Escalating Costs of Social Health Insurance Essay Example for Free

Escalating Costs of Social Health amends EssayUn alike each other expanse in the world, the joined States continu in ally experience rising cost of wellness negociate provision. Wolfe (1999) reports that wellnessc be be has been change magnitude at a high rate for decades, it is estimated that e precise 40 months, the share of Gross Domestic intersection point (GDP) spent on wellnesscare goes up by 1 share. Health expenditure which stood at 12. 3 pct of GDP in 1990 increased to 16. 0 bulge of GDP in 2006 and is projected to pull ahead 20 portion in the next 7 age.Between 2005 and 2006 alone, wellnesscare pass increased by 6. 7 percent, exceeding nominal GDP growth by 0. 6 percent, to a whooping $2. 1 trillion, representing an estimated $7,000 spending per person (Kuttner 2008 Catlin et al 2008). Various factors including inflation, aging population and advances in medical technology has been indicted as been answerable for the global increase in wellness expe nditures, however, the American situation appears to be peculiar.Kuttner (2008) call fors that the proliferation of new technologies, poor diet, need of exercise, the tendency for supply (physicians, infirmarys, tests, pharmaceuticals, medical devices, and novel treatments) to generate demand and the culture of the American litigation, resulting in spendthrift malpractice litigations and the practice of defensive medicine, all adds together to ensure that the country experiences the largest and fastest growth in health expenditures, while at the same time, defeating efforts at cost containments.Like every other developed country, health indemnification systems, especially affable health redress systems constitute the primarily methods of health financing (Carrin and James, 2004). This parade ensures that most of the cost of healthcare are compensable by third parties, either through ordinary establishments, as in fond (public) health insurance policy systems, or by un der dog bodies, as in mystical health insurance system, or in close to racing shells, a admixture of both (Wolfe, 1999).The mixture of toffee-nosed and social health insurance is present in almost every country, with variations in their cover age. eon in most European countries, social health insurance is deeply ingrained in social fabric and provides the largest source of funding and insurance reportage (Saltman, 2004), the vast majority of Americans befool their health insurance coverage through employer based private insurance, with the rest of the country covered by any of the some(prenominal) public health insurance syllabuss (Glover et al 2003).It is estimated that employer private health insurance covers approximately 63 percent of the population, with 51 percent of these amount covered by their own employers, while the remaining 41 percent are covered as a workers dependent 14 percent are covered by public programs, 5 percent covered by mortal insurance policies w hile an estimated 17 percent of the population are uncovered by any insurance (Devi, 2005).Medicare is largely regarded as the primary depicted object (social) health insurance program in the United States, providing coverage for an estimated 44 gazillion Americans over the age of 65. It is to a fault estimated that Medicare provides health insurance coverage for about 7 million Americans under the age of 65 who keep back a disability or chronic condition (Fact Sheet, 2007).Social health insurance is a vital part of any countrys health care and health financing program, in some part of Europe, there is a general contention that social health insurance is not alone an insurance arrangement, but a way of life, they are seen as a part of a social incomes insurance that seek to redistribute wealth and health risk take downly amongst the population, however, the rising cost of these systems, not just in the United States but across the modern world, threatens the system.Before an an alysis of the costs and factors driving costs of social health insurance systems, especially in America and in other European countries, it is of import to first briefly describe the underlying principles of the social health insurance system and its difference from the private health insurance programs.This will be followed by a description of the United States Medicare program and some social health insurance programs in selected European countries and then a look at the costs of these programs. Steps taken towards cutting costs of the social insurance programs and the differences in cost cutting approaches among the United States and European Union countries will be examined.Lastly, future approaches that could help ameliorate the financial challenges veneer the United States public insurance programs shall be recommended. Social Health restitution Social health insurance, in its basic principle, in any society achieves a set of societal objectives through its peculiar normal of financial cross subsidies, which covers redistribution from the healthy to the ill, from the well off to the less well off, from the young to the old and from the individual to the family.This redistributive focus of any social health insurance program distinguishes it from what is nominally regarded as insurance, thus, in some(prenominal)(prenominal) societies, it entrenches solidarity, income redistribution and is thus seen as a key part of a broader structure of social security and income restrain that sits at the heart of civil society (Saltman, 20045) Saltman and Dubois (2004) contend that although Ger legion(predicate) is considered the source of the modern day form of social health insurance, when it codified existing voluntary structures into compulsory state supervised legislation in 1883, the archives of social health insurance (SHI) dates back longer to the medieval guilds in the late Middle Ages.However, they concur that the structure and harmoniumization of SHI over time has considerably evolved the number of raft covered has increased from a small number of workers in particular trades to a larger portion of the population, the central concept SHI has evolved from wage replacement a death benefit into chip inment for and or provision of outpatient physician work, inpatient hospital care and drugs thirdly, the administrative structure of SHI has alike evolved from cooperative workers association to state mandated legislative character, beginning with Germany in 1883 and the most recent, 1996 in Switzerland.Structurally, social health insurance everywhere possesses three common characteristics. Social health insurance programs are administered privately in both funding and in the provision of health services as a result of their private administration, social health programs are self regulating, and lastly, as a consequence of their independence and self regulation, social health insurance programs are relatively stable, both in organ izational and financial terms (Saltman, 2004).As a fall out of these structural characteristics, social health insurance posses several core components that differentiate them from private health insurance programs. Under SHI, the raising of funds is tied to income of beneficiaries, usually in the form of a trans upraise and fixed percentage of wages. As a result, contributions are risk independent and thus encourage maximal risk pooling. Also, collection and administration of revenues for the program are handled by not-for-profit and sometimes, state run funds and these funds are usually managed by table members that are usually representative and elected. The United States Medicare program posses most or all of the characteristics of a social health insurance program.For over 40 years, the program has successfully provided healthcare access for the elderly and millions of mountain with disability. It is regarded as the nations single largest health insurance program and it cover s a wide range of the society for a broad range of health services. For example, Potetz (2008) report that one out of ever five dollars spent on healthcare in 2006 came through the Medicare program. The program is also reported to fund, at least, one third of all hospital term of enlistments, nationally. In most European countries too, national, public (social) health insurance programs reportedly covers a large equipoise of the population, in most cases, reaching up to 100 percent coverage.Saltman and others (2004) reports that in Austria, Belgium, France, Germany, Luxembourg, the Netherlands and Switzerland and from 1995, Israel, all rich person health insurance systems where (public) social health programs plays predominant roles in organization and funding of health care services, where between 60 to 100 percent of the population are mandatorily covered. They further argue that even countries like Finland, Sweden and the United Kingdom, Greece and Portugal that have a tax fun ded National Health Service schemes, segments of SHI based healthcare funding also exists. Explaining the difference between social health insurance programs and private health insurance, Thomson and Mossialos (2004) contend that private health insurance play very insignificant role in the health systems of several European countries, either in terms of funding or access to healthcare.Unlike in the United States where more than 60 percent of the population are covered by private employer based insurance, private health insurance programs covers a relatively small proportion of the population and accounts for less than 5 percent of the total health spending, with the set off oution of France, Germany and the Netherlands. The most common difference between social and private health insurance includes eligibility, risk pooling and benefits. For social health insurance programs, contributions are mostly based on a fixed or set outing proportion of wages, without regard for risks, thu s a wider proportion of the people are eligible and benefits i. e. health services offered are broader with less out of pocket costs (Thomson and Mossialos, 2004 Saltman 2004). For private health insurance, the reverse is the case in most situations.Especially in for-profit private health insurance systems, contributions are adjusted according to risks and for the most part high risks individuals are rejected or expected to buy off higher premiums. Consequently, eligibility requirements are strict out of pocket expenses might be higher, while services provided vary significantly across programs, depending on an array of factors. Depending on the generally functions and services offered by private health insurance, the relation to social health insurance can be substitutive, complementary or supplementary. Substitutive private health insurance programs provides insurance covers that is otherwise available from the public programs purchased by individuals or groups who are excluded f rom the SHI.The larger proportion of the US society is excluded from the public insurance programs, which are usually available to the elderly, the disabled or the very poor, the rest of the population must rely on private employer based insurance. However, in European countries with impressive SHI, only certain individuals with income above a certain upper threshold are excluded from the public insurance program e. g. in Netherlands and Germany, while the rest of the population are eligible. Complementary private health insurance programs provide cover for services not fully covered by the SHI programs or totally excluded, the Medicare + pickax plans is an example of such covers. Lastly, supplementary private health insurance provides cover for faster access and also increased consumer choices for individuals who can afford it (Thomson and Mossialos, 2004).Eligibility and CoverageThe United States Medicare program is essentially for the elderly, thus, individuals are eligible for Medicare coverage if they are citizens of the United States or have been a permanent legal resident for five continues years and over 65 years old. Individuals younger than 65 years of age can also be eligible for Medicare coverage if they are disabled and have been on the Social Security Disability Insurance (SSDI) or the Railroad Retirement Board benefits for a period of both years. Further, individuals with end state renal disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS) known as Lou Gehrigs disease also qualifies for Medicare coverage. However, many people with disability do not qualify for SSDI benefits and by extension, Medicare.To qualify for these benefits, disabled individuals must have a family member under age 65 who have a work history which include Federal Income Contribution fleck tax (FICA), an individual may also qualifies for SSDI on the FICA contributions of a parent as a Childhood Disability Beneficiary (CDB) or as a disabled better half of a deceased spo use. Whichever qualification route applicable, an individual qualifies for Medicare two years after he/she starts receiving the SSDI benefits, except for the Lou Gehrigs disease where Medicare benefits starts in the first month SSDI payments are received or in the case of the ESRD where Medicare benefits starts within three months of the first dialysis (Fact Sheet, 2007). As of 2007, it is estimated that Medicare provides cover and health services to about 43 million Americans.This figure is expected to double to 77 million by 2031 when the baby boomers of the post World contend II period start to retire. However, as mentioned previously, SHI in European countries offer universal coverage that is mandatary in some countries. Coverage for these countries varies from 63 percent in Netherlands to 100 percent coverage in France, Israel and Switzerland. In most of these countries, it is usually the highest income groups that are either allowed or required by law to leave the social heal th programs for private health insurance (Saltman, 20047). Benefits Benefits for Medicare members have continually been modified. The original program has two parts, Medicare Part A and part B.The Part A program known as Hospital Insurance, covers hospital stays with stays in skilled nursing facilities for limited periods if certain qualifying criteria are met. much(prenominal) criteria include the length of hospital stay, which most be three days, at least, excluding the discharge day and stay in skilled nursing facility must be for conditions diagnosed during the hospitalization. Medicare Part A allows up to a maximum of 100day stay in skilled nursing facilities, with the first 20 days completely paid for by Medicare and the remaining 80days paid in part and requiring a co-payment from the beneficiary. The Medicare Part B covers services and products not covered by Part A, but on an outpatient basis.The benefits under this coverage includes physician and nursing services, scienc e lab diagnostic tests, influenza and pneumonia vaccinations x-rays and blood transfusions. Other services include renal dialysis, outpatient hospital procedures, Immunosuppressive drugs for organ transplant recipients, chemotherapy, limited ambulance transportation and other outpatient medical treatments carried out in a physicians office. This coverage, to some extent, also includes medical equipments like walkers, wheelchairs and mobility scooters for individuals with mobility problems, while prosthetic devices, such as breast prosthesis after mastectomy or eye glasses after cataract surgery are also covered. The recently added Part C and D of the Medicare benefits slightly deviate from the original Medicare concept.After the Balanced Budget Act of 1997 came into effect, Medicare beneficiaries were allowed the option of receiving their Medicare benefits through private health insurance plans if they do not want to go through the original Medicare plans. These became known as Medi care + Choice as beneficiaries could choose any private health insurance plans and have it paid for by Medicare. The Medicare + Choice or Part C arrangement later became known as the Medicare Advantage conception after the Medicare prescription medicine Drug, Improvement, and Modernization Act of 2003 came into effect. The Part D plan, on the other hand, covers mainly prescription medicine drugs and anyone in the original Plan A or B is eligible for this plan.However, in other to receive the benefits of the Plan D, a beneficiary must enroll and be approved for a Stand-alone Prescription Drug Plan (PDP) or Medicare Advantage plan with prescription drug coverage (MA-PD). However, because Plan D is effectively operated by private health insurance companies, there are no standardized benefits, like the plan A and B the private insurance companies could choose to cover some drugs or classes of drugs and not cover others, with the exception of drugs excluded from Medicare coverage. Ben eficiaries are therefore restricted to the drugs coverage of the plans they choose (Merlis, 2008 Potetz, 2008). Contributions towards Social Health Insurance Medicare financing, like social health insurance everywhere, is financed through a complex mix of taxes, contributions, co-payments and the likes.The most in-chief(postnominal) source of financing for the Medicare expenditures is through the payroll tax imposed by the Federal Insurance Contributions Act and the Self-Employment Contributions Act of 1954, while other sources of financing includes general revenue through income taxes, a tax on Social Security benefits, and payments from states required for the Medicare drug benefits which started in 2006. In addition to these, beneficiaries also contribute right away to Medicare financing through premiums, deductibles and co-insurance. It is reported that income cases, physician do charge beneficiaries an additional out-of -pocket balance billing to cover for services rendered ( Potetz, 2008). The federal payroll taxes are paid by the working population or by the beneficiaries throughout their work history.The tax equals 2. 9 percent of gross wages, with half (1. 45 percent) deducted from the workers salary and the other half paid by the employer. Initially, there was a ceiling on the maximum amount any single person can contribute however, beginning from 1994, the maximum limit was removed. Self employed people who do not have an employer to cover the other half of their taxes are mandated by law to pay the full 2. 9 percent of their estimated earnings. However, the contributions from the beneficiaries vary considerably depending on the plan and also range from premiums, deductibles, co-payments or in some cases, the balance billing mentioned previously.