The US Healthcare System
The US healthcare system is the mixture of public and private insurers
where private insurers are more powerful than public insurers. According to a 2003 report 62% non-elderly Americans had private insurance and 15% had public insurance and 18% were uninsured (Kao-Ping Chua, 2006).
Public Health Insurance
Medicare: It covers people aged 65 and above and also disabled people. It is managed by the government solely, which is responsible for the reimbursement of insurance. The finance comes from the federal income taxes that is the collective effort of employers and employees. It is divided into four parts, where Part A covers services related to hospitals, Part B has physician services, Part C is related to Medicare Benefits and Part D gives drugs benefits (Kao-Ping Chua, 2006). It has the coverage of 39.7 million people, which is 14% of the population. .
It has some drawbacks like no coverage for efficient nursing facilities, preventive care, dental, vision and hearing care. That is why many people have to pay 22% of their income for the cost of their healthcare apart from the Medicare coverage.
Medicaid: This program is planned for disabled and low-income people and it includes children, elderly disabled, poor pregnant women and parents. It does not include the adults without children and it is difficult for many poor people to qualify Medicaid. It runs under the administration of District of Columbia and The states with valuable fifty-one programs. It receives the finance from the federal government and the states mutually through taxes. Federal government’s share for the payment is 57% of the costs of Medicaid. It has extensive benefits for its clients which includes prescription drugs.
Its drawback is that many of its clients face difficulty because of its low rate of reimbursement.
Other Public Systems:
S-CHIP- It is the State Children’s Health Insurance Program especially for children whose parents cannot purchase private health insurance. Its administrative and financing formation is same as Medicaid.
VA- The Veteran’s Administration focuses on veterans of the military. It benefits them with exceptionally reasonable care. The veterans get the treatment in government hospitals and clinics.
Private Health Insurance
Employer Sponsored insurance: In this program the employees receive the benefit of health insurance from their employers as a package. Both for-profit and for-non-profit companies plan for the insurance. It is financed by both employers and employees as the majority of the premium is paid by the employers and the reminder is paid by the employees. Different health insurance plans have different benefits. For example, some plans include the benefit of prescription drugs though other plans don’t include (Kao-Ping Chua, 2006). In 2004, 174 million people (59.8% of the population) were targeted by this program.
Private non-group: It benefits the people who are self-employed or retired. It also takes in the people whose employer does not provide any facility of health insurance. The private insurance companies govern the plans. The finance comes from the individuals only. As the risk depends only on the health condition of the person so sometimes the person has to give unaffordable payment for the premium. A healthy person has low premium as he has low risk and a sick person has to pay more for the premium as the risk is high. The benefits depend upon the particular health insurance plan.