Income - Poverty - and Health Insurance Coverage

Question: Discuss about the Income, Poverty, and Health Insurance Coverage. Answer: Introduction Even to the highly industrialized and economic powerhouses like America and Australia, healthcare provision and delivery has become a challenge. The two countries have used several strategies in attempting to curb the ever increasing cost of this essential service. To shift medical enrollees to health managed forums, the United States enacted the balanced budget act in 1997. In this legislation, there would be a gatekeeper physician who would reduce costs by eliminating unnecessary admissions and examinations. The enrollees realize a reduced out of pocket expenditure on medication (Luxford, Safran and Delbanco, 2011). On the other hand, Australia had for a long time provided a medical system to her citizens through the universal healthcare; they, however, changed when this costs could not be sustained. They then adopted the private healthcare system. The Australian philosophy is anchored on the fact that health services should be availed to all citizens regardless of the costs (Tilbu rt et al., 2013). Contrastingly, the threat of United States emphasizes on the fact that Citizens can access the service without having to entirely dependent on the government. However, the healthcare cost in the United States is continuously on the rise and consuming a generous chunk of the GDP. Given the recent escalation of cost in the health services, it has become a big business (Neumann et al.,, 2008). The government has the burden of having to fund approximately 65% of the country's healthcare budget. With the adoption of the Affordable Healthcare Act, this figure is expected to rise further as it approaches 2024 where it is projected to hit the 68% mark. As at 2013, the government spent $5,960 per capita on healthcare costs. This was the highest recorded globally (Raleigh et al., 2008). It even beat countries with the universal healthcare systems like United Kingdom, Canada, Australia and Sweden. The perception that American health care system is predominantly private conflicts with the finding of how much the government spends on the healthcare system. This implied that they also paid the highest health-related taxes (Chassin, 2013). Sustaining healthcare programs like Medicaid and Medicare accounted for almost50% of the total government spending on health. Other overlooked funding expenditures include the outlay of the government for private health insurance coverage for the public employees. This amounted to 6.4% of the total spending, $188 billion. Another hidden expense is the subsidies the government provides to healthcare. This amounts to $294.9 billion, or 10% of the total spending on healthcare. The high costs are related to the expensive technological advancements that the health sector has adopted (Ahern et al., 2011). The expenditure has continuously increased at a rate greater than the economy has grown. In the 1960s, the healthcare spending was reasonably small and ranged from about 6% of the GDP (DeNavas-Walt, 2010). This high expenditure of GDP on healthcare has to be reduced if the country has to realize more growth. The government is consequently, contemplating on ways it could provide universal health care to reduce these costs. The high healthcare expenditure means a decrease in the national budget since funding for other programs have to be reduced (Weisfeld, 2011). At individual levels, more spending on healthcare means reduced expense on other things. For the employed, it means the employer is paying less as a result of the deductions. Moreover, most people cannot afford healthcare but still have to receive the service. Whichever way, this service must be paid for. This means that other people have to pay more to cover this. The 48million citizens in the United States do not have healthcare insurance, yet they have to be covered (Zimlichman et al., 2013). Different government levels including state and local fund the country's healthcare system. Private health arrangements for health insurance also support the same. Like in the United States, Medicare is funded and issued by the Australian government. This insurance scheme consists of three components. This includes medical services (incorporates fees to visit general and medical practitioners). Secondly, it includes patient pharmaceuticals prescription. The government funds a broad range of health services as the health facilities for the community, medical research, and health services for Straight Islander. Mental health services are also included together with other health related infrastructural development. The territorial governments are also responsible for delivering and managing public health services. Most healthcare practitioners and doctors are employed in private practice, and the government salaries fewer (Stiggelbout et al, 2012). In the 2011/2012 budget, the Australian government spent a total of $140.2 billion which reflected 9.5% of its budget. Compared to 1001/2002, this figure has increased by a factor of 1.7. Similar to the United States the healthcare is fast growing than the population and economic growth. Such growth of healthcare needs can be attributed to social factors like the continuously aging population, the increased incidences of disease and risk factors. Other factors such as increased personal income, economic trends together with technological advancements all play an integral role in the determination of income spent on health care services. This is a reflection of the intertwinement between the healthcare sector and the society. The country's philosophy is also built on the fact that a healthy nation is critical to personal and national prosperity and well-being (Neumann et al., 2008). Medicare gives an opportunity for the citizens to access subsidized medical services and free treatment to her citizens. It was introduced in 1984. Its primary objectives are to make healthcare services affordable and accessible to Australians. Furthermore, it seeks to provide a high quality of health care services. In its benefit schedule entails covering bills and expenses related to fees for the practitioners in the form of rebates. The benefits of Medicare are based on fee schedules set by the government with the consultation of medical professions. In other cases when the health insurance covers the medical expenses, for the case of private health services, Medicare caters for 75% of the required fee. When the services are to be provided out of the hospital, Medicare provides 100% of the benefits especially for the schedule for non-referred patients. This cover includes the fees for the nurses' items (Parekh and Barton, 2010). Medicare and prescription pharmaceuticals Under the medicines benefits scheme, Medicare also provides subsidies to prescription pharmaceuticals. This scheme allows the citizens only to pay for a portion of the drugs they buy in pharmacies. The scheme then covers the rest of the bill. The patients pay a varying amount of payments up to the maximum of $36.10 by general patients. Those with concession cards pay up to $5.90. The drugs that are not listed by the scheme have to be fully paid for by the customer. Furthermore, the state covers the costs of medicines that are to be provided in public hospitals (N.C.H.S, United States, 2013). There is also another scheme for repatriation that includes the pharmaceuticals provided to war veterans, their widows, and other dependants. Other programs are also available that targets the disadvantaged in the community. People living in the rural and remote regions may be included. There is also a package of $805 million provided for chronic disease by the government and targets at reducing and preventing the occurrence of chronic illnesses among the Australian population (N.C.H.S, United States, 2013). Limited healthcare access in the rural areas The implementation of health programs should be effective in meeting their goals with the efficient resource use. The target beneficiaries should also receive these services in an equitable manner. Achieving all the principles at one go may be tricky. Equity, however, is integral for sustainability of programs (Gulliford and Morgan, 2013). Healthcare access is varied across the several populations of United States. There is a disparity in health care service provision. The difference majorly occurs due to different reasons. The rural areas in the country specifically have limited access to healthcare. They cannot access, dental care, behavioral health, and emergency services. Accessing these services is important for the general rural population regarding the general physical and mental health. Disease prevention is also critical to the rural people. Improving access to health services would also mean early detection and treatment of illnesses. For example, the earlier cancer is diag nosed, the better regarding cure possibility. All these will be under the umbrella of increasing life expectancy (Gulliford and Morgan, 2013). Residents of rural areas are often limited to getting access to the healthcare they may need. This implies that improving health services would mean adequate healthcare services availed promptly. Most people in the rural areas lack insurance for health covers. About 23% of nonelderly residents of the rural America were not insured. Their counterparts in the urban areas recorded a slightly lower figure of 21%. In the case of affordable healthcare access, more citizens in the countryside were hence eligible compared to those in the urban areas. Most rural residents works in the low-paying sectors hence are not able to afford the health insurance. This limits their access to these services. Moreover, there are also very few health providers who make their services affordable and still make it to the rural areas (Barker, Gout and Crowe, 2011). In particular, the services that would not be accessed by these people would include; Obstetric services; since the 1980s, there have been a continuously reduced obstetric services in the rural areas. This was attributed to the reduced number of hospitals and specifically those providing obstetric services. In fact, less than half of rural women live in areas less than a 30-minute drive from the nearest point of accessing prenatal services. Mental health services; scarcity of specialists in the rural areas offering mental health services makes it difficult for this service to be accessed by the rural residents. As a result, this service is increasingly being provided by the telehealth. This means the citizens to provide these services in schools. This was found to be effective and efficient. Dental health services; since the oral health affects the ability of an individual to perform in other activities, dental services are critical for them. Most insurances coverage does not entail dental health; hence the proportion rural residents who can receive dental services are limited. These regions also lack qualified dental professionals (Luxford, Safran and Delbanco, 2011). Workforce shortage; in most cases, lack of health professionals can prevent the supply of services. In 2014, 60% of areas marked for low health professional numbers were the countryside. These challenges could be addressed through partnering with other healthcare units. Recruitment and retention of these service providers could serve to reduce these shortages. The pay and allowances for those professionals working in these areas could encourage them to work in such environments (Fitzpatrick et al., 2004). The status of health insurance; the individuals without health insurance cannot access medical service unless at a higher cost typically not affordable by the rural community. Most of the rural communities cannot afford such covers compared to their urban counterparts. Such individuals are forced to forego medical services due to it not being affordable. The proportions of low-income earners in the rural areas are also lower than those in the urban areas. 7% of rural residents live in areas, not in access to Medicaid. This further limits the affordability of healthcare insurance scope (Barker, Gout and Crowe, 2011). Transportation and distance; to access health care services, those living in rural areas might be compelled to travel longer distances especially the care that would need special professions. This is because these specialists are often far away. The special facilities are also located not within their productive. This might compel them to have to travel longer distances thereby wasting time and money. Emergency services might also not be addressed in time. Another key challenge is transportation. The rural areas lack public transit that would carry patients to hospitals. The chronic conditions by the older adults in the rural may call for frequent and multiple visits (Chassin, 2013). Privacy concern and social stigma; there is little anonymity in the countryside; social factors may hinder access to healthcare. The residence may show reluctance to seeking services related to sexual health, mental health or pregnancy issues due to privacy. These concerns may stem from their personal relationships with the healthcare providers. Poor Health Literacy; this affects the ability of a patient to comprehend health-related information from the providers. In the rural areas, there are lower education levels and higher levels of poverty. This has a positive correlation with health illiteracy (Laditka and Probst, 2009). Comparison of the United States and Australian health care system In cases of emergency, it may not be fair to ask a patient to pay $7 for admission. The patient should be entitled to a free medical care in case they need it. Currently, Australian patients pay nothing to see their health providers. It is argued that the treatment cost is made higher out of control for the Australian government and patients have to be charged something to reduce this burden on the government and keep the healthcare sustainable. Compared to the United States which sought to reduce the admission and examination costs for minor conditions, the Australian emergency rooms in hospitals are filled with patients with minor complications such fees have been argued to be unfair on moral grounds (Squires , 2012).The argument is that Australians should continue the enjoyment of not having to worry about payment when they are in need of emergency services (Armstrong et al., 2007). The United States can have some lessons to learn from this different model in Australia. Both systems have undergone tremendous changes since time immemorial. The higher costs have been the primary reasons for changes in the sector. Changes have occurred in several dimensions including legislative and funding. In Australia, the national system changed to the private system then reverted to the national system. Today, Australia is based on the universal healthcare system which is known as Medicare. This system was returned in 1984. To alleviate the chances of catastrophic losses, the government maintains that those receiving a certain threshold of income maintain health insurance (Armstrong et al., 2007). As opposed to the United States which adopts the system of market justice, the Australian system is anchored on social justice. The Australian system is based on the fact that every citizen should have access to basic health care. It even attempts to find ways of incorporating the Australians of aboriginal origin. The ministry of health and aging holds the docket for health service delivery. The department holds a central point of distribution of services. As opposed to the United States which spends a bigger chunk of its GDP on healthcare provision, Australia spends a reasonably manageable amount of 9.1%. Since then the country has the universal system, the government is targeting to implement legislations as a means of managing the ever increasing costs. The American health sector is technologically advanced compared to those in most parts of the world (Ahern et al., 2011). In fact, other countries rely on the United States for the development of healthcare technology. In Australia, citizens pay to see a general practitioner. 50% of this amount can be claimed from the medical insurance. Ambulances are however not considered in the Medicare scheme. Problem facing health care in the United States United State has substantially been losing its citizens either by errors, accidents or terrible infections. Many of those people who are looking after the patients either by paying their bills in hospitals or paying for their care lose hope. Many births in the United States lack a particular medical schedule hence many women deliver unsafely thereby bring out major problems to the state (Parekh and Barton, 2010). There is the great shortage of doctors. There are no enough physicians in the states hence the number is estimated to be low by tens of thousands of doctors. This will be a great challenge to the United States because the government does not employ other doctors while the current ones are getting aged and the care demand also increases. To avoid this, the policy makers should know how they could conquer this problem. The state will need more than 61700 doctors by 2025 because of the shortage of specialists (Feczko, 2008). However, the nation should start to train more doctors for the patients to receive special needs they require. The main issue is that in the country there are many aged people and they need special care, this means that the state needs primary care physicians (Petterson et al., 2012). Avoidable harms are striking patients; this is one of the most common problems that face the Health Care in United state. An example is a Medicare patient who is admitted to an individual hospital suffers from certain harm during his or her stay. An example of the damage is like someone having a heart attack; would that person just enter to his or her car and drive? The early deliverance of babies is of great effect to the newborns and their mothers. Those babies who are born between 37-39 weeks are at high risk of dying. They are also easily attacked by certain harms like respiratory problems hence end up being admitted to NICU (Levay and Waks, 2009). Lack of transparency; the medical society and the national health organization had declared strict warnings to those women who will be found delivering babies before the appropriate time (Levay and Waks, 2009). Despite these warnings, the percentage of the early deliverance has greatly increased a report from a non-governmental organization called The Leapfrog Group. This voluntary survey was done with 800 hospitals that provided this data willingly. One of the biggest hospitals in the United States has tried to practice this transparency. They offered to provide physicians who treated the patients in a right way, and the patients were well satisfied (Sinaiko and Rosenthal, 2011). In conclusion, to reduce these problems, the number of training institutions of doctors should be increased by building more slots. The sector should also employ more professionals who can appropriately fill the gap. The government should ensure that he quality of the health care increases. The policymakers, the advocate and the department of human and health services should come in and declare the early deliverance as the top emerging issue. 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