Health insurance is a concern for everyone. we need to have coverage for basic medical care, as well as to be prepared for any medical emergency. However, a 2017 Gallup poll showed that 45% of Americans surveyed had a somewhat or very negative opinion of health insurance companies, and 80% said they were dissatisfied with the cost of health care.
In just three months in 2011, the top five health insurance companies made more than $3 billion in profits and the percentage of gross domestic product (GDP) in the United States spent on health care is projected to reach 20 percent by 2025 the united states is the country that spends more per capita on health care costs, including drugs, than any other country, more than $9,000 per person.
us? benefit from the best expenses?
This difference in spending does not necessarily provide results. The quality of medical care is generally judged on two factors; infant mortality rates and life expectancy.
2015 figures rank the united states 29th in infant mortality among 35 oecd countries. In the Nordic countries, Japan, and Slovenia, the infant mortality rate is half that of the United States.
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Life expectancy stats aren’t much better. the United States. It ranks 26th out of 35 OECD countries, with an average life expectancy of 79 years, compared to Japan’s 84 years. In at least three countries, life expectancy is greater than the US figure by three years, and in 25 countries, the average life expectancy is at least 80 years.
what went wrong?
The collapse of the American health insurance system dates back to the Nixon presidency.
In 1973, Nixon, as a personal favor to his friend Edgar Kaiser, signed the Health Maintenance Organization Act that allowed hospitals, insurance companies, clinics, and even doctors to operate as for-profit entities.
These establishments were no longer the service organizations they were meant to be. The first insurance company to try federal subsidies was, of course, Kaiser-Permanente, which happened to be headed by a friend of Nixon’s.
Before the hmo act, these organizations did not operate on a for-profit model, but now for-profit ipa-hmos were authorized to contract with independent practice organizations (ipas), which would contract with physicians for services and compensation.
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In the ipa-hmo model, each doctor received a flat fee for each patient seen, regardless of the time the doctor spent with the patient. Physicians received incentives to spend as little time as possible with each patient, and certain hmos gave end-of-year bonuses to physicians that limited referrals and costly procedures.
In the late 1990s, 68 percent or less of premiums paid actually went to health care; the rest was paid in compensation to executives and insurance salesmen.
hmos for profit
compared to nonprofit health maintenance organizations, for-profit hmos in new york city spent more than five times the amount per member on marketing and administration than nonprofits . Savings to ensure profitability lie in providing care, restricting time spent with patients, replacing physicians with less expensive staff, and reducing spending on supplies, all of which could affect quality of care.
However, this system does not necessarily lead to a reduction in the number of medically unnecessary tests or procedures. Waste is estimated to account for 30 percent of health care costs, about $7.5 billion per year. additional testing may lead to overdiagnosis and not necessarily better results.
profit as king
The change also created a system in which health care became a multibillion-dollar business, from insurers to pharmaceutical companies. the healthcare industry benefits more from addressing chronic conditions than from curing diseases like diabetes.
A for-profit system may result in a conflict of interest in the provision of patient care. For-profit HMOS and PPO plans offer physicians incentives to limit services, such as the control approach in which patients must be examined by their primary care physician before referring them to a specialist or whereby an employee of the insurance decides whether or not to approve the treatment. , impacting medical care
ethics of “for profit” health care
First, for-profit establishments have shifted the focus from patient care to profit. Before Blue Cross and Blue Shield went for-profit, insurers spent 95 cents on the dollar in out-of-pocket health care costs.
However, the shift to profit has resulted in expenses shifting to marketing, lobbying, management, and dividends instead of health care. the medical loss rate jumped from five percent to around 80 percent in some states.
Furthermore, for-profit organizations only worsen access to health care, because it’s getting harder to afford health insurance. To cover rising costs, premiums must steadily rise, putting health care out of reach for many Americans.
At the same time, these for-profit entities include incentives that negatively affect doctor-patient relationships, creating a conflict of interest that ultimately diminishes the quality of care and can also erode patient trust in the system as well as your own confidence. doctor.
health care as a commodity
Most importantly, health care has become a commodity to be bought and sold rather than a right to be granted to all citizens. The very definition of a commodity is something that has market value or relative exchange value, and since tests, treatments, and services are assigned market prices, this makes health care a clear commodity.
Health care now has a market system, influenced by natural endowments and wealth, just like any other market system. therefore, the distribution of the health care market is based on the initial distribution of assets (income and wealth), which means that there will be no equality in the care that people receive.
Given the unpredictable nature of health care needs, only those with the greatest resources or wealth can budget for health care expenses, which is where insurance comes in.
health insurance as risk management
Health insurance is a form of risk management that allows people to protect themselves from financial loss in the event of illness or serious illness. competition for insurance in the market causes a great differentiation in terms of risk pools among patients.
Different packages with different premiums are created for different groups of people with the result that those with the greatest need for insurance will end up with the highest costs. which we end up with health insurance that is unaffordable for a large number of individuals and families in this country.
the end result
Ever since President Nixon signed the HMO Act of 1973 into law, health care has been a commodity or luxury rather than something every American should have. With profit as the motive, significantly less money is spent on actual patient care, and treatment decisions are based on balance rather than medical necessity.
If the motive is to fund executive bonuses and fill insurance coffers to provide dividends, premiums, deductibles, and copays should rise regularly as coverage declines. The insurance spreads the risk among the insured so that the premiums of healthy patients who do not use the services end up subsidizing the cost of older patients or those who need care the most.
A for-profit system cannot prioritize patient care over financial interests because the goal is to make money for insurance companies and other stakeholders. Physicians often have restrictions on the care they can provide to patients at the request of insurance company personnel.
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