15.2: Healthcare

Healing people has been done differently throughout the world and throughout history. Many Americans use medical treatments that are not part of mainstream (conventional or western) medicine. When you are using these types of care, it may be called complementary, integrative, or alternative medicine.

In the U.S., how you pay for your healthcare is dependent on whether you have insurance and the type of insurance you have. In many other countries healthcare is covered through universal health coverage.

Western medicine: Conventional Medicine

Conventional medicine, also called allopathic medicine, biomedicine, mainstream medicine, orthodox medicine, and Western medicine, is the medical system most Americans are used to. It is a system in which medical doctors and other healthcare professionals (such as nurses, pharmacists, and therapists) treat symptoms and diseases using drugs, radiation, or surgery. Western medicine is the basis of most of the modern healthcare in the world utilizing a systemic approach, incorporating: 1.) physically examining the body and the associated symptoms, 2.) diagnosing diseases and conditions using scientific evidence, and 3.) using treatments that are clinically proven to be effective^[3].

Eastern Medicine: Complementary and Alternative Medicine (CAM)

The words “complementary,” “alternative,” and “integrative,” are often used interchangeably to represent practices that are not included in conventional medicine. These are typically supported by tradition and seldom taught in a Western medical setting.

If a non-mainstream practice is used together with conventional medicine, it’s considered “complementary.” However, If a non-mainstream practice is used in place of conventional medicine, it’s considered “alternative.” There are many definitions of “integrative” health care, but all involve bringing conventional and complementary approaches together in a coordinated way. True alternative medicine is uncommon. Most people who use non-mainstream approaches use them along with conventional treatments.

The National Center for Complementary and Integrative Health (NCCIH) is responsible for conducting and supporting research and providing information about complementary health products and practices.

Complementary approaches can be classified by their primary therapeutic input (how the therapy is taken in or delivered), which may be nutritional or psychological/physical. These include^[4]:

• Mind–body therapies: These combine mental focus, breathing, and body movements to help relax the body and mind.
  • meditation: focused breathing or repetition of words or phrases to quiet the mind and lessen stressful thoughts and feelings.
  • biofeedback: using special machines, the patient learns how to control certain body functions that are normally out of one’s awareness (such as heart rate and blood pressure).
  • hypnosis: a trance-like state in which a person becomes more aware and focused on certain feelings, thoughts, images, sensations or behaviors. A person may feel more calm and open to suggestion in order to aid in healing.
  • yoga: ancient system of practices used to balance the mind and body through stretches and poses, meditation, and controlled breathing
  • tai chi: a form of gentle exercise and meditation that uses slow sets of body movements and controlled breathing
  • imagery: focusing on positive images in the mind, such as imagining scenes, pictures, or experiences to help the body heal
  • creative outlets: interests such as art, music, or dance
• Biologically based practices: This type of CAM uses things found in nature.
  • vitamins: nutrients the body needs in small amounts to function and stay healthy
  • dietary supplements: products added to the diet that may contain ingredients such as vitamins, minerals, and herbs, to name a few
  • botanicals: plants or parts of plants. One type is cannabis.
  • herbs and spices such as turmeric or cinnamon
  • special foods or diets
• Manipulative and body-based practices: These are based on working with one or more parts of the body.
  • massage therapy: a therapy where the soft tissues of the body are kneaded, rubbed, tapped, and stroked
  • chiropractic therapy: a type of manipulation of the spine, joints, and skeletal system
  • reflexology: a type of massage in which pressure is applied to specific points on the feet or hands, which are believed to match up with certain parts of the body
• Energy healing: Energy healing is based on the belief that a vital energy flows through the body. The goal is to balance the energy flow in the patient. There’s not enough evidence to support the existence of energy fields. However, there are no harmful effects in using these approaches.
  • reiki: placing hands lightly on or just above the person with the goal of guiding energy to help a person’s own healing response
  • therapeutic touch: moving hands over energy fields of the body or gently touching a person’s body

How to decide whether to use complementary or integrative medicine

Decisions about whether to use complementary health practices are important. Learning the results of studies and understanding a therapy’s potential benefits, risks, and scientific evidence can help you make those decisions.

Review the Tips on Complementary Health Practices

Health insurance in the U.S.

No one plans to get sick or hurt, but most people need medical care at some point. Health insurance covers essential health benefits critical to maintaining your health and treating illness and accidents, for example getting free preventive care, like vaccines, screenings, and some check-ups, even before you meet your deductible. Health insurance protects you from unexpected, high medical costs by paying less for covered in-network health care, even before you meet your deductible. People without health coverage are exposed to these costs, which can sometimes lead into extreme debt or even into bankruptcy.

The U.S. does not have universal health coverage, meaning the government does not provide health insurance for every person, rather the U.S. health system is a mix of public and private, for-profit and nonprofit insurers and health care providers^[5]. The federal government provides Medicare, medicaid and the Children’s Health Insurance Program (CHIP). Private insurance is provided primarily by employers and people can also purchase their own health insurance coverage. Although there are options for health insurance, there are still about 8.5% of Americans who are un-insured, which is a reduction from 16% in 2010 before the passing of the Patient Protection and Affordable Care Act.

Medicare is health insurance for:

• People 65 or older (eligible to sign up for Medicare 3 months before turning 65)
• Those with a disability, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig’s disease) may be able to sign up before 65.

Medicaid is a joint federal and state program that:

• Helps with medical costs for some people with limited income and resources.
• Offers benefits not normally covered by Medicare, like nursing home care and personal care services.

The Children’s Health Insurance Program (CHIP) is a joint federal and state program that:

• provides health coverage to eligible children, through both Medicaid and separate CHIP programs.

Managed Care Plans

• Managed care plans are a type of health insurance. They have contracts with health care providers and medical facilities to provide care for members at reduced costs. These providers make up the plan’s network. How much of your care the plan will pay for depends on the network’s rules.
  • With an Health Maintenance Organizations (HMO) you choose a primary care doctor who coordinates most of your care. HMO’s usually only pay for care within their specified network of doctors/providers. HMO plans typically have lower monthly premiums. You can also expect to pay less out of pocket.
  • With a Preferred Provider Organizations (PPO) you tend to have higher monthly premiums in exchange for the flexibility to use providers both in and out of network without a referral. Out-of-pocket medical costs can also run higher with a PPO plan.
  • Point of Service (POS) plans let you choose between an HMO or a PPO each time you need care.

If you’re unemployed, or your employer does not provide health insurance, you may be able to get an affordable health insurance plan through the Health Insurance Marketplace. The Health Insurance Marketplace was developed in response to the Patient Protection and Affordable Care Act passed in 2010. Its primary goal is to achieve universal health insurance coverage by facilitating cooperation among employers, citizens, and the government. Its other objectives are to make healthcare more affordable while simultaneously increasing healthcare quality and reducing unnecessary spending^[6].

The Affordable Care Act (ACA) created a dramatically different marketplace for individual health insurance through three key reforms: prohibiting insurers from considering subscribers’ health status or risk; providing substantial subsidies for millions of people to purchase individual coverage, many for the first time in their lives; and creating an “exchange” structure that facilitates comparison shopping. Due to the ACA the uninsured rate has dropped from 16 percent in 2010 to 8.5%.

Universal Healthcare

The World Health Organization states that:

• Half of the world’s population do not have access to the health care they need.
• 100 million people are driven into poverty each year through out-of-pocket health spending.
• 75% of national health policies strategies and plans are aimed at moving towards universal health coverage.
• Over 930 million people spend at least 10% of their household income on health care.

In an effort to bring healthcare to all people across the world, The World Health Organization (WHO) is encouraging all countries of the world to adopt Universal Health Coverage (UHC). The WHO is providing support and technical expertise to advance universal health coverage in 115 countries, representing a population of at least 3 billion people. The goal is to bridge global commitments with country action to achieve universal health coverage.

The WHO defines universal healthcare as “ensuring that all people have access to needed health services (including prevention, promotion, treatment, rehabilitation and palliation) of sufficient quality to be effective while also ensuring that the use of these services does not expose the user the financial hardship. It includes the full range of essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care.”

Many countries offer universal healthcare, these include:

• Australia (Healthcare System in Australia)
• Canada (Canadian Health Care System)
• France (French Healthcare System)
• Germany (German Healthcare System – GKV)
• Ireland (Healthcare System in Ireland)
• Italy (Healthcare System in Italy)
• Japan (Japanese Healthcare System)
• New Zealand (New Zealand’s Healthcare System)
• Portugal (Healthcare System in Portugal)
• Spain (Healthcare System in Spain)
• Sweden (Sweden’s Healthcare System)
• United Kingdom (Healthcare System in the UK)