It is important as a healthcare consumer to understand the history of the U.S. healthcare delivery system, how it operates today, who participates in the system, what legal and ethical issues arise as a result of the system, and what problems continue to plague the healthcare system. We are all consumers of health care. Yet, in many instances, we are ignorant of what we are actually purchasing. If we were going to spend $1,000 on an appliance or a flat screen television, many of us would research the product to determine if what we are purchasing is the best product for us. This same concept should be applied to purchasing healthcare services.
Increasing healthcare consumer awareness will protect you in both the personal and professional aspects of your life. You may decide to pursue a career in health care either as a provider or as an administrator. You may also decide to manage a business where you will have the responsibility of providing health care to your employees. And lastly, from a personal standpoint, you should have the knowledge from a consumer point of view so you can make informed decisions about what matters most—your health. The federal government agrees with this philosophy. Recently, the Centers for Medicare and Medicaid Services (CMS) used its claim data to publish the hospital costs of the 100 most common treatments nationwide. The purpose of this effort is to provide data to consumers regarding healthcare costs because the costs vary considerably across the United States. This effort may also encourage pricing competition of healthcare services (Godert, 2013).
As the U.S. population’s life expectancy continues to increase—increasing the “graying” of the population—the United States will be confronted with more chronic health issues because, as we age, more chronic health conditions develop. The U.S. healthcare system is one of the most expensive systems in the world. According to 2010 statistics, the United States spent $2.6 trillion on healthcare expenditures or 17.6% of its gross domestic product (CMS, 2013a). The gross domestic product (GDP) is the total finished products or services that are produced in a country within a year. These statistics mean that nearly 18% of all of the products made within the borders of the United States within a year are healthcare related. Estimates indicate that healthcare spending will be $4.6 trillion by 2020, which represents nearly 20% of the gross domestic product. In 2011, there were 48.6 million uninsured U.S. citizens, a decrease from 50 million in 2010 (Kaiser Family Foundation [KFF], 2013). The Institute of Medicine’s (IOM) 1999 report indicated that nearly 100,000 citizens die each year as a result of medical errors. Although there have been quality improvement initiatives in the healthcare industry such as the Patient Safety and Quality Improvement Act of 2005, recent research indicates that medical errors in hospitals remain high (Classen et al., 2011).
Employers are offering less healthcare benefits. In 2002, 72% offered health insurance benefits, which has dropped to 67.5% in 2010. This is typical of smaller businesses that have a small number of employees who need benefits (Kliff, 2012).
These rates are some of the highest in the world but, unlike most developed countries, the United States does not offer healthcare coverage as a right of citizenship. Most developed countries have a universal healthcare program, which means access to all citizens. Many of these systems are typically run by the federal government, have centralized health policy agencies, are financed through different forms of taxation, and payment of healthcare services are by a single payer—the government (Shi & Singh, 2008). France and the United Kingdom have been discussed as possible models for the United States to follow to improve access to health care, but these programs have problems and may not be the ultimate solution for the United States. However, because the United States does not offer any type of universal healthcare coverage, many citizens who are not eligible for government-sponsored programs are expected to provide the service for themselves through the purchase of health insurance or the purchase of actual services. Many citizens cannot afford these options, resulting in their not receiving routine medical care. The passage of the Patient Protection and Affordable Care Act of 2010 (PPACA, or ACA) has attempted to increase access to affordable healthcare. One of the mandates of the Act is the establishment of state-run health insurance marketplaces, which provide opportunities for consumers to search for affordable health insurance plans. There is also a mandate that individuals who do not have health insurance purchase health insurance if they can afford it or pay a fine. Both of these mandates should decrease the number of uninsured in the United States. These programs will be closely evaluated to assess whether their goals will be achieved.