Health Care in Usa

Health care in the United States is the best in the world and the most expensive. The cost and financing of health care is directly related to the control of healthcare. Who controls health care is a difficult and complex question to consider and answer.

Early on in the development of hospitals physicians had the responsibility of setting guidelines for care and setting appropriate reimbursement guidelines (Applebee, 2006). By the 1900's some private insurance was available but the true form of employer based health insurance did not take root until after World War Two (Shi, 2008). Physicians continued to have the ability to control care, admissions to hospitals and reimbursement rates. Along with the physician dominated health care system came a dramatic growth in the size and status of the U.S. hospital industry (Kovner, Knickman, Weisfeld, & Jonas, 2011). As the hospital industry grew the cost of providing care increased. This increase in cost brought forward the recognition that the average middle income American could not afford care thus the creation of the first form of Blue cross (Kovner, Knickman, Weisfeld, & Jonas, 2011). Post World War Two brought great growth but also the knowledge that the poor, elderly, disabled, unemployed, self employed worker were left out of the coverage system. In the 1960's Medicare and Medicaid were introduced to assist the uninsured.

The amazing growth of technology and scientific advances in medicine have greatly increased the cost of care and brought us to where we are today. Today control of healthcare is in the hands of third party payers and the government. Managed care was introduced in the 1980's with the intention of decreasing costs and utilization. Along with managed care came the corporatization of health care delivery (Shi, 2008). Hospitals became large corporations controlling inpatient as well as outpatient services. Private practicing physicians found themselves unable to maintain their practices and were forced to join large groups or become employed by hospitals. Most private insurance companies and Medicare on Medicaid have developed criteria for admission, average length of stay criteria and assigned cost to particular diagnosis. This has controlled some costs but not enough to successfully fix the system. Third party payers and government continue develop rules, regulations and standards surrounding who can receive care, what kind of care, and the length of time the care can be given. The third party payers may argue that they do not dictate care however the average citizen would disagree. Anybody that has been hospitalized or has presented at the emergency department knows that the insurance company decides on the admission and dictates the length of stay.

Hospital administrators are challenged on a daily basis with regards to third party payer requirements. The requirements that need to be met for insurance companies to pay the hospital