N 502 Module 4 Discussion Since Primary Care Is The Basis For Maintaining Health And Early Diagnosis Of Potential Health Problems, Who Should Be Responsible For Rectifying This Misplaced Emphasis of H

N 502 Module 4 Discussion Since Primary Care Is The Basis For Maintaining Health And Early Diagnosis Of Potential Health Problems, Who Should Be Responsible For Rectifying This Misplaced Emphasis of H

N 502 Module 4 Discussion Since Primary Care Is The Basis For Maintaining Health And Early Diagnosis Of Potential Health Problems, Who Should Be Responsible For Rectifying This Misplaced Emphasis of H

The United States’ healthcare system has both private insurers and a public system that

covers the elderly and low-income families. Employer-sponsored private insurance is the main

way Americans receive insurance coverage, and most services are provided by private providers.

The Medicaid program serves poor families and the disabled. States are required to cover low-

income pregnant women, children, elderly and the disabled, but states can also expand

eligibility if they choose. Separately, the Medicare program covers those over age 65. Benefits

vary according to type of insurance in the U.S., but often include inpatient and outpatient

hospital care and physician visits. Many plans also include preventive services, dental care and

prescription drugs. Medicaid covers a broad range of services including inpatient and

outpatient hospital care, physicians and medications. Basic Medicare covers hospital services,

but individuals can pay premiums to receive extra coverage for physician services and

prescription drugs. The U.S. government uses money generated from taxes to reimburse

providers who take care of patients enrolled in Medicare, Medicaid, SCHIP or VA. There is also a

tax subsidy of employer-based insurance. The government accounts for nearly 46 percent of the

total health spending in the country. The U.S. spends more than any other country on health

care, because “it pays higher prices and has greater volume of services, particularly high-tech

services” (De Lew, 2019).

In comparison, Mexico has a fractionalized system with a variety of public programs, but

does not have universal coverage. There is also a private insurance market, mostly used by

wealthy residents. A social security administered system covers those who are employed,

unless they have private employer-sponsored insurance, while the Seguro Popular program,

created in 2003, has been set up to help cover more of the uninsured population. Poor families

can participate in Seguro Popular for free and people who do not participate in the insurance

program can still access services through the ministry of health, though sometimes with some

difficulty. The social security system-based insurance in Mexico provides broad coverage for

medical services, including primary care, acute care, ambulatory and hospital care, pregnancy

and childbirth as well as prescriptions medications. Out of pocket payments by patients

represent over half of financing for the Mexican health care system, according to the WHO.

Government expenditures accounts for 44 percent of health spending. The public schemes,

including the Mexican Institute for Social Security and the Institute of Social Security for

Government Employees, are financed through general taxes, and payment from the employer

and employee, determined by salary. The Seguro Popular also is funded by taxes, contributions

from the state and federal government and payments by the families, as a percentage of

income. Participants in Seguro Popular pay nothing at the time of delivery of the service.

As with most other middle-income countries, Mexico does not have universal access to

coverage for its population. About half of Mexico’s population does not have health insurance

under the current siloed system (Vargas, 2012).

References:

Hernandez. (2019, February 25). Health Analysis – Healthcare Costs in Mexico vs. United States.

Retrieved July 02, 2020, from https://allista.care/blog/healthcare-costs-in-mexico/

Vargas Bustamante, A., Laugesen, M., Caban, M., & Rosenau, P. (2012). United States-Mexico

cross-border health insurance initiatives: Salud Migrante and Medicare in Mexico.Revista

panamericana de salud publica = Pan American journal of public health, 31(1), 74–80.

De Lew, N., Greenberg, G., & Kinchen, K. (2019). A layman’s guide to the U.S. health care

system. Health care financing review, 14(1), 151–169.