UNDERSTANDING THE AMERICAN HEALTHCARE SYSTEM

The American healthcare system is quite different from the Indian one. I find it a tad complicated. Over the course of time I realized medical insurance is really important in America.

In India I could walk into my general physician’s clinic for a common cold or cough ailment without an appointment. However in America there is a certain protocol one needs to follow. You need to call up your medical providers’ helpline & explain to the duty nurse your ailment. The duty nurse will take a call on whether you need to come in & visit the doctor. In certain cases he/she might want you to try some over-the-counter medicines & wait for a few days to see how you faring.

Out-of-pocket healthcare costs in America are exorbitant. Hence medical insurance is a necessity in America. Your simple cold & cough ailment visits are also covered under insurance. The good thing about insurance is that preventive care like your vaccinations are free of cost.

In America broadly there are four different types of medical insurance plan which can be overwhelming to digest for a newcomer like me. Broadly the plans are as listed below

* Health maintenance organizations (HMOs)
* Preferred provider organizations (PPOs)
* Exclusive provider organizations (EPOs)
* Point-of-service (POS) plans.
* High-deductible health plans (HDHPs), which may be linked to health savings accounts (HSAs)

Insurance terms like co-pay, deductible, provider networks among others sounded alien to me.

As per The Patient Protection and Affordable Care Act, popularly known as Obamacare, Americans who do not have health insurance will have to cough up income tax of $695 per adult or 2.5% of annual income (whichever is greater). Thanks to the Trump regime, the fate of Obamacare hangs in balance; but that’s a story for another time.

Coming back to health insurance, in India we pay out of our pocket for normal visits to the doctor. When it comes to major things like surgery we claim the expenses through insurance.

The inability to pay Medical bills has been cited as one of the common reasons for bankruptcy in America. Bankruptcy in turn directly impacts the credit history of the individual, which is very important for your future purchase, loans among others.

Despite healthcare being so expensive in America, the World Health Organization ranked the U.S., 37th in healthcare systems as of 2015. A 2016 Commonwealth Fund Report states that 43% of low-income Americans went without medical care because of costs. The fund is a non-partisan health-care think tank.

Obamacare was established with the aim of gradually reducing healthcare costs in the country by bringing more people under its ambit. However the uncertainty surrounding it is forcing insurance players to hike premiums & pull out of it.

A former American Healthcare industry insider says that the sector spent a staggering $509.5 mn just in lobbying.

America is also one of the most expensive places in the world to deliver a baby. According to Castlight, the average national cost for a routine vaginal delivery in 2016 was $8,775. The national average for c-sections was $11,525. The costs are based on a combination of employee sponsored health plan coverage & out-of-pocket costs. Castlight Health is a health-care benefits information company. For the uninsured the costs would be triple of the national average. Despite the high costs America also has the second highest maternal mortality rate among high-income countries.

Pregnancy ultrasounds can cost up to $2000 if you paying from your pocket. Most insurance plans provide coverage for one or two pregnancy ultrasounds. Similarly if you opt for genetic testing of your unborn baby not all insurance plans provide coverage for the same.

According to a Harvard economist, one of the primary reasons for healthcare being so expensive in America is the high administrative costs associated with it. Various studies have also pointed out that Americans shell out more money for prescription drugs than any other country in the world. Healthcare costs also continue to soar in the country as hospitals spend money on acquiring the latest electronic gadgets. Unlike other countries prices of prescription drugs are not regulated by the American government. Approval of new drugs takes up to three years time.

While Obamacare’s future is in jeopardy, the system cannot improve unless costs are brought under control & all stakeholders focus on the service rather than outcome.

 

 

EBOLA CRISIS DEEPENS; FIRST PATIENT DIES IN THE U.S.

In a dramatic turn of events Thomas Eric Duncan the first patient to be diagnosed with Ebola outside of Africa died in Dallas, Texas, U.S. Last month the Liberian became the first person in the U.S. to be diagnosed with the deadly disease which has killed almost 4,000 people.

As a cargo driver by profession the Liberian happened to offer a lift to an Ebola-affected family in the capital city of Monrovia where he apparently contracted the virus. Later Duncan travelled to the U.S. where he soon fell sick.

Before travelling to the U.S., Duncan failed to declare he had been in contact with Ebola in the mandatory pre-flight questionnaire. This move has prompted the Obama administration to tighten & expand Ebola screening at 5 major U.S. Airports. The check will extend to travelers coming in from Sierra Leone, Liberia & Guinea; worst-affected by Ebola. Incoming travelers will be screened with high-tech thermometers which don’t touch the skin.

After falling ill Duncan approached a hospital where he was turned away only to be admitted two days later after his condition worsened. Duncan was being treated with an experimental drug in an isolation ward in the Texas Health Presbyterian Hospital.

Duncan’s body will be cremated according to guidelines laid down by the Centers for Disease Control & Prevention (C.D.C). Ten other people who came in close contact with Duncan including health care workers & close family members haven’t been quarantined yet. These special cases are staying at their respective homes & are closely being monitored for Ebola symptoms.

Duncan’s death has shifted the spotlight on the hospital’s role in handling the case. Five days after he arrived in Dallas, the Liberian went to the hospital’s emergency room. After an initial treatment he was discharged by the hospital which failed to recognize him as a potential Ebola patient. Three days after his condition worsened Duncan was admitted to the hospital. Lack of care at the right time could have cost the victim his life.

Meanwhile Spain reported its first case of Ebola; a sign that Europe too is not immune from Ebola. A Spanish nurse, Teresa Romero Ramos who treated two Spanish missionaries who flew back from Africa has become the latest victim of the deadly virus. Ebola spreads though bodily contact of fluids of an infected person. The nurse claims to have touched her face with a gloved hand while removing hear protective clothing after treating an Ebola patient.

Like in Duncan’s case the nurse was first told to take an aspirin to treat her fever & reportedly didn’t exhibit Ebola-like symptoms. However just a week later she tested positive for the virus. During this one week Romero went on a short holiday, sat for a civil service exam with 20,000 other people & even used public transportation. Many in Madrid are anxiously waiting to see if they also exhibit any Ebola-like symptoms.

With an increasing number of patients coming in to Europe from West Africa for Ebola treatment the World Health Organisation (WHO) hasn’t ruled out the possibility of an outbreak. More than 50 people who were in close contact with her before she was isolated are being closely monitored now for the virus. Spanish media reports suggest that the nurse had to beg for an Ebola screening test. She was reportedly made to wait in the hospital’s crowded waiting room for hours without any protective gear, thus increasing the exposure of the virus.

Isolation is the first form of defense against the disease which was not followed in both cases. Currently the nurse is being treated with antibodies of Ebola survivors; the only known successful treatment for the virus so far. However Duncan’s family claims he wasn’t administered these antibodies thus denying him a fair treatment.

It is baffling that developed economies like the U.S. & Europe have been so slack in responding to Ebola compared to poor African nations struggling with limited resources. The Spanish hospital did not provide nurses with bio-hazard suits confirming to WHO norms & nurses were given rushed training on treating Ebola patients. Human waste of Ebola patients was transported through the hospital’s same elevator used by unprotected staff.

In Sierra Leone, burial teams responsible for collecting Ebola victim corpses have resumed work after striking over delay in payment of dues. Around 600 workers working in teams of 12 receive an extra $100 per week over their regular pay for doing the hazardous work. Unclaimed bodies increase the risk of the virus spreading. While Britain & the U.S. are sending in troops, aircraft with supplies & medicines the Ebola-hit nations are struggling with shortage of trained medical personnel.

Panicked doctors are fleeing away in Ebola-hit West Africa thus leaving patients to fend for themselves. Most of these nations are so poor that they lack basic infrastructure like clean drinking water, soaps & hand sanitizer. A few healthcare workers haven’t been paid for months but are still treating Ebola patients without surgical or rubber gloves. Some clinics do not have electricity & are plagued with poor internet & mobile phone network.

In one of the Ebola-hit nations thousands of boxes of medical supplies & protective gear are sitting idle due to a dispute between the Government & the shipping company. Bureaucracy & tensions from political rivalries are hampering the disbursement of aid. People on the streets are questioning where the money coming in from donations has disappeared.

Meanwhile a World Bank study has pointed out that the economic costs of Ebola is close to $33 bn over the next two years if the virus spreads to neighbouring countries in West Africa.

African nations have to shake off their bureaucracy first & serve the ailing people first before thinking about their own needs. Only if the virus is contained in West Africa it can be prevented from spreading globally.