The United States healthcare system

The health care system in the United States has been subject to criticism, notably ever since the release of the film SICKO in 2007, which was directed by Michael Moore from the United States.

On the other hand, from the perspective of optimizing economic efficiency, a system that is founded on the market and competition would appear to be the best option. However, it is experiencing severe financial difficulties: health expenditures amounted to 15.3% of gross domestic product (GDP), which is significantly more than the 11.1% that France had in 2005 [1]. This places it at the lowest level in the world, which is the highest level, and it creates a huge difficulty for health finance.

The outcomes in terms of inequality and access to medical care are not very good. In point of fact, the absence of universal health care, in conjunction with a challenging economic environment, ultimately leads to a sizeable group of residents who are without health insurance (15.3% of the population in 2007 [2]). When it comes to providing equal access to high-quality medical care and maximizing economic efficiency, it is abundantly clear that no health care system can claim to have implemented the ideal formula. In contrast, bringing attention to the shortcomings of the American healthcare system while simultaneously recognizing its strengths, particularly with regard to preventative measures, enables us to contemplate the alternatives that are accessible to the American system as well as to other health care systems, particularly the French system.

With that being said, what are the shortcomings of this system, and what other options are we beginning to see emerging? To begin answering this question, it is necessary to first investigate how it operates, beginning with the coverage and ending with the organization of care. After that, it will be required to provide a description of current events, particularly those that have occurred since the election of Barack Obama as president of the United States, which promises a significant overhaul of the nation’s healthcare system.

With a liberal and market-based approach, the American system is structured on private insurance, which is frequently related to employment, and mandatory health insurance, which is linked in particular to elderly people and those with low incomes. On the other hand, because this system is not universal, it does not cover the entire population, and a portion of the population does not have health insurance.

In contrast to the French health system, the health care system in the United States is mostly structured around private insurance that is supplied as an optional benefit to nearly all employees by their respective employers. There were 177.4 million people in the United States who were covered by job-related private insurance in 2007, which is equivalent to two out of every three Americans. There may be variations in the benefits that are provided from one firm to another; nevertheless, larger companies typically provide better coverage.

5A fundamental that is deeply rooted in the history of this nation, which has a liberal tradition, is the desire to protect the freedom of choice of its residents at all costs. This desire is demonstrated by the absence of mandatory membership in health insurance. On the other hand, the federal government has established health insurance that is restricted to persons who are either elderly or extremely poor.

Basic coverage is provided by the health care system in the United States, which mitigates substantial risks for the elderly and the economically disadvantaged. As a result, there are two mandatory health insurance programs that are funded by taxes and contributions: Medicare, which is for persons who are over the age of 65 or disabled, and Medicaid, which is for families who have limited means. According to the United States Bureau of Statistics [2], this affects over 83 million people in the United States, which is equivalent to 27 percent of the total population.

7Medicare provides mandatory hospitalization insurance, which is funded by payments from both employees and employers, as well as optional, paid supplementary medical insurance, which is funded by contributions from the state and organizations affiliated with the programme.

8The federal government and the states work together to provide funding for Medicaid, which provides assistance to specific groups of underprivileged populations. The eligibility requirements for Medicaid are established by federal mandates.

Despite the fact that private health insurance is tied to employment and that the state guarantees health insurance for all citizens, an ever-increasing portion of the population does not have access to medical treatment. According to projections, the number of people who do not have medical coverage will increase from 45 million in 2009 to 54 million in 2019 [4]. It is primarily due to the rise in insurance premiums, which has not been matched by a commensurate rise in salaries, that this increase has occurred. Therefore, the majority of people who do not have health insurance are low-wage workers, who are not qualified for public health care and whose employers do not provide insurance coverage for them. Additionally, it is possible that it would be interesting to take note of the fact that one quarter of the population would be eligible for insurance without being aware of it [5].

10As a result, we are able to very clearly observe the flaws of a system that is based on private insurance that is tied to employment but is not required for the employer: contributions are not proportional to income, as is the case in France, for example. The rise in insurance premiums consequently results in an increase in the number of workers who do not have health insurance and a decrease in the number of businesses who participate in health insurance programs.

A significant portion of the healthcare system in the United States is structured around integrated networks. When it comes to healthcare organizations, these private enterprises can be compared to laboratories since they are seeking for ways to address the mounting issues they are experiencing with finance. Additionally, we see that their experiences are reminiscent of certain procedures that are performed in France. These practices include the filtering of access to specialized treatment by the attending physician, as well as the agreement and preventative missions that are carried out by health professionals.

Managed care organizations, often known as MCOs, are the most common type in the United States. These organizations are coordinated care networks that were established in response to the concerns of employers regarding the expense of health insurance. These organizations combine the roles of insurance and care. A cooperation between funders and healthcare providers [6] is the foundation of these programs, which enables resources to be distributed in the most effective manner possible. As a result, the healthcare experts in question provide advantageous pricing in exchange for the continued patronage of their services. It is common practice for the family physician to act as a gatekeeper for access to specialized treatment in order to maintain cost management. Insured members of these networks are strongly encouraged to seek consultation from the aforementioned approved professionals.

When it comes to managed care organizations (MCOs), the insured are subject to higher costs because the choice of practitioner is more flexible than it is with PPOs [7]. Certain activities of these organizations ought to be highlighted, such as the gathering of specialists from a variety of disciplines in the same location, the particular attention that is placed on preventive treatment, or even the integration of networks that are specialized in particular diseases. As a result, it is abundantly obvious that in the United States, care coordination and prevention are regarded as potential solutions to enhance the effectiveness and quality of the health care system.

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