The health care system of America is unique, unlike any other health care system in the world. Usually in most developed countries, all the citizens are entitled to health care services under the national health insurance programs run by their governments. The case is not such in America. The truth is that there is no particular system of health care delivery. The health care system, as it is called, suffers from crisis and makes the delivery of health service a failure.
The growing concern is that the healthcare is a huge business which is not being managed properly. This business is consuming over 17.3% of the gross domestic product of U.S.A and the costs exceed over $2.5 trillion (Truffer, Keehan, Smith, et al., 2010). The health care has been commercialized, which has created huge conflicts between the medical care providers, policy makers and the payers. The basic questions to be focused are the cost, access and quality of the health care. How much do we spend on medicine? How good is it? Who has the access? Only after answering these questions, the issue can be raised of improving the system.
Cynicism about the healthcare system has grown rapidly due to the increased knowledge of the conflicts of costs, quality and access to the public. The highest quality of care is provided in the United States to most but not all individual patients. Almost 15% of the Americans still do not have a health insurance, which means that they are negated of the access to the best care and services. Another fact is that as compared to other developed countries, U.S. lags behind on a number of health measures pertaining to the population as a whole like the life expectancy and the infant mortality (Sultz & Young, 2010).
The issues of cost, quality and access still hold major significance relating to healthcare delivery in the United States. In 2000, the total national health expenditures were $1.35 trillion (Hartman, Martin, Nuccio, Catlin, et al., 2010) and in 2010, these expenditures were estimated to be $2.57 trillion (Truffer, Keehan, Smith, et al., 2010) which is an increase of 90%.
According to the Institutes of Medicine, quality is defined as, “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” The quality of care can be reviewed through various issues but here the rate of infant mortality and life expectancy are being discussed. A higher rate of infant mortality may be due to many reasons but the basic impact is that it leaves a nation to suffer through. The number one and two of the deadliest categories of disease in America are heart disease and cancer. U.S. ranks 28th in infant mortality rate (Peterson and Burton, 2007). The life expectancy at birth and at the age of retirement also indicates the relative effectiveness of the healthcare services in the prevention and the management of the disease. According to a survey conducted in 2001 published in Health Affairs, the patients showed very low level of satisfaction. U.S. ranks 23rd in the life expectancy rate (Peterson and Burton, 2007); well below other industrialized nations. Although the quality of the medicine provided is best in the world and America is also considered excellent at acute care. America leads the world in research but, the truth is that it falls behind its peers in providing the quality care to a majority of its citizens. A study in 2006, by then Rand Corporation found that the rate of provision of the recommended care in America is only 50%. It also stated that not only the poor or the uninsured, but all the socio-demographic groups were at risk.
In 2011, the estimated expenditure in healthcare was $2.7 trillion. The reason for such a higher share in GDP is due to much higher prices as indicated by Anderson et al. (2003). According to a study by Heyman et al. (2009), over 43 million Americans were without health insurance coverage in year 2008. Almost equal or more were without proper access to the health insurance. The reason for this huge gap is the high cost of premiums that is creating a financial barrier to both the health care and the health insurance. A survey in 2008 by Kaiser indicates that 29% of the uninsured usually postpone the health care decision due to the cost considerations (Kaiser Commission on Medicad and the Uninsured, 2009) as compared to only 7% of the insured. Delaying the health care services when required may lead to worsening of the case or even a premature death. Therefore, there is a clear link between the high cost and the poor access, which may lead to certain undesirable and threatening outcomes. The growing health care costs will place an enormous burden on the coming generations as their payroll taxes will have to meet the contractual obligations of the government.
Health guarantees a happy and satisfied life along with high productivity at work. Therefore, access to health care should be considered the most important aspect. But, access means that people can easily afford the health care services, which means that access means affordable cost of the health service. Along with this the quality of the service is also very important. Therefore, all these three objectives are interdependent on each other. The provision of quality heath service at an affordable price is important so that each and every individual can receive it.
According to Friedman (1991), the cost has been of great importance since the last decade and would remain so in the coming years. Cost has great influence on the access and quality of the service, which makes it difficult to deal with one leaving the rest untouched. The providers of the healthcare perceive the relation between the three as positive and look from the angle of ‘more is better’. Although this is the opposite of what should be in reality, where the high quality should actually lead to a reduction in mistakes, meaning lesser work and ultimately lesser costs. But, when the cost is higher, lesser people afford them and the employers and insurers would limit their expenditures. The savings from the increased efficiency could be passed on to the consumers in the form of reduced insurance premiums, which means the consumers would have greater access to the health service. And of course, more efficient process means better quality would be practiced. This whole phenomenon can be regarded as the total quality management.
When addressing the healthcare reforms, it must be made sure that al the three issues are being dealt with. The starting point of the reform must be the lower cost or affordability of the health care. Rising cost makes it difficult for the people to get access to health insurance and increased pressure is put on the taxpayers. According to Senator John McCain (2008), a refundable tax credit of $2500 for the individuals and $5000 for the families would be provided. The people who would be purchasing their insurance coverage for the first time would get the same tax benefits as those under employer coverage.
The senator also said that the control would be given to the doctors and the patients and the competition would be increased. The competition would bring up many choices and would drive the costs down. Having more choices, people would choose the best plans and can put pressure on the companies to lower the costs and provide better facilities. No American would be denies access to the coverage due to any preexisting condition like cancer (McCain, 2008).
Where quality is concerned, the fact remains that America has the best doctors in the world, but the system of health care financing impedes their ability to practice. The reforms will be such that the doctors will be allowed to practice medicine with the interest of their patients on high priority. Another issue to be addressed is that there needs to be more research on diagnosing, managing and preventing chronic diseases like cancer, heart disease, high blood pressure, and diabetes. The dilemma of obesity is growing at a higher rate and innovative ways should be found out to promote healthy habits and tackle the troubles. These reforms shall help in increasing the efficiency of the healthcare providers, which is one of the best approaches to address all the three issues (McCain, 2008).
It can be deduced that “cost, access, and quality have become functions of each other, as part of the natural progression of the system and the ever-longer shadow cast by cost on all other parts of health care. It is from this the campaign interweaving of the three that for broader access has become the campaign for "health care system reform," as analysts and advocates alike become more sensitive to the fact that the search for quality will inevitably have an impact on cost, and that the access crisis is rooted in the cost crisis.” (Friedman, July-August, 1991). As already mentioned, the reforms should address the access rather than the cost, as addressing the issue of access would eventually lead to a cost reduction.