1. Health care system, of USA confronts a number of challenges.

2. The study of aging process and the number of specific health needs of the elderly.

3. An increase of the infant mortality rate among minority groups.

4. Efficacy of the preventive measures.

5. AIDS is a severe challenge to the health care system.

HEALTH CARE CHALLENGES

Although Americans, on the average, are healthier and live longer today than ever before, a number of challenges still confront the medical care system in the United States. While advanced technology can provide artificial hearts or transplanted kidneys to a few at high cost, others still suffer from diseases, such as tuberculosis, that medicine already has "conquered."

Older Americans are one of the fastest growing segments of the pop­ulation. About five percent of the elderly population live in nursing homes. Many suffer from Alzheimer's disease, an increasingly common ailment that affects the brain, leaving its victims mentally confused and hard to care for. Other patients, who might have died in previous years from strokes and other ills, live on; but they suffer from; speech and memory defects, paralysis and other disabilities. As Americans have grown more aware of the specific health needs of the elderly, the field of gerontology, the study of the aging process, has attracted increasing numbers of physicians. Medical research has focused on this health issue as well, notably with the establishment of the federal government's National Institute on Aging.

The nation's infant mortality rate is also a concern. The number of infants per thousand live births who died before their first birthday remains higher for the United States than for several other industrialized nations. His rate is also higher for blacks and other minorities than for white Americans. Health authorities agree that better nutrition and pre­natal (before birth) health care could substantially lower the infant mor­tality rate among these minority groups.

Delivering better health care to poor and disadvantaged groups in the United States is only one way of improving the nation's overall health. Research in recent years has made it clear that disease is the result of the way people choose to live. Money spent to persuade people to lose weight, exercise regularly, eat more healthful foods and stop smoking can often provide greater benefits for more people than the most advanced medical technologies. For example, studies have linked a significant drop in the rate of lung cancer to a nationwide decline in cigarette smoking.

Another severe challenge to the health care system is Acquired Immune Deficiency Syndrome, or AIDS.

This worldwide disease, first reported in the United States in 1981, is caused by a virus spread by sexual contact, needle sharing (such as in illegal drug use) or exchange of blood (such as in transfusions). Since 1981, more than 83 000 Americans have died of AIDS.

X. Make a summary of the text using these statements as an

outline.

1. Health management organizations.

2. USA has produced a very fragmented health care system.

3. New trends in insurance flaming.

HEALTH CARE REFORM

The large insurance companies will band together into groups called health management organizations (HMOs) which will contract with hos­pitals to provide health care for their insureds at the best rates. There are those who feel very little will change.

The USA already spends nearly 14 per cent of its Gross National Product on health care. Most Americans feel that they do not get value for money and there is considerable evidence that many people voted for President Clinton in November 1992 purely because of his promise to reform the fragmented and disorganised health care system. The only problem, of course, is that everybody has a different idea of what is wrong with the health care service and what needs to be done about it, and everybody has their own solution.

Although the USA spends nearly 50 per cent more per head of the population on health care than any other country, it has produced a very fragmented and patchy system with numerous opportunities to fall through the cracks. Many workers and their relatives receive health insurance via the place of work. This is apparently a system that grew up after World War II, when employers were not allowed to raise wages and had to find other fringe benefits to attract workers, and found that pro­viding private health insurance was one of the most popular. From that, it grew into a right.

However, with the recent recession and the switch from large indus­tries to fairly small companies, many firms no longer offer health insur­ance for their employees. This is the reason for the present statistic that the largest percentage of citizens without health insurance are actually working full time but in fairly lowpaying jobs that do not carry health insurance. In addition, many of these private insurance funds vary con­siderably in the coverage and the excess (the amount the patient must pay before the insurance company starts to contribute), and also the co-pay­ment, as most insurance companies only pay 80 per cent of the cost. Many employers also provide private dental insurance.