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06-Feb-2016 10:02

health care system is unique among advanced industrialized countries. Rather than operating a national health service, a single-payer national health insurance system, or a multi-payer universal health insurance fund, the U. health care system can best be described as a hybrid system. The federal government accounted for 28 percent of spending while state and local governments accounted for 17 percent.[1] Most health care, even if publicly financed, is delivered privately. Nationally, health care costs for chronic diseases contribute huge proportions to health care costs, particularly during end of life care. It is difficult to determine the exact differences between public and private administrative costs, in part because the definition of “administrative” varies widely. does not have a uniform health system, has no universal health care coverage, and only recently enacted legislation mandating healthcare coverage for almost everyone. health care spending came from private funds, with 28 percent coming from households and 20 percent coming from private businesses. Among the insured, 115.4 million people, 36.5 percent of the population, received coverage through the U. government in 2014 through Medicare (50.5 million), Medicaid (61.65 million), and/or Veterans Administration or other military care (14.14 million) (people may be covered by more than one government plan). Some analysts have argued “that the availability of more expensive, state-of-the-art medical technologies and drugs fuels health care spending for development costs and because they generate demand for more intense, costly services even if they are not necessarily cost-effective.”[12] In 2013, the U. spent ,026 per capita on pharmaceuticals and other non-durable medical care, more than double the OECD average of 5.[13] Another explanation for increased costs is the rise of chronic diseases, including obesity. leads all other industrialized countries in the share of national health care expenditures devoted to insurance administration. In 2015, 85 percent of union members in the civilian workforce had access to paid sick leave compared to 62 percent of nonunion workers.[44] At the median, private-sector unionized workers pay 38 percent less for family coverage than private-sector nonunionized workers, according to a 2009 study.[45]Universal coverage, in countries like the United Kingdom, Switzerland, Japan, and Germany makes the number of bankruptcies related to medical expenses negligible.[49] Conversely, a 2014 survey of bankruptcies filed between 20 found that medical bills are the single largest cause of consumer bankruptcy, with between 18 percent and 25 percent of cases directly prompted by medical debt.[50] Another survey found that in 2013, 56 million Americans under the age of 65 had trouble paying medical bills.[51] Another 10 million will face medical bills they are unable to pay despite having year-round insurance.[52] It has been suggested, based on the experience of Massachusetts, where medical-related bankruptcies declined sharply after the state enacted its health reform law in 2006, that the ACA may help reduce such bankruptcies in the future.[53] In March, 2010, President Obama signed the ACA into law that made hundreds of significant changes to the U. By taking an international perspective and looking to other advanced industrialized countries with nearly full coverage, much can be learned. ranked fifth, but came in last place in efficiency, equity, and healthiness of citizens’ lives.[78] Comparing other health care indicators in an international context underscores the dysfunction of the U. DPE-affiliated unions represent: teachers, college professors, and school administrators; library workers; nurses, doctors, and other health care professionals; engineers, scientists, and IT workers; journalists and writers, broadcast technicians and communications specialists; performing and visual artists; professional athletes; professional firefighters; psychologists, social workers, and many others. Their findings suggest that this holds true even when controlling for socio-economic disparity.[15] Experts are focusing more on preventative care in an effort to improve health and reduce the financial burdens associated with chronic disease.[16] One provision of the Patient Protection and Affordable Care Act, commonly referred to as simply the Affordable Care Act (ACA), implemented in 2013, provides additional Medicaid funding for states providing low cost access to preventative care.[17] Finally, high administrative costs are a contributing factor to the inflated costs of U. The aim is to improve administrative efficiency by allowing doctors and hospitals to bundle billing for an episode of care rather than the current ad hoc method.[20] While the majority of U. citizens have health insurance, premiums are rising and the quality of the insurance policies is falling. “Patients with chronic illness in their last two years of life account for about 32% of total Medicare spending, much of it going toward physician and hospital fees associated with repeated hospitalizations.”[14] The National Academy of Sciences found that among other high-income nations the U. has a higher rate of chronic illness and a lower overall life expectancy. Further, the government outsources some of its administrative needs to private firms.[18] What is clear is that larger firms spend a smaller percentage of their total expenditures on administration, and nationwide estimates suggest that as much as half of the 1 billion spent annually on administrative costs is wasteful.[19] In January 2013, a national pilot program implemented under the ACA began. [13] OECD (2015), Health at a Glance 2015: OECD Indicators, OECD Publishing. Available at: [14] The Dartmouth Atlas of Health Care. Experts suggest that the economic pressure to go to work even when sick can prolong pandemics, reduce productivity, and drive up health care costs.[24] Health insurance premiums in the U. This rate of increase outpaces both inflation and increases in workers’ wages.[41] The Union Difference: Union workers are more likely than their nonunion counterparts to be covered by health insurance and paid sick leave. Available at: [4] OECD (2015), Health at a Glance 2015: OECD Indicators, OECD Publishing. In March 2015, 95 percent of union members in the civilian workforce had access to medical care benefits, compared with only 68 percent of nonunion members. Provisions included in the ACA are intended to expand access to healthcare coverage, increase consumer protections, emphasizes prevention and wellness, and promote evidence- based treatment and administrative efficiency in an attempt to curb rising healthcare costs. The Department for Professional Employees, AFL-CIO (DPE) comprises 22 AFL-CIO unions representing over four million people working in professional and technical occupations. Average annual premiums for family coverage increased 11 percent between 19, but have since leveled off to increase five percent per year between 20.[21] Deductibles are rising even faster.

The lack of health insurance coverage has a profound impact on the U. While the low end of the estimate represents just the cost of the shorter lifespans of those without insurance, the high end represents both the cost of shortened lifespans and the loss of productivity due to the reduced health of the uninsured.[23] Health insurance coverage is uneven and often minorities and the poor are underserved. Department of Health & Human Services, Health System Measurement Project, “Percentage of People Who Did Not Receive or Delayed Needed Care Due to Cost in the Past 12 Months.” Available at: https://hhs.gov/measure/282 [12] Adara Beamesderfer and Usha Ranji.

Forty million workers, nearly two out of every five, do not have access to paid sick leave. From 2005 to 2015, average annual health insurance premiums for family coverage increased 61 percent, while worker contributions to those plans increased 83 percent in the same period. [3] OECD (2015), Health at a Glance 2015: OECD Indicators, OECD Publishing.

and Mexican governments play the smallest role in overall financing of health care.[4] However, public (i.e. Prohibitively high cost is the primary reason Americans give for problems accessing health care. [27] Kaiser Family Foundation, “Health Insurance Coverage of the Total Population.”2014.

spends considerably more on health care than any other OECD country. Available at: [26] Kaiser Family Foundation, “Key Facts About the Uninsured Population,” 2015.

population had some type of health insurance, with 66 percent of workers covered by a private health insurance plan. had no health insurance.[2] This fact sheet will compare the U. health care system to other advanced industrialized nations, with a focus on the problems of high health care costs and disparities in insurance coverage in the U. It will then outline some common methods used in other countries to lower health care costs, examine the German health care system as a model for non-centralized universal care, and put the quality of U. The first is the cost of new technologies and prescription drugs.

The Organization for Economic Co-operation and Development (OECD) is an international forum committed to global development that brings together 34 member countries to compare and discuss government policy in order to “promote policies that will improve the economic and social well-being of people around the world.”[3] The OECD countries are generally advanced or emerging economies. government) spending on health care per capita in the U. is greater than all other OECD countries, except Norway and the Netherlands.[5] This seeming anomaly is attributable, in part, to the high cost of health care in the U. Americans with below-average incomes are much more likely than their counterparts in other countries to report not: visiting a physician when sick; getting a recommended test, treatment, or follow-up care; filling a prescription; and seeing a dentist.[9] Fifty-nine percent of physicians in the U. acknowledge their patients have difficulty paying for care.[10] In 2013, 31 percent of uninsured adults reported not getting or delaying medical care because of cost, compared to five percent of privately insured adults and 27 percent of those on public insurance, including Medicaid/CHIP and Medicare.[11] While there is no agreement as to the single cause of rising U. health care costs, experts have identified three contributing factors. Washington, DC: The National Academies Press, 2013. Available at: [28] Employer Health Benefits 2015 Annual Survey, 2015.



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