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In 2000, Americans spent on health care $ 1 trillion, that is, More than 15% of the gross domestic product. More Americans are spending only on food and housing.
In the U.S. health insurance is voluntary and is carried out almost entirely by employers. Health Insurance - the most common type of insurance in the workplace, but employers are not obliged to provide. Not all U.S. employees receive such insurance. Yet in most major health insurance companies is almost a sine qua non, and in 1990 they had reached about 75% of the population USA1.
There are many types of health insurance. The most common is the so-called compensation insurance, or insurance "fees." In this form of insurance the employer pays the insurance company's insurance premium for each employee, secured the relevant policy. Then the insurance company pays the checks presented by the hospital or other medical facility or physician. Thus the paid services included in the insurance plan. Typically, the insurance company covers 80% of the cost of treatment for the rest to pay the insured himself.
There is an alternative - the insurance of the so-called managed services. The number of Americans covered by this type of insurance is growing rapidly (more than 31 million people. In 1991). In this case, the insurance company contracts with doctors, other health professionals, as well as c institutions, including hospitals, to provide all the services provided by this type of insurance. Typically, hospitals receive a fixed amount that is paid in advance for each insured.
The differences between these two types of insurance is very important. In case of insurance "fees" paid the cost of services actually provided to patients. In case of insurance "managed service" hospitals receive only a fixed amount at the rate of each insured patient regardless of the volume of services rendered. Thus, in the first case, health care professionals interested in attracting customers and providing them with a variety of services, while the second - they would rather abandon the use of additional procedures for patients, at least, is unlikely to appoint more of them than necessary.
Currently, the U.S. government also pays for more than 40% of health spending in the major programs - "Medicaid» (Medicaid) and the "Medicare» (Medicare). In accordance with the program "Medicare" is covered by insurance for all Americans older than 65 years, as well as those who are approaching this age and who has a serious breach of health. The "Medicare" is partially funded by the tax levied on all employees - both salaried workers and to employers. In general, this tax is about 15% of the income of employed Americans. In addition, the "Medicare" is funded from general revenue tax. The "Medicaid" provides coverage for low-income Americans, mostly women and children from poor families. The program also paid stay in a nursing home who requires constant care and can not do without the daily assistance.
The "Medicaid" is financed by the federal government and state governments. The federal government pays about half of all spending on the program "Medicaid" from general tax revenues. The rest is paid by the government of each state.
However, there are many Americans who are not covered by any kind of insurance. Many of them work, but employers do not provide them with health insurance. At the same time, these people are too young to meet the requirements of "Medicare" does not belong to the category of unsecured and are not covered by the program "Medicaid." According to various estimates, the number of uninsured Americans ranges from 20 to 50 million people. (8-20% of the population).
Most of the costs of medical services in the United States is covered by medical insurance which is paid by employers and government. Nevertheless, the share of people accounts for a significant portion of the costs for providing medical services. These payments are considered to be an appropriate mechanism for the regulation and reduction of costs (if the employee pays part of the costs themselves, it is less likely to go to the doctor.)
In the U.S. there is a coherent system of relations between the customer and insurance company doctor. Particular attention is paid the insurance companies to the list of drugs and regimens. In a country with effective legislation every step of the physician is under control. American doctors do not prescribe drugs that are not included in the officially adopted at the Ministry of Health or the insurance company a list of medicines. In the event of a claim for professional medical error is checked all of its provisions. If the list of appointments appears "illegal" drug, the consequences of such a test could be disastrous for the doctor. Waste and precise treatment regimen, regularly updated list of medications relieve insurance companies of the medical polypharmacy, the client - from the consequences of medical errors, and the doctor - from litigation.
Health insurance includes such major items:
• Client Relations Insurance Company;
• client-doctor relationship;
• the relationship the insurance company doctor.
The first paragraph of the agreement is sealed with a guarantee of health insurance paid by the insurance company for their costs of customer care.
The second paragraph specifies the conditions under which medical care is provided directly in the time of the accident. As a rule, the notion of an insured event include acute illness, exacerbation of chronic and accident.
The third point - the payment for providing medical care, monitoring of care provided, compliance with doctor's prescriptions to standard protocols of diagnosis and treatment, accepted and agreed upon by medical experts (underwriters - underwriters) an insurance company. As a prerequisite to the last paragraph also includes the value of professional level medical requirements of the insurance company.
All items of insurance "work" very smoothly. It is particularly important for the insurance company and the client relationship been established as an insurance company doctor. In each case, the doctor operates an insurance scheme approved by the insurance company. Minutes of the diagnosis and treatment include those destinations that are in each case, the insurance is the most appropriate, effective, efficient. Correct diagnosis and appropriate treatment - the result sought by the insurance company offering health insurance.
List of drugs in the arsenal of an American doctor is very specific. It does not have, such as immunomodulators - these drugs on such indicators as efficiency, have not reached the level of antibiotics and nonsteroidal anti-inflammatory drugs, so there is always a probability of no effect from their use. The ineffectiveness of the drug - are almost always extraordinary event in the insurance company and doctor, which may lead to litigation. To avoid such consequences, appoint highly effective medicines that can achieve a positive result.
Perhaps Ukrainian doctors seem not quite the usual application of non-steroidal anti-inflammatory drugs such as ibuprofen, an exacerbation of urolithiasis, but American doctors are practicing their purpose. In turn, American doctors surprises frequent and habitual appointment GIK (glucose-insulin-potassium mixture) our doctors for various diseases. They are trying to analyze the effect of each drug, which is part of the mixture, and do not understand why the GIC is almost a panacea for all ills and takes first place in frequency of hospitalization. Also puzzling appointment of aminophylline in hypertension. According to the American counterparts, this drug has a very narrow and specific application, namely the treatment of bronchial asthma.
Of course, a doctor's thinking can be characterized as a sandwiched narrow limits. But the truth is known to be located somewhere in the middle. So today, experts avoid detailed prescriptions (the so-called medical polypharmacy), a large number of drugs, compatibility was not always sure.
In America, medical insurance, with its voluntary health insurance is the guardian of the health of their customers, ensuring that payment has not only provided medical services, and quality treatment of traditional medicines. No insurance company will not pay the cost of treatment with hypnosis, acupuncture, homeopathic or herbal remedies. In terms of health insurance, such therapy is a non-traditional and effects of its use is controversial.
Health insurance in the United States has one more feature. There is a certain credibility medicines prescribed by your doctor. But if the result of their use is inadequate and the disease is slowly but steadily progressing, the next step is the only correct treatment for clients of the insurance company - not the prescribing of drugs and surgical treatment. U.S. ranks first in the number of coronary bypass operations. American Association of Cardiovascular Surgery, reported that in 2000 the U.S. produced more than 519 thousand coronary bypass operations (in the world - about 800 thousand) 2.
One of the basic principles of health insurance - high efficiency of care. As health care costs, the insurance company covers the costs associated with the use of only one right way to treat the high rate of positive results. Of course, the cost of heart surgery is very high, but still less than the cost of medicines to be taken quite a long time. Yes, and the effect of conservative therapy is not always desirable. Therefore, insurance companies prefer to bear the high costs, but only once.
Americans are serious about their health. On the one hand, insurance companies shield their clients from non-occupational medical care, on the other - Americans trust their doctors and do not buy drugs without a recommendation of a specialist.