Healthcare in the United States has been a hot topic for a long time. The need for reform, the high insurance rates, and people being denied healthcare for having pre-existing conditions made the healthcare system a big problem. After the passing of the Affordable Care Act, these things became less of a problem. The Act was passed in 2010 and made way for much-needed healthcare reform.
Characteristics of the US Healthcare System
Today, we want to have a look at the characteristics of the American healthcare system so you can understand the basics of how it works. Some of these things may be changing slowly but surely and some may be addressed by the Affordable Care Act.
1. Privately Governed
The US healthcare system is not governed by a central agency. Instead, there are several privately owned hospitals, practices, and clinics which all work on their own. There is little integration between services and service providers which leads to very high costs for patients. When such a system is centrally governed, it is less complex and offers the opportunity for cheaper healthcare options. In other countries, the government play a big role in healthcare provision. In America, the government is basically a subsidiary to the private sector as the private sector runs the healthcare system.
Our health system is very focused on technology for healthcare. This is not really a bad thing as it means that we have the best equipment and procedures to offer our patients. However, when the use of technology is taken too far and too much money is spent on this equipment, it pushes the cost of healthcare up. Most Americans can already not afford healthcare services, so having high-tech equipment available to them is redundant because they cannot afford it. When we use technology in the right way and for the areas where it truly adds value, this is a good characteristic. When we overuse it, it becomes just another factor that makes healthcare inaccessible and too expensive.
3. Limited Access
Not everyone has easy access to healthcare. Healthcare is part of our human rights and it is a necessity for us to live and stay healthy. However, the way our system works makes it difficult for some people to have access to this basic necessity. Why is access difficult? Access is difficult because many healthcare providers require health insurance before they will treat a patient. So, patients without health insurance or who cannot afford to pay from their own pocket cannot gain access to healthcare. There is no alternative. What makes things worse before the passing of the Affordable Care Act is that insurance companies could deny people coverage if they had a pre-existing condition. So, there were people who needed healthcare but weren’t given access to it because they didn’t have health insurance because the insurance company refused them coverage. You can start seeing why this is a problem.
4. Legal Risks
In America, people have come to believe that they can sue anyone who does them wrong no matter how big or small the issue. We are very quick to bring about lawsuits against those that we feel wronged us. This makes things very hot for private healthcare providers as they fear being dragged into court for the smallest things. Therefore, these healthcare providers are very careful to avoid malpractice lawsuits. In order to keep them out of court, they have additional tests done or schedule a whole lot of follow-up appointments to make sure they cover all their bases. Sounds like thorough practice, right? Yes, but the problem with this is that many of these extras are completely unnecessary and simply adds on more numbers to the healthcare costs that the patient already cannot afford.
So, these are four the main characteristics of the US healthcare system. There are good and bad in them and, as with most things, when they are overdone or taken too far, the patient suffers.
The Affordable Care Act
Let’s move on to some more positive things. In 2010, the Affordable Care Act was passed and it changed many lives. It didn’t necessarily improve the working of the healthcare system as such, but it did help with health insurance issues. Here are some of the main things that changed with passing if the Affordable Care Act:
1. Anyone Can Get Coverage
Before January 1, 2014, not everyone could buy health insurance. If you had a pre-existing condition or were sick already when you applied for insurance, you could be denied coverage or asked to pay much more than usual. Once the Act was passed, this changed and now anyone can buy insurance whether they are already sick or not.
2. No More Capped Benefits
The Act stipulates that every health insurance provider must include essential health benefits in their packages. Essential health benefits include inpatient and outpatient hospital services, pediatric care, chronic disease management, emergency services, mental health counselling, laboratory tests and services, etc.
The Act also states that health insurance can no longer cap your essential health benefits. This means that if you require any of the essential health services, your insurance must by law pay that. This is very good news for people with chronic diseases who often ran out of benefits because of the severity of their condition.
This was the two major changes that the Affordable Care Act brought about. It definitely changed the accessibility to healthcare problem for many people. Now, they can no longer be denied healthcare because they don’t have and cannot get health insurance.
From this, it should be clear that the US health system is a complex one that definitely still needs some changes. The quest for integration and reform to make it more accessible and affordable is ongoing. Hopefully, there will be more solutions in the coming years.