Liberais de pacotilha (2)
After the county-run Martin Luther King Jr.-Harbor hospital closed its doors last summer, South Los Angeles residents have flooded nearby clinics like St. John's Well Child Center in need of care. The closure is another episode in the ongoing health-care saga among this city's sickest and poorest residents, the vast majority of whom are either uninsured or on the state's Medicaid program, which offers the lowest reimbursement rates in the nation. link link link
NYTimes 05.06.08É isto que querem para o nosso país?
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In 2005, almost 20% of adults reported they did not receive needed health-related services in the past 12 months because they could not afford them.
New technological advances can prevent, treat, or ameliorate conditions and diseases that were once thought untreatable.
Yet many people who could benefit from these services do not receive them. Identifying which Americans do not receive potentially beneficial services, and the reasons underlying suboptimal use of services, is essential to identifying solutions that can improve access to health care. Providing needed preventive, curative, rehabilitative, and palliative health care services to people in need benefits not only the individuals but also their communities, in terms of having a healthier population, increasing productivity, and reducing spending for expensive types of care such as emergency department care or care for persons who are needlessly ill or disabled .
This Special Feature examines access to health care in the United States for the noninstitutionalized population. A 1993 Institute of Medicine panel defined health care access as ‘‘the timely use of personal health services to achieve the best possible health outcomes’’ . Due to the difficulty of directly measuring need for services, appropriate timeliness of services, and health outcomes, access is usually studied indirectly by examining whether rates of service use are at recommended or expected levels, or whether population groups differ in use of services. Lower rates of service use among a group may reflect a barrier to access but must be further studied to determine if there is differing need for services among the groups, and whether services are underutilized in the lower-use group or overutilized in the higher-use group. However, having equal access to health care services does not guarantee that needed services are received or that outcomes are optimal. Not everyone who has access to services receives them when needed, and people who live in areas with few services may still obtain them .
Additionally, the relationship between health care and outcomes is influenced by a myriad of factors other than access, including propensity to seek care, health status, compliance with medical advice, and quality of services provided.
Health insurance coverage is also used as a proxy measure of access to health care because the lack of any health insurance coverage has been established as a major barrier to receiving most health care services. However, insurance alone is not sufficient to ensure access to all health care services. Few insurance policies cover all needed or desired services, and many policies exclude coverage for pre-existing conditions . Cost-sharing varies widely across insurance policies, so that even people with insurance may have to pay substantial copayments, deductibles, and other out-of-pocket expenses. Generosity of coverage, especially for long-term care, medical supplies, psychotherapy, or dental, vision, home health, or rehabilitative services varies considerably among private health insurance policies. States also vary in the extent to which they cover these types of services in their Medicaid and State Children’s Health Insurance Program (SCHIP) programs. The Medicare program does not cover several health services, including general physical, vision, or hearing exams; long-term custodial care; dental care; and the cost of eyeglasses or hearing aids, and it requires a deductible and copayment for most services. The majority of Medicare enrollees have supplemental insurance to cover some costs for services not covered by Medicare .
The burden of out-of-pocket health care expenses is greatest for poor and uninsured people. But some higher-income families with health insurance who have catastrophic illnesses or high out-of-pocket expenditures for noncovered services may devote a substantial portion of their income to medical care, or to health insurance premiums, or both .
Health insurance premiums alone can be a burden on family income. Even with employer subsidies for their workers’ health insurance, worker contributions averaged $627 for a single-person plan and $2,973 for a family plan in 2006; employers paid an average of $3,615 per worker for single plans and $8,508 for family coverage . Individual insurance policies paid entirely by the beneficiary can cost substantially more—particularly for people with pre-existing conditions—and can account for a large share of disposable income in poorer families .
The majority of Americans do not report having problems accessing health care services due to cost. In 2005, 19% of adults 18 years of age and over—more than 40 million people—reported they did not receive one or more of the following health-related services in the past year because they could not afford them: medical care, prescription medicines, mental health care, dental care, or eyeglasses . About 12% of adults reported they did not receive needed dental care and 7% did not purchase needed eyeglasses due to cost . About 7% of adults (representing about 15 million people) reported they did not receive needed medical care in 2005 because they could not afford it. The percentage of adults who did not receive prescription drugs because they could not afford them increased from 6% in 1997 to 9% in 2005 . Fewer problems in obtaining needed services were reported for children and adults age 65 years and over than working-age adults 18–64 years of age .
National Center for Health Statistics Health, United States, 2007
With Chartbook on Trends in the Health of Americans Hyattsville, MD: 2007
A América vai mudar
...É preciso eleger Barack Obama como o próximo Presidente dos Estados Unidos": para garantir que todos os americanos têm acesso a cuidados médicos; podem pagar as contas da mercearia, a gasolina ou as propinas da universidade; encontram novas oportunidades de emprego, combatem o aquecimento global, vejam um fim para a guerra do Iraque e reconheçam o serviço dos veteranos. ...
Hillary Clinton,
USA e a criação de um modelo universal
The U.S. health care system is deteriorating in terms of decreasing access, increased costs, unacceptable quality, and poor system performance compared with health care systems in many other industrialized Western countries. Reform efforts to establish universal insurance coverage have been defeated on five occasions over the last century, largely through successful opposition by pro-market stakeholders in the status quo. Reform attempts have repeatedly been thwarted by myths perpetuated by stakeholders without regard for the public interest. Six myths are identified here and defused by evidence: (1) “Everyone gets care anyhow;” (2) “We don’t ration care in the United States”; (3) “The free market can resolve our problems in health care”; (4) “The U.S. health care system is basically healthy, so incremental change will address its problems;” (5) “The United States has the best health care system in the world”; and (6) “National health insurance is so unfeasible for political reasons that it should not be given serious consideration as a policy alternative.” Incremental changes of the existing health care system have failed to resolve its underlying problems. Pressure is building again for system reform, which may become more feasible if a national debate can be focused on the public interest without distortion by myths and disinformation fueled by defending stakeholders.
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International Journal of Health Services, Volume 33, Number 2, Pages 315–329, 2003
Em Portugal o Estado quer ver-se livre da prestação de cuidados e aligeirar o financiamento da Saúde. O Estado confia na prestação dos privados (CC, na recente entrevista ao DE voltou a elogiar, a qualidade dos cuidados do Amadora Sintra, o que deve ter deixado deveras contente o senhor Salvador). O Estado confia nos seguros de saúde privados como forma de financiamento da Saúde. O Estado tem vindo a entregar a ADSE aos privados (o que suscitou a compreensível indignação da ministra da saúde na AR). O Estado prepara-se para transformar a ADSE num seguro de saúde voluntário, permitindo assim o "opting out" dos funcionários de melhores recursos económicos. O Estado entregou à gestão privada cinco unidades do SNS, entre elas o Hospital Universitário de Braga.
Todo um conjunto de medidas visando a privatização da Saúde em Portugal em prejuízo dos mais pobres (cerca de 45% da população) e dos contribuintes.
Isto apesar da experiência de outros países como os EUA, aconselhar-nos a preservar a todo o custo o nosso SNS, que apresenta alguns indicadores que onbreiam com os dos melhores sistemas de saúde mundiais.
The U.S. spends twice as much as other industrialized nations on health care, $7,129 per capita. Yet our system performs poorly in comparison and still leaves 47 million without health coverage and millions more inadequately covered. link
This is because private insurance bureaucracy and paperwork consume one-third (31 percent) of every health care dollar. Streamlining payment through a single nonprofit payer would save more than $350 billion per year, enough to provide comprehensive, high-quality coverage for all Americans.
Currently, the U.S. health care system is outrageously expensive, yet inadequate. Despite spending more than twice as much as the rest of the industrialized nations ($7,129 per capita), the United States performs poorly in comparison on major health indicators such as life expectancy, infant mortality and immunization rates. Moreover, the other advanced nations provide comprehensive coverage to their entire populations, while the U.S. leaves 47 million completely uninsured and millions more inadequately covered.
The reason we spend more and get less than the rest of the world is because we have a patchwork system of for-profit payers. Private insurers necessarily waste health dollars on things that have nothing to do with care: overhead, underwriting, billing, sales and marketing departments as well as huge profits and exorbitant executive pay. Doctors and hospitals must maintain costly administrative staffs to deal with the bureaucracy. Combined, this needless administration consumes one-third (31 percent) of Americans’ health dollars.
Single-payer financing is the only way to recapture this wasted money. The potential savings on paperwork, more than $350 billion per year, are enough to provide comprehensive coverage to everyone without paying any more than we already do.
Under a single-payer system, all Americans would be covered for all medically necessary services, including: doctor, hospital, long-term care, mental health, dental, vision, prescription drug and medical supply costs. Patients would regain free choice of doctor and hospital, and doctors would regain autonomy over patient care.
Physicians would be paid fee-for-service according to a negotiated formulary or receive salary from a hospital or nonprofit HMO / group practice. Hospitals would receive a global budget for operating expenses. Health facilities and expensive equipment purchases would be managed by regional health planning boards.
A single-payer system would be financed by eliminating private insurers and recapturing their administrative waste. Modest new taxes would replace premiums and out-of-pocket payments currently paid by individuals and business. Costs would be controlled through negotiated fees, global budgeting and bulk purchasing.
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