Health care services in the usa

American hospitals are in general well-equipped and efficient, and doctors earn incomes far above the general average. For anyone who is ill, the cost of treatment is very high. There is strong prejudice against ‘socialised medicine’ (particularly among the doctors), and there are only two federal programmes. Medicare provides nearly free treatment for elderly, Medicaid for the poor – though, with an extremely complex system of admissible charges through Medicare, elderly people do not receive the full cost of some types of expensive treatment. Even so, the cost of Medicare to federal funds rose to seventy billion dollars in 1985, or more than two thousand dollars for each of the thirty million participants. Medicaid, for the poor, varies from one state to another because the states are heavily involved in it and some contribute more generously than others.

Working people and their families are normally insured through private schemes against the cost of treatment and against possible loss of earnings if they are ill. The schemes are often operated by deductions from the wage or salary. They too are enormously expensive, and the cost is rising. No single insurance system is absolutely comprehensive; some people have more than one policy and yet remain liable to bear some costs themselves.

Among ordinary people anxiety about the possibility of illness is accentuated by fears about its cost. These fears are reflected in some resentment against the medical profession, and this resentment is not alleviated by the doctors’ reluctance ever to visit patients in their homes.

About one-tenth of the Gross National Product is spent on health care, private and public together.

Although the GNP is high, this proportion is among the highest in the world, and the high earnings of doctors are a factor in the cost. There is reason for doubting whether the Americans are getting good value for this expenditure. Expectation of life is lower than in several other countries, and has risen less than in Japan, where health treatment absorbs less of the GNP – and several European countries can show a better record. Meanwhile, in some aspects of health where the people’s own behaviour may have more effect than the activities of hospitals and doctors, there are more favourable indications. Deaths of men aged 40-60 from heart diseases have declined in recent years, more than in some comparable European countries. But much of the improvement here is due to factors such as better diet and more exercise.

In the later 1980s two new developments are adding to the nation’s health-care costs: first, suits for damages, second, AIDS. There has been a dramatic increase in lawsuits brought by patients, claiming damages against hospitals or doctors or grounds that continuing illness or incapacity has been due to inadequate or misjudged treatment. Some lawyers argue such cases on the basis that if they win they keep a large proportion of the damages awarded. In 1985 the number of awards of even a million dollars reached seventy-nine; and many cases are settled out of court. Doctors must insure themselves against the risks, and in 1985 paid over three billion dollars in insurance premiums – about one-tenth of their total earnings. Medical decisions are being affected; births by Caesarean section have risen to a quarter of all births. Fear of being sued discourages some doctors from helping victims of accidents which they see by chance. Drug producers are affected too. Two-thirds of the cost of a child’s vaccine against diphtheria and whooping-cough goes to protect the drug company against damages awarded for cases which go wrong.

Second, the United States had, by 1987, seven times more people suffering from AIDS than the whole of Western Europe, with its bigger population. By then more than 18,000 people had died of AIDS. The number of victims was expected to be five times as great by 1991. With no national health service fund available, the problem of paying for the treatment of the patients, was expected to rise to eight billion dollars in 1991.

(Peter Bromhead, Life in Modem America)

Exercise 1. Answer the following questions.

1. Is there a system of free medical care in the USA? 2. What are the two government programmes in the sphere of medical service? 3. The system of health insurance is widely used in the USA. What are the reasons? 4. Why are Americans so much afraid of getting ill? 5. What per cent on Gross National Product (GNP) is used for health care? 6. Do Americans get good health care for this money? 7. What are the two main problems which have appeared recently in the health care system of the USA? 8. Why do doctors insure themselves against inadequate or misjudged treatment? 9. What are the reasons for Americans to worry so much about AIDS? 10. What is the difference in Health Service in Britain and the USA?

Exercise 2. A. Compare the Health Service Systems of Britain and the USA with the one you have in your country.

B. Speak about the Health Service in Russia, its advantages and disadvantages, system of life insurance.