The United States of America is composed of fifty states and a federal district. The USA has a total land area of 9.83 million kilometres squared and a population of more than 300 million people. It is a wealthy country, fairly densely populated across a very large continental land mass.
Healthcare in the USA at a glance
The USA has a very high standard of healthcare, setting the benchmarks for international standard in many respects.
Issues of high cost of care, non-equal access and inequitable distribution of resources exist, but do not impact on overall quality of care.
Healthcare costs are very high compared with most other highly developed international healthcare systems.
The country is self-sufficient and manages all its healthcare funding requirements from domestic revenue sources.
Healthcare is organised in 3 tiers: primary, secondary and tertiary levels of care.
Primary care is delivered through family physicians and associated professions working either in solo or group practices, on a fee-for-service basis. Many are incorporated into preferred provider networks for specific insurance carriers – PPO’s, PPN’s. Public primary healthcare centres also operate, based on location and size of population served. Non-profit community health centres provide access to primary care for low-income, uninsured, and minority populations. Other public services include clinics for the military (such as those run by the VHA), prisons, the IHS, and centres for migrants and the homeless.
Secondary care is provided through local hospitals and ambulatory surgical centres. Long-term care and residential care for the elderly is also organised on an institutional basis.
Tertiary care centres offering highly specialised care are usually affiliated with universities as teaching hospitals and offer state of the art services at all levels. Many are public facilities funded by the relevant state of city municipality, others are private or semi-private, owned and operated by charitable or religious foundations. Level 1 Trauma Centres are usually located in all major cities in every state.
The referral system between healthcare levels is relatively efficient, considering the multiple organisations and agencies involved. Specialised hospitals are also used by patients as primary level points of contact, including for walk-in services through ER – this impacts adversely on the efficient use of resources and causes long waiting times for care. Nurse triage systems are in place to improve efficiency.
Emergency Care in the USA
In the event of an emergency and where you cannot get to the hospital yourself, you can call 911 and request an ambulance to assist you. Calls are answered in English and Spanish in states with large Hispanic populations. The 911 medical staff are trained to handle any emergency situation. It is important to note that the utilisation of the ambulance service will likely result in a large fee being charged. However, if you do not want to be taken to the hospital during an emergency, you can always seek treatment from your doctor. Additionally, if you are still capable of taking yourself to the emergency room, call the hospital ahead so that when you arrive the medical staff will be expecting you.
Helicopter emergency rescue services are also available in most areas of the USA from the central dispatch centre. Fixed-wing air ambulances also operate all over the USA and also bring many inbound emergency cases into the USA from South America and the Caribbean region.
Finding a doctor
Being a highly-industrialised nation, finding a doctor in the United States is not difficult at all. There are hundreds of medical practitioners to be found in every state. However, you will have to find a practice that accepts new patients. Once there, you will then be asked to state your medical history and fill out some forms. If possible, ask for a copy of your medical records from your previous doctor before you travel, that way you will have a detailed account of your medical history. This will also help your new doctor to keep track of your health.
Prescriptions in the USA
A wide range of prescription drugs, over-the-counter medications and medical supplies is available all over the USA.
The pharmaceutical industry is highly regulated, innovation is high in the local industry and medicines are consistently of high quality. A doctor’s prescription is necessary for all scheduled medication. Pharmacies are all privatised.
Costs are either out of pocket or are variably covered by private health insurance plans. There is variable coverage for medication under the federal Medicare and Medicaid. Costs of medication are high and generic substitution is usual practice on most plans.
Paying for your hospital treatments
You will need to have some proof of your insurance and show it at the front desk of the hospital. In emergency cases the doctor’s treatment will precede any payment or insurance issues. You will also be expected to pay the medical treatments before you leave. Even if you have international health insurance (which is strongly recommended), you are still required to pay a portion of the cost. The rest of your hospital bills will then be sent to you through mail.
If you’re moving abroad and want to know more about the healthcare in place, take a look at Allianz worldwide care’s guides healthcare systems abroad.