Health care finance in the United States
[3] The Office of the Actuary (OACT) of the Centers for Medicare and Medicaid Services publishes data on total health care spending in the United States, including both historical levels and future projections.
[17] Health insurance costs are rising faster than wages or inflation,[18] and medical causes were cited by about half of bankruptcy filers in the United States in 2001.
The authors of the study concluded that the prices paid for health care services are much higher in the U.S.[22] According to Financial Times United States spent more than $600 billion on medicines in 2022, nearly half of the world's total.
The Kaiser Family Foundation reported that the concentration of health care spending in the U.S. in 2010 was as follows: Other studies have found similar results using AHRQ analysis.
[25] Relative to the overall population, those who remained in the top 10% of spenders between 2008 and 2009 were more likely to be in fair or poor health, elderly, female, non-Hispanic whites and those with public-only coverage.
[31] According to a report from the Agency for Healthcare Research and Quality (AHRQ), aggregate U.S. hospital costs in 2011 were $387.3 billion—a 63% increase since 1997 (inflation adjusted).
[35] One consequence of employer-based coverage (as opposed to single-payer or government-funded via individual taxes) is that employers facing increasing healthcare costs offset the expense by either paying relatively less or hiring fewer workers.
Since health insurance benefits paid by employers are not treated as income to employees, the government foregoes a sizable amount of tax revenue each year.
[33] On March 1, 2010, billionaire investor Warren Buffett said that the high costs paid by U.S. companies for their employees' health care put them at a competitive disadvantage.
[39] The CBO estimated that ending or not enforcing the individual mandate (which requires those without health insurance to pay a penalty) would increase the uninsured by 13 million by 2027, reducing the budget deficit by $338 billion over 10 years as subsidies fall.
[43] The Affordable Care Act ("Obamacare") significantly expanded both eligibility for and federal funding of Medicaid starting in 2014, with an additional 11 million covered by 2016.
[44] Under the law as written, all U.S. citizens and legal residents with income up to 133% of the poverty line, including adults without dependent children, would qualify for coverage in any state that participated in the Medicaid program.
It employs over 300,000 personal and has a budget of $65 billion USD (2015)[52] The reasons for higher U.S. healthcare costs relative to other countries and over time are debated by experts.
There are many reasons why U.S. healthcare costs are higher than other OECD countries: In December 2011, the outgoing Administrator of the Centers for Medicare & Medicaid Services, Dr. Donald Berwick, asserted that 20% to 30% of health care spending is waste.
Reasons include, among others: In September 2008 The Wall Street Journal reported that consumers were reducing their health care spending in response to the current economic slow-down.
[66] Doctors and hospitals are generally funded by payments from patients and insurance plans in return for services rendered (fee-for-service or FFS).
The negotiated rate may not cover the cost of the service, but providers (hospitals and doctors) can refuse to accept a given type of insurance, including Medicare and Medicaid.
[69] The City and County of San Francisco is also implementing a citywide health care program for all uninsured residents, limited to those whose incomes and net worth are below an eligibility threshold.
Long wait times have become a problem nationally, and in urban areas some ERs are put on "diversion" on a regular basis, meaning that ambulances are directed to bring patients elsewhere.
[73] A survey issued in 2009 by America's Health Insurance Plans found that patients going to out-of-network providers are sometimes charged extremely high fees.
Despite a substantial body of research demonstrating that many staff-model HMOs deliver high-quality and cost-effective care, they have steadily lost market share.
Government programs directly cover 27.8% of the population (83 million),[71] including the elderly, disabled, children, veterans, and some of the poor, and federal law mandates public access to emergency services regardless of ability to pay.
[77] Per-capita spending on health care by the U.S. government placed it among the top ten highest spenders among United Nations member countries in 2004.
[85] However, one advantage of health insurance accounts is that funds can only be used towards certain HSA qualified expenses, including medicine, doctor's fees, and Medicare Parts A and B.
[88] It has been reported that the number of physicians accepting Medicaid has decreased in recent years due to relatively high administrative costs and low reimbursements.
The uninsured still receive emergency care and thus if they are unable to afford it, they impose costs on others who pay higher premiums and deductibles to cover these expenses indirectly.
"[100] Numerous publicly funded health care programs help to provide for the elderly, disabled, military service families and veterans, children, and the poor,[101] and federal law ensures public access to emergency services regardless of ability to pay;[102] however, a system of universal health care has not been implemented nationwide.
[106] In July 2009, Connecticut passed into law a plan called SustiNet, with the goal of achieving health care coverage of 98% of its residents by 2014.
[108] On the other hand, research conducted by Novartis argues that the countries that have excelled in getting the highest value for healthcare spending are the ones who have invested more in prevention, early diagnosis and treatment.
However, preventive measures such as improved diet, exercise and reduction of tobacco intake would have broad impact on many diseases and will offer good return of investment.
