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建立人际资源圈关于美国的卫生服务业--Essay代写范文
2016-12-26 来源: 51Due教员组 类别: Essay范文
美国人均在健康问题上的花费比世界上任何国家都多.。总的趋势是全球医疗保健成本超过GNP很大程度上是由于技术成本。这导致了一个全球趋势，医疗保健支出作为国民生产总值百分比上升。戏剧性的转变，在1980年几乎增加一倍，15.2%，2003年，增长趋势无处不在，甚至在欧盟也出现大型卫生支出预算。
The Health Service Industry In The Us
The United States spends more per capita on health related issue than any country in the world. However, this might be expected given the huge economy and wealth of the nation. However, since 1980 the U.S. also has the dubious honor of having the largest per capital growth rate in health care as well. It is true that the general trend globally is that healthcare costs outpace GNP - largely due to technology costs. This has resulted in a global trend of healthcare spending as a percent of GNP to rise, but not to the level it has in the United States. The dramatic shift from 8.8 percent in 1980 to almost double that of 15.2 percent in 2003, an increase seen nowhere else, even in the European Union and their reorganization and large health spending budgets ("Health Care Costs," 2003).
Availability of Health Services - It is always interesting to first compare where the United States falls within the spectrum of the developed world. Not that in 2003, the U.S. had the highest per capita expenditures on health care of any developed country. Yet, that being said, the perceived quality of care did not match the spending differential and, as we will see with other statistics, perceived care was not high at all:
While it is true that at first blush, the trend shows increased spending, the percentage difference between each year, when graphed, shows a different sort of trend. Note the direction of the trend in which figures represent change between decades in per capita spending. One other way of looking at relative healthcare spending is to examine how much of a country's national income it spends on healthcare. We find that the United States spent 15.2 of national income specifically on health related issues, while most of Europe, by all data collected, provided superior healthcare for their population by spending 10.1 percent - 1/3 less than spent in the United States. (Compatibility over time" at: http://www.irdes.fr/).
Direct comparisons between countries are complex because of the large number of variables that effect spending, population and demographic density and economic issues. One study found that although the system in the United States, for instance, is the most expensive, it is the one that most consistently underperforms (Davis, et.al., 2007). The major difference between the United States and other developed countries is that it is the only country without universal healthcare. Table 2 provides additional information on medical issues between the United States and the EU.
Healthcare in the United States (Environmental, Structural, Political - Healthcare in the United States is provided by numerous entities, institutions, and programs. Healthcare facilitates are largely owned and operated by the private sector. Health insurance is also provided by the private sector, with large Health Maintenance Organizations (HMO's) having increasing presence within the last three decades. Exceptions to this are national programs such as Medicare, Medicaid, Children's Health Insurance Program and Veteran's Health Administration, all of which are part of the governmental bureaucracy ("Americans at Risk," 2009).
The situation in the United States is quite dire, and the new administration has been working diligently to find a solution to the problems of inequity. Currently, between 15 and 20 percent of the total population has either no insurance or is underinsured for their level of risk - the highest in the developed world. This is concerning, since more government dollars are also spent per capita than in any global nation. Also, a larger percentage of total income is directed towards healthcare in the United States than in any other U.N. member. Finally, healthcare issues for the single largest cause for personal bankruptcy in the nation ("Underinsured in America," 2002; DeNavas-Walt, et.al., 2008).
There are segments of the scholarly arena that disagree about the statistics presented regarding the insured versus the uninsured in the United States. One claim is that the portion of the population that is totally uninsured means that they are not eligible for any government plan, which, according to the census figures, would mean roughly 16% of U.S. citizens. However, one might conclude that with the economic crisis, more individuals have lost their benefits, or assigned reduced benefits, are not eligible for any government plan, and thus there are likely over 50 million Americans without any form of insurance. What do these individuals do when they are sick or have an emergency? They are forced to go to the Emergency Rooms of their closest hospital, wait hours for care that, because of the very nature, costs 3-4 times more than it would in a clinic or office setting ("What's Wrong With America's Health Care," 2009).
Obviously, the closer to the poverty line, the greater chance of having little or no insurance. In 2007, 25% of people in households with a total annual incomes of less than $25,000 had improper health insurance, but as income rose, so did the percentage of uninsured. Those households that had incomes between $50-75,000 at 15% and those with incomes over $75,000 down to 7.8%. Thus, almost 30 million American workers, and another 10 million children are not covered by any plan whatsoever - regardless of their location (urban versus rural), or area of the country; although uninsured rates increased in a southern belt from New Mexico to Mississippi between 1-4% (Census Data).
The American system of healthcare is, admittedly, fractured. There are hospitals, clinics, outpatient rehabilitation centers, private practice doctors, and more - yet due to economic constraints, employees are moving in the direction of providing limited care packages in which the burden of healthcare coverage is on the employed. This is a sometimes ignored segment of the issue - we've looked at those who are disenfranchised and have no insurance, but often we forget about the backbone of the economy - the American worker.
The average working American family has, for some time, experienced unheard of double-digit increases in the overall cost of health care, their co-payment, and their out-of-pocket expenses for non-covered care and pharmaceuticals. This has, unfortunately, forced a number of families to delay or ignore needed medical care and even to decline work insurance coverage because of cost. This then puts the burden back on emergency care when situations get so bad care is required. When one compares this rise in cost to the rate of inflation, and pricing on other goods and services, we find that health care is increasing five times inflation. At the turn of the century, health care costs jumped 10 percent in 2001, then another 10 percent in 2002, and over that in 2003. Employers saw a 13-15 percent increase in their costs, forcing many to reduce their share of insurance, thus causing millions of people to lose their health coverage ("Getting to the Real Issues," 2009).
There are diverse suggestions for improving the American system. One very basic issue that is different within the United States is the high cost of pharmaceuticals. Most insurance companies will pay a portion of certain drugs based on their view of the costs, appropriateness, and ability for the provider to choose a generic. However, in other countries, governments are allowed to negotiate drug discounts with pharmaceutical companies and/or help defray some of the costs of research and development. In an alarming story, The New York Times reported that drug companies, while promising to maintain prices and help with an $8 billion reduction in the nation's drug costs, have secretly been raising their prices at the fastest rate in years. In the last year, the industry has raised the wholesale prices of brand-name prescription drugs by about 9 percent, according to industry analysts. This will increase America's pharmaceutical bill to over $300 billion, a $10 billion increase. By at least one analysis, it is the highest annual rate of inflation for drug prices since 1992. The Pharmaceutical companies insist that they have valid, and necessary, reasons to increase prices - their own R&D costs and inflationary items make it impossible to continue with raising prices. Detractors say that, in fact, drug makers are wanting to inflate the price prior to any legislation capping charges in a new plan (Wilson, 2009). Thus, it appears the companies can raise the prices over $10 billion, then negotiate $8 billion and still have a $2 billion cushion on pricing.
Healthcare reform in the United States is incredibly complex and divisive. Besides the costs of care, the American legislative system is set up so that non-medical personnel (e.g. Representatives and Senators) can debate the appropriateness of care in moral and ethical issues (e.g. abortion) and attach conditions to certain types of healthcare. However, in contemporary times, there has not been a single more debated issue since the Clinton years that matches the intensity of polarized opinion on governmental health insurance plans in the United States. These "public options" would compete with private insurance companies, expand the rate of the insured, but put some of the fiscal burden back onto the government. There have been two major options in the debate; the first patterned off Medicare, and funded in a similar manner (which is substantially less expensive than private insurance); the second a negotiated and graduated payment plan based on insurance rates, pharmaceutical costs, health care statistics and demographics. As might be expected, the large insurance companies and providers oppose the former - costs would be so low, they say, that they cannot fairly compete. This option, then, has been called the "robust" option, and is certainly one favored by the current administration (Ginsburg, 2009). The proposed plan, having gone through a number of changes and committees, is not particularly robust, but does offer a semblance of protection not currently offered, as well as the ability for some negotiation on price. Most economists think that allowing more people to negotiate their health care costs would, at a minimum, provide them with more spendable income on a monthly basis, and, through attrition, help stimulate sales in other areas of the economy (Obama, 2008).
In the United States, 80-85% of the population have some sort of insurance coverage, but those that are not insured are never denied critical care; they simply do not have access to the preventative options that the insured do. There will be changes in America's healthcare system in 2010; some portions which have already passed. What the system resembles today is not what it will resemble at the end of President Barack Obama's first term. In fact, there are many similarities to plans already in place in the EU, so it is likely that the system will look a bit more like the EU model (Subramanian, 2009). Because of the many drastic differences between the population base, sheer volume and distance, and economic stability, though, it is quite unlikely that most Americans would accept another 15-22% tax increase simply to fund more Federal programs. Instead, the system must compromise in numerous ways: the private hospitals and physicians will need to accept greater efficiencies and perhaps less monetary rewards, but be allowed to practice medicine; the large insurance and pharmaceuticals will also need to compromise on their profit margin, in lieu of better coverage and care; and the American consumer will need to compromise with their share of healthcare costs, use the system as needed, try for generic brands when available, and move from a litigious society to one in which there is again trust between doctor and patient, and unnecessary and expensive tests and procedures are used only when truly needed.
Conclusions- There are clear and distinct consequences to health care reform in the United States. The most recent figures show spending of about $8,000 per person, 17 percent of GDP, or $2.4 trillion dollars of GDP (Herrington, 2009). A 2007 study by the Kaiser Foundation shows the gradual increase in costs, burdens to the overall economy, and differences technology brings to healthcare. The same study shows that it has become increasingly difficult for both consumers and small businesses to purchase healthcare due to rising premiums. Healthcare reform will address those issues for some - barring insurance companies from cutting healthcare or refusing healthcare for preexisting conditions, but there is a cost to this. This is especially relevant when one considers two major trends: 1) the demographics of the U.S. (and world) population shows a trend towards aging; people are living longer and have the chance for more health issues and, 2) Healthcare costs are growing faster than the overall economy - particularly relevant in terms of the recent housing crisis (Kaiser, 2007).
We cannot, however, look at simply reducing expenditures and percentages as the true costs of healthcare reform. President Obama indicates that the waste in the industry, when reformatted, will save 10-15 percent of the overall budget, as will caps on certain pharmaceuticals, bundling insurance packages for smaller businesses, etc. One analyst indicates that the burden of taxation with increase or decrease based more on the healthcare issue than any other issue facing the United States - with the possible exception of defense. The issue is not as polar as whether the U.S. government should take steps to shrink the economy by inaction or the "wait and see" method; but how rapidly they should push through proposals that will seemingly cost billions up front but should show some savings over time (Herrington).
The official position, however, indicates that slowing the annual growth rate of health care costs by approximately 2 percent would increase real GDP by at least that much by 2020, and up to 8 percent by 2030. For the typical family of four, this implies and increase of income of about $3,000 in 2020 and $10,000 in 2030 (based on 2009 dollars). Managing the growth of healthcare costs will have the additional effect of lowering unemployment consistent with inflation by .025 percent yearly. Finally, expanding health insurance coverage, removing unnecessary and confusing roadblocks to employment improvement, and allowing both small and large businesses to compete fairly in the health care market, and their ability to manage health care will increase labor supply, increase net income, and see a real dollar increase of $100 billion/annum, or about .66 percent of GDP. This, says the administration, is the necessary direction reform, and the economy, and must head (White House, 2009).
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