Health Care Systems - What is a health care system?



The United States health care system encompasses everyone and everything from the individual who is sick and in need of care, the clinic doctor who sees homeless people and families with no health insurance, to the hospital surgeon who performs state-of-the-art surgeries for thousands of dollars. It also includes executives and other business people who make decisions about health care that influence millions of people, and government officials who are desperate to reform (improve) health care. Health care is as small as the most personal and intimate choices people make about their own health and as big as multi-million-dollar business decisions and local, state, and federal policy-making. The U.S. health care system includes everyone who needs health care and everyone who delivers health care, which means that everyone is affected by health care.

Health Care Systems: Words to Know

Advocate:
A person who supports or defends a cause or a proposal.
Appeal:
To take a court's decision and have another higher court review it to either uphold or overturn the first decision.
Capitation:
An agreement between doctor and managed care organization wherein the doctor is paid per person.
Carve out:
Medical services, such as substance abuse treatment, that are separated from the rest of the services within a health care plan.
Chronic condition:
A condition that lasts a long time or occurs over and over again. Chronic conditions can be treated but not cured.
Clinical trial:
An investigation into new treatment methods for a specific disease or condition.
Copayment:
A fixed amount of money that patients pay for each doctor's visit and for each prescription.
Credentials:
Proof that a person is qualified to do a job.
Deductible:
The amount of money a patient must pay for services covered by the insurance company before the plan will pay for any medical bills.
Detoxification:
A process in which doctors use medication to reduce or eliminate drugs or alcohol from a person's body.
Emergency:
The unexpected onset of a serious medical condition or life-threatening injury that requires immediate attention.
Fee-for-service:
When a doctor or hospital is paid for each service performed.
Formulary:
A list of prescription drugs preferred by the health plan for its members.
Generic drug:
Drugs that are approved by the Food and Drug Administration but do not go by specific brand names and therefore are less expensive than brand name drugs.
Indemnity plan:
A plan in which the insurance company sets a standard amount that it will pay for specific medical services.
Medicaid:
The joint state-federal health care program for low-income people.
Medicare:
The federal health insurance program for senior citizens.
Medigap:
Private insurance that helps pay for some of the costs involved in Medicare.
National health care system:
A system in which the government provides medical care to all its citizens.
Off-label drug:
A drug that is not formally approved by the Food and Drug Administration but is approved for legal use in some medical treatments.
Point of service:
A health plan in which members can see the doctor of their choosing at the time they need to see a doctor.
Preferred provider organization:
A health plan in which members have their health care paid for only when they choose from a network of doctors and hospitals.
Premium:
Consideration paid for a contract of insurance.
Preventative care:
Medical care that helps to maintain one's health, such as regular checkups.
Primary care physician:
The doctor who is responsible for the total care of a patient and has the ability to refer patients to other doctors or specialists.
Rationing:
The process of limiting certain products or services because of a shortage.
Referral:
Permission from the primary care physician to see another doctor.
Reimbursement plan:
A plan where a patient must pay for medical services up front and then get paid back from the insurance company.
Social Security:
A government program that provides economic security to people.
Specialist:
A doctor who concentrates on only one area of medicine, such as a dermatologist (skin specialist).

The United States has the most advanced medical care in the world. Most Americans receive health care that is adequate, or even excellent, under the current system. However, there are many problems with the health care system in the United States. For those Americans who are insured because they can afford private health insurance or they receive health insurance through their employers, the current health care system usually works. However, more than thirty-seven million Americans do not have health insurance. Some of the uninsured people work for companies that do not provide health insurance, and some are denied medical insurance because they suffer from previous medical conditions. Others are unemployed or cannot afford private insurance, but they may not be poor enough to qualify for government assistance.

Most people without health insurance cannot afford preventative care—such as regular physicals or immunizations—which helps maintain one's health. As a result, small health problems can develop into big health problems, and many of the uninsured are left with no choice but to seek treatment in hospital emergency rooms, which is extremely costly for hospitals. If patients cannot pay for their care, the hospitals must either absorb the loss or pass the cost on to paying patients as costs rise for everything from doctors' services to aspirin. Sometimes hospitals turn away uninsured patients to avoid the expense of treating them. (When there is a medical emergency, however, it is illegal for hospitals to turn away uninsured patients.)

WHEN HEALTH INSURANCE WAS CREATED IN THE MID TO LATE 1800S, ITS PURPOSE WAS NOT TO HELP PEOPLE PAY FOR THE CARE THEY NEEDED BUT TO MAKE SURE THAT HOSPITALS DID NOT GET LEFT WITH UNPAID BILLS.

In recent years, health insurance has become big business and competition between health care providers is fierce. As a result, the price of health insurance has gone up, even while the coverage of services and treatments has become more limited and restricted. The costs for health care in America are the highest in the world. Most Americans agree that health care costs must be controlled, but few agree on how to control the costs. Many reforms have been proposed, from minor improvements to broad sweeping changes. Health insurance and health care are at the center of a nationwide debate: how can America make health care more widely available to everyone and also control costs?

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