Throughout history, every country has elaborated its healthcare system with distinctive features formed based on particular philosophies, local traditions, and views. In this regard, despite many economic and political commonalities of the United States with the most developed countries, its healthcare system is strikingly different and unique, especially in terms of management and insurance. This paper aims at examining the USA healthcare system and conducting an in-depth comparison with other states such as the United Kingdom, Canada, and Germany. In addition, the paper will cover the most significant milestones in the historical development of the US system and indicate some prominent individuals in history.
The Preindustrial Era
In the preindustrial era, that is, the time before the 20th century, the US healthcare principally brought a primitive and unorganized form of entity and developed rather slowly. The first professional hospital opened in Philadelphia only in 1751, and the care of the sick was traditionally the responsibility of the family (“In the beginning,” n.d.). The extensive construction of hospitals started only at the beginning of the 19th century, but they lacked competent nurses, doctors, equipment, and even people’s trust. It is worth noting that, in this period, the first nursing apprenticeship training began. Valentine Seaman organized the first course of lectures for nurses in 1798, and, in 1869, the six-month training program of nursing was instituted by Women’s Hospital of Philadelphia in Pennsylvania (Whelan, n.d). Moreover, the number of schools for physicians and doctors accordingly also increased at a rapid pace. Nevertheless, the state of the US medical education noticeably conceded European medical schools. The United States did not have adequate science-based training, clinical practice and conditions, laboratories, and research.
The Post-Industrial Era
The post-industrial era (from the late 19th to late 20th century) was marked by a notable shift in care delivery, treatment, public health, and education. These changes were stipulated by technological advancements, urbanization, and the tremendous necessity for qualified medical workers. The 1920s can be regarded as a specific landmark in the progress of physicians’ profession, demonstrating the significant leap in their prestige and authority (Shi & Singh, 2019). Scientific and professional changes required the enhanced competence of doctors, which, in turn, entailed institutionalization that implied organizing medical services around hospitals. It is worth indicating that the process of institutionalization ended in Europe about one century earlier.
Another distinguishing trait of that period was the independence of physicians from hospitals and medical organizations’ control. Only since 1900, American Medical Association (AMA), formed in 1847, firmly advocated for establishing the legal requirements and state medical licensing laws (Shi & Singh, 2019). Herewith, medical licensure, administrated by states, began in the 1870s, while in Europe, licensing was regulated by governments much earlier. The specialization of US medicine also significantly retarded compared to European countries. For instance, in Great Britain, the medical profession fell into two categories: consultants, occupying specialist positions, and general practitioners, practicing in the communities (Shi & Singh, 2019). The American system lacked such coordination and control of healthcare providers’ functions.
Another significant event in US healthcare history was the adoption of the Community Mental Health Centers Act of 1963, supporting the policy of community mental care. Furthermore, public health received considerable push for development, and by 1900, most states conducted sanitary inspections, health education, communicable disease control, and other essential public health activities fees (Shi & Singh, 2019). Besides, in 1914, first workers’ compensation programs were introduced, and the basic health insurance policies became available, which included the protection against loss of income and, then, surgical.
However, all the national healthcare insurance initiatives during the 20th century experienced failures, primarily because of ideological differences, tax aversion, political inexpediency, and institutional dissimilarities. For example, in 1920, the AMA approved a resolution forbidding mandatory health insurance regulated by the government (Shi & Singh, 2019). Individualism, reliance on the private sector, and distrust of government discouraged American people, especially the middle class, from supporting health care reform regarding insurance. Nonetheless, in 1965, Congress created Medicaid and Medicare programs and passed the Social Security Act, thereby taking partial responsibility for vulnerable classes such as the poor and elderly. It is worth adding that in Europe, sickness insurance, including against workplace accidents, became totally compulsory by 1912, indicate the profound difference with the US.
The Corporate Era
The present corporate era, starting late the 20th century, is mainly characterized by the rampant increase of group practices, corporatization of healthcare delivery, globalization of healthcare. Specifically, in 1973, the Health Maintenance Organization Act was adopted to spur the growth of health maintenance organizations (HMO) delivering prepaid medical care as an alternative to fee-for-service practice (Shi & Singh, 2019). Additionally, due to the rising popularity of managed care and medical providers’ attempts to preserve their autonomy, the United States has grown into the realm of corporations consolidating medical services and research within their clinics. Finally, it is worth mentioning another landmark event, namely, the passage of the Patient Protection and Affordable Care Act (ACA) in 2010, allowing millions of Americans to receive and broaden medical insurance services.
Current Characteristics, Principles, Conditions
Unlike most other developed countries, especially those in the European continent, the USA does not possess the universal, free healthcare system serving all Americans. Instead, most citizens have public, private, or employment-based insurance covering a part of expenses or a particular number of services depending on the amount of the fee. In particular, Medicare is the national health insurance program that partly covers medical expenditures of people 65 and older, as well as disabled persons and people suffering from permanent renal failure, irrespective of their income. In 2019, Medicare comprised over 61 million people, including above 52 million aged 65 and older and almost 9 million disabled (“The boards of trustees,” 2020). Medicare costs are comparatively low; for example, Medicare Part B’s monthly premium for enrollees amounts to $144.6 (“2020 Medicare Parts,” 2020). It is worth noting that depending on the services and drugs delivered, Medicare contains four parts (A, B, C, D) and is funded by the payroll taxes levied from both employers and workers.
Medicaid is a public program of medical assistance to people with incomes below the official poverty line, including the elderly, people with disabilities, and families with children. As of July 2020, 68,8 people were enrolled in Medicaid (“July 2020 Medicaid,” n.d.). Every state determines its Medicaid programs, but mandatory benefits include physician services, inpatient and outpatient hospital services, laboratory and x-ray services, home health services. The program is mutually sponsored by the federal and state governments. Besides, managed care organization (MCO) is a group of doctors, hospitals, and other healthcare providers delivering comprehensive health services and reducing medical costs through contracts with insurers or self-insured employers for a prepaid fee. This type of insurance is private and includes HMOs, Preferred Provider Organizations (PPOs), and Point of Service Organizations (POS).
Unlike the United States, most of the wealthiest nations predominantly use three models of national healthcare insurance: national health insurance (NHI), national health system (NHS), and socialized health insurance (SHI). Specifically, Canada possesses the first model financed and administrated by the government via general taxes but delivered by private providers (Shi & Singh, 2019). An excellent example of the second pattern is the United Kingdom that not only funds the program but also manages healthcare delivery infrastructure and supervises most medical institutions. The third variant is Germany, where insurance is funded based on employers’ and employees’ contributions mandated by the government. Moreover, the government assumes control of the overall system, but private providers deliver medical services, and delivery brings the character of independent private arrangements.
Despite the high quality of care and treatment, US healthcare system experience numerous issues, primarily regarding accessibility, cost, and prevention. According to the most recent data, uninsured individuals aged under 65 comprise an impressive 32.8 million, namely, over 12 percent of the entire population (“Health Insurance Coverage,” 2021). Such demonstrative but adverse statistic indicates that the American medical system is one of the least affordable and equitable, mainly for disadvantaged social groups and racial minorities. As a result, the age-standardized mortality rate from preventable causes for the US amounts to 175 persons per 100 000 population (OECD, 2019). These indicators for the UK, Australia, and Japan comprise 119, 96, and 87, accordingly.
Herewith, the expense on the maintenance of the healthcare system in the United States is impressive. In 2020, the US total healthcare expenditure achieved 17.0 percent of GDP, spending nearly $11,100 per individual, the highest indicator among the OECD’s countries (“How does,” 2020). The UK and Canada, for instance, spend 10.3 and 10.8 percent, respectively. Overall, based on 71 performance measures, the latest research inferred that the US healthcare system is the worst among 11 high-income countries, including Germany, Australia, the UK, and France (Parker, 2021). This is primarily caused by excessively high medical costs and lacked access to prevention and care programs, contributing to the increase of obesity, diabetes, and hypertension.
Future Perspective and Tendencies
In the new millennium, the US healthcare delivery system continues undergoing various technological, structural, and ideological changes based on current demands and challenges. Policymakers begin placing a strong emphasis on disease prevention and health promotion, which stimulates the design of respective programs and technologies. Patient-centered care, chronic care models, and continuous care became accelerating trends in improving patient health outcomes. Besides, many medical organizations widely introduce various health information systems (HIS), such as clinical decision support system, electronic medical record, and computerized provider order entry, among a few. These information technologies support clinical staff in strenuous conditions, increase patient safety, primarily by averting medical errors, and increase staff performance. Furthermore, telemedicine, telehealth, e-therapy, and nanomedicine start occupying a distinctive niche in the delivery of appropriate health services. The growing acceptance of inclusiveness also promotes the engagement of minorities in employment, insurance, and the decision-making process. However, the management and healthcare expenditures and affordability still serve the main burdens of the US nation.
In summary, the paper has explored the USA healthcare system, including its historical development, and performed an in-depth comparison with other countries. In the preindustrial era, healthcare was rather primitive and disorganized, and domestic care delivery was prevalent. With the foundations of medical institutions and organizations, the healthcare system gradually has grown into a unique, complicated entity providing high-quality services and comprehensive research. Nevertheless, the overall performance and affordability of the US healthcare system lag behind all developed countries, including the UK, Canada, and Germany. These states apply other models of health healthcare, delivering the coverage of the entire population, unlike the United States.
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