XII. Read the text and find the answers to the following questions.

1. Does the present system provide sufficient care to Americans?

2. What are the usual blames of American people concerning the cost for health care?

3. What is the initial charge covering the cost of a bed per day?

COSTS OF THE PRESENT SYSTEM

The present system costs so much and appears to provide so little, especially when it is realized that many of the parameters normally used to judge the health of a nation place the United States somewhere in the middle, not far above many third world countries. These parameters in­clude neonatal and perinatal death rates and overall life expectancy.

There are those who blame the doctors'fees, and there is no doubt that there are many millionaire doctors, mainly surgeons, in the USA. Ho­wever, for most hospitalisations, the doctors' bills are only a small pro­portion of the total bill and, even if doctors provided services for free, health care costs would probably only drop around 10 per cent. Others blame the lawyers for the large malpractice claims which have forced up malpractice insurance for doctors, nurses, hospitals and just about every­one else who have to pass these costs on to patients. Additionally, it has greatly increased defensive medicine, which means that many patients are over-investigated and over-tested, often more for medicolegal reasons than for clinical reasons. There is no doubt that this does increase the cost of health care to a certain extent but again is probably not a major factor.

Others blame the fact that most medical care in the US is provided by specialists rather than by general practitioners. It is well known that spe­cialists charge more for diagnosing and treating a condition than would a general practitioner with the same condition. Specialists charge more for their time and tend to order more tests. This criticism may well be valid. Those who have been hospitalized in the USA may well look at the hospital bill that they receive with astonishment. The initial charge for the hospital bed may run around $ 1500 per day before one counts any of the additional costs of monitoring, medications, tests and the use of the operating theatre and recovery room. The $1500 per day only covers the cost of a bed, compared to even the best hotel room in New York costing only $1 200 a day.

XIII. Read the text and give answers to the following questions.

1. What are the funds financing dental care?

2. Is insurance a method of sharing patients expenditures?

3. What are health care corporations?

FINANCING MECHANISMS

The payment and financing of dental (health) care may be classified in a number of ways. One can consider the sources of funds, the timing of payment, the method of paying, or the one who pays. Regardless of how payment for medical care is classified, a basic point to remember is that the public must pay for care under any system of finance. The cost falls on families and individuals through taxes, higher prices, or lower takehome pay, even when the payment mechanism makes it appear that the bills are being sent elsewhere. The financing system can make a sig­nificant difference for high- and low-income families, but average tax- paying families all pay the same.

The present system for financing medical care in the U.S. is diverse- part self-pay, part government pay, and an increasing part third party payment through private insurance. Insurance is a method of sharing risk and often of spreading payments over an extended period. There has been a rapid growth in dental insurance in recent years; one out of seven fam­ilies is now covered by some form of third party payment plan. By 1980 the ratio will probably be one in four. Dental prepayment, described by HEW simply as "a system for budgeting the cost of dental services in advance of their receipt," is a method of financing payment for all or part of the cost of dental care for persons covered by a plan. Usually a sub­scriber pays dues or premiums into a fund or to an insuring organization, and the money is subsequently used to cover the cost of dental services as the subscriber receives them.

Third party and prepayment arrangements can be made with a vari­ety of organizational forms such as commercial insurance companies, health service corporations (such as Blue Cross), dental service corpora­tions, and through group practices and clinics. Most of these arrange­ments are made with groups of patients other than individuals.