United States Health Report

United States Health Report: Group 2 Healthcare in the United States is drastically different from many other healthcare systems around the world. We are one of the world's leading spenders on healthcare, spending $4.5 trillion in 2022, making up almost 17.3% of the nation's gross domestic product. The US healthcare system does not provide universal coverage and can be defined as a mixed system, where government health coverage coexists with privately financed market coverage. We are a nation of 330 million people and are supported by one of the most complex healthcare systems in the world. This is due to the intertwining relationships between providers, payers, and patients receiving care, and the US healthcare system is constantly evolving. This is because, on average, payments for healthcare services typically exceed the hospital's cost of providing the underlying services. Also, hospitals/clinics, on average, are reimbursed less than the costs of services for Medicare, Medicaid, and uninsured patients. These healthcare services are provided by loosely structured delivery systems determined by the local level of organization throughout the United States. These local levels of organizations include healthcare providers, clinics, emergency departments, and hospitals. These businesses are free to open or close according to the community resources, preferences, and the dictates of an “open market for hospital services.” This refers to a healthcare system where patients can freely choose which hospital, physician, or clinic to receive care from. Different hospitals compete for business based on factors like price, quality, convenience, and reputation. Mainly, it means that hospitals are not restricted by regulations or limited to a specific patient pool, enabling them to actively compete for customers. How patients pay for the care they receive is typically done by a combination of methods including private insurance, Medicare, and Medicaid. Healthcare systems receive payments from both public (government resources Medicare and Medicaid) and private institutions (private insurance groups). Insurance can be covered through their employer (group insurance), private insurance (nongroup insurance), Medicaid (designed for low-income individuals and families, government-provided), or Medicare (based on age and physical condition, the government provided.). Out-of-pocket payments and market provision of coverage predominate as a means of financing and providing healthcare. Hospitals receive payment from both public and private financing sources. They are typically paid through DRG (diagnostic-related group) for inpatient procedures and Medicare. DRG assigns a set payment for a particular condition or treatment sequence; commonly used as the main payment scheme for hospitals. This payment covers accommodation, procedure, support staff, and drug/medical device costs. For outpatient settings, APC (ambulatory payment classification) codes are used by healthcare systems for billing and reimbursement. APC represents a fee-for-service style of billing rather than the capitation, cost-based style of DRGs. Physician and other clinical fees are not included with DRG or APC codes, CTP (current procedural terminology, used in both in & outpatient settings) codes are used and billed under the name of the provider. Medicare pays the hospital a fixed amount based on the DGR, regardless of the actual cost of treatment. Private insurance pays hospitals based on DRGs, case rates, per diems, fee-for-service, and/or discounted fee-for-service schemes. Our group believes that healthcare is a basic human right. As of 2024, approximately half of the world’s countries have a form of universal healthcare. The United States does not, despite it making up approximately 17% of the nation’s GDP. Countries with universal healthcare tend to spend significantly less (around 8-12%) of their GDP on healthcare every year. The high cost of healthcare in the United States is driven by the high prices of pharmaceuticals and medical services, utilization of more advanced medical technology, and higher rates of chronic diseases. Due to the high costs, around 8% of Americans do not have health insurance and cannot afford basic healthcare. Medical debt is the most common cause of bankruptcy in the United States. Countries with universal healthcare also tend to have a healthier population than those without. Lower infant mortality rates, higher life expectancy, and better detection and monitoring of chronic diseases and illnesses are key characteristics in countries with universal healthcare. The World Health Organization, a United Nations agency, also believes in universal healthcare as a basic human right. “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition… One should get sick and die just because they are poor, or because they cannot access the health services they need,” says Dr. Tedros Adhanom Ghebreyesus, the WHO Director-General. The U.S. healthcare system faces several critical weaknesses that contribute to high costs, inefficiency, limited access, and unequal care. One of the most significant challenges is the high cost of healthcare, which burdens both individuals and the economy. The system’s inefficiencies arise from administrative complexity, lack of coordination between providers, and the heavy reliance on private insurance, which often leads to duplication of services and unnecessary overhead. Access to care is also limited, with many Americans—particularly in low-income or rural areas—facing barriers such as lack of insurance, high out-of-pocket expenses, or insufficient healthcare facilities. Furthermore, there is a stark disparity in the quality of care provided to different populations, often based on socioeconomic status, race, or geographic location. The fragmentation and complexity of the system, where multiple payers and providers operate without a unified approach, exacerbate these problems, making it harder to deliver consistent, equitable care. Addressing these issues is crucial not only for improving health outcomes, but also for ensuring that all individuals have access to the care they need, regardless of their financial or social circumstances. With the complexity of the United States Healthcare, it is difficult to come up with reasonable solutions to these critical issues without any sort of backlash from the public. Some resolution to this issue could be changing the way organizations pay for providers' salaries. Some organizations require medical providers to do a certain amount of operations per day to get paid. This number of operations is not on the low side of things, either. They usually require a lot of surgeries per day. Changing the number of operations a Dr. can do in a certain amount of time could change the whole system for the betterment of patients. Drug regulation could also drive drug costs to an all-time low. The United States government already regulates the prices of essential items like oil, food, electricity, etc. The regulation would change the entire market and make healthcare more affordable for the common person. In conclusion, the US healthcare system is one of the most complex and expensive in the world, characterized by a blend of public and private financing, varied delivery mechanisms, and significant disparities in access to care. Despite being a global leader in healthcare spending, the U.S. fails to provide universal coverage, leaving millions without access to necessary services and contributing to the alarming rise in medical debt and bankruptcy. This system, driven by high costs, technological advancements, and a fragmented approach to insurance and care delivery, often, results in poorer health outcomes than countries with universal healthcare systems. The stark contrast between the U.S. and nations prioritizing healthcare as a fundamental human right underscores the urgent need for reform. As the World Health Organization advocates, “the right to health should not be determined by one's economic status, and the United States must reassess its priorities to ensure that every individual has access to affordable, comprehensive care”. Works Cited De Lew, N, et al. “A Layman’s Guide to the U.S. HealthCare System.” Health Care Financing Review, U.S. National Library of Medicine, 1992, pmc.ncbi.nlm.nih.gov/articles/PMC4193322/. Accessed 14 Nov. 2024 “US Healthcare System Overview-Background.” ISPOR.Org, www.ispor.org/heor-resources/more-heor-resources/us-healthcare-system-overview/us-heal thcare-system-overview-background-page-1. Accessed 14 Nov. 2024.