The US Health Care

Subject: Administration and Regulation
Pages: 17
Words: 4479
Reading time:
16 min
Study level: College

What in broad terms is the health care crisis in the United States?

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Although the US is considered the most prosperous nation on earth, it is ironic that its health care system is in a crisis. The country is renowned for its finest medical schools, medical institutions, and hospitals all over the world (Schulte, 2009). The country spends over 18% of its annual budget on health care. Despite this, it is worrying to note that up to 50 million individuals are uninsured. Similarly, millions of Americans are underinsured. As a replacement for warranting insurance coverage for all people, the health care depends on a hodgepodge structure of market-based institutions (Sharma & Lamm, 2012).

Based on the above illustrations, it is apparent that several issues constitute to the perception of a health care crisis. Regardless of the fact that the country spends more funds on health care compared to other nations, higher hospital costs have led many Americans to bankruptcy. Notably, most of the uninsured individuals have jobs. In the past decades, the country has depended on employer based health insurance system. Currently, the system faces a number of challenges. Insolvency, foreclosure, and increased cost of healthcare have forced companies to transfer too much burden on their employees.

Briefly explain how health care is financed in the U.S. How is it different from other industrialized nations?

In the United States of America, healthcare is financed through several ways. Americans can pay directly for medical services received. Alternatively, individuals can pay indirectly through employer-based health insurance programs. The federal government provides health coverage to armed forces employees and their dependents. Aging Americans receive their health coverage through Medicare, whereas low-income mothers and their siblings depend on Medicare for their health coverage. Siblings who may possibly not get access to health care are financed through State Children’s Health Insurance Programs. A number of the employees are covered through the employer-based insurance system. Through this system, groups of employers pay for a particular insurance plan for their employees. As such, workers may or may not be involved in choosing an insurance plan to be adopted. Given that in the US there are a number of insurance plans, a majority of Americans are covered by two or more plans. In general, the government provides 55% of the health care funds while the private sector provides the remaining 45%.

Unlike in the US, healthcare in other countries such as the EU countries are financed differently. In the EU countries, health care is financed through publicly funded health care programs. Through this, these governments are able to provide healthcare access to their citizens from publicly controlled funds. These funds are either managed by the governments or agencies. Unlike in the US, publicly funded health care allows people to receive equal cover in spite of their contribution or financial status. This system has been praised to be effective compared to employer based insurance cover. Through this approach, other developed countries such as Canada, UK, France, and Germany have been able to spend less on health care and provide their citizens with better services compared to the US.

How much was spent on health care in the U.S. in 2011? What, in broad terms, was it spent on? What were the major sources of funding and what was their proportional share of funding?

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American health care spending is higher compared to the spending of other developed countries. In the year 2011, $2.7 trillion was spent. This implies that approximately $8, 680 were spent on every individual (National Health Expenditures 2011 Highlights, 2013). In the same year, the physicians’ earnings in the US tripled that of physicians in France. As compared to the spending used in the years 2009 and 2010, the amount spent in the year 2011 grew by 3.9% to $ 850 billion. In the year 2011, spending on hospital care rose by 4.3% unlike in the previous year, which had risen by 4.9%. The sluggish growth was attributed to the slower price growth and reduced utilization of hospital services. Medicaid expenditure on hospital services in the same year were reduced unlike other health insurance providers who reported an increase in their spending. In the same year, physician and clinical services expenditure rose by 4.3% to $541 billion. In the previous year, 2010, the growth was registered at 3.1%. Dental services expenditure recorded an increase of 3% to $108 billion. Expenditure for residential and personal care services rose by 4% to $133 billion. Nursing care facilities’ expenditure rose by 4.4% to $149 billion. Unlike other services, spending on home health care recorded a decrease by 4.5% to $74 billion.

With respect to the major sources of funding in the year 2011, Medicare expenditure rose by 6.2% to $554 billion, Medicaid expenditure rose by 2.5% to $408 billion, private health insurance expenditure rose by 3.8%, and out of pocket spending rose by 2.8% to $308 billion. Based on these figures, it is apparent that Medicare represented the largest portion of the Americans health expenditure in the year 2011.

Explain briefly what fee-for-service and capitation are. What financial incentives do they create? Why is capitation often perceived as the solution to problems created by fee-for-service? Identify one additional form of payment that in theory would overcome the problems associated with fee-for-service.

In human history, physicians have always been remunerated through three ways. These ways are capitation, fee-for service, and salary. Through fee- for-service method, a client pays for the medical services received. The physician is paid with respect to the fees he or she has generated. Unlike the other two methods, fee-for-service can be of great financial benefits to the physicians who work hardest, and at the same time yield lowest income to physicians who do not work hard. Fee-for-service method is discouraged because it emphasizes on treating sickness rather than on maintaining health. As such, they encourage the physicians to administer unnecessary tests and procedures. On the other hand, capitation is defined as a remunerating method through which physicians and hospitals receive payment for the services provided by an employer. Through this method, a physician or a hospital is paid a fixed amount of cash for a certain period regardless of the services rendered. This method has been employed to solve the problems created by fee-for-service payment. As such, the method emphasizes on preventive care as a means to maintain health. It stresses on the use services chosen to prevent illness, education and regular checkups, and early detection and screening services. Equally, capitation emphasizes encourages the use of resources for the benefit of all rather for an individual benefit.

Another payment method that can be employed as a solution to the problems created by fee-for-service payment. Through this method, a physician is paid a fixed amount of cash depending on her qualifications, specialty, and the years of experience. The amount of cash paid is not related to the amount of the fee the physician generates to the employer or the number of clients served. Similar to capitation, this payment method emphasizes on preventive care as a means to maintain health rather than on curing disease.

What is managed care? Why is it widely perceived as key to improving America’s health care system?

In the US, managed care is a term used in reference to a health care system designed to lower the cost health care services and enhance its value. Managed health care system is perceived as a key to improving America’s health care system because it can eradicate unnecessary amenities subsequently lowering the cost of health care. Managed care is a distinct form of health care delivery as it is based on a principle that stresses that in good health rather than in the intervention. This implies that not all visits to the physicians are necessary and that not all medications are effective. Preferably, medicine should be employed based on the reasonableness and efficiency in the option and execution of assessments and treatments. Thus, the inconsistency among providers can be eradicated, and the only aspects that should make a distinction in making a decision about who to treat and means of interventions should be the degree of patient’s illness or injury.

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Physicians cannot be able to treat every ailment or injury. Therefore, there is a necessity for them to come up with the differences between treatments based on efficacy and cost. With an increase in the cost of health care, managed care in the US presents explicit rationing with regard to a collection of variables that can manipulate outcomes. Some treatments or treatment methods may be ruled out because of the client’s age or nature of illness. For instance, hardly any surgeon would fix a hernia in 100-year-old person. Physicians who attend to clients using managed care system are motivated by the need to evade redundant resource utilization. They encourage their patients to have regular checkups at the same time not to overuse the most expensive kinds of interventions.

Democrats did not propose either a national health service or a government-based single payer plan. Briefly explain these approaches to provide universal coverage and why they were not proposed.

The U.S. president Barrack Obama has campaigned for the health care reforms since the year 2010. The objectives of these reforms are to increase Americans access to health care, control the ever-increasing health care budget, solve several controversial health care issues, and ensure that consumer satisfaction is enhanced in the healthcare.

The triple aims are the designs proposed for enhancing healthcare system performance. The Institute for Healthcare Improvement (IHI) introduced these designs. The goals of the designs are to enhance the value of clients’ care, enhance the health of the population, and to lower per capita expenditure on health care. The US believes that through the triple aim programs they will enhance the efficiency of their healthcare system.

What are 5 key elements of the Affordable Care Act?

Unlike in other developed countries, health care services in the US have always been subject to individual purchasing power. Critics to this form of health care plan argue that the government should implement a national health service or a government-based single payer plan to enhance distributional efficiency. They assert that if the country adopts this system, it would be able to lower the cost of health care and eradicate expensive and extravagant bureaucracy in the sector. According to the critics, the US government can only be able to overcome the challenges it currently faces in the healthcare if it implements a national health service or a government-based single payer plan.

In the last few years, a number of democrats’ supporters have always called for the implementation of a government-based payer plan. However, it is disappointing to note that the democrats did not propose this plan in the healthcare negotiations. They have never done so probably because of the deep opposition they would have received from the republicans. Rather than proposing for a government-based payer plan, the democrats did propose for a public option in the past. In the recent past, the Democrats have dropped the public option for Obamacare plan. Based on the past negotiations, it is apparent that the democrats could have proposed the government-based payer plan if it they were sure that they were not going to receive opposition from the republicans. Therefore, the democrats dropped their single-payer plan and adopted Obamacare with the aim of getting republicans’ approvals.

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Why is the individual mandate critical to the financial viability of health care reform?

The first key element of the act is to enhance a near-universal health care coverage. The second element is to enhance the quality, value, and accessibility of health care coverage. The third element is to enhance the value, efficiency of health care services, and reduced on unnecessary expenditure. The fourth element is to enhance primary health care access. The last element is to come up with planned investments in public health care.

In the act, several mechanisms have been outlined on how to meet the above goals. These mechanisms are mandates, tax credits, and subsidies. Within a period of 10 years, this act will ensure that every American has access to quality and affordable health care services. Currently, the top three issues of the U.S. health care system affecting the employees are reduced access, reduced quality, and increased costs. When the act will be fully implemented in the year 2014, the government expects that the act will tackle the above health issues (Rosenbaum, 2011). The U.S. health care system has continually faced multiple challenges.

Identify 3 elements of the Affordable Care Act that contribute to enhanced quality and accountability?

In the Affordable Care Act, the individual mandate is so vital that a major impediment would doom the whole plan. Individual mandate necessitates Americans to obtain a health insurance cover by the start of the year 2014. Its supporters assert that the element will reduce the number of uninsured Americans significantly. With increased number of insured individuals, the costs of funding the healthcare will be enhanced. The democrats believe that if this element would not be implemented, healthy individuals would not obtain coverage leaving the sick and the few insured individuals to meet the cost of increased health care.

Some experts also assert that although the failure to implement the individual mandate would not mean an end to Affordable Care Act, it would be a huge political embarrassment to the supporters and jeopardize the implementation process of this activity. Currently, the government has not relented to critics who urge for the postponement of an individual mandate. Possibly, it would not relent because of the repercussions that would result from failing to implement this act.

Why do Republicans oppose the Affordable Care Act?

In the Affordable Care Act of the year 2010, there are several provisions that will contribute to enhanced quality and accountability of health care. The provisions are comparative researches meant to analyze the efficacy of a number of medical interventions, demonstration projects meant to come up with medical misconducts options to reduce clinical errors, and demonstration projects aimed at coming up with efficient payment methods. These provisions are primarily aimed at increasing the number of Americans under medical insurance cover and decreasing the cost of health care services.

The act is primarily aimed at increasing the number of Americans under medical insurance cover and decreasing the cost of health care services. In the act, several mechanisms have been outlined on how to meet the above goals. These mechanisms are mandates, tax credits, and subsidies. Within a period of 10 years, this act will ensure that every American has access to quality and affordable health care services.

Republicans generally prefer the use of health savings accounts. What are the major features of HSAs? Why do Democrats generally oppose them?

Ever since the passage of the Affordable Care Act, the republicans have always been opposing it. There are several reasons given by these critics as to why Americans should reject the act. Republicans argue that the full implementation of the in the year 2014 will destroy the US economy through job losses, loss of personal sovereignty, and loss of existing insurance coverage. Some Republicans and their followers assert the act will lead to significant job losses. They estimate that the act might lead to 650,000 job losses. A similar analysis by the business owners group indicates that the employer mandate enshrined in the act will ultimately lead to eradication of up to 1.6 million jobs for the next five years. Democrats and supporters of the act have always refuted these figures arguing that the republicans’ analyses are inflated.

Some republicans assert that with full implementation of this act, every individual adult will be required to purchase a health insurance cover to afford quality and accessible health care services. Failing to do so would result in penalties. Although the act will eventually enhance universal health care, they assert that it infringes on individual’s sovereignty. They believe that individual sovereignty will be infringed when a person will be forced to purchase the insurance cover contrary to his or her wishes. Another reason to why the republicans are opposed to Affordable Care Act is they believe that its full implementation would disadvantage the low-wage employees. They assert that the act discourages employers from recruiting new workers. Thus, employers will be forced to come up with other means of reducing the cost of doing business. They have pointed out that for higher skilled workers employers would obey the government directive and offer the required benefits. However, these employers would compensate the cost by reducing these employees’ wages. Because of this, they believe that employers would be offered with little reason to offer medical insurance cover to their low skilled workers. Therefore, employees would reduce job creation and employment for this category of job workers.

What were the major reasons for the shift from institution-based to community-based mental health policy in the United States?

Health savings account was launched in the US in the year 2003. This program enables people under high-deductible health programs to be given tax-preferred favor of funds saved for health care. Under these programs, when individuals re deposing their funds there are exempted from tax. If not used, the money rolls over annually. These accounts are won by individuals and are usually used to meet medical expenses. Republicans prefer the use of these accounts contrary to democrats’ views. They assert that in the long term the programs would decrease the cost of healthcare services and improve on their quality.

The democrats are opposed to these programs because they believe that they would worsen the current US healthcare crisis. Healthy individuals would shun these programs leaving the sick and the registered few to meet the increased cost.

What was deinstitutionalization? How did the Community Support Program respond to the inadequacies of deinstitutionalization?

In the late 20th century, the US witnessed a major move from institution-based to community-based mental health policy. This change was initiated because the patients longer felt safe in the institution, the cost of maintaining the attendants had increased, there was a lack of adequate supervision by the medics, and the hospital conditions had worsened.

The situation in these institutions had deteriorated to the extent that children and adults shared same wards. This situation combined with inadequate supervision, saw many children being victimized. In general, the changes were warranted because the living conditions in these institutions were compromising on individual moral rights.

What is “assisted outpatient treatment?” Why is it controversial?

Deinstitutionalization is an approach that transfers the stay of mentally ill individuals in mental hospitals to community mental health centers with the aim of enhancing their treatment. Through this, the government ensured that less individuals are admitted in mental hospitals and that fewer intervention measures are offered in such institutions. After the government noted that the treatment of the mentally ill individuals were not effective in the mental hospitals, it puts in place measure that were to spearhead deinstitutionalization. In the early 1960s, when the government came up with Medicare and Medicaid programs, it was realized that the treatment of the mentally ill was becoming very costly (Flurazepam, 2013). Therefore, in the 1970s measures meant to enhance deinstitutionalization were accelerated.

The community supported the program by responding to its inadequacies. They accommodated individuals with mental illness in their communities, they provided generic housing, and provided moral support to these patients.

What is a “system of care” as applied to child mental health?

Assisted outpatient treatment is an officially authorized process through which a court orders a mentally ill individual, an individual with criminal histories, or an aging individual to abide by court-ordered interventions within a community. This process is suited for patients who are not likely to participate in voluntary treatment or cause chaos in the community. The objective of this process is to prevent the subject from causing chaos in the community, destroying property, or committing suicide. In the US, an individual can be referred to this program if he or she has attained the age of 18 and above.

This method of treatment has been controversial from the time it was established. Its proponents argue that this program prevents the subjects from causing chaos in the community and increases the effectiveness of the treatment. However, those opposed to the programs argue that this method is not efficient as alleged. They believe that the drugs the subject are forced to ingest have resulted in unpleasant side effects. Others believe that the program is socioeconomically biased. Normally, people believe that the mentally ill individuals pose security threat to the community and that they are fit to be institutionalized. This is an assumption that may result in peaceful mentally ill individuals being institutionalized.

Why has integration of physical and behavioral health services become a major policy goal?

System health is defined as a managerial attitude and structure that comprises of alliance across groups, relations, and youth with the aim of enhancing access and increasing the range of harmonized community-based services and aid for people below the age of 21 years who are mentally ill.

This program acknowledges that children with mental illness are more often involved in chaotic service in their communities causing a burden to their families. Therefore, in our societies there is a need to incorporate mental health training, children’s welfare, juvenile justice, and children’s health care under this program. This can be achieved through individualized care model and comprehensive system of care. Individualized care model stresses on family aid and community based services. On the other hand, comprehensive system of care stresses on therapeutic foster care, family aid, home-based support, and friends’ support.

Briefly describe at least 3 different ways in which physical and behavioral health services are being integrated.

Incorporating physical health and mental health has become a major policy goal. This policy has been prioritized because of an understanding that individuals with serious mental disorders have low life expectancy, an understanding that most mentally ill patients get their interventions in primary healthcare, an understanding that mental illness may result in chronic disease, and an understanding that the increase Medicaid expenditure are used in treating co-occurring disorders.

Some mental illness such as subsyndromal mental distress worsens the disability linked with physical disorders obscuring their control (Mechanic, 1969). Therefore, the incorporation of mental health care into primary settings will enhance the treatment of the patients. Similarly, mental illness worsens the disability linked with physical disorders. Patients with such disorders need a lot of medical attention increasing the cost of health care. In this regard, it the treatment of mental health challenges in individuals with physical health challenges would lower the cost of health care. Equally, physical and mental challenges are related. This implies that if one is improved it will have an adverse effect on the other.

Both health and mental health policy in the United States now emphasize the use of “evidence-based” practices. What is evidence-based practice? Why are such practices regarded as important? Identify one or more arguments that critics give against requiring evidence-based practices.

The key to the successful incorporation of physical and behavioral health services is to understand the connection between primary care and the field of mental health providers. As such, the two fields can be integrated in several ways. The most common models of integration are coordinated care, co-located care, and integrated care. Through coordinated care, relationships are synchronized across all parties in the healthcare settings with the aim of delivering an all-inclusive care to the patients. With advancements in technology, sharing of information has been made possible. Ability to share information within the healthcare setting has enhanced coordinated care. With respect to co-related care, health service providers work separately despite the fact that they are situated in the similar locality. On the other hand, integrated care embraces incorporation as a means of enhancing healthcare services with respect to its value, access, and consumer satisfaction.

Several organizations have integrated physical and behavioral health services. These organizations are the Eastern Band of Cherokee Nation, Tennessee Cherokee Health, Haight-Ashbury Free Clinics, Intermountain Healthcare, and the Northern California Kaiser Permanente.

What are the major elements of the Americans with Disabilities Act? Evidence-based practices involves the incorporation of medical expertise, client’s principles, and top research supports aimed at coming up with the appropriate intervention for the patient. Medical expertise’s years of experience, education, and skill come in handy for such programs. The clients are also required to forward their likings, distinct concerns, expectations, and principles. The appropriate research evidence is selected from the existing clinical research records. Evidence-based practices are essential because they offer comprehensive medical service to people on individual grounds. Similarly, it has been found that evidenced-based service is an effective way delivering health care services in our communities. As such, it saves the clients’ money and time.

Critics of evidence-based service argue that this method should be banned. According to them, the practice lacks adequate scientific claims to substantiate on its success, has hurdles in using high quality medicine, and meets the challenges in applying the facts to the care of each client.

What are the major components of the Olmstead decision?

In America, the Disabilities Act asserts that no individual shall be singled out on the grounds of disability either in government or in the private sector. This act is applicable to individuals who are categorized as disabled in the act. There are several elements outlined by this act. In the first title, all the companies with more than 15 workers should allow qualified and disabled individuals have access to employment or other available opportunities in the organization. The second title mandates all government and state agencies to allow disabled individuals to gain from their services, opportunities, and employment. The third title mandates the public accommodations, and privately owned properties not to segregate the disabled based on building facilities that would not benefit them. The fourth title mandates telecommunications and media owners to come up with a service that will enable people with hearing disabilities communicate with each other.

Olmstead Decision is a landmark ruling made by a US court in June during the year 1999. The court ruled that the unfounded separation of persons with disabilities amount to unfairness as stipulated in the Americans with Disabilities Act. Through this, the court asserted that all public entities are liable to provide individuals with disabilities with community-based services when services are suitable, as long as the subject do not reject the community-based interventions, and when community- based services are rationally accommodated. The court maintained that their ruling was based on two evident judgments. The first judgment was that segregation of people with disabilities enhances the perception that these people cannot live peacefully in the community or benefit from its services. The second judgment was that segregation of people with disabilities denies their right to participate in community day-to-day activities.


Flurazepam, D. (2013). Mental Disorders. Deinstitutionalization. Web.

Mechanic, D. (1969). Mental health and social policy. Englewood Cliffs, N.J.: Prentice-Hall.

National Health Expenditures 2011 Highlights. (2013). Web.

Rosenbaum, S. (2011). The Patient Protection and Affordable Care Act: Implications for Public Health Policy and Practice. NCBI. Web.

Schulte, M. F. (2009). Healthcare delivery in the U.S.A.: an introduction. Boca Raton: CRC Press.

Sharma, A., & Lamm, R. D. (2012). Brave New World of Healthcare Revisited What Every American Needs to Know about Our Healthcare Crisis.. New York: Fulcrum Publishing.