Thus, the low SES segments of the population are in most need of accessible, quality health insurance, and economic strain results from an unhealthy and uninsured low SES [ 25 , 26 ]. Like diabetes, hypertension—the leading risk factor for death worldwide [ 29 ], has a much higher prevalence among low SES populations [ 30 ].
It is estimated that individuals with uncontrolled hypertension have more than USD greater annual healthcare costs than their normotensive counterparts [ 31 ]. Lastly, the incidence of obesity is also much greater among low SES populations [ 32 ]. The costs of obesity in the U. Accessible, affordable healthcare may enable earlier intervention to prevent—or limit risk associated with—non-communicable chronic diseases, improve the overall public health of the U.
Beyond providing insurance coverage for a substantial, uninsured, and largely unhealthy segment of society—and thereby reducing disparities and unequal access to care among all segments of the population—there is great potential for universal healthcare models to embrace value-based care [ 4 , 20 , 34 ]. Value-based care can be thought of as appropriate and affordable care tackling wastes , and integration of services and systems of care i. In line with this, the ACA has worked in parallel with population-level health programs such as the Healthy People Initiative by targeting modifiable determinants of health including physical activity, obesity, and environmental quality, among others [ 36 ].
Given that a universal healthcare plan would force the government to pay for costly care and treatments related to complications resulting from preventable, non-communicable chronic diseases, the government may be more incentivized to i offer primary prevention of chronic disease risk prior to the onset of irreversible complications, and ii promote wide-spread preventive efforts across multiple societal domains. It is also worth acknowledging here that the national public health response to the novel Coronavirus virus is a salient and striking contemporary example of a situation in which there continues to be a need to expeditiously coordinate multiple levels of policy, care, and prevention.
For example, investing USD 10 per person annually in community-based programs aimed at combatting physical inactivity, poor nutrition, and smoking in the U. Additionally, simple behavioral changes can have major clinical implications.
While universal healthcare does not necessarily mean that health policies supporting prevention will be enacted, it may be more likely to promote healthy i lifestyle behaviors e. Nordic nations provide an example of inclusive healthcare coupled with multi-layered preventive efforts [ 41 ]. In this model, all citizens are given the same comprehensive healthcare while social determinants of health are targeted.
Such coordinated efforts within the Nordic model have translated to positive health outcomes. For example, the Healthcare Access and Quality HAQ Index provides an overall score of 0— 0 being the worst for healthcare access and quality across countries and reflects rates of 32 preventable causes of death. Nordic nations had an average HAQ score of Though far more heterogenous compared to Nordic nations, e.
To provide further context, other industrialized nations, which are more comparable to the U. Non-inclusive, inequitable systems limit quality healthcare access to those who can afford it or have employer-sponsored insurance. These policies exacerbate health disparities by failing to prioritize preventive measures at the environmental, policy, and individual level. Low SES segments of the population are particularly vulnerable within a healthcare system that does not prioritize affordable care for all or address important determinants of health.
Failing to prioritize comprehensive, affordable health insurance for all members of society and straying further from prevention will harm the health and economy of the U. While there are undoubtedly great economic costs associated with universal healthcare in the U. Again, this is not to suggest that universal healthcare will be a cure-all, as social determinants of health must also be addressed.
However, addressing these determinants will take time and universal healthcare for all U. Only through universal and inclusive healthcare will we be able to pave an economically sustainable path towards true public health. Conceptualization, G. All authors have read and agreed to the published version of the manuscript. National Center for Biotechnology Information , U.
Journal List Medicina Kaunas v. Medicina Kaunas. Published online Oct Kerr , 1 Justin B. Moore , 2 and Lee Stoner 1. Find articles by Gabriel Zieff. Zachary Y. Find articles by Zachary Y. Justin B. Find articles by Lee Stoner. Their countries had agreed that such things should never be allowed to happen. I saw all kinds of health systems in action: true single-payer in Taiwan, a mix of public and private insurance in Australia, private coverage for everybody in the Netherlands.
Each of them surpassed the United States in two critical ways: Everybody had insurance, and costs to patients were much lower. Specialty care in the rural parts of the country is lacking. On the whole, the medical field seems to be ambivalent about the national health insurance. But raising taxes to more adequately fund the system or bumping up cost sharing to encourage more discretion in health care use is almost as big of a political challenge there as it would be here. Nobody wants to pay more for health care next year than they did the year before.
Australia has layered a private health care system on top of its universal public insurance program, and that gives both doctors and patients more choice about medical care.
But once you have different tiers in your health care system, disparities are going to emerge. And because the Australian government is spending billions of dollars supporting a struggling private insurance industry for middle-class and wealthier patients, it has fewer resources to devote to disadvantaged populations, like indigenous Australians or patients living in rural areas who have less access to medical care.
Public patients in public facilities face longer wait times. The Netherlands, meanwhile, has handed over the responsibility for providing coverage to private health insurers, and that has come with costs too. The Dutch have had to impose strict regulations on health insurance, including harsh penalties for people who fail to sign up for insurance on their own. Doctors in the Netherlands are more likely than those in more socialized systems to say their patients struggle to afford medical care.
They are also more likely to say the administrative work they have to do is a drain on their time. Health care spending in the Netherlands has also been rising at a faster clip since the move to the mandatory private insurance system. So the question becomes what kind of trade-off is more palatable. There is no way to avoid it: If you want universal coverage, the government is going to play a huge role. In Taiwan and Australia, that means the government runs a universal insurance program that covers everybody for most medical services.
But even in the Netherlands, which relies on private health insurers, the government oversees everything. It sets rules about what benefits have to be covered, what prices can be charged, and what cost sharing is required. It collects contributions from employers to pay the cost of covering everybody and spreads it among the insurers based on the health status of their customers.
All told, about 75 percent of the funding for health insurance in the Netherlands is still running through the national government, even if the actual insurance benefits are being administered by private companies.
Under all of these insurance schemes, the governments use much more force to keep health care prices down compared to the US. In Taiwan, that means global budgets — an annual amount set aside every year for various sectors of the health industry hospitals, drugs, traditional Chinese medicine, etc. In the Netherlands, even with private insurers, the government sets limits on how much health spending can accrue in a given year and has the authority to impose budget cuts if spending exceeds that limit.
Prices are also set for particular services, like after-hours primary care. Insurers do have some limited flexibility in which providers they contract with, but the government sets their health care budget for them.
We have experimented with that kind of system in the US, as Tara Golshan covered in this series in her story on Maryland. She documented how the state has tried to use a model like this, global budgets, to improve care for patients by encouraging hospitals to focus on the health of their patients instead of whether they have enough people in their beds.
But Maryland remains an exception. This access to healthcare is not considered contingent on employment but rather as an intrinsic part of citizenship. Public authorities fund this system through taxes rather than through social contributions. It automatically covers all citizens and residents. More on how to get an Italian health insurance card tessera sanitaria on this page in English. In contrast, a decentralized system has been adopted by Mediterranean countries Greece, Spain, and Portugal.
This model, which was developed during the s in the Soviet Union, spread to the USSR's satellite states after Healthcare services belonged to the state , and the state paid healthcare professionals.
Services were usually free, but patients had to pay out-of-pocket fees for medication, for example. The system provided universal access to health care. It was broadly a benefit in the kind system. Central authorities defined coverage levels and the amounts set aside for healthcare spending share of GDP.
Health care and health insurance systems are currently undergoing a radical change in the Central and Eastern European countries. The fundamental principle of the American healthcare system is that health is a matter of individual responsibility and private insurance. In practice, then, there is no compulsory national system and a preponderance of private organizations two-thirds of Americans under the age of 65 are covered by employment-related insurance.
Public healthcare is only provided for the elderly Medicare and disadvantaged Medicaid , not unlike the Beveridge model. CMS directly manages Medicare and oversees Medicaid. The idea of universal healthcare - a system that delivers good-quality medical care to all citizens and residents, regardless of their ability to pay- dates back to Theodor Roosevelt, who has served nearly eight years as a Republican president - decided to run again on a progressive ticket.
He promoted a platform that called for the creation of a centralized national health service. He ultimately lost the elections. Harry Truman proposed a national healthcare system twice: in and with no results. Lyndon Johnson's Great Society campaign included the idea of helping those populations the market economy had left behind instead of a radical change and challenging head-on private insurance.
Needless to say that nearly a fifth of the population lived just one illness or accident away from personal bankruptcy. In , more than 48 million Americans were uninsured source CDC reports , and millions more were underinsured an estimated 16 million adults in But they can't obtain insurance through their work for three main reasons:. The Clinton Health Care Plan included universal coverage and a basic benefits package, but the bill was never enacted into law. As of , the rate is even lower at 2.
According to Gallup , the ACA increased the number of insured citizens and residents but did not achieve universal health coverage. The ACA originally mandated that all residents buy a health insurance policy or face a fine or penalty.
The percentage of uninsured US adults reached The ACA still earns a split decision from Americans in , according to the American analytics and advisory company, Gallup.
Government Printing Office. Current population report no. Accessed July 1, First look at health insurance coverage in finds ACA gains beginning to reverse. May 1, Income, poverty, and health insurance coverage in the United States: A roadmap to health insurance for all: principles for reform. October 1, Bailit M, Hughes C. The care of patients with severe chronic illness: an online report on the Medicare program by the Dartmouth Atlas Project.
Joint principles of the patient-centered medical home. March Koller C. Accessed July 5, The opportunity for health plans to improve quality and reduce costs by embracing primary care medical homes. Accessed July 3, Kacik, A. Monopolized healthcare market reduces quality, increases costs. Himmelstein, D. A comparison of hospital administrative costs in eight nations: U.
Patient-Centered Primary Care Collaborative. Results and evidence. Read More. Goal To ensure health care coverage for everyone in the United States through a foundation of comprehensive and longitudinal primary care. Introduction The health care system in the United States is uncoordinated and fragmented and emphasizes intervention rather than prevention and comprehensive health management.
Key Elements of the Framework Everyone will have affordable health care coverage providing equal access to age-appropriate and evidence-based health care services.
Everyone will have a primary care physician and a medical home. Insurance reforms that have established consumer protections and nondiscriminatory policies will remain and will be required of any proposal or option being considered to achieve health care coverage for all. Any proposal will reflect at least a doubling of the percentage of health care spending invested in primary care. Additionally, U. A defined set of visits and services to a primary care physician will not be subject to cost-sharing.
In any system of universal coverage, the ability of patients and physicians to voluntarily enter into direct contracts for a defined or negotiated set of services e. Additionally, individuals will always be allowed to purchase additional or supplemental private health insurance. To achieve health care coverage for all, the AAFP supports bipartisan solutions that follow the above referenced principles, are supported by a majority of the American people, and involve one or more of the following approaches, with the understanding that each of these have their strengths and challenges: A pluralistic health care system approach to the financing, organization, and delivery of health care is designed to achieve affordable health care coverage that involves competition based on quality, cost, and service.
Such an approach involves multiple for-profit and not-for-profit private organizations and government entities in providing health insurance coverage. Such an approach to universal health insurance coverage must include a guarantee that all individuals will have access to affordable health care coverage. A Bismarck model approach is a form of statutory health insurance involving multiple nonprofit payers that are required to cover a government-defined benefits package and to cover all legal residents.
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