% of GDP, an increase of 6.7% over 2004 spending. Growth in spending is projected to average 6.7% annually over the period 2007 through 2017.
In 2009, the United States federal, state and local governments, corporations and individuals, together spent $2.5 trillion, $8,047 per person, on health care. This amount represented 17.3% of the GDP, up from 16.2% in 2008.[33] Health insurance costs are rising faster than wages or inflation,[34] and medical causes were cited by about half of bankruptcy filers in the United States in 2001.[35]
The Congressional Budget Office has found that "about half of all growth in health care spending in the past several decades was associated with changes in medical care made possible by advances in technology." Other factors included higher income levels, changes in insurance coverage, and rising prices.[36] Hospitals and physician spending take the largest share of the health care dollar, while prescription drugs take about 10%.[37] The use of prescription drugs is increasing among adults who have drug coverage.[38]
One analysis of international spending levels in the year 2000 found that while the U.S. spends more on health care than other countries in the Organisation for Economic Co-operation and Development (OECD), the use of health care services in the U.S. is below the OECD median by most measures. The authors of the study concluded that the prices paid for health care services are much higher in the U.S.[39] Economist Hans Sennholz has argued that the Medicare and Medicaid programs may be the main reason for rising health care costs in the U.S.[40]
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