Problems With American Health Care

The American health care system is made up of the most sophisticated technologies and best-trained professionals. Unfortunately, this expertise and technology is accessible to fewer and fewer people each year. High out-of-pocket costs, health care business models and unavailable service options have left nearly 47 million Americans without health insurance coverage. As a result, financial ruin is just one illness away for many individuals and families.

Business Motivations

• The American health care industry is built on a business model that seeks to make profit, as well as provide a marketable service or product. And while this industry is among the best in the world at what it does, the resulting costs coupled with a for-profit purpose has made their services nearly inaccessible for many. Between insurance providers and direct care professionals, the old adage "time is money" is a primary motivation in terms of how services are delivered to the consumer.

Time Factors

• The payment system within the American health care industry puts service providers in a precarious position where providing quality of care may actually be detrimental to the provider's ability to make a profit. Billing practices and schedules have taken center stage in terms of what can and can't be provided for a patient, with cost-effectiveness as the measuring stick. As a result, profitability for providers is best obtained through spending minimal amounts of time with patients, providing minimal care and seeing as many patients as possible in a day's time.

Cost Factors

• One major problem for consumers within the American health care system is the costs associated with services. High out-of-pocket costs paid out in deductibles, co-pays and premium payments can drain even the healthiest of bank accounts when multiple treatments and medications are needed. From a business perspective, the prevalence of high out-of-pocket costs accomplishes two profit-bearing objectives: fewer claims to pay out and less money to pay out per claim. These factors, coupled with the practice of "covered" versus "non-covered" services, works to streamline excess costs all the way around.

Effects

• Statistics compiled by the Commonwealth Fund, an organization that promotes health care reform, shows more than 98,000 American deaths are caused by medical errors, be they paperwork-related or procedural. As a result, patient safety concerns have come into question in terms of the quality of care being provided under the current health care "profit" model. Also of concern are the minimal provisions made for preventative health care services under the current insurance model. Doctors receive little to no reimbursement for providing these services, making them more likely to prioritize patient load according to likelihood of reimbursement rather than patient need.

Considerations

• Many of the problems related to American health care can be attributed to a common practice within the industry called "health care rationing." The advent of the managed care network brought with it an increased ability to restrict choice of providers, as well as payment models and covered services. By limiting a patient's choice of doctors and facilities, insurers only have to work with those providers who've agreed to the insurer's reimbursement terms. Low fee arrangements between insurers and providers are typically the standard that guarantees a minimum cost outlay on the insurer's end. Co-pays, deductibles and yearly maximums also help to "ration-out" those who can go without adequate care if it means keeping money in their pockets.