Will the American healthcare system withstand the test of coronavirus: 5 features of medicine in the US

The coronavirus pandemic COVID-19 is also a test for healthcare systems in countries around the world. The features of the US medical system can both help in the fight against the spread of the disease, and significantly complicate the containment of the virus and the treatment of patients.

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An ambulance ride is expensive

On April 2019, XNUMX, my son broke his arm after falling from a fence on the school playground. The school quickly realized what had happened, but did not call an ambulance. We waited for my husband, who was working at home, to arrive. “Will you take the child to the hospital yourself or call an ambulance?” — the nurse asked him when he finally got to school. The man called an ambulance, but many parents would not do this. If you don't have health insurance, such a trip can cost a pretty penny.

Without health insurance, ambulance services cost on average from $400 to $1200. In some cities they are covered by local taxes. The system as a whole is very diverse: According to the American Emergency Medical Services Association, there are 14 ambulance services in the United States - private, public, volunteer and hospital-based.

The study revealed many cases where patients received bills for fantastic amounts even if they had health insurance. Among the 350 complaints from 32 states that the researchers analyzed, it turned out that one person received a bill for $3600 when he was taken to a hospital seven kilometers away, another received a bill for $8460, despite the fact that the hospital where he was first taken could not provide treatment. he received help and was sent to another. One woman was in a car accident with a bill for $26 because the ambulance called the “trauma team” before arriving, even though the woman didn’t need to.

Such amounts are completely legal. They appear because medical insurance does not cover medical services in any hospital and any procedure or drug. Each insurance policy contains a network of doctors whose services it covers. And the ambulance that came for you may turn out to be such that it is not included in your insurance, or along the way will make a procedure that your policy does not cover.

Forty years ago, ambulance services in the United States paid taxes, and they were free to the public. Then the system was privatized. Some states have laws that limit the amount that a patient can charge, but not all.

An ambulance came to my son immediately with a whole team of orderlies. And then we got a $ 100 bill.

Surprise Accounts

If you have medical insurance after a visit to the doctor, you can either pay the so-called surcharge or pay nothing if everything is covered by insurance. In other cases, the bill is sent later, after the insurance company pays its part. Often an explanation is also sent home (with fantastic amounts to be paid), but this is not an account that you must wait before drinking a sedative and calling the hospital. Most of this amount will be paid by the insurance company.

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But it also happens that fantastic amounts come to pay, the so-called surprise accounts. As in the case of an ambulance, if you suddenly get to a doctor or hospital department that is not part of the network of your insurance policy, or you have a procedure that it does not cover, you can get bills for amounts that are completely unexpected.

According to consumer research, in 2015, every third American every two years becomes a victim of surprise accounts. Time magazine, which devoted an article to this topic, cites the example of Elaine Hightower, a web designer from Atlanta. Due to arthritis, she needed two finger surgeries. The woman made sure that the surgeon who will perform this operation is on her network, and the insurance policy for which she pays $ 568 per month will cover the procedure. But a few months after the successful operation, she received an invoice in the amount of $ 6300. It turned out that the insurance did not cover the anesthesiologist, and the implants that the surgeon used were also not included in the medical plan of the policy.

Desperate gynecologists in New York and "pursuers of ambulances"

Sometimes, although by no means always, such surprise bills can be appealed or at least agreed with the hospital to reduce the amount.

In the United States, there is an army of lawyers specializing in claims against doctors, as well as manufacturers of medical drugs and products. No sooner had my son left the hospital than we received a letter from a law office asking if we wanted to sue the school?

My trip to the MRI through a tendon torn by my dog, too, did not go unnoticed by experts in law. In the hospital, where I came with an injury, the first thing they asked me was who my lawyer was. In the US, lawyers who actively offer their services only to injured people are jokingly called "persecutors of ambulances."

In 2010, then Congressman Tom Price, who was the head of the Department of Health at the U.S. Government President Donald Trump, said that so-called protective medicine, as a result of fears of lawsuits, cost the United States $ 650 billion annually. It is in lawsuits that the high cost of the entire healthcare system in the United States is blamed, since doctors themselves have to buy insurance policies to protect themselves in the event of lawsuits, and also, to be safe, write out extra tests and procedures.

Although few people like to work under threat of lawsuits, there are doctors in the United States who will say that the problem is exaggerated. California family physician David Belk writes in his blog that he pays less than $5000 annually for his insurance policy. Doctors working with him range from $5000 (nephrologist) to $35000 (obstetrician-gynecologist). According to statistics, nurses and obstetricians-gynecologists are the most likely to be sued.

According to the National Medical Practice Database, the number and size of lawsuits paid out in the United States have been declining sharply since 2001. If in 2001 there were 16 lawsuits against doctors, then in 000 there were 2017. Most lawsuits against doctors are in New York, where there are more lawsuits and the amounts paid are higher than in other cities.

Thirty-three states have introduced legal restrictions on the ability to sue and the upper limit of payments that a court may order. But in general, Belk writes, the cost of lawsuits against doctors is only 0,33% of the value of the entire medical industry in the United States.

Handful pills

Although in the USA there are religious sects and communities where almost all medicine is prohibited (Christian Science, Amish, etc.), Americans generally trust medicine. You won’t hear words like “I won’t be poisoned by your chemicals” here. Folk methods, which in the United States are called “old wives’ tales,” are less common than in Ukraine. The only popular non-drug treatments here are rest and warm drinks. American society is more concerned about the opposite problem - the use of excessive amounts of medications.

Once while still studying at Ohio State University, while waiting in the corridor of a medical center, I heard a doctor talk with a previous patient. When asked what medicines she was taking, a female voice listed a list. I expected to see a man in a wheelchair. But a woman bursting with health fluttered out of the office. Although, of course, I do not know her diagnosis, and often serious diseases do not manifest themselves in any way at all.

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But it is a fact that drugs, particularly opioids and antibiotics, are overprescribed in the United States. After I gave birth, a nurse came into my room three times to tell me that the doctor gave me permission to take Vicodin, a painkiller that contains a synthetic opioid, and that she could bring me some. Barely fought back.

Over the past 20 years, the number of medicines prescribed for patients has increased. Between 2000 and 2012, the percentage of adults taking 5 or more drugs increased from 8,5% to 15%. Among Americans 65 years and older, 42% take more than five medications. These data are contained in a study done for the Laun Institute. According to another study, 55% of all Americans take the drugs prescribed by the doctor every day, on average four tablets.

There are many reasons for this. Here are a few of them.

Influenced by advertising on which pharmaceutical companies spend billions, patients ask doctors to prescribe specific drugs - ones they have seen on television. Less noticeable, but no less effective, drug manufacturers exercise direct influence on doctors - through the organization of conferences, presentations, study visits, etc.

Since the early 1980s in the United States, even the slightest discomfort has begun to be perceived as unacceptable. The so-called pain management has become an expected part of the doctor’s work, according to which patients, in particular, evaluate them. Thus, painkillers began to be prescribed more. I am still used to enduring pain if it is not severe, which my young man does not understand.

Patients can go to different doctors who do not always know what his colleague wrote out.

The effects of long-term use of certain medications are unknown or hidden. From time to time in the United States a wave arises about the inadmissibility of prescribing excessive amounts of certain drugs - psychotropic drugs, antibiotics, opioids. Now the so-called opioid epidemic, where people become addicted to prescription drugs, is a huge problem in the United States.

But at the same time, without a doctor’s prescription in a pharmacy you can buy a very limited number of drugs. And there are no recipes by hand here. As soon as the doctor has prescribed treatment during the visit, a hospital representative reports what has been prescribed directly to the pharmacy, where the patient takes his medications by ID.

High quality medicine

This feature, probably, will not surprise anyone. American hospitals, at least those where I was and I saw it on the news, it looks exactly like in the movies. The latest methods - at least in our area, near the American capital. We do 3D mammograms, and my dentist himself prints the crowns on a XNUMXD printer.

So, if you have good insurance, then the most advanced treatments will be available to you. The medical industry in the USA is expensive, modern and prestigious.

Just like the medical education industry. Among the top ten medical universities in the world, according to various indicators, 6 are in the United States. Best: Harvard, Stanford, Jones Hopkins, Michigan, Columbia, Washington and the University of North Carolina.

Medical universities host laboratories and hospitals. Irina Bird, a Ukrainian who came to the United States from Zaporozhye, is a professor in the department of gynecology and obstetrics and director of research in fetal medicine and fetal neurology at Johns Hopkins University.

“Johns Hopkins is a unique place. We work together with the Baltimore community to make healthcare accessible. The obstetrics department delivers babies to women living in the Baltimore area who do not have health insurance. Unlike private clinics, our salary does not depend on how many patients or how many births we have attended. Our mission is to contribute to research and society. That’s why Hopkins is one of the best hospitals,” she says.

In general, all of the listed features of American medicine boil down to one thing: unlike other developed countries, medicine here is a highly profitable business, and not a public good, like safety, school education or the environment. And this has both significant benefits and huge problems. And how successful this model is will be shown in particular by the coronavirus epidemic.

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The original column is published on the website. Ukrainian service "Voices of America".

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