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American Health Care System vs Norwegian Health Care System

"Term paper" i engelsk om helsesystemet i USA sammenlignet med det norske.

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This assignment (project) is mainly about the Health Care System in the United States of America. Reason for why I have chosen this topic is because I am very interested in health matters generally because many of my closest friends are professionals in this field and we often discuss topics concerning health and thing related to this topic. My knowledge about the American system is very short at this time. My goal is to learn about how the health system is functioning in United States of America. I hope that I will achieve some knowledge about the health system over there when I have completed this assignment. I will try to describe how the system is functioning and its influences towards the social welfare system. I will also shortly describe the functioning of the Norwegian System and how it is build up. I,ll try to compare these two systems with each other and make a conclusion about which system I believe is the best for the society generally. I will also give an opinion about which system of mentioned above is best to live in where i would prefer to spend my and my children,s life in.


Since there are many common aspects between American culture and way of living compared with Norway, therefore it is naturally to compare these to countries on this topic.


“ Should Health Care be available equally to everyone?”.


The American Health Care system

The American health care system is totally different compared to the health services in Norway. Whenever a citizen have any need for assistant concerning health services, the government provides it immediately and covers all costs that are caused by that in Norway. The American system is based on a different structure where things work totally different. If you unfortunately needs any assistance concerning health matters in USA you are in that situation totally dependent of a health insurance (I,ll describe this phenomenon some later in this assignment).


Cost of the treatment is very high for everyone who needs medical care. American hospitals are in general well-equipped and efficient with the latest technology and high level of treatment in different medical fields. The doctors earn incomes is far above the general average in America. There is strong prejudice against “socialized medicine” (especially among doctors).


What does “socialized medicine” means?. It is a public system of national health insurance where doctors are usually paid for their services by the government, and everyone is eligible for medical care without any pre-existing condition. Most European countries have some form of socialized medicine. In America there is only two federal health insurance programmes. Those are Medicare and Medicaid.


In 1965, the Social Security Act established both Medicare and Medicaid. Medicare was a responsibility of the Social Security Administration (SSA), while Federal assistance to the State Medicaid programs was administered by the Social and Rehabilitation Service (SRS). SSA and SRS were agencies in the Department of Health, Education, and Welfare(HEW). In 1977, the Health Care Financing Administration (HCFA) was created under HEW to effectively coordinate Medicare and Medicaid. In 1980 HEW was divided into the Department of Education and the Department of Health and Human Services (HHS). In 2001, HCFA was renamed the Centers for Medicare & Medicaid Services (CMS).


Medicare; provides nearly free treatment for the elderly and retired people. Elderly people do not recover the full cost of some types of treatment that are expensive. People age 65 or older, some people under age 65 with disabilities, People with End-Stage Renal Disease (ESRD), which is permanent kidney failure requiring dialysis or a kidney transplant.


This category of people represents 12.3% of the U.S. population, about one in every eight Americans. By 2030, there will be about 71.5 million older persons, more than twice their number in 2000. People 65+ represented 12.4% of the population in the year 2000 but are expected to grow to be 20% of the population by 2030. Even so the cost of Medicare to federal funds rose to billions.


Medicaid; This is a program that pays for medical assistance for poor people and families with low incomes and resources. This program came at the same time as Medicare program and became law in 1965 and is funded by the Federal and State governments to assist states in providing medical long-term care assistance to people who meet certain eligibility criteria. Medicaid is the largest source of funding for medical and health-related services for people with limited income.


The rest of the population such as working people and their families are responsible for their health by them self and are therefore normally insured by private schemes against the cost of treatment and against possible loss of earnings if they get ill. There are a lot of HMOs and PPOs who makes big money from workers because of their anxiety to get ill and the costs an illness brings. This has become a big business in USA today. This types of schemes are often operated by deductions of earnings from wages and salaries. A new post-election survey says that almost two-thirds of Americans say that lowering the costs of health care and health insurance should be a top priority for President Bush and Congress in 2005.


What is HMOs and PPOs?

HMO is a health maintenance organization that provides comprehensive health care to a voluntarily enrolled population at a predetermined price. Members pay fixed, periodic fees directly to the HMO and in return receive health care services as often as needed.

PPO is a preferred provider organization that associates contracts with a group of doctors, dentists, hospitals or other health care service providers to provide care at prearranged rates or discounts.


The American Health care system is the most expensive system in the world. In 2002 Americans spent $ 2000 per person annually on healthcare where of roughly half was for insurance, a quarter for drugs and medical supplies and a quarter for medical services. Americans use 12 percent of the gross national product to pay for medical care, and yet in the year 2003 some data from the Census Bureau show that " 45.0 million people in the United States had no health insurance coverage. Almost 8.4 million American children are uninsured as well. These people don't have medical coverage because they can't afford it. People who do have some form of medical coverage are often unaware of the hidden costs dictated by the private insurance companies.


Insurance systems works like this:

I will now try to design a picture of how the insurance system is functioning in America. Mr. Thomas Olsen is a Texas based construction worker. Thomas (38) is married to Eli (32). They have two kids, Daniel and Chris and they are 7 and 9 years old. Mr. Thomas pays approximately $ 500 to the Health Maintenance Organization (HMO). It is the owner of the construction company (his employer) who has provided him this service. In addition to this does his wife pay approximately $ 250. This fee will cover almost everything (excepting to special medications) his family will need in case of medical assistance. Thomas has chosen his own so called primary care physician. This is the doctor they visit for routine check-ups and the doctor they visit if they get ill. This doctor is also responsible to arrange check-up with a specialist for Thomas and his family if that is required. Every treatment prescribed by the primary care physician is covered by HMO insurance.


Here is a little summary of what the family can get from their insurance policy:

Thomas receives $ 150 of covered physician care in two visits.

Eli receives $ 350 of covered physician care in 5 visits.

Chris receives $ 800 of covered physician services in 16 visits, $ 3 000 covered surgery, and $ 10 000 in covered hospital charges, all in network.

Daniel receives covered physician charges of $ 300 in 6 visits.

(This example is taken from one the biggest insurance organizations in Us)


Public or Private

It seems to me that majority of consumer of the health services in America are unsatisfied with todays healthcare system. I have figured it out from the literature that i have collected concerning this important issue. Many people are of this opinion that the health care system has serious problems. People says that the current system is an not including system and neither the public system or private but a restricted market. This means that the insurance industry is a large group of profit seeking firms who is doing whatever to run their businesses at consumers expence.


The former democrat president of United States Bill Clinton suggested to change the system following European and Canadian models. But the lobbying campaigns from Republicans, The American Medical Association and Insurance industry caused that he failed to get sufficient political support in the Congress.


I believe that health care should be available to anyone and especially in America, the richest country in the world. All citizens deserve good and affordable medical coverage, but this is not the situation in America. The Americans should adopt a public health care system instead of private. I believe there is more fairness and equality as consequence to having a public medical care system and it ensures that all people have access to affordable, high quality and reliable health care. Including those 45 million people who did not have any insurance of health coverage. Today there are too many Americans who have lack of health coverage because their income, their gender, the colour of skin or disability. A Public Health Care system will eliminate this discrimination and this system will also impact on the bureaucracy in HMOs and give consumers free-choice to switch between the marked alternatives and freedom of choosing their own doctor and have access to the specialists they wish to see.


I would like to state a conclusion that a Study of inequalities in healthcare came with in Chicago: It reflects the situation of current health care system very well.


What is it to be sick and poor in the United States? It depends on how sick, how poor and how old you are. It depends where you live. It depends on colour of you skin. It depends on your sex. If you are either very poor, blind, disabled, over 65, male, white or living in a middle or upper class neighborhood in a large urban center, you belong to a privileged class of healthcare recipients, and your chances of survival are good. But, if you are none of these, if you are only average poor, under 65, female, black, or live in a low income urban neighborhood, small town, or rural area, you are a disenfranchised citizen as far as health rights go and your chances of survival are not good.


Today in the American health care system you're more alone and more at risk than you probably realize. This is a system growing more dysfunctional - and more hostile

by the day.


The Norwegian Health Care System

I will now try to describe shortly how the Norwegian Health Care system is build up and functioning. We can call the Norwegian system for socialized medicine.


All worker's pay a tax from monthly salary to cover not only medical care but the welfare programs as well. The Norwegian health care system is mostly publicly funded. The central government provides grants to the counties who redirects finance to the hospital sector. The municipalities also receive grants from the central authorities, and largely fund the primary health care system. The state-run National Insurance Scheme (NIS), created in 1967. It offers public insurance against individual medical expenses (fees for service) for ambulatory care provided by hospitals and private practitioners.


In addition to this hospitals have some income from patient's charges for ambulatory care and transfers from other counties to cover the cost of the treatment of non-resident “guest” patients.


In addition to the public hospital sector there is also small private hospitals consisting of five very small private hospitals with outpatient clinics in Oslo. This sector is representing less than 1 per cent of the total number of hospital beds and 5 per cent of the outpatient services provided in Norway. These private clinics have specialised in open heart surgery, hip surgery and minor surgery such as arthroscopy, inguinal hernia, cataracts, sterilisation and varicose vein operations, because of to long waiting lists for this type of health care at public hospitals. Norwegian law imposes tight restrictions for establishing private hospitals like this. Some medical laboratories and x-ray institutes are also private. Specialists can engage in private practice (with their fees partly reimbursed by the social insurance system), part-time or fulltime, although the hospitals employ the majority of specialists.


Some private commercial hospitals are financed only by patient co-payments, NIS reimbursements and contract-based grants from the counties.



I believe that the health care system problem in America compared to Norway is complex. It is hard to find the perfect program, which might not even exist, but americans should look for better solutions and try to implement them. They can't just be negative to the new proposals. For instance, maybe President Clinton's plan would work, but they will never know because congress rejected it. President Clinton's plan would cover all the 45 million uninsured people. I think this plan is worth reviewing. Also, they have to learn how to cooperate. Politicians should put aside their political differences, insurance companies and the doctors should stop thinking only about their financial benefits. I strongly believe that concentrating on what's best for America will lead to the creation of a better health care system.


General conclusion:

I asked a question in my introduction, “ Should Health Care be available equally to everyone?”.

My opinion and answer for this question is YES, off course health care should be available equally to everyone. It is a responsibility of the whole community that all cictizens get the necessary treatment when they get ill. Especially in countries like USA and Norway. These are among worlds richest countries and should afford it.


I think America should consider a health care system similar to health care systems in the other European countries and Canada. The American system is very bureaucratic and it only strengthens the class distinctions. In Norway we have a history of strong solidarity and economical equality. Even if we are privileged and have high standard if living, we should remember that there will always exist people who are not fitting into the society and earn their own money. A health care system built on an American model will create an elite who can afford to get ill. Is this type of society we wants our children to grow up in? NOT me ;-))!!



Bibliographical references



David E. Nye, Contemporary American Society, Akademisk Forlag, 2003.

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