** Note: This is a repost of the original posting from my blogsite: http://docjowl.wordpress.com/
I have always been interested in health care systems even when I was a medical student. Through the years, I was fortunate enough to have been exposed to the various features of the health systems in developed countries, particularly that of Japan and Finland. No wonder, that upon coming to the United States (US) for my masteral studies in public health, I was excited to learn more about the US health care system. I have heard many personal testimonies from relatives and friends back home that it is “best” in the world. Moreover, I recognize fully well the similarity of the structure of the health care system between the US and the Philippines, since the Philippines had been colonized by the US for over 40 years. Actually, it was partly due to this similarity that I decided to pursue my studies in the US, since the Philippines’ health care system follows the more private-market economy orientation of the US, as opposed to the more public-socialized system in Europe and Scandinavia.
After being in the US for the last one-and-a-half year, I learned about the US health care system both in and out of the classroom. Last semester, I had the chance to synthesize my views on the various problems plaguing the US health care system in one of my classes focusing on the analysis of health care issues in the US. I wrote about what I think are the most significant health policy issues in the US that needs to be addressed currently. I came up with the top five issues, and they are: (1) cost containment of high health care costs, (2) ensuring health insurance coverage and access to health care, (3) quality of care assurance, (4) coordination of patient care and (5) lack of health human resources, particularly that of primary care.
Of these health policy issues, I believe that the biggest problem, if not THE most important problem, is the high and rising cost of health care. According to the March 2009 publication of the Kaiser Family Foundation on Trends in Health Care Costs and Spending, the US has the most expensive health care system in the world, with an estimated national health care spending of over US $2.5 trillion in 2009, or US $8,160 per capita, projected to have accounted for 17.6% of the Gross Domestic Product in 2009. It is important to note that among developed countries, the US has the highest percentage of the gross domestic product spent for healthcare, as shown in the figure from the Organization for Economic Cooperation and Development in 2008.
In the New York Times August 13, 2009 issue on 10 Steps to Better Health Care, Atul Gawande, et. al. discussed this problem, starting with the statement that “Americans have recognized that our health system is bankrupting us and that we have dealt with this by letting the system price more and more people out of health care.” I think that this issue of high health care costs is a very central component of the reform that is needed to make the US health system better. It is of prime importance, as this is deeply connected with most of the other problems affecting the US health system today.
High health costs underlie the problem in the affordability of health care. It is one of the factors that lead to an increase in insurance premiums, which then contributes to the rising number of the uninsured, resulting to health inequality in terms of access to health care. Recently released data from the US Census Bureau showed a record number 50.7 million uninsured Americans without access to health care, representing 16.7% of the total population. In the same manner, high health costs increase health care spending, that threatens to produce funding deficits for government supported programs, such as Medicare and Medicaid. This results in concomitant budget cuts that greatly affect scope of health service delivery and quality of care in the US. It is to be noted, however, that high health costs and spending does not equate with good health outcomes.
Upon reflection of these problems of the US health care system, it led me to think that societies arrive at the current state of their health care system through policy decisions made during the course of their history that represent their societal values. While other countries chose the path of solidarity and universal coverage, they also face the problems of lack of innovation and sometimes low health care quality, of which the US system could very well brag about. As what I have learned in my health economics course, decisions made to allocate the scarce resources in health care result in economic trade-offs upon which the pros and cons stem from. The high and rising health care cost in the US could be thought of as the price the US has to pay for a health care system that is innovative and high quality. There is really no such thing as a “perfect” health care system. Indeed, to each his own.
I think you make good points Joel, but as far as high health care costs being “the price we pay” for innovation and technology – I have to ask how many people are actually benefiting from that innovation, and how much do we need it? I bet the masses of people who are uninsured or just otherwise can’t afford treatments and medications would much rather have lower costs on the things we actually need (like generic medicines and basic medical supplies) rather than pay for development of treatments that may be seen as unnecessary or superfluous. I guess what I’m trying to say is that I don’t think we always need the “gold star” treatment, or the fastest or most technologically-advanced treatment to have a good quality of life, or to be healthy people. I think it’s easy for us as a nation to feel good about saying that our health care system is of the highest quality in the world and that we are always discovering new treatments, but when that quality and that research prevent other human beings from getting even the most basic, fundamental care, we need to re-examine our priorities.
I agree with your comment. Actually, that is the challenge in health policy in terms of balancing the trade offs, i.e. high quality of care that comes with high cost or a universal health insurance coverage that equates with lower quality of care. The aim, for example, when deciding on policies for the US is to try to have a system that reduces cost and at the same time improving access to health care. In socialist societies like Canada and Europe, there is universal coverage and cost is contained through the budget set by the government. However, people complain of long waiting times and lower quality of care when compared to the US; some would say they have “rationed health care”. Also, their health care system has a primary care that is stronger, as opposed to the more specialist-care orientation in the US. This means that people cannot go to whoever specialist doctor they want unless they pass through their primary care physician, which people could do in the US. Thus, in the end, the issue is really deciding on how to balance these trade-offs. It is difficult (or maybe impossible) to have both, as resources will always be limited.