HP 353 - Chapter 1 : Strengths & Weaknesses of the U.S. Healthcare System

What factors contribute most to premature death?

• Lack of access to timely care (uninsured/underinsured)

• delayed treatment for treatable conditions

• inability to afford medications

• unnecessary procedures that worsen health

• racial/ethnic disparities

Health (according to WHO)

A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity .

T/F: the U.S. has universal healthcare coverage.

FALSE the U.S. is one of the only high-income countries with NO universal healthcare coverage!

The U.S. spends the most on healthcare but experiences what kinds of rates with respect to life expectancy, maternal mortality, and death rates for avoidable conditions?

• Lowest life expectancy

• highest infant/maternal mortality

• highest death rates for avoidable/treatable conditions

• why? underinsurance, wasteful spending, health inequities

Why is financing of the U.S. healthcare system one of its weaknesses?

Financing is primarily employer-based as a fringe benefit.

• an employer provides and often subsidizes health coverage for its employees in addition to their regular wages.

• arrangement was originally developed during World War II when wage freezes were in place, and companies used health benefits to compete for talent. 

What are some other weaknesses (besides financing) that makes our healthcare system weak?

• Lack of overall planning, direction, and coordination

• access to healthcare is compromised for people with low socioeconomic status

• lack of LONG TERM care insurance coverage

• PREVENTION is not invested in (only 3.5% of $) high capita per cost in contrast to low health outcomes

Strengths of U.S. healthcare system?

technology, research, medical training

T/F: administrative costs in the U.S. are 300% higher than in Canada

True! One of our weaknesses is that we lack overall planning, direction, and coordination in our healthcare systems, driving up administrative (like receptionist) costs.

What does Sweden invest in in comparison to the U.S.?

They invest more in the non-medical determinants of health.

Examples of Sweden's investments that contribute to its high life expectancy, lower infant mortality rates, and lower GDP spending on healthcare?

🇸🇪

Housing

physical environment

work conditions

supportive social environment

family allowances

income support

unemployment support

For most working people under 65, what are U.S. healthcare payments like with respect to policy premiums and treatments?

Workers and employers share health insurance policy premiums.

Insurer pays most of treatment expenses.

Patients pay a small portion through copayments/coinsurance.

How are health care costs for native Americans, military personnel, or veterans?

Veterans only use doctors who are government employees.

Native Americans enrolled in the Indian Health Services plan don’t pay either.

Americans in these systems never get a medical bill.

How are healthcare costs covered for people over 65?

Medicare: national (federal) health insurance system; almost all participate, and the system has low administrative costs.

T/F: the U.S. healthcare system relies on for-profit private insurance plans.

True, the U.S. healthcare system maintains separate systems for separate classes of ppl and relies heavily on for-profit private insurance plans to pay the bill (private equity!)

What is the number one concern for U.S. voters? Particularly with respect to healthcare?

#1: Unexpected medical bills due to accidents!

#2: cost of healthcare services in general.

Premium costs also a concern

Affordable Care Act

law passed in 2010 to:

• expand access to insurance

• address cost reduction and affordability

• improve the quality of healthcare

• introduce the Patient's Bill of Rights

T/F: all Americans must have healthcare insurance.

False. Clearly not true cus so many people don't have insurance. But in Massachusetts, it IS the law!

Copayment (copay)

requires the patient (policyholder) to pay a specified dollar amount to a health care provider for each visit or medical service received.

Coinsurance

the sharing of expenses by the policyholder and the insurance company

Deductible

the total dollar amount you must pay for most eligible medical services and medications each year before your insurance plan starts to share costs