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Welcome to the HLH 7100 US Healthcare Finance Wiki!

This Wiki is for UDM HLH 7100 Health Care Policy, Economics and the Law in Clinical Practice class Summer 2019. It is meant to discuss the current financing structure of health care coverage in the U.S.

Introduction

Financing Structure of Health Care in the United States

Health Care costs in the United States, are one of the largest throughout the world.  According to Centers for Medicare & Medicaid Services (CMS), nearly $3.5 trillion dollars was spent on health care in 2017 (Centers for Medicare & Medicaid Services, 2018).  Americans are requiring treatments and prescriptions that are paid by various mechanisms and insurance programs.  As the average lifespan of people increases, this adds to the cost of health care expenditures and puts a strain on the overall U.S. economy.  The Organization for Economic Co-Operation and Development (OECD) has estimated that Americans 16.9% of GDP on health care (OECD, 2019).  That equates to nearly $9,900 per person in 2016 (OECD, 2019).

According to the World Health Organization (WHO), health financing systems are critical for any country to obtain health care for its citizens. As mentioned earlier, the costs of health care are increasing at a tremendous rate. The WHO points out that the availability of coverage and affordability are dependent on the infrastructure of the health financing system of any country. Another recommendation, by the WHO, focuses on the three areas: raising funds for health, reducing financial barriers and allocating funds efficiently. These areas can be applied to the United States health care system and used as a means of evaluating the effectiveness and understanding of the structure.

The United States has many factors that contribute to the high cost of health care.  Government, employers and the people are responsible for paying for health care.  In some cases, one or a combination of these groups pays for services.  In the United States, the government does not provide socialized health care coverage and individuals must seek coverage through private insurance groups or assistance from government agencies. 

The structure of the health care system in the United States is comprised of funding through private insurance, government insurance programs or out-of-pocket funds by the individuals themselves.  Each of these options have specific qualifications and limitations.  Understanding the specifics of health care funding can be complicated and confusing for the average person.  This wiki is intended to define each of basic parts of the funding in the health care system to give a better understanding of how funds are generated to pay for health care services and how individuals qualify and obtain health insurance coverage.  In cases where no coverage is available, the options people must pay for health care out-of-pocket. 

References

Centers for medicare & medicaid services. (2018). Retrieved from https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html

Merck Manual. (2019). Retrieved from https://www.merckmanuals.com/home/fundamentals/financial-issues-in-health-care/overview-of-health-care-financing

Organization for economic co-operation and development. (2019). Retrieved from https://stats.oecd.org/Index.aspx?DataSetCode=SHA

World Health Organization. Retrieved from https://www.who.int/healthsystems/topics/financing/en/

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