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Health insurance in the United States
In 2000, Americans spent on health care 1 trillion dollars, that is more than 15% of gross domestic product. More Americans spend only on food and shelter.
In the United States, health insurance is almost entirely voluntary and is carried out by employers. Insurance against disease is the most common type of insurance on the job, but employers are not obliged to grant it. Not all American employees receiving such insurance. Yet in most major health insurance companies is almost an indispensable condition, and in 1990 they reached approximately 75% of the population SSHA1.
There are many types of health insurance. The most common is the so-called compensatory insurance, or insurance "fees". In this form of insurance the employer pays the insurance company premium for each employee, secured the relevant policy. Then the insurance company pays the checks provided by the hospital or other medical institution or doctor. Thus paid services, members of the insurance plan. Typically, the insurance company covers 80% of the cost of treatment for the rest of the insured must pay.
There is an alternative to insurance for the so-called managed services. The number of Americans covered by this type of insurance, a rapidly growing (over 31 million people. Founded in 1991). In this case, the insurance company contracts with physicians, other health professionals, as well as c institutions, including hospitals, the provision of all services provided by this type of insurance. Typically, medical institutions receive a fixed amount that is paid in advance for each insured.
The differences between the two types of insurance described very significant. In case of "user fees" paid for the cost of services that are actually provided to patients. In case of "managed services" medical facilities only receive a fixed amount per patient each insured regardless of the services rendered. Thus, in the first instance, the health profession are interested in attracting customers and providing them with a variety of services, while in the second, they quickly abandon the appointment of additional procedures to patients, at least, are unlikely to appoint them more than necessary.
Currently, the U.S. government also pays for more than 40% of health expenditure in the core programs, "Medicaid" (Medicaid), and "Medicare" (Medicare). According to the "program" Medicare coverage for all Americans conducted over 65 years, as well as those who are approaching that age and who have serious violations of health. "Medicare Program" is funded in part by a tax levied on all workers, as employees or employers. In general, this tax is about 15% of income employed Americans. Moreover, "" Medicare is financed from general income tax revenue. "" Medicaid program provides coverage for low-income Americans, mostly women and children from poor families. The program also paid stay in nursing homes for those who require constant care and could not live without daily assistance.
"Medicaid Program" is funded by the federal government as well as state governments. The federal government pays for about half of all program costs "from Medicaid" of the total tax revenue. The rest pays each state government.
But there are many Americans who are not covered by any forms of insurance. Many of them are working, but their employers do not provide health insurance. At the same time, these people are too young to conform to the requirements of "Medicare" do not fall into the category of unsecured and are not subject "Medicaid program." According to various estimates, the number of uninsured Americans ranges from 20 to 50 million people. (8-20% of the population).
Most of the cost of health care in the United States is covered by the voluntary health insurance, which is paid by employers and the government. Nevertheless, the citizens accounted for a large share of the expenses for the medical services. These payments are considered to be an appropriate mechanism for managing and reducing costs (if the employee pays a portion of the costs themselves, he rarely turns to a doctor).
In the United States, there is a harmonious relationship klient-strahovaya kompaniya-vrach system. Particular attention insurance companies are paying list of medicines and treatment schemes. In a country with effective law every step is under the doctor's supervision. American doctors do not order drugs, which are not included in official at the Ministry of Health or the insurance company list of medicines. In the case of a claim for professional doctor error, a review of all of its regulations. If the sheet appointments included "illegal" drug, the effects of such verification can be deplorable for a doctor. Waste treatment and clear, regularly updated list of drugs absolve insurance companies from medical polipragmazii, customer-from the effects of medical errors, and a doctor from the trials.
Health insurance includes such basic items:
klient-strahovaya relations company;
Insurance kompaniya-vrach relations.
The first paragraph of the contract seal with a guarantee of health insurance payments insurance company costs for providing medical assistance to the client.
The second paragraph specifies the conditions under which medical care is provided directly in the time of the occurrence. Typically, the notion of insurance loss includes acute illness, chronic and worsening the accident.
The third item-payments for the medical care provided to control medical care, doctor appointments line standard diagnosis and treatment protocols adopted and the agreed medical experts (underwriters, underwriters) insurance company. As a prerequisite for the last paragraph also includes professional-level adequacy requirements of the insurance company physician.
All items of "health insurance" are working very smoothly. Especially important for the insurance company and for the customer, as established relationship kompaniya-vrach insurance. In each case, the insurance doctor operates on the scheme approved by the insurance company. The protocols include the diagnosis and treatment of those supplies, which, in each case, the insurance is essential, effective, efficient. Properly installed diagnosis and appropriate treatment is the result sought by the insurance company that offers health insurance.
The list of drugs in the arsenal of an American doctor very specific. It does not, for example, immunomodulyatorov-these drugs for such a measure, as the performance had not reached the level of antibiotics and non-steroid anti-drugs, so there are always likely to lack the impact of their use. Ineffective drugs almost always extraordinary in the case of insurance companies and physician, which could lead to legal proceedings. To avoid such consequences, high-designate drugs, which can achieve a positive result.
Perhaps Ukrainian doctors seem not quite accustomed to the use of non-steroid anti-drugs such as Ibuprofen, as worsening bladder disease, but American doctors are practicing their appointment. In turn, American doctors are surprised frequent and habitual appointment GIK (glyukozo-insulino-kalievaya mixture) our doctors in various pathologies. They are trying to analyze the effect of each drug, a member of the mixtures, and do not understand why the HEC is almost a panacea for all illnesses, and took first place on the frequency of use in the hospital. Also, the appointment is puzzling eufillina in hypertensive disease. According to the American colleagues, this drug, and is very narrow-specific applications, namely in the treatment of bronchial asthma.
Of course, such thinking Hospitalization can be described as tense narrow frame. But the truth is, as you know, is somewhere in the middle. Today, therefore, avoid specialists deployed appointments (so-called medical polipragmazii), large quantities of drugs, in which interoperability is not always assured.
In America Insurance medicine with its voluntary medical insurance protects the health of its customers, guaranteeing not only proplatu provided medical service, but also the quality of traditional medicine treatment. No insurance company would cover the cost of treatment with the use of hypnosis, acupuncture, herbal or homeopathic. In terms of medical insurance is such an unconventional therapy and the effect of its application moot.
Health insurance in the United States is another feature. There is a credibility medication appointed doctor. But if the result of their application and insufficient disease is slowly but steadily progressing, the only right next stage of treatment for clients of insurance company-not the appointment of medicines and surgical treatment. The United States took first place by the number of coronary bypass operations. The American Association of Cardiovascular Surgery reported that in 2000, in the United States fired more than 519 thousand coronary bypass operations (in the world-about 800 thousand) 2.
One of the basic principles of health insurance-effectiveness of medical care. Regarding the cost of the treatments, the insurance company covers the cost of using the only correct way to treat the high rate of positive result. Of course, the value of the transaction at the heart of a very high, but still less than the cost of medications to be taken quite a long time. Yes, and the effect of conservative therapy is not always desired. Therefore, insurance companies prefer to bear the high costs, but once.
Americans differ serious attitude towards their health. On the one hand, insurance companies protect their clients from the non-medical assistance, on the other hand, the Americans have confidence in their doctors and not buy drugs without a recommendation of a specialist.