| The American Health Care System WESTPORT, Jan 07 (Reuters Health) - The American healthcare system, the most expensive in the world, is nonetheless riddled with problems and contradictions, according to a report in The New England Journal of Medicine In a Health Policy Report in the January 7th issue, National Correspondent John K. Iglehart tracks the unwieldy economic factors influencing national healthcare expenditures and observes a number of opposing forces. "[T]he American system is a work in progress, driven by a disparate array of interests with two goals that are often in conflict: providing...healthcare to the sick, and generating income for the persons and organizations that assume the financial risk," Iglehart says. Iglehart remarks that working adults bear the brunt of healthcare costs in the form of taxes, payroll deductions and direct payments to providers. He notes a decline in healthcare expenditures in the past 5 years, and yet a jump in 1997 in government healthcare spending, to 46% of the total versus 40% in 1990. He cites Health Care Finance Administration (HCFA) figures for 1997, revealing a $1,092 billion national health expenditure, consuming 13.5% of the GDP. The government's annual bill for healthcare spending--$3,925 per person--significantly exceeds that of other nations, Iglehart says, because physicians' salaries and hospital costs are higher, and medical technology is more widely used. The transfer of funds among federal and state Medicare and Medicaid programs is another important component of national healthcare spending, he comments. Iglehart reports that in 1997 hospital costs consumed the largest portion of the healthcare dollar, accounting for $371 billion. The bill for physicians' services was $217.6 billion, nearly 20% of the healthcare dollar. Nonetheless, the annual growth in mean net income for all physicians declined from an average of 7.2% (1986 to 1992) to 1.7% (1993 to 1996), largely as a result of managed care contracting. In an accompanying editorial, Dr. Marcia Angell writes, "The American healthcare bsystem is at once the most expensive and the most inadequate system in the developed world." N Engl J Med 1999;340:48,70-76. |
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