Inthe USA, similar to most developed countries, the government payshealth care or an organization associated with health care. Thegovernment provides health care to the citizens through a portion ofthe taxes collected.The government established the Affordable andcare Act (PPACA) in the year 2010 that introduced the “sharedresponsibility” of health care services. It was a move to improvethe quality and reduce the cost of health care services by combiningthe contributions by the individual citizens (employees), theemployersand the government. The combined contributions aimed atproviding subsidies on health insurance and business tax credits forsmall enterprises. The subsidies reduced the burden of health care for low to middle income citizens and guaranteed their access tohealth insurance(Mossialos, et al., 2015).
TheAct made a portion of the health care system market-based partlypaid by private entities such as employees and individuals. In amarket-based system, both individuals and the private organizationsare responsible for care provision. Consequently, all parts of thehealth care system are subject to high competition due to theincrease in the number of care suppliers, payers, and providers. Thecitizens have a wide option of market players to choose from based onthe provider that offers the best service. On the other hand, thedoctors have the advantage to practice best practice guidelines thatspecify when and for whom various treatment methods is applied(Mossialos, et al., 2015).
Thedoctors are free to make decisions on a case basis depending on thedifferent needs of the patients. The major problem with the marketsystem is the increased possibility of duplication of services due tothe freedom advanced to the patients and Medicare providers. However,the system`s main advantage is the motivation it provides for theadvancement of innovation by offering financial incentives todoctors. The resultant market-based healthcare system obtains fundsfrom both private and public sources. Consequently, the variety infunding creates coverage gaps for the citizens (Mossialos, et al.,2015).
Thehealth program covered approximately 64 percent of US residents inthe year 2013 through the private voluntary health insurance. Another54 percent obtained cover from employer-provided insurance while11percent-acquired direct insurance. The responsibility to administerthe Medicare program remains with the Center for Medicare andMedicaid services (CMS). The Medicare program is available tocitizens aged 65 years and older, the disabled and patients diagnosedwith the endstage renal disease. In addition, there is partnershipbetween the Medicaid program and the state governments in theadministration of the Children Health Insurance and the Medicaidinsurance programs. The Medicaid and the Children Health Insuranceprograms were designed by the federal and the governments to caterfor citizens with low incomes.
Inthe year 2014, there was an increase in the number of people thataccessed health insuranceafter the implementation of the Care andAffordable Act (PPACA) of 2010.Consequently, there were feweruninsured adults of the age 19-64 in the period from April to June2014 compared to last quarter of the year 2013. The number of theuninsured is projected to reduce by 26 million by 2017 (Collins,Rasmussen, and Doty, 2014).
Inthe year 2012, the government spent 47.6 percent of its budget onhealth care. The budget should increase as the Affordable healthcareact is implemented. The government finances health care throughpayroll taxes, the government`s general revenues, and premiums. TheUnited States Medicaid insurance program gets its fund from both thefederal and member states. The states administer the insuranceprograms as per the guidelines of the federal government. The federalgovernment remits the funding to the states at rates that correspondsto the states per capita incomes. For example, in the year 2014, thematching rate of the federal government remittances to the state`sMedicaid insurance expenditure ranged from 70 percent to 73percent(ASPE 2014). The Patient Protection and Affordable Act 2010provides that the Medicaid insurance shall be entirely funded by thefederal government. The fully funded period includes the initialphases of implementing the program for three years starting with theyear 2014. Consequently, by the year 2020, the funding of the federalgovernment funding shall reduce by 90 %(Mossialos, et al., 2015).
Thesecond type of funding is through the private sector whichis thethird largest health care expenditure by the government preceded byMedicare and Medicaid. It reduces the tax revenues by $ 260 billionper annum (NBER, 2014). It is a voluntary based contribution by boththe employers and the employees, based on employer’s terms. Thecontribution varies from one company to the other. In the year 2012,the United States expenditure on private health insurance amounted to33% of the years public health care spending. The private insurersare allowed to operate either at a profit or for the nonprofitpurpose. The commissioners of state insurance that follow variousstates regulations regulate the insurers. There are citizens thatdecide to be covered by the private and public insurance systems.Citizens that are covered by Medicare also purchase the privateinsurance as a supplemental for additional services. Private insurerspay higher rates compared to the individual program such as Medicaid.Consequently, the health care system is composed of wide variationsin the rates for various providers. The rates depend on the marketmix and the payer’s power(Mossialos,et al., 2015).
Inthe USA, one-third of all physicians entail the primary care doctors.They provide health care services in small settings that are eitherself or group owned. However, they are growing into bigger practices.They include less than five full-time physicians. The physicians arepaid through various methods such as negotiated fees, capitation andpublic insurance. There are also the outpatient specialists that workin both hospitals and private practice (Mossialos, et al., 2015).
Collins,S. R., P. W. Rasmussen, and M. M. Doty (2014).GainingGround: Americans’ Health Insurance Coverage and Access to CareAfter the Affordable Care Act’s First Open Enrollment Period.New York: The Commonwealth Fund.
Mossialos,E.,and Wenz,M., Osborn, R., and Anderson, C., (2015). 2014 InternationalProfiles Of Health Care System.New York. Print
AssistantSecretary for Planning and Evaluation (ASPE), Department of Healthand Human Services (2014). ASPE Federal Medical AssistancePercentages (FMAP) 2014 Report.
NationalBureau of Economic Research (NBER) (2014). Tax Breaks forEmployer-Sponsored Health Insurance.
Centersfor Medicare and Medicaid Services (CMS) (2014b). Fact Sheets:Medicare ACOs Continue to Succeed in Improving Care, Lowering CostGrowth