1. Discuss.

   1. Compare the cost of medical services in the USA and the U.K. In what country patient's expenditures on health are higher? Explain your reasons.

   2. Analyze:

      1. Freedom of choice of any kind of treatment, suitable to the English patient.

      2. Freedom of choice, applied to doctors and dentists.

   3. Prove that serious problems in the U.K. exist among people of dif­ferent socio-economic background. Compare them with the similar problems in the USA.

2. You take part in a "press-conference". You are the group of reporters of different newspapers and magazines. Some

of the students are the "guests" from the U. K. (a family doctor, a member of the Local Health Authorities, a doctor of the Health Centre, a rich patient, etc.).

1. Ask them as many questions as possible about the organization of health care in the U. K.

2. Write reports for your newspapers on the following topics:

   1. The National Health Service.

   2. Freedom of choice of English doctors and patients.

   3. English hospitals.

Problems of British health care system.TEXTS FOR INDIVIDUAL READING

I. Read the text through and find the answers to these questions.

Remember that you do not have to understand every word to

answer them.

1. What is Medicare responsible for?

2. What groups of the population is Medicaid addressed to?

3. What are the advantages of Medicare?

4. What are the drawbacks of it?

Medicare and Medicaid are programs of medical care for the aged and for the needy in the United States. The Medicare and Medicaid programs are under the direction of the United States Department of Health and Human Services. Medicare is a uniform national health insurance pro­gram for the aged and certain disabled persons. Medicaid is administered by the states within broad federal guidelines and finances health services for certain low-income groups.

MEDICARE

'^Medicare is the popular name for the federal health insurance pro­gram for persons 65 years of age and over. The ^^gram-went4nta effect 196Ф Benefits are divided kito two parts: (1) a basic hospital-insurance plan covering hospital care,^xtende(^ care,Tiorrie health services, and ItbV-' pice care for terminally ill patients; and (2) a voluntary medical-insurance program covering physicians' fees, outpatient services, and other medical services |[ Medicare costs are met by social security contributions, month­ly premiums from participants, and general revenues.

Medicare is responsible for major improvements in the health of elderly ^nd^is^le^ citizens, is well managed, and provides the financial ^jlnfffrpnuwig^fof much of the US health care system.

^Before Medicare's enactment, 50% of ^elderly,people had no health insurance. Now more then 97% of senior cmzens £re insured by Medi- cartOas are more then 90% of those who have end-stage renal disease and 3?<Hnilli(>n disabled people. Medicare has relieved elderly people of the ter­rible ahxiety they suffered when they did not have health insurance and coujd not pay for their own care. ⁵

l^Who is eligible for Medicare? - Workers and their dependents earn Medicare Part A eligibility, jiospital insurance, through payment of the hospital insurance payroll-fax (2.9% of wages, half of which is paid by the employer and half by the employee) during their working years. They receive coverage when they become 65 years old or earlier if they qualify for Social Security disability benefits or have ESRD (End stage renal dis­ease).

What Services does Medicare Pay for? -Medicare pays for acute care services including inpatient and outpatient hospital services, physician services, durable medical equipment, home health care, mid shmfr-fffesyeJji jofeillod-цщ uing f JClll Ll<jar)Services such as long-term nursing home care, hearing aids, and outpStrent prescription drugs are not covered. Medicare coverage has recently been extended to certain preventive services includ­ing hepatitis B, flu, pneumococcal vaccines and screening mammography.

Medicare is highly effective, but there is considerable room for improvement. Although Medicare beneficiaries have lower incomes, on average, then other insured persons, their out-of-pocket expenses for health care are far greater. Medicare requires beneficiaries to make sub­stantial payments for co-insurance and copayments. On average, older Americans spend 14% of their disposable incomes on health care, com­pared with 4% for the nonelderly (Office of the Actuary,. HCFA, unpub­lished data, 1995). Further, Medicare does not cover outpatient prescrip­tion drugs or most institutional long-term care. Many elderly people are forced onto poverty to pay for nursing home care, while the high cost of prescription drugs means that some beneficiaries d^ not _ч gel^the drugs they desperately need.jlviedicare has been called a dm&Saur⁵- aIprogJ^m that is too costly, is too inefficient, and has outlived its usefulness. In the^yiew o| Medicare's critics, radical restructuring is the only сигеД

Medicare should be correctedTjpver time these corrections should make Medicare less costly as well as more effective. Americans are looking for ways to make Medicare more efficient, both for today's senior citizens and future generations who are now paying into the systen^We know one thing for sure: -without any changes Medicare will go bankrupt^ But with the right changes that give beneficiaries more choices, we can guarantee the Medicare program for today's and tomorrow's beneficia­ries. ^This is the challenge before Congress and the American people. Together they can solve this challenge^