Health Policy Analysis Essay

It is officially recognized that the organizational structure of medical care in the United States is characterized by pluralistic essence, large variety of medical institutions, and absence of a unified central management. All forms and types of health care facilities provide medical services on a commercial basis, i.e. all medical services are paid. The question is only who, how much and how they compensate for the costs. The guarantor of health care provision is health insurance system, public and private, that is, a third party that pays health care providers.
In the U.S. there are three types of hospitals: public, private profitable (commercial), and private “nonprofit.” Private profitable or commercial hospitals are ordinary private business ventures with their typical features. They form their capital on individual, group and joint-stock basis.
Public hospitals are funded by federal and state government, that is, completely at taxpayers’ expense. They serve, as a rule, government officials, war veterans, invalids, persons suffering from mental illness and tuberculosis. Private “nonprofit” hospitals are established by local municipalities involving public funds, private individuals, as well as various organizations and charities. Healthcare institutions of this type are in many respects similar to commercial corporations of hospitals. They establish health maintenance organizations and preferred provider organizations, rehabilitation centers for persons suffering from alcoholism and drug addiction, manage other hospitals, invest in real estate, and receive profits (Mehrotra and Delamonica 141-174).
Nationwide, profit and non-profit hospitals combined allocate only 3 to 5% of their income on unreimbursed costs to help the poor. Moreover, both types of hospitals under the pressure of cost cutting measures tend to reduce the proportion of income allocated to such assistance (Mehrotra and Delamonica 141-174).
The central figure of the U.S. health care system is a private medical practitioner. According to a study conducted by the University of California in San Francisco, about 80% of all health spending in one form or another is controlled by them (Scanlon 37-55s). Many doctors are also shareholders in profit hospitals, health centers, diagnostic laboratories, or own shares of medical corporations. The motive for gaining profit in health care is no different from the desire to make profits in other sectors of the economy. Over the past three decades in the United States a trend has formed toward specialization and super-specialization of medical professions.
Thus, one of the key strategies for saving at the expense of treatment quality is the attempts of corporations that own hospitals to reduce competition and merge (the same process of merger for the same reason of reducing competition for the sake of stabilization of profit growth is seen in the mass media, banking system and in many other industries). Hospitals owning companies buy HMO, which, in turn, buy companies that produce drugs and the latter buy each other. Doctors often become sellers of specific drugs and medical procedures (Scanlon 37-55s). The problem is that monopolization and centralization of medicine is a dangerous sign of the destruction of competition and pluralist capitalism. For example, in the field of mental diseases treatment, Magellan Health Services Inc. owns 90% of U.S. psychiatric hospitals, controlling the treatment of nearly 50 million people with health insurance (Mehrotra and Delamonica 141-174).
In the whole, the failure of the introduction of public medical care system has led to the formation of a corporate, no less normalized system. The problems that meant to be avoided by rejecting the Clinton plan are fully present in the new profit-oriented (and, hence, money-saving) system. It involves group administrative-controlled health service plans implemented throughout the country by special agencies (HMO) (Scanlon 37-55s). The reform has been carried out, but in the direction imposed by medical insurance companies.
Patients assigned to HMO are faced with bureaucratic procrastination, severe restrictions in choosing a doctor, loss of privacy, and restrictions in the medical service itself. It has been assumed that the new system would require less paper work and bureaucratic accountability than the public one. However, in choosing a course of treatment the doctors are obliged to use bulky reference books, and if the proposed medical treatment exceeds the cost of generalized parameters of authorized medical service, he/she must account for it to the special official responsible for controlling the funds. In short, the bureaucracy of private medical service agencies is no weaker in their ability to restrict the treatment than the public ones.
If complete regulation of the economy, as it has been proved by the example of East European economies, kills economic development, the complete deregulation may also lead to poor product quality because unaccountable to anyone manufacturers can begin to neglect the interests of consumers (Scanlon 37-55s). Likewise, if the lack of material incentive lowers the quality of work, the exceptional focus on profits also may lead to such a decline.
The current reduction in state regulation of medical services leads, as one can see, not to the increased competition and increased choice for consumers associated with it, but to the reduction of competition (Scanlon 37-55s). Several giant corporations divide the entire market between each other fixing the prices for medical services. In this atmosphere, some health professionals are more focused on the money they gain, not on the job (Mehrotra and Delamonica 141-174). Medical personnel often work for too many hours trying to earn as much as possible. And a tired doctor or nurse, like a tired pilot of a passenger aircraft, is more prone to mistakes and miscalculations.
However, the U.S. has a generally well-functioning mechanism for monitoring the quality of medical care and appropriate use of funds from the state treasury. American Medical Association, which unites half of all private practitioners in the United States, directs and supervises their activities. The U.S. Congress has developed a special legislation aimed at curbing malpractice in American health care. Thus, the main role in the structure of federal executive office belongs to MHW. As the lead coordinating agency of the federal government in health and social programs, the Ministry provides the President the recommendations on policy in areas of health, welfare, and income security. The Congress also has the right to monitor the activities of this government agency (as well as the work of other federal agencies). Reporting of the Minister and senior officials of MHW at the meetings of committees and subcommittees of the Congress is one of the forms of supervision.
The destruction of pluralist capitalism with its competition and increasing consumer choice, which are the mechanisms of improving the quality of products or services, takes place in the United States not only in medicine and medical care. The same thing is happening today in the American airline industry where there are only two multi-corporations which are also very likely to soon become one. To preserve competition, in the U.S. there are laws against excessive corporate associations (antitrust laws). And while the tendency of corporations to avoid competition by increasing their control over the market continues to grow, it is necessary to make these laws applied more frequently.