The American healthcare system is one of the most advanced in the world in terms of technology and professional training. We can find clinics and hospitals anywhere, even in rural and remote areas of the country. Most of these hospitals are part of the private system, although they have subsidies from local and state governments.

In other cases, they are listed as "nonprofit associations", despite being affiliated with large medical companies. Health centers have high-tech equipment, medicines, and highly trained professionals. To learn more about how the healthcare system works in the United States of America, continue with this article.

Health expenses

It was estimated that in 2013 an average of US $ 8,000 per capita was spent on healthcare in the USA. At that time Luxembourg spent US $ 4,000 per year per capita and Britain - which the WHO considers the best system in the world - allocates only 3,600 per inhabitant. The United States, on the other hand, allocates 16% of its GDP to health (2017).

However, despite large health expenditures, this country has results well below the standards of developed countries. For example, the United States is 34th in the world ranking that measures infant mortality, well below all developed countries and even some developing countries.

Types of Insurance

Like most countries, the health care system in the United States is mixed, with public and private health insurance. What sets it apart from the rest is the private sector's dominance over the public and the lack of universal health coverage. A survey conducted in 2011 revealed that:

  • 48% of the US population received private health insurance through their employer
  • 5% acquired health insurance independently
  • 13% were covered by the Medicare program
  • 18% were covered by Medicaid
  • 16% did not have health insurance

This 16% represents 50 million people without coverage. Given the high cost of healthcare in the United States, most people without coverage cannot afford the most expensive treatments, which puts their health and life at risk.

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How Medicare and Medicaid Work

Created in 1965, Medicare covers people over 65 and young people with disabilities or severe kidney problems. People who have contributed to the system for at least 10 years can also use it. Medicare has four parts:

  • (A) Hospital insurance: covers hospitalization for one night with semi-private room service, meals, exams, and medical fees, and may occasionally cover short stays for convalescence;
  • (B) Medical insurance: covers outpatient services not included in part A;
  • (C) Medicare Advantage: allows you to receive Medicare services through private insurers;
  • (D) Prescription Drug Plans: included in 2006, allow access to medicines for people covered by parts A and B.

Medicaid covers low-income families. The following are protected by federal law: pregnant women, children, the elderly, people with disabilities, and parents qualified under the country's poverty standards. The conditions imposed to be able to present this "poverty certificate" are so many that even thousands of people with basic needs do not qualify for this insurance.

There is also the SCHIP program (State Children's Health Insurance Program), which offers financial aid to families who earn more than the threshold to qualify for Medicaid help, but not enough to obtain health insurance. private.

However, these programs are not sufficient to guarantee universal access to health and coverage of all services. Medicare, for example, does not cover preventive medicine, dentistry, and ophthalmology. Medicaid and SCHIP are constantly rejected by private healthcare providers because their rate of reimbursement or financial recovery is very low.

The private sector also has its disadvantages. There are two ways to obtain private health insurance: through your employer or by hiring you individually. The first is the most common, while the second presents great difficulties since companies can deny coverage based on the person's health or pre-existing conditions.

Obamacare - What is it?

In March 2010, the Patient Protection and Accessible Medical Care Act, popularly known as Obamacare, was passed. With strong resistance in Congress by Republican Party lawmakers, who accused it of being a socialist measure, this law does not affect the structure of the US healthcare system.

The law obliges all people living in the USA to purchase some type of health insurance under penalty of a tax fine, that is, those who do not have, to pay a fine. It also grants subsidies to those who need to pay for it, prohibits denying coverage to people with a pre-existing medical condition, expands the minimums necessary to cover the health insurance offered by companies, and limits the cost by requiring insurers to publicly justify the price increase.

Ex-president of EUA, Barack Obama - via Pixabay

Source: Resumen Latinoamericano