Which Is The Most Expensive Service Provided By State And Local Governments? Quizlet

MEDICINE AND Health Intendance

By Anne Cusack (Educational Author)

In the final decades of the 20th century, Americans increasingly view good health as something to which they have a right. They believe they take a right to good wellness because widespread advances in medical research have made it possible to treat many previously "unbeatable" diseases, and because the Constitutional responsibleness of the American regime to "promote the general

Welfare" is far more broadly interpreted today than it has been in the by. These ascent expectations regarding wellness intendance in the United States are a result of vastly increased medical noesis; and the belief that in an affluent and democratic society all people should accept admission to well-trained physicians, fully equipped hospitals and highly sophisticated procedures for the treatment of illness. While remarkable progress in the field of medicine has satisfied many of these expectations, each new discovery or procedure brings with it new challenges to be overcome and new questions to be answered. Ane instance is the treatment of centre disease.

Treatment of eye disease is one of modern medicine'southward triumphs. Today surgeons routinely perform middle surgery that would accept been extraordinary, or even unthinkable, just a few years ago. Even center transplants, though by no means routine, are becoming more than common. In 1987, 1,441 were performed in the United States. Transplants, however, pose serious difficulties: a donor center must get bachelor, claret and tissue must match, and the patient's immune system must be suppressed with medication to ensure that the body does not pass up the new centre.

THE Artificial Center

In 1982, American md William C. DeVries undertook a major pace beyond transplants when he implanted an bogus heart known as the Jarvik-7 into the chest of a retired

the Humana Corporation, which owns a chain of private hospitals, Dr. DeVries implanted artificial hearts into two patients, which successfully kept blood pumping steadily through their bodies. However, both patients remained sick, suffered strokes, or brain seizures, and other complications. One of these patients, all the same, survived for nearly two years before dying in mid-1986.

The artificial centre is a swell achievement for modern medicine, merely it also poses important questions that are at the center of the argue over the grade of medical care in the United States. For example, does the artificial heart offer plenty benefits to patients to justify the suffering caused past such an operation? What is the quality of life for an individual who, for the fourth dimension being, must remain fastened to the bulky air compressor which powers the center? Who should be chosen to receive artificial hearts? What other medical needs might be neglected if many millions of dollars are spent on providing people with artificial hearts?

ACHIEVEMENTS AND LIMITS

The development of the bogus heart represents the kind of dramatic medical advance that Americans have come to look in recent decades. As medical knowledge has avant-garde, then has average life expectancy, from 69 years in the 1950s and '60s to 75 years today. Physicians at present can treat center disease and cancer with a variety of drugs or surgical techniques. Individuals whose kidneys have failed can alive for years with regular dialysis, or cleansing of their blood, to remove waste products. Drugs are used to control loftier claret pressure�a risk factor in both strokes and eye attacks. Cardiac pacemakers, or heart regulators, go along many people from dying of abnormalities in the heart rhythm. Surgery, drugs and radiation treatments keep cancer patients alive longer. Childhood leukemia and Hodgkins' disease no longer carry with them an automatic sentence of death. Surgeons can supplant damaged joints with artificial ones, and eye doctors use lasers and other advanced techniques to preserve or restore sight. Advances in microsurgery have even fabricated information technology possible to reattach limbs which have been discrete in accidents, and burn down victims benefit from the evolution of new skin grafting techniques. Among the hundreds of newly developed drugs are tranquilizers, or calming drugs, which have made it possible to release many patients from mental hospitals.

Physicians, notwithstanding, are not miracle workers, and the public's expectations of medical progress sometimes outstrip reality. About 65 percent of Americans who died in 1988 suffered from cancer, middle affliction or other problems of the circulatory organization. Modern medicine can treat�just usually not cure�such atmospheric condition: There are no inoculations confronting cancer or heart disease. Since physicians often cannot predict who volition do good from a handling, they by and large recommend treating every patient who has even a slight risk of benefiting. On the other hand, many medical tests and procedures involve adventure, and so the value of medical treatment must be weighed against the possibility that the process itself may crusade disease or injury.

THE PHYSICIAN

Self-employed private physicians who charge a fee for each patient visit are the foundation of medical do in the United States. Most physicians have a contractual relationship with ane or more hospitals in the community. They send their patients to this hospital, which commonly charges patients according to the number of days they stay and the facilities� operating room, tests, medicines�that they use. Some hospitals vest to a city, a state or, in the instance of veteran'southward hospitals, a federal government agency. Others are operated by religious orders or other non-turn a profit groups. All the same others operate for profit.

Some medical doctors are on salary. Salaried physicians may work as hospital staff members, or residents, who often are still in training. They may teach in medical schools, be hired by corporations to care for their workers or work for the federal government's Public Health Service.

Physicians are amongst the best paid professionals in the United states. In the 1980s, it is not uncommon for medical doctors to earn incomes of more than than $100,000 a twelvemonth. Specialists, particularly surgeons, might earn several times that amount. Physicians list many reasons why they deserve to exist so well rewarded for their work. One reason is the long and expensive preparation required to become a physician in the The states. Nigh would- be physicians commencement attend college for four years, which can price nearly $20,000 annually at one of the best individual institutions. Prospective physicians then attend medical school for four years. Tuition alone can exceed $10,000 a year. By the fourth dimension they accept obtained their medical degrees, many young physicians are deeply in debt. They still face three to five years of residency in a hospital, the starting time yr as an intern, an apprentice physician. The hours are long and the pay is relatively depression.

Setting up a medical practice is expensive, likewise. Sometimes several physicians will decide to establish a grouping exercise, and so they can share the expense of maintaining an office and buying equipment. These physicians also accept care of each other's patients in emergencies.

Physicians work long hours and must accept a smashing bargain of responsibility. Many medical procedures, even quite routine ones, involve gamble. It is understandable that physicians want to be well rewarded for making decisions which tin mean the difference betwixt life and death.

MEDICAL COSTS

Physicians' fees are only one reason for rising health costs in the United States. Medical enquiry has produced many tests to diagnose, or discover, patients' illnesses. Physicians usually feel obliged to order enough tests to rule out all likely causes of a patient'due south symptoms. A routine laboratory bill for claret tests can easily be more $100.

Sophisticated new machines have been adult to enable physicians to browse torso organs�even the brain�with a clarity never before possible. One technique involves the utilize of ultrasound�sound waves beyond the frequencies that human beings tin hear�to produce images. Others use computers to capture and analyze images produced by X-rays or magnetic fields.

These machines often make unnecessary older diagnostic tests which are painful and sometimes unsafe. Only the machines are extremely expensive: The price of a single machine can exceed one million dollars.

New technologies also mean new personnel. Physicians, nurses and orderlies i no longer staff a hospital lonely. Hospitals n require a bewildering number of technical specialists to administrate new tests and open up advanced medical equipment.

Physicians and hospitals likewise must buy malpractice insurance to protect themselves should they be sued for negligence by patients who feel they accept been mistreated or accept received inadequate intendance. The rates that physicians were charged for this insurance i very steeply in the 1970s and '80s as patients became more medically knowledgeable, and juries sometimes awarded very large amour of money to injured patients.

Every bit a result, hospital costs and physicians' fees rose steadily through the 1960s and '70s. By 1986, the average cost a stay in the infirmary had climbed to more than than $500 a day. Government agencies became convinced that it was necessary to limit rising medical costs. One approach i: crave hospitals to evidence that a need exist for new buildings and services. Hospitals; have faced pressure to run their operations more efficiently, and to subtract the duration of hospital stays for patients receiving routine treatment or modest surgery.

PAYING THE BILLS

The United States today has evolved a mixed system of private and authorities responsibility for health care. While private citizens and health insurance companies spent about 230 k meg dollars on health care in 1986, federal, country and local governments spent 179 yard million dollars for medical services of all kinds. Public funds financed much of the research on the bogus heart, but it was a private corporation Humana, which paid for artificial heart surgery and patient intendance. This interchange between public and private sectors is typical of how Us provides many kinds of wellness and medical services.

How do well-nigh Americans pay their medical bills? For the vast majority, the answer is medical insurance. About five out of even six workers, along with their families, are covered by group health insurance plans, paid for jointly by the employer and employee � the employee alone. Under the most common blazon of health programme, the individual pays a monthly premium, or fee. Typically, employees who wish more extensive medical coverage will choose a plan requiring higher premiums.

In return, the insurance visitor covers most major medical costs, except for a minimum amount, chosen the "deductible," which the employee pays each year earlier insurance coverage begins. Benefits then cover a certain percentage, ofttimes 80 percentage, of the patient's bills in excess of the deductible. Due south policies provide that afterward the employee'due south b have reached a sure amount, the insurer covers 100 percent of all additional costs. Depending on the plan, deductible amounts

near health insurance policies range from $50 to $300. Insurance plans vary considerably, with some offering coverage for dental costs and others providing for mental health counseling and therapy.

Another blazon of health care programme available to many workers is a Wellness Maintenance Arrangement (HMO). An HMO is staffed by a group of physicians who agree to provide all of an individual'southward medical care for a prepare fee paid in advance. HMOs emphasize preventive health intendance, since the system loses coin rather than gaining fees when it is necessary to prescribe treatment or place someone in the hospital. For this reason, medical experts generally credit HMOs with helping to agree down overall medical costs. In 1987, about 660 HMOs served about 29 one thousand thousand people.

MEDICAID AND MEDICARE

Although most families have some form of private wellness insurance, some citizens cannot beget such insurance. These people receive medical coverage through two major social programs enacted in 1965.

Medicaid is a joint federal-state program which funds medical care for the poor people. The requirements for receiving Medicaid, and the scope of the medical care available, vary widely from state to state. Medicaid has proved more than plush than expected, and has been exploited for unjustified gain by some physicians. As a result, the government has decreased Medicaid services by making the requirements for those entitled to participate in the program more strict. Nonetheless, Medicaid has greatly increased the use of health intendance services by the poor.

Medicare is a federal program financed through the Social Security Administration, which provides a national system of retirement and other benefits. Medicare pays a substantial part of the medical bills of Americans who are over 65 years of age or are disabled. Medicare is not a poverty program, simply is rather a course of federally administered and supported health insurance. One part of Medicare covers a major portion of infirmary bills for the elderly and is financed by a portion of the Social Security revenue enhancement. Another role is financed by premiums paid past Medicare recipients, as well as from direct federal funds. Everyone who collects Social Security is covered by Medicare.

As is the case with the remainder of the wellness intendance system in the Usa, Medicare has felt the pressure of rising costs. In response, the authorities has taken two steps. Offset, Medicare has raised the corporeality of the deductible that patients must pay before insurance benefits begin. 2nd, information technology has changed its method of paying hospitals. Instead of paying hospitals through a vague formula called "reasonable charges," Medicare at present pays according to the patient's diagnosis. This provides an incentive for the infirmary to keep costs downward. If, for case, the hospital tin care for a patient who needs gall float surgery for less than Medicare pays to care for such an illness, the infirmary makes a turn a profit. If the patient's handling costs more Medicare pays, the hospital loses coin.

In addition to controlling costs, the Usa confronts the problem of those who cannot afford individual health insurance and withal are non eligible for either Medicaid or

Medicare. 1 estimate is that more 30 one thousand thousand people or 1 in seven Americans have no health insurance during at to the lowest degree office of the year. These may exist individuals who are unemployed for a time, families close to the poverty line or those living in remote rural areas. Such individuals can go to public hospitals, where they can always receive handling in an emergency, just they often fail to obtain routine medical care that could prevent later on chronic or serious illness.

Ethical ISSUES

The very successes of modern medicine accept produced issues and dilemmas unknown in previous periods. The ability to treat newborn infants with severe deformities is i instance. Should expensive operations be performed to salvage the lives of babies who volition be seriously retarded or disabled all of their lives? Some parents want every possible endeavor made to save such babies, in the hope that treatment to better their child'due south condition may be adult in the time to come. Others, less optimistic, call up that an early death is amend than a life of pain and suffering. In either case, who should make such life-or-death decisions: the parents, the doctor, the hospital administrators, the community (through passage of laws)?

The availability of amniocentesis and legal abortion too raises complicated ethical questions. Physicians tin now withdraw a pocket-sized corporeality of the amniotic fluid that surrounds a fetus in the womb. They can thus obtain fetal cells and study them for possible abnormalities. They tin tell, for example, whether the fetus has Downward's Syndrome, a defect that causes mental retardation and, often, other physical disabilities. Since amniocentesis carries a slight take a chance of harming the fetus, it is usually performed only on older mothers who are at greater risk for giving nativity to infants suffering from nascency defects. Many types of birth defects, even so, cannot exist discovered through amniocentesis.

Parents who learn of severe abnormalities can choose to abort the fetus prior to the 24th week of pregnancy. Ballgame, however, is an intensely controversial field of study in the United States, every bit it is in many other countries. Although ballgame is legal in the U.s.a., many feel that it should be legal only when the mother'south life is in danger. Others believe that abortion should never exist undertaken under whatever conditions.

Occasionally, a very small living infant is born prematurely. Such infants seldom survive, and the take chances of their suffering permanent handicaps is great. Many hospitals take established special intensive care units which can at present salvage many such premature babies. But should all premature infants be treated in this manner, especially if they are below a certain weight and therefore probable to suffer severe disabilities?

At the other cease of the spectrum, the situation of unconscious patients too triggers intense argue. Physicians can use respirators�machines that breathe for patients�and other medical equipment to keep patients live indefinitely, even though the patients will not regain consciousness. When is it proper to plough off these machines and let the patient die?

Nigh physicians now recognize that there is a point at which further treatment just prolongs the agony of expiry, and with the family'south consent, they may decide not to resuscitate (restart the stopped heart) an old person dying of cancer. Young victims of auto accidents who are unconscious pose a dissimilar set of issues. Often, the decision to maintain an unconscious, critically ill patient may turn on whether or not the person is "brain-expressionless"� with no measurable electrical action in the brain. Physicians today recognize that these patients are, in fact, dead, and their life support systems tin can be removed. Such patients as well become valuable sources of organs for transplants for other patients.

Wellness Intendance CHALLENGES

Although Americans, on the average, are healthier and live longer today than always before, a number of challenges still confront the medical intendance system in the U.s.. While advanced engineering science tin can provide artificial hearts or transplanted kidneys to a few at high toll, others still suffer from diseases, such as tuberculosis, that medicine already has "conquered."

Older Americans are one of the fastest growing segments of the population. Nigh five pct of the elderly population live in nursing homes. Many endure from Alzheimer'southward disease, an increasingly common ailment that affects the brain, leaving its victims mentally confused and difficult to intendance for. Other patients, who might have died in previous years from strokes and other ills, live on; just they suffer from speech and memory defects, paralysis and other disabilities. As Americans have grown more aware of the specific health needs of the elderly, the field of gerontology, the written report of the aging procedure, has attracted increasing numbers of physicians. Medical research has focused on this wellness result as well, notably with the establishment of the federal regime's National Plant on Aging.

The nation's infant mortality rate is also a concern. The number of infants per thousand live births who died earlier their starting time birthday remains higher for the United States than for several other industrialized nations. This rate is also higher for blacks and other minorities than for white Americans. Health regime concur that improve nutrition and prenatal (earlier birth) health intendance could essentially lower the baby mortality rate among these minority groups.

Delivering better health care to poor and disadvantaged groups in the United States is merely 1 way of improving the nation'south overall health. Research in contempo years has fabricated it clear that much disease is the result of the manner people cull to live. Money spent to persuade people to lose weight, exercise regularly, eat more healthful foods and finish smoking tin ofttimes provide greater benefits for more people than the nigh advanced medical technologies. For example, studies have linked a significant drop in the rate of lung cancer to a nationwide decline in cigarette smoking.

Another severe challenge to the wellness intendance system is Acquired Immune Deficiency Syndrome, or AIDS.

This worldwide disease, first reported in the U.s.a. in 1981, is caused by a virus spread past sexual contact, needle sharing (such every bit in illegal drug use) or commutation of claret (such as in transfusions). Since 1981, more than 83,000 Americans have died of AIDS. Scientists and pharmaceutical companies are

working on vaccines to foreclose this affliction and medicines to treat it. As of 1991, several drugs had been developed to care for some of the symptoms of AIDS, only not to cure or forbid the illness.

In improver to the grief and pain caused by this disease, it has strained the system because many AIDS patients do non accept acceptable health insurance. Some are cared for by friends and relatives or at clinics run by churches and other groups. Others are treated in hospitals under the Medicaid program.

PATTERNS OF CHANGE

The wellness intendance organization in the United States today is in a menstruum of rapid change on many unlike fronts. Ane example is the distribution of medical services. By the mid-1980s, the United States, in a reversal of a long-standing pattern, no longer faced a shortage of physicians. There was, in fact, a developing surplus of medical doctors. But physicians oftentimes prefer to practice in urban areas or comfortable suburbs. Every bit a result, many inner metropolis areas and rural communities withal lack sufficient physicians and acceptable medical facilities.

As the number of medical specialties has grown in recent years, patients sometimes take found it frustrating to deal with a number of different physicians for differing ailments, rather than with the traditional family unit doctor. Medical schools have responded by creating a new specialty�family unit medicine. Such family physicians can diagnose and care for many kinds of illnesses, though they too send patients to specialists when necessary. Not every medical problem requires a highly trained specialist, or even a dr.. In some communities, physicians' assistants, working with medical doctors, perform some routine medical procedures. Nurse mid wives manage normal pregnancies and deliveries, calling upon obstetricians simply if problems develop.

The Humana Corporation's highly publicized bogus centre program highlights another change in American medical practice. Profit-making corporations are playing an increasingly large role in providing medical care, and bondage of individual, "for-profit" hospitals are growing. Private companies too compete for contracts to run public hospitals for a fee, promising more efficient and cost- witting management.

Can profit-making corporations deliver more economical and higher quality medicine? Or do they just depict patients with sufficient funds or wellness insurance abroad from non-profit and public hospitals, leaving these institutions to cope with the poorest and sickest patients?

Liberal social critics deplore the lack of authorities planning and primal oversight inherent in a free market approach to health care. Conservative critics, on the other hand, feel that government-funded health insurance and medical programs are inefficient and more expensive than private medical intendance in the long run. Critics on both sides often concord, however, the medical profession has been given too much liberty in determining the price of medical care.

While some groups might benefit from funds spent to improve medical care further, many people feel that differences in the way people live account for much of the health gap between rich and middle class and the poor. Is it possible to spend besides much money saving a unmarried life? Would spending less money on avant-garde medical treatments increase the amounts bachelor for better nutrition, pollution controls, safety devices, campaigns to increment exercise and cut dorsum smoking, and other preventive measures? Should people be held responsible for habits and behaviors which make them sick?

Physicians, politicians, medical experts and ordinary citizens were debating these questions in the early 1990s. The answers are by no means clear-cut, but involve a number of merchandise-offs and compromises betwixt equally desirable goals. In a nation in which more than 11 per centum of the Gross National Product (the value of all goods and services) is spent on medical services of all kinds, Americans are in agreement on one central indicate: Quality, affordable wellness intendance must be available to everyone.

Suggestions for Farther Reading

Aaron, Henry J.

Painful Prescription: Rationing Hospital Intendance. Washington: Brookings Institution Printing, 1984.

Gorovitz, Samuel. Doc's Dilemmas: Moral Conflict and Medical Intendance. New-York: Macmillan, 1982.

Starr, Paul.

The Social Transformation of American Medicine. New York: Basic Books, 1982.

Thomas, Lewis. The Youngest Science: Notes of a Medicine-Watcher. New York: Viking, 1983.

U.Southward. Office of Engineering Cess. Medical Technology and Costs of the Medical Plan. Washington: U.South. Government Press Function, 1984.

---

Date: 2015-02-28; view: 3233

---

Source: https://doclecture.net/1-15410.html

Posted by: lamontbost1962.blogspot.com

Share this post