(Note: After importing the information I was not able to immediately post graphs. I will post at a later date.)
Some
of the issues when it comes to United States Healthcare are that the cost is
too high. The number given many times when it comes to uninsured in the United
States news articles will tell you that the number is about 47 million people.
According to the Public Broadcasting Station (PBS) there are 47 million
uninsured in the United States. (PBS 2008) This can be quite alarming when you
believe that 47 million people are sick or unhealthy because there is no
healthcare affordable for them. To add
to the situation the annual cost of healthcare $2.7 Trillion Dollars according
to USNews. (USNews 2013) Then you look at the the estimates according to
Pricewaterhousecoopers are that over $1.2 Trillion dollars is wasted in the
United States Healthcare system. (PwC
2008)
Reading
the previous information can lead to the idea that there is a lot of money
wasted and there are a lot of people without health care. Another figure is that the US has about 316
million people according the CIA World Factbook. (CIA 2013) With a population of 316
million approximately so per capita the spending in the U.S. is nearly double
the next biggest spender country. The U.S. spends about $8500 per capita and
yet still has comparable or higher incidents per capita in obesity, high blood
pressure, diabetes, and other illnesses and diseases. Odier, N. (2010). Compare this with the U.S. European
neighbors. Instead of having people that are uninsured everyone has a, “right”
to free healthcare. According to some
reports, the US (while the biggest spender) has the worst healthcare indicators
in developed nations? Does the United
States need to implement what the Germans have in healthcare- a dual payer
system? Do we need to implement things from the United Kingdom- where the
government pays for everything? Odier, N. (2010). I want to examine these healthcare systems to
see if there is anything worth implementing in the United States to make our
healthcare better in terms of access to care, quality of care, or the efficient
utilization of resources.
The
U.S. Healthcare system is one that does have its issues but is fundamentally
different than European Healthcare Systems.
One
European model is usually some form of Healthcare called the Beveridge health
system implemented after World War 2. Denmark, Finland, Ireland and Sweden have
founded their health systems on this model. This is a Social Insurance System
based on the Three U’s:
·
Universality
: Every citizen is protected against all social risks regardless of employment
status.
·
Unit
: A different administrative agency handles each type of risk.
·
Uniformity
: Each individual receives services according to his or her needs, regardless
of income.
Then
there is the Bismarck health system Austria, Belgium, France, Luxembourg and
the Netherlands use a similar form of the Bismarck health system. In the
Bismarck. Established around 1883 by Chancellor Otto von Bismarck the German
healthcare system was for the workers. Under this system they rely on public
health insurance funded by workers and business. This is supplemented by
private insurance. The system is also
divided between ambulatory care and hospital care. There is a portion of costs
that is covered by private insurance. Odier, N. (2010).
According to one
article, “The US health system is a prime example of a market-based health-care
system in need of reform. Compared to systems of major European countries, the
US system generally has lower quality care despite higher costs and covers a
smaller percentage of the population. Unlike European models, which provide
governmentally centralized care, the US system is decentralized and primarily
operates on a contract basis between private actors (private insurance
companies, health-care institutions and health-care professionals and clients
seeking care). Hence, the challenge before the United States remains: How in
these conditions can a reform be proposed that would decrease costs, increase
quality and expand coverage to include as many people as possible? Odier, N. (2010).
After
reading the highlights abstracts of articles such as the one in the Journal of
Medical Marketing one can quickly come to a conclusion that there is something
monumentally wrong with the U.S. Healthcare system. But why? What is used to
compare the systems?
One
entity where a majority of comparative data comes from is the Organization for
Economic Co-Operation and Development or OECD. Since 1961 the OECD has
published information that records several indicators of its participant’s
health key indicators from percent of GDP to mortality, obesity, etc. The
Organization for European Economic Cooperation (OEEC) was established in 1948
to run the US financed Marshall Plan for reconstruction of the European
continent. Canada and the United States joined the OEEC members in signing the
new OECD Convention on December 14, 1961 when the Convention entered into
force. The mission of the OECD is to promote
policies that will improve the economic and social well being of the world. (OECD 2013)
Cost:
When
you examine the Beveridge systems and countries United Kingdom, Denmark,
Finland, Ireland and Sweden you will find that the per capita spending for
these countries as a component of public expenditures is slightly lower than
the United States, while the Bismarck
health systems Austria, Belgium, France, Luxembourg and the Netherlands are
closer to what the United State spend. What this shows is that our public
spending on healthcare is at least close to what the public spends.
Another
interesting find is the amount of out of pocket expenses as a percent of total
expenditure. With the exception of France and Germany the U.S. pays less as a
percentage of total spending.
The argument for some reports
is that based on spending the outcomes of heart complications, high blood
pressure, and obesity the U.S. system lags behind. Odier, N. (2010). These are complications that are usually the
result of poor choices versus a healthcare issue that can be cured by visiting
the Doctor. When
you visit the National Institute of Health Website you will find that treatment
for high blood pressure is, “adopting healthy lifestyle habits is an effective
first step in preventing and controlling high blood pressure. If changes alone
are not effective in keeping your pressure controlled, it may be necessary to add
blood pressure medications.” (NIH 2013)
When you visit the World
Health Organization website and look up obesity you find the following:
The fundamental cause of obesity and
overweight is an energy imbalance between calories consumed and calories expended.
Globally, there has been:
• an
increased intake of energy-dense foods that are high in fat; and
• an
increase in physical inactivity due to the increasingly sedentary nature of
many forms of work, changing modes of transportation, and increasing
urbanization. (WHO 2013)
Quality/Access:
The majority of hospitals in
the US are the not for profit hospitals comprising 50.7% of the total. The
government run hospital rate is around 18% not accounting for the federal,
prison, psychiatric, or long term care facilities. While the proprietary for profit hospitals
make up approximately 17.9% of the hospitals in the US. (AHA 2013)
Another indicator of the
quality of care could be wait times to receive appropriate care according to an
OECD survey in 2010 the only country to have shorter wait times was Germany the
survey was Waiting time of four weeks or more for a specialist appointment. In
this survey was just access waiting times of four weeks or more to see a
specialist this is not for treatment. (OECD 2 2013) The waiting times of four
months or more for Elective surgery as collected by the OECD is a measure
tracked that Germany and the Netherlands were the two countries that had a
lower percentage of wait times. A quick
regression analysis of the 10 countries would show a negative correlation of
.19% or an r^2 of .0019. This means that .19% of the variance in the wait times
is explained by the variance in amount of physicians.
Additionally
using OECD data for 19 countries to assess the relationship between physician
supply and healthcare outcomes, we have determined that there is no association
between avoidable mortality and overall physician supply. (NIH 2009)
What
we have seen using the same data from the OECD is a few things.
• Public expenditure on health,
/capita, US$ purchasing power parity the U.S. is not spending the most. Nor is
the spending more than $1000 per capita different than the following 10
countries in the OECD.
• Typical Comparisons of Obesity and
High Blood pressure are not conditions that are a result of lack of Medical
Care. While medical care can improve the situation there is not a cure for
these lifestyle choices.
• Physician supply does not directly
correlate to quicker access.
Accountable
Care Organizations ACOs can include hospitals, specialists, post-acute
providers and even private companies like Walgreens. (Kaiser 2011) An instance
of solutions to cost are retail clinics. Retail Clinics can be used to provide
savings if 10% of patients went to retail clinics for outpatient care Out of
pocket expenditure per capita according to the OECD is $987.4 further, About
14-27 percent of all emergency department visits could take place at retail
clinics and urgent care centers, with a potential cost savings of approximately
$4.4 billion annually. (Rand 2013)
One
of the larger opportunities in the U.S. is to save money in prevention with
behavior based care such as obesity as well as measuring following instructions
from physicians. A German Structured Outpatient Education and Treatment
Programs for Patients with Diabetes Mellitus and/or Hypertension report in 2003
results demonstrate the practicability and effectiveness of the implementation
of programs as an integral part of disease management in routine primary
healthcare for patients with diabetes mellitus or hypertension. (Gruesser 2003) In Germany laws have been
passed the most recent healthcare reform under the motto ‘prevention before
treatment, rehabilitation, and long term care’ came into force on 1 April 2007
(Schmidt 2007). Even if this information does not directly relate to cash
savings this could have a significant impact on the Obesity epidemic in the United
States.
The OECD collect data across
countries to measure healthcare systems but the inputs are different to the
point where more data could be sifted through to make better correlations. Is
it possible that one solution will solve the multiple problems facing the
United States healthcare? The thing that can be taken away from the comparisons
is that each country can benefit from using these benchmarks to compare their
histories of performance. According to
the Commonwealth Fund England and the United States are addressing similar
challenges, including how to get more value out of health care spending, and
both nations are experimenting with techniques to steer clinicians,
institutions, and patients toward value-enhancing behaviors. (CWF 2010) Some of
the solutions to the problem in the United States healthcare problems are to
continue to focus on value enhancing behaviors access, and quality. When
looking at the data provided by the OECD and the many citations by multiple publications
and journals the U.S. Healthcare system can improve, however, to completely adapt
to another countries success models based upon limited segments of highlighted
information collected by the OECD misses correlations to make effective policy
changes.
References
American
Hospital Association (2013). Fast Facts
on US Hospitals. Retrieved from:
Central
Intelligence Agency. (2013). The World Factbook : United States:
Commonwealth
Fund. (2012). Health Care Reforms in the
USA and England: Areas for
Useful
Learning.
Retrieved from Website http://www.commonwealthfund.org/Publications/In-the-Literature/2012/Oct/Health-Care-Reforms-in-the-USA-and-England.aspx
Gruesser,
M. (2003). Structured Outpatient Education and Treatment Programs for
Patients with Diabetes Mellitus and/or
Hypertension: The German Experience. Disease Management & Health
Outcomes, 11(4), 217-223.
Kaiser
Health News (2013). FAQ On ACOs:
Accountable Care Organizations,
Explained
Retrieved
from Website http://www.kaiserhealthnews.org/stories/2011/january/13/aco-accountable-care-organization-faq.aspx
National
Institute of Health. (2013). Treatment of High
Blood Pressure.
Retrieved from
NIH Website http://www.nhlbi.nih.gov/hbp/treat/treat.htm
National
Institute of Health (2009). More Doctors
or Better Care Retrieved from
NIH Website http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2732652/
Odier,
N. (2010). The US health-care system: A proposal for reform. Journal Of
Medical
Marketing, 10(4), 279-304.
Organization
for Economic Co-Operation and Development (2013). History Retrieved
from: http://www.oecd.org/about/history/
Organization
for Economic Co-Operation and Development 2 (2013). Frequently
Requested
Datas Retrieved
from: http://stats.oecd.org/Index.aspx?DataSetCode=SHA
PricewaterhouseCoopers
Health Research Institute. (2008). The Price of
Public
Broadcasting Station (2008). Critical
Condition. Retrieved from: PBS Website
Rand
Corporation (2010) Many Emergency
Department Visits Could Be Managed at
Urgent
Care Centers and Retail Clinics Retrieved from Rand Corporation Website http://www.rand.org/pubs/external_publications/EP20100123.html
Reinberg,
Steven (January 7, 2013). U.S. Health Care Spending Now at $2.7 Trillion:
Schmidt,
H. (2007). Personal Responsibility for Health — Developments Under the
German Healthcare Reform 2007. European
Journal Of Health Law, 14(3), 241-250.
World
Health Organization (2013). Obesity and
Overweight Retrieved from World
Health Organization Website http://www.who.int/mediacentre/factsheets/fs311/en
I am not one of those proponents saying the Affordable Health Care Act is a wash however I would argue that these liberal policies for health care are not the answer to achieving better access for the poor or anyone for that matter. 
