Characteristics of US Health Care Systems

This paper identifies and focuses on the primary characteristics of US healthcare services distinct from other countries. The characteristics include free from government control, partial access, imperfect market, balance of power and multiple payers, advanced technology, continuum of services, legal risks, quest for quality, and third party-insurers and players.

Characteristics of US health care systems
CHARACTERISTICS OF US HEALTH CARE SYSTEMS
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Characteristics of US health care systems
The primary characteristics of US healthcare systems from free market perspective
Introduction
Every country of the world has their own primary characteristics in their health care
system depending on the level of their knowledge and government policies put in place (Shi &
Singh, 2014). This paper tries to identify and focus the attention on the Unites States’ primary
characteristics in healthcare services distinct from other countries. There are ten distinct
characteristics of US healthcare system that differentiate it from other systems of other countries
and they include:
Free from government control. The health care system of US is not government,
departmental or agency controlled. The government subsidizes healthcare services by paying a
minimum of 46% of total expenditure in private hospitals where the remaining 54% is privately
financed by the employers. This means that majority of hospitals and physician’s clinics are
owned privately as business without government interference (Buerhaus, DesRoches,
Dittus&Donelan, 2015).. Unlike other developed countries where comparison of global budget is
done to determine the government subsidiary according to the resources within budgetary limits,
US have no central agency to monitor total expenditure through global budget (Singh, 2015).
Even though, United States federal government plays a key role in health care system. The
government determines public-sector reimbursements and expenditures rates for services given
to Medicare, CHIP, and Medicaid beneficiaries (Buerhaus, DesRoches, Dittus&Donelan, 2015).
Also the government sets standards through formulating health policy regulation which providers
must comply with to be certified to provide services to Medicare, CHIP and Medicaid
beneficiaries.

Characteristics of US health care systems
The second characteristic is partial access. Access simply means the ability of a patient to
access the health care services whenever there is a need. The is restricted for health care in US
for people who have (1) employers have given them health insurance, (2) government health care
program covers them, (3) can individually afford to pay their own insurance, and (4) can afford
to pay services themselves (Rejda, 2015). The primary means of ensuring access therefore
remains Health Insurance (Rejda, 2015).However, community health centers supported by
federal government providephysician services to both those who can and those who can’t pay by
themselves. There are still barriers to accessing needed health care to uninsured even though they
are allowed to access certain types of services. The hospital emergency departments are required
by the United States law to evaluate patients’ condition and provide medically needed
medication services without a guarantee of direct payment not unless patient themselves can
afford (Califf et al., 2012).
The third characteristic is the imperfect market. Although the delivery of services in the
United States is actually owned privately healthcare is not fully governed by free market forces
(Singh, 2015). In the United States the delivery of healthcare services can’t pass the basic test of
free market forces hence described as imperfect or quasi-market (Shi & Singh, 2014). For a
market to be free, it must have; multiple patients (buyers)and providers (sellers) acting
independently and patients can choose to get services from a provider of their choice (Singh,
2015). When market conditions are free, there will be increase in demanded quantity while the
prices are reducedfor a particular product or service and also the prices will increase as the
quantity demanded reduces. Practically, instead of consumers of the services negotiating with the
providers of the service the providers negotiate with the payers of the service who could be

Characteristics of US health care systems
Medicaid, Medicare, or managed care. Since external agencies to the market are the once who
sets prices they do not govern the unencumbered forces of demand and supply (Singh, 2015).
The fourth characteristic is balance of power and multiple payers. Single-payer system is
sometimes also used interchangeably by a national health care system because it has only one
payer who is the government (Chernew, Mechanic, Landon &Safran, 2011). Service Providers
send the bill to the government agency after providing services that subsequently sends payment
to all service providers (Califf et al., 2012). In the Unites States there are many health plans and
insurances companies as employers have freedom to determine the type of services they want to
offer (Chernew, Mechanic, Landon &Safran, 2011). In this case, every enrollee is aware of
which plan to take from each plan. Service providers are faced with billing and collections
nightmares from these multiple payers (Brock, Hinings& Powell, 2012). Stresses of monitoring
payments receipts, rebilling denied claims by payers, lack of standardized billing practices, bad
debts etc. are the major problems that face service providers from multiple payers (Chernew,
Mechanic, Landon &Safran, 2011). Also due to lack of central governing body, government
groups, private, and many other occupations compete for power making it even more
cumbersome.
Physicians, insurance companies, the government, large employers, administrators of
health service institutions have been the key players in the US health care systems (Blank,
Burau&Kuhlmann, (2017). They each have their own economic interest they protect and are well
represented before lawmakers by well-paid lobbyist (Rejda, 2015). These groups make up the
most powerful and special interest groups. Without going into details of how different interest
conflict with each other, the results is just produces countervailing forces in the system of
healthcare (Singh, 2015).

Characteristics of US health care systems
The fifth characteristic is the advanced technology. Growth in science and technology in
US has been fundamental in their health care services (Singh, 2015). The country has been a hot-
bed of research and innovation in medicine. People equate high technology with high quality
care (Brock, Hinings& Powell, 2012). There has also been a trend of physicians and technicians
wanting to try new devices everyday. There is also a tough competition amongst hospitals
towards having the most advanced technology (Raghupathi&Raghupathi, 2014).There are
several reasons though for the need for the advancement of technology once it is developed.
Other characteristics includes continuum of services, legal risks, quest for quality, and third
party-insurers and players.
Conclusion
The above discussed primary characteristics of US health care services have either
positive or negative consequences to both healthcare service providers (sellers) and patients who
are the consumers of services. Technology being one of the most outstanding and unique feature
it has made the Unite States more competitive in research and innovation in science and
medicine. To reduce some pressure it is advisable the government intervene to reduce the
pressures experienced in the system as a result of key players wanting to protect their economic
interest.

Characteristics of US health care systems
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