US Healthcare System for Public and Insurance Firms

Introduction

It is not a secret that healthcare remains an essential element of people’s lives. Nowadays, it is difficult to imagine a person who has never applied to medical institutions either for medical help or for immunization to prevent diseases. Therefore, access to healthcare is a crucial factor that defines standards of living in any country. In this paper, access to healthcare in the US from the perspectives of both the general public and insurance companies will be discussed. Also, the variables that impact access to healthcare will be observed. The strategies to mitigate these variables, as well as the means of measuring the progress over time, will be included.

Main body

Access to healthcare in the US from the perspectives of the general public and insurance companies can be different. Thus, for the general public, there is an opinion that for those who have insurance, healthcare is more accessible. Indeed, medical insurance brings a number of advantages to its holders. First of all, in case of any health problems, those who have insurance do not have to spend the time choosing an appropriate hospital for medical services. Insurance companies work with certain medical institutions, which are part of their network, and all the patients are informed about it in advance.

Second, if a person has a severe illness, the cost of its treatment can be so high. In this case, an insurance company can cover substantial costs for medical bills. For example, in terms of the use of disease-modifying therapy in multiple sclerosis, insurance companies remain the main provider of financial means for patients (Wang et al. 2016). Third, insurance gives free access to preventive care, such as vaccines or regular check-ups.

However, despite its obvious advantages, more than 28 million people in the USA do not have health insurance (ProCon.org, 2019). The reason for that is because obtaining insurance might be unaffordable for some people due to its cost. The high cost of medical insurance remains its primary disadvantage. In the USA, about half of the population is provided with insurance by their employers. About 37% of the population uses the coverage provided by the government through programs such as Medicaid or Medicare (“Should All Americans Have the Right to Health Care”, 2019).

Unfortunately, there are still many people who are not eligible for these programs and cannot afford to purchase private health insurance due to its high cost. As a result, these people pay for medical services out of their pockets and tend to be reluctant to apply for medical help. Trying to treat themselves at home, they miss the moment when they should be seen by professionals, which results in the deterioration of their health conditions or even death. Therefore, it can be concluded that there are about 28 million people in the USA who do not have or have insufficient access to healthcare.

In terms of insurance companies, they face other difficulties, which, however, are also connected with financial straits. As was mentioned above, about 28 million Americans remain uninsured. However, the situation was even worse five years ago, when their number achieved 47 million (Dalen, Plitt, Jaswal, & Alpert, 2019). To deal with this problem, the US government implemented a program called Medicaid. This program implies providing medical care to those who do not have private insurance. It is administered by the federal government and funded by taxes paid by the citizens and legal residents of the country. The main advantage of this system is that it enables poor, elderly, and disabled people to receive medical help when they need it.

However, even though this program is quite beneficial, it is not possible to provide public insurance to everyone. The main reason for that is because it would immediately cause high expenses, which would result in increasing the rates of taxes for the population. Since the majority of inhabitants of the country have insurance provided by their employers, they do not want to register for Medicaid and pay more taxes.

Moreover, it has one more significant drawback in terms of access of individuals to health care. Due to the large number of patients and limited resources of public insurance, people have to wait for a long time to have an appointment with a doctor. It is especially risky for humans’ health as it can lead to deterioration of their physical conditions.

As for private insurance, it also has some benefits and drawbacks. Thus, the private insurance system allows its users to choose a doctor they want to be seen by, to shorter wait times, and use improved facilities. However, as was mentioned above, it has a high cost and not all people can afford to pay for that. In addition, in most cases, private insurance does not cover all medical services. For example, very often, it does not cover dental services, which limits people’s access to dental care.

Therefore, the primary variable that impacts people’s access to health care is its cost. The cost of services defines if an individual purchases an insurance plan and applies to healthcare professionals on a regular basis. Moreover, the cost of health care services has an indirect impact on the second variable, which is the waiting time. The waiting time is also a significant variable that affects the access of human beings to medical services.

Thus, if an individual does not have enough financial means, he or she will have to apply for public health insurance. As it was mentioned above, the sources of public insurance are limited. Usually, people have to wait for a significant period of time before they can have an appointment with a physician or use any other medical services. It makes access to health care services more challenging for patients.

Another factor that impacts access to health care is the remoteness of medical institutions from some settlements. For the Americans, who live in vulnerable rural or urban communities, it is highly significant to have a hospital close to their districts (Bhatt, & Bathija, 2018). Thus, if an individual lives in a small settlement hundreds of miles away from a hospital, it does not even matter what kind of insurance he or she holds. Sometimes, the distance between a patient and a hospital plays a crucial role, especially when it comes to unexpected issues, such as appendicitis or premature births. The situation is even worse if there is no public transportation in the settlement and a patient does not have a car.

It is not a secret that the USA is a multinational country. Except for the native populations, there are representatives of other nations and cultures, such as Mexicans, Indians, Arabs, Chinese, and so on. Therefore, it is not surprising that some difficulties related to access to health care are related to the language barrier. Unfortunately, sometimes, patients who are not English native speakers, find it challenging to explain their symptoms and understand diagnoses, which are usually made using medical terminology.

Another variable that affects the access of the population to health care services is the government’s social policy. The social policy of the state regulates the health care system, identifies its main issues and difficulties, and finds possible ways to deal with them. It is the state policy, which eventually defines the accessibility of health care for its inhabitants and suggests possible ways to improve the existing systems. In terms of the USA, it has introduced the Medicaid program, but there is still a lot to be done to make access to healthcare more available.

There are some strategies that can be used to mitigate the mentioned variables. For example, it would be beneficial to find out new ways to fund the Medicaid program to increase the number of people who use it and reduce the waiting time. Also, it is necessary to open medical offices in settlements locate far from central medical institutions. To eliminate the language barrier, it can be suggested to provide patients with manuals that have translations of basic medical terminology from English to the other most common languages. Regular social surveys and research will help to measure the progress over time and adjust government policy toward the health care system according to the changes that occur in society.

Conclusion

Therefore, it can be concluded that there are some advantages and disadvantages in terms of access to health care for both the general public and insurance companies. The most significant challenge that prevents people from using health care in the US is its high cost. In addition to the cost, other variables define people’s access to medical services, such as waiting time, geographical location, language barrier, and government policy. However, there are some strategies that should be used to mitigate the variables mentioned above and measure the progress over time.

References

Bhatt, J., & Bathija, P. (2018). Ensuring access to quality health care in vulnerable communities. Academic Medicine: Journal of the Association of American Medical Colleges, 93(9), 1271–1275.

Dalen, J. E., Plitt, J., Jaswal, N., & Alpert, J. (2019). An alternative to Medicare for all. The American Journal of Medicine, 132(6), 665–667.

Should All Americans Have the Right (Be Entitled) to Health Care? (2019). Web.

Wang, G., Marrie, R., Salter, A., Fox, R., Cofield, S., Tyry, T., & Cutter, G. (2016). Health insurance affects the use of disease-modifying therapy in multiple sclerosis. Neurology, 87(4), 365–374.