6 Cost recovery in exceptional circumstances

In general, the cost of NHS health care is met from taxation and the NHS does not bill for its services. Each NHS system, however, reserves the right to claim compensation for treatment required as a result of the negligence of others. For example, when compensation is received from motor insurance companies through the Injury Costs Recovery Scheme following the determination of fault in motor accidents. Foreign visitors to the UK are not charged for emergency NHS treatment to stabilize a health problem that has started in the UK during their visit but cannot receive any other NHS services. If it becomes clear that a patient has received services who was not in fact eligible to receive free treatment, the NHS will recover costs from the patient.

7 Dentistry

Each NHS system provides dental services through private dental practices and dentists can only charge NHS patients at set rates (though the rates vary between countries). Patients opting to be treated privately do not receive any NHS funding for the treatment. About half of the income of dentists comes from work sub-contracted from the NHS. Not all dentists choose to do NHS work and there is a trend of movement from the NHS to private dentistry.

The English, Northern Irish and Scottish health services have charges for prescriptions, with exclusions for those who are not of working age (the young and the elderly), or those who satisfy certain criteria such as low income or permanent disabilities. Prescriptions are £5 in Scotland; £6.85 in Northern Ireland and £7.10 in England. Wales has no prescription charges. Overall, around 86% of prescriptions are provided free across the UK.

However, in addition to the public NHS systems which dominate healthcare provision, private healthcare and a wide variety of alternative and complementary treatments are available. Private health care continues parallel to the NHS, paid for largely by private insurance, but it is used by less than 8% of the population. Private health care is sometimes funded by employers through medical insurance as part of a benefits package to employees though it is mostly the larger companies that do. Insurers also market policies directly to the public. There are no private hospitals providing accident and emergency services. Most ambulance services are publicly run but some private and charity run ambulance services also exist.

The United States is alone among developed nations with the absence of a universal health care system. Health care is provided by many separate legal entities. Including private and public spending, more is spent per person on health care in the United States than in any other nation in the world. In 2007, the U.S. spent $2.26 trillion on health care, or $7,439 per person, up from $2.1 trillion, or $7,026 per capita, the previous year.

There is no nationwide system of government-owned medical facilities that is open to the general public. The care is generally provided by privately owned hospitals or physicians in private practice.

Healthcare in the U.S. does, however, have significant publicly funded components. Government programs directly cover 27.8% of the population (83 million), 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. U.S. government programs accounted for over 45% of health care expenditures, making the U.S. government the largest insurer in the nation.

Federally funded programs include:

Medicare[covers the elderly (65 years and older) and disabled with a historical work record]. (2)

Medicaid [generally covers low income people in certain categories, including children, pregnant women, and the disabled, administered by the states].(3)

State Children's Health Insurance Program [provides health insurance for low-income children who do not qualify for Medicaid, administered by the states, with matching state funds].

TRICARE [for military personnel in civilian facilities].

The Veterans Administration [provides care to veterans, their families, and survivors through medical centers and clinics].

There are also various state and local programs for the poor.

All government health care programs have restricted eligibility, and there is no national system of health insurance which guarantees that all citizens have access to health care. Americans without health insurance coverage at some time during 2007 totaled about 15.3% of the population, or 45.7 million people. More than a third of the uninsured are in households earning $50,000 or more per year.

In the United States, doctors and hospitals are generally funded by payments from patients and insurance plans in return for services rendered. Around 84.7% of citizens have some form of health insurance; either through their employer or the employer of their spouse or parent (59.3%), purchased individually (8.9%), or provided by government programs (27.8%, there is some overlap in these figures).

Among those whose employer pays for health insurance, the employee also usually contributes part of the cost of this insurance, while the employer usually chooses the plan and, for large groups, negotiates with the insurance company. Individuals with private or government insurance must generally find a medical facility which accepts the particular type of medical insurance they carry. Visits to facilities outside the insurance program's "network" are usually either not covered or the patient must bear more of the cost (usually waived for emergencies).

A research brief published by the Center for Studying Health System Change, in December 2008, found that most U.S. consumers rely on word of mouth and physician referrals when choosing health care providers.

Today, most employer-provided health coverage is provided through managed care organizations, which pay substantially lower prices for health care services than an individual patient would be charged if paying out-of-pocket. Managed care organizations include both health maintenance organizations (HMOs) and preferred provider organizations (PPOs). In an HMO, health care is covered only for services delivered by providers (such as doctors or hospitals) in the network with whom the health plan has contracts. A PPO covers health care delivered by either in-network or out-of-network providers, but the enrollee's cost is higher when using out-of-network providers.

Consumer driven health care (CDHC) (4) in the U.S. refers to health insurance plans that allow members to use personal Health Savings Accounts (HSAs), (5) Health Reimbursement Arrangements (HRAs), (6) or similar medical payment products to pay routine health care expenses directly, while a high-deductible health insurance policy protects them from catastrophic medical expenses. High-deductible policies cost less, but the user pays routine medical claims using a pre-funded spending account, often with a special debit card provided by a bank or insurance plan. If the balance on this account runs out, the user then pays claims just like under a regular deductible. Users keep any unused balance or "rollover" at the end of the year to increase future balances, or to invest for future expenses.

This system of health care is referred to as "consumer driven health care" because routine claims are paid using a consumer-controlled account versus a fixed health insurance benefit. That gives patients greater control over their own health budgets.

In September 2008 The Wall Street Journal reported that consumers were reducing their health care spending in response to the current economic slow-down. Both the number of prescriptions filled and the number of office visits dropped between 2007 and 2008. In one survey, 22% of consumers reported going to the doctor less often, and 11% reported buying fewer prescription drugs.

Notes

1. National Health Service (NHS) in Britain, system of state provision of health care established in 1948. The NHS undertook to provide free, comprehensive coverage for most health services, including hospitals, general medical practice and public health facilities. It is administered by the Department of Health. General practitioners (GPs) have registered patients; they may also have private patients and may contract out of the state scheme altogether. They refer patients, when necessary, to specialist consultants in hospitals.

2. Medicare national health insurance program in the United States for persons aged 65 and over and the disabled. It was established in 1965 with passage of the Social Security Amendments and is now run by the Centers for Medicare and Medicaid Services. Coverage for the disabled began in 1973. Medicare provides for a basic program of hospital insurance, under which enrollees are protected against major costs of hospital and related care; and a supplementary medical insurance program, through which persons are aided in paying doctor bills and other health-care bills. It is funded by a tax on the earnings of employees that is matched by the employer and by premiums paid by enrollees.

3. Medicaid is a federal-state entitlement program for low-income citizens of the United States.

All Medicaid recipients must have incomes and resources below specified eligibility levels.

These levels vary from state to state depending on the local cost of living and other factors. In most

cases, persons must be citizens of the United States to be eligible for Medicaid, although

legal immigrants may qualify in some circumstances depending on their date of entry.

Illegal aliens are not eligible for Medicaid, except for emergency care.

4. Consumer driven health care (CDHC) plans had their origins in the U.S. in the late 1990s,

primarily as business model for health e-commerce ventures. They were designed to engage

consumers more directly in their health care purchases. The initial conceptual model made cost and

quality information available to the consumer, usually through the Internet.

5. A health savings account (HSA), is a tax-advantaged medical savings account available to taxpayers

in the United States who are enrolled in a High Deductible Health Plan (HDHP). The funds contributed

to the account are not subject to federal income tax at the time of deposit. Unlike a flexible spending

account (FSA), funds roll over and accumulate year over year if not spent. HSAs are owned by the

individual, which differentiates them from the company-owned Health Reimbursement

Arrangement (HRA) that is an alternate tax-deductible source of funds paired with HDHPs.

6. Health Reimbursement Accounts or Health Reimbursement Arrangements (HRAs) are Internal Revenue

Service (IRS)-sanctioned programs that allow an employer to reimburse medical expenses paid by

participating employees, thus yielding "tax advantages to offset health care costs".

Vocabulary

1. expend (v) тратить; расходовать; истратить; expend money on- тратить (расходовать)

деньги на что-либо; expend some effort – прилагать усилия;

expenditure (n) затраты; расходование; расходы; public welfare expenditure –

государственные расходы на социальное обеспечение; recover expenditure –

компенсировать расходы; prescribe expenditure – устанавливать сумму расходов;

2. practise (v) практиковать; применять на практике; заниматься; license to practise as

a doctor – патент на врачебную практику; practise a method – практиковать метод;

practice (n) практика; применение; деятельность; метод; прием; contract practice –

врачебная практика по договору; family practice centre – центр семейной медицины;

practitioner (n) практикующий врач; врач-практик; general practitioner – врач

широкого профиля; private practitioner – врач, ведущий частную практику; nurse practitioner – медицинская сестра высшей квалификации с правом самостоятельной

практики;

3. treat (v) относиться; лечить; трактовать; обходиться; treat someone with drugs –

лечение лекарствами; treat a question – рассматривать вопрос; treat someone like a

dog- плохо обращаться с к-л.;

treatment (n) обращение; лечение; уход; трактовка; drug treatment – лекарственная

терапия; in-treatment – лечение в стационаре; medical treatment room –

процедурный кабинет; receive/get treatment – лечиться;

4. serve (v) служить; обслуживать; подавать; сервировать; serve interests – соблюдать

интересы; serve faithfully – служить преданно; serve notice – официально известить;

service (n) служба; обслуживание; сфера деятельности; услуги; health service

industry – система служб здравоохранения; technical support service –

техническое обслуживание;

4. emergency (n) экстренный случай; крайняя необходимость; emergency care – неотложная мед. помощь; emergency room – отделение оказания экстренной помощи; Emergency Call service – Служба экстренной медицинской помощи; emergency call – вызов скорой помощи;

5. guarantee (v) обеспечивать; гарантировать; ручаться; guarantee payment –

гарантировать платеж;

guarantee (n) поручительство; гарантия; give(grant) a guarantee – предоставлять

гарантию; guarantee liability – гарантийное обязательство; lifetime guarantee –

пожизненная гарантия;

7. deliver (v) представлять; передать; подавать; deliver medical care - оказывать

медицинскую помощь; deliver a speech – выступить с речью; deliver a

judgment/verdict – вынести вердикт; deliver on promises – выполнять обещанное;

delivery (n) поставка; передача; обслуживание; means of delivery – средства

доставки; cash on delivery – доставка наложенным платежом; service delivery –

оказание услуг;

EXERCISES