Thursday, August 07, 2003

Providing some services for more people vs. providing more services for some people

This is a fundamental question regarding the social or private health care. We can look at this issue from to angels: individual feeling that usually is mixed with our personal experiences and holistic vision, which is based on more scientific evidences. Living in an idealistic world is interesting fantasy, but it is not necessarily true. We may be against Capitalism, but in reality we enjoy its results. We may hate the pharmaceutical companies, but we use their products, when we are seeking for better treatment. We may be against the private medical system, but medicine cannot survive without money. I am not saying that I agree or disagree with those doctrines. What I am trying to say is that we have to solve this paradox: how can we use America products and in the same time criticize what they do. Mind you I do not mean Mc Donald or Barbie!. I mean scientific and industrial matters. If you are against the US, you should not fly by plane, you should not drive a car with American engine, you should not take any American pills, you should not read any American journal. You should not…

Anyway, when I was in Iran I thought that a socialized medical system is the best option though I was familiar with Norwegian medical system which is almost socialized. It is extremely bureaucratic and ineffective. Here in Canada, say Quebec, I have been involved in the medical system and I am close enough to see what is going on. Recently I have read an American articleabout their medical system and I found it very interesting. Here I quote some parts of it and in the next post I will try to write about what I think about this issue.
It is unavoidable that there will be tough policy choices between providing some services for more people and providing more services for some people. In either case, policy makers will seek better quality for the money being spent. This question of where to invest in quality raises fundamental philosophical (and political) questions about whether to seek allocative efficiency (spreading the available money around to cover a larger number of people to achieve fairness) or technical efficiency (spending money so that the greatest amount of positive health outcomes are achieved regardless of who receives them). Will policy makers seek distributive justice or utilitarian cost-effectiveness?
Experts estimate that more than 42 million Americans—roughly 1 in 6—are without health insurance.6 From Medicare and Medicaid in the 1960s through the Health Insurance Portability and Accountability Act and the State Children's Health Insurance Program of the 1990s, the United States has attacked the problem of insurance access. Yet during the past 2 decades, the problem of uninsurance has actually grown. Between 1977 and 1998, the proportion of nonelderly Americans without health insurance increased from 12.3% to 15.8%. The Medical Expenditures Panel Survey shows that more than 20% of African Americans and nearly 32% of Hispanics lack health insurance, compared with 12% of whites.6 Of all uninsured, 23% are Hispanic and 16% are African American, while only 10% of the total population is Hispanic and 11% is African American.8 Men are less likely to be insured than women, and young adults are at a higher risk of lacking insurance than other age groups. Nearly 32% of adults aged 19 to 24 years are uninsured, compared with 12.9% aged 55 to 64 years.
(posted by Iman)

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