Wednesday, March 12, 2014

Why the US has the highest total health expenditure (PPP) per capita

US spends 7,400$ per capita per annum for health-care, being the most expensive system in the world, seconded by Norway paying 4,300$ per year. (http://en.wikipedia.org/wiki/Health_system#International_comparisons[1] )
US has the highest spending in terms of %-of GDP in the world as well.
Generally, it is argued that one of the reasons the US system is so expensive, is because of - "all the middlemen" if you want. Before a person can see a doctor for treatment, a system of "payers" (i.e. the insurance companies) have to verify that you are eligble for treatment, that they will pay for it, and that you are indeed sick. At the same time, the providers can be private companies (or associations of doctors) who are, besides making you well, interested in making money.
These two incitaments are argued to create an effective market, where you get what you need, at the cheapest price (The effective market theory). However, what is argued, with respect to the expensive health care system in the US, is that another incentive (that of profits) trumphs the effective-market effect. In other words:
1) The payors are not interested in paying for your health care unless you really need it, leading to postponement of early-detection and preventive heath care, which means in turn, that most diseases are not treated before its 'too late and too expensive'. As an example: its better to identify and prevent futher development of say Diabetes, than wait until people have gangrene and need surgery to have toes removed, then training and asissted livign. This leads to too little prevention and too little treatment of people without proper insurance.
2) The doctors are not interested in 'just' treating you, they are interested in making money, which means 'overservicing' you. a light example is you getting medication when you dont need it (think of getting penicilun when you have the flu.. it doesnt work, but you might be prescribed it anyways; or getting 3 kinds of painkillers when you really only need one). Worst case; you will receive surgery when you dont need it, in order for the doctor to make more money in his/her private company (story sample:http://www.usatoday.com/story/news/nation/2013/06/18/unnecessary-surgery-usa-today-investigation/2435009/[2])
In countries with single-payer (the state) healthcare systems, where the doctors are public or semi-privately owned, the market might be less effective (i.e. they pay more for a drug than they need to) but on the other hand, they wont' get the two abovementioned drawbacks, meaning it might seem more 'bureaucratic' that the state runs it, but it is in fact, more cost-effective and less risky to patients and citizens. Preventive medication and early identification is at the focus of a single-payor system, whereas profits and high-cost/high-margin treatments are the focus of a multi-payor (insurance-paid) system.
From Wikipedia - estiamte of savings is 350 billion or roughly 10% of the total federal budget (incl. army).
An analysis of the bill by Physicians for a National Health Program estimated the immediate savings at $350 billion per year.[21] Others have estimated a long-term savings amounting to 40% of all national health expenditures due to preventative health care.[22] Preventative care can save several hundreds of billions of dollars per year in the U.S., because for example cancer patients are more likely to be diagnosed at Stage I where curative treatment is typically a few outpatient visits, instead of at Stage III or later in an emergency room where treatment can involve years of hospitalization and is often terminal.[23] Recent enactments of single-payer systems within individual states, such as in Vermont in 2011, may serve as living models supporting federal single-payer coverage.[24]

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