From Big Medical Encyclopedia

UNITED STATES OF AMERICA (USA) — the state in North America. The area — 9363,2 thousand km 2 , population of 232,6 million people (April, 1983). The capital — Washington, the population (1980) — 637,6 thousand people (without suburbs), 3 712 thousand (with suburbs). Official language — English.


In the administrative relation the territory of the USA is divided into 50 states and the federal District of Columbia. The states are divided into districts. Possession of the USA include Puerto Rico, the Virginia islands in West Indies, the lake of Guam, East Samoa and a number of small islands in the Pacific Ocean. Under the administration of the USA there are wards of the territory of the UN — Carolinian, Mariana and the Marshall Islands in the western part of the Pacific Ocean, under jurisdiction of the USA there is a zone of the Panama Canal.

Political system. The USA — the federal republic. The existing constitution is adopted in 1787. Convention. The constitution is very laconic, its many articles have the general character, from here exclusive importance of interpretation of the constitution, a cut is considered a prerogative of the Supreme Court. The legislature belongs in the USA to parliament — the congress, executive — to the president, judicial — to the Supreme Court. Competences of these authorities are sharply differentiated. The congress consists of two chambers: the senate and the House of Representatives elected by the population as direct elections. The senate includes 100 people (on 2 from each state) elected for 6 years (each 2 years V3 of the senate is updated). The chairman of the senate — the Vice President of the United States. The House of Representatives consists of 435 deputies elected for 2 years. The chairman of chamber — the speaker — is elected by the chamber. The head of state and the governments — the president elected by the population for 4 years by indirect samplings through the electoral college; along with it the vice-president is elected (the president and the vice-president can be residents of one state). Early removal of the president from a post is possible only as an impeachment — the special procedure of accountability of federal civil officials, including the president and judges of the Supreme Court, for commission of high treason, for the bribery and other crimes provided by the constitution. Powers of the president are very wide: he has the right of the suspensive veto concerning the bills adopted by the congress sends messages to the congress, in to-rykh offers the legislative program, drafts the draft budget, is the Supreme Commander armed forces, signs the international agreements and performing agreements (the last without consent and approval of the senate), makes decisions on the beginning of the actual military operations, appoints to the highest positions (from consent and approval of the senate) and displaces from them, has the right of pardon etc. The executive power subordinated to the president has several links — the government, executive management of the president and various administrative agencies and the commissions. The government (office), in a cut enters 11 ministers, and also a number of persons in the rank of members of the cabinet, is the advisory body which does not have the constitutional powers. The order of its convocation and the procedure are defined by the president. Members of the cabinet cannot be Congressmen. The bodies forming executive management of the president (White House administration, National Security council, administrative and budget bureau, council for internal affairs, council of economic consultants, etc.), carry out coordination of domestic and foreign policy. The judicial system includes federal courts, courts of states and local courts. The federal system consists of 85 regional, 11 district (appeal) courts and the U.S. Supreme Court. All judges of this system are appointed the president from consent and approval of the senate. The U.S. Supreme Court consists of 9 members, is court of the first instance on especially important issues <and exercises supervision of activity of inferior courts. It also executes functions of the constitutional supervision. The federal system includes also a number of special vessels (customs, tax, on claims to the government, military). In states there are judicial systems led by the Supreme Courts.

Each state has the constitution (most of them acts since the end of the 18th century), system of the highest and local bodies of authority and management. The legislature belongs to legislative assemblies (legislatura), executive — to governors, judicial — to the Supreme Courts. In total legislature, except legislative assembly of the State of Nebraska, two-chamber. The states install system of local bodies. In counties (the large cities are equated to them) are chosen council and the mayor.

Climatic conditions. The main part of the territory of the USA is located in subtropical and partially in a moderate belt of the continent. Alaska lies in subarctic and Arctic belts. In a tropical belt there are a peninsula California, the southern parts of the peninsula Florida and the Mexican Plateau, the Hawaiian islands. The Cordilleras generally consist of a number of mountain chains (up to 3000 — 5000 m high) and a wide strip of internal plateaus and the plateau. In the main territory of the country ridges are oriented from the North to the South.

The climate of the following types is characteristic of the main territory: moderate and subtropical sea — on the coast of the Pacific Ocean, continental and sea — on the coast of the Atlantic Ocean, continental — on Internal plains and sharply continental — on the internal plateau and the Cordilleras plateaus. On Alaska in sowing. parts — the Arctic climate with very severe winter and in the cold summer, in the central and southern districts — subarctic sea in the south and continental — on the plateau Yukon. Contrasts of climate of different areas are most sharply expressed in the winter. The lowest temperature was observed on the plateau Yukon (— 64 °). Temperature lower than 0 ° is noted in the winter in all territory, except a southwest part (State of California), the southern part of the peninsula Florida and the Hawaiian Islands. In the summer of distinction in temperature are not so big (except areas of the internal plateau of the Cordilleras where very hot weather keeps). Most high temperature(s) - 56,7 ° — the most high temperature in the western hemisphere) — in Death Valley. Average temperature of January in Washington + 1 °, the average temperature of July + 25 °.

Annual rainfall: in the southeast of Alaska and in the west of the State of Washington — 3000 — 4000 mm, in the southeast of the country — 1500 — 2000 mm, on Internal plains — of 1500 in the east to 300 mm at a foot of the Rocky Mountains, on internal plateaus and the plateau — places less than 100 mm.

The atmosphere is characterized by considerable pollution, especially over the large cities and industrial centers; annually from the territory of the country about 215 million tons of dust, and also poisonous gases come to the atmosphere.

More than 72 million hectares of lands are struck with an erosion (generally western part of the Great Plains). It is annually washed away by waters and carried away by wind of 3 billion tons of the soil. Dust storms are observed. There is more intensive a salinization of soils, pollution by their industrial wastes and pesticides.

From minerals oil and gas fields, reserves of black coal, iron are essential. There are sedimentary fields of uranium, numerous fields of non-ferrous metals — copper, mercury, gold, molybdenum, tungsten, etc., and also svintsovotsinkovy fields.

Economy. The USA — the imperialistic power surpassing other countries of the capitalist world in the sizes of gross national product, industrial and agricultural production, in labor productivity level, the income per capita and to export of the capital. An overwhelming part of national wealth is controlled by a small number of monopolistic groups.

The gross national product in 1981 according to preliminary data made 2925,5 billion US dollars; the public expenditures — 591,2 billion US dollars. The foreign assets of the USA which reached 603,6 billion dollars in 1980 are big. Over 4/5 these sums are made by private capital investments, from them more than a half is the share of direct investments. Constantly expenses on the military purposes grow: in 1985 they will reach the record sum — 291 billion dollars. Along with it the internal national debt of the U.S. Government by the beginning of 1983 rose to 1,2 trillion dollars. Total number occupied in economy reached 100,4 million people, unemployment made nearly 11% of the total number of labor.

Population. The main part of the population is made by Americans — the nation created during mixing and ethnic integration of descendants of immigrants from the countries of Europe. Among emigrants of 17 — 18 centuries the British who became a kernel of the American people, Scots, Dutches, Germans, Irish prevailed; from the 3rd quarter of 19 century — Germans, Irish, British, natives of the Scandinavian countries; from the last quarter of 19 century — Italians and immigrants from Austria-Hungary, Russia and other countries of Southern and Eastern Europe. In 20 century among immigrants the share of immigrants from the countries of the American continent — Canada, Mexico, West Indies more and more increases. In 17 — 18 centuries from Africa many Black slaves are imported. All these groups gradually assimilated, perceived English in its American option and participated in creation of the American culture. Blacks formed special group in the American nation (23 million people in 1970, 25,9 million people, or 11,8% of the total number of the population, in 1979, 4,3 million made other groups of not white population). Immigrants make the transitional ethnic groups which are continuously updated by new immigrants and washed away by assimilatory processes. Between them and actually American nation it is impossible to carry out a clear boundary. The number of Americans in narrow sense, including Blacks and immigrants (starting with the 3rd generation), reached about 180 million people, or 80% of the population (1976). The share of the population living in the USA rather recently (2 generations) and keeping considerably the native languages makes 16,5% of the population of the USA. The remains of indigenous people are not numerous: about 800 thousand Indians (a considerable part lives in reservations), about 30 thousand Eskimos.

Dynamics of population of the USA (one million people) made by years: 1900 - 76,2; 1910 - 92,3; 1920 - 106,0; 1930 - 123,2; 1940 - 132,2; 1950 - 151,3; 1960 - 179,3; 1970 - 203,2; 1979 - 220,2; 1980 - 227,0; 1981 — 230,5.

Process of an urbanization amplifies. The share of urban population increased from 45,7% in 1910 up to 69,9% in 1960. In 1970 149,3 million people, or 73,5% of the population (to the cities in the USA in the American statistics carry settlements with number of inhabitants from 2,5 thousand people) lived in the cities p suburbs. On a census of 1970 in the country there were 7062 cities; the most populous pz them New York (over 16 million people, 1970). More than a half of citizens (52%) were inhabitants of residential suburbs.

The data characterizing the natural movement of the population from 1920 for 1979 are presented in tab. 1.

For almost 70-year period birth rate was reduced twice, the general and child mortality at the same time decreased; for the same time the number of stains sharply increased.

Reflection of social contrasts of the American society is distinction of such indicators of health as child, maternal, neonatal mortality and mortinatality at the white and black population (tab. 2).

Indicators of child mortality almost twice, neonatal mortality and mortinatality more than by 1,5 times and maternal mortality almost by 4 times at the black population above, than among white. It is known also that the number of abortions on 1000 women at the white population made 22,7, at the black population — 60,4. Told it is caused by distinctions of life of the black and white population.

The average duration of the forthcoming life in the USA (1976) made 73 years (69 years at men and 77 years at women). According to the national forecast (average option) the population of the USA in 2000 will reach 260 million people, in 2050 — 316 million persons.

Incidence. Due to the lack of the national accounting of incidence as a source of information on her data on causes of death are used. In structure of causes of death cardiovascular diseases, new growths, traumatism, diseases of lungs, etc. dominate. In structure of causes of death atherosclerosis and «degenerative» heart troubles (33,8%) are on the first place, then there are malignant new growths (16,8%), vascular damages of the central nervous system (10,9%), accidents (6,1%), diseases of early age and premature (3,5%), an idiopathic hypertensia (3,3%), pneumonia (3,0%), a diabetes mellitus (1,9%), cirrhosis (1,5%), suicides and most damages (1,2%), etc. Rates of mortality at men and women on 100 thousand population from diseases of the blood circulatory system (1973) made respectively 547,0 and 460,0 and for both floors — 502,8.

Decrease in rates of mortality from a row chronic, generally from' cardiovascular, diseases, more considerable among women was in recent years noted. Racial distinctions in rates of mortality from heart troubles are most brightly expressed at women, especially at young age. Heart troubles mortality in group of men of the black population aged from 25 up to 40 years was in 1977 twice higher, than among white. Coronary heart disease mortality makes about 90% of all mortality from heart diseases. Cardiovascular diseases continue to remain the leading cause of death and disability in the USA. In 1979 in the USA cardiovascular diseases were observed almost at 30 million Americans, from them: an idiopathic hypertensia — at 24 million people, coronary heart disease — at 4,1 million, rheumatic! damages of heart — at 1,8 million, a cerebral palsy — at 1,8 million. In 1979 from coronary heart disease 650 thousand people, died of an idiopathic hypertensia — apprx. 15 thousand, of rheumatic damages of heart — 7,5 thousand.

The second place in structure of mortality belongs to malignant new growths. Mortality from malignant tumors of bodies; breath, a mammary gland, a large intestine, a pancreas, a bladder raised, and from tumors of a stomach, rectum, neck of uterus it snrshitsya. New growths of a respiratory organs are the reason of V4 of all death from malignant tumors.

On the third place — accidents, poisonings and injuries. Accidents are the main reason for death among the population aged from 1 up to 34 years. Accidents on transport make 48% of all injuries; they prevail among male population aged from 15 up to 24 years. In 1978 in the USA 51,3 thousand death as a result of road accidents were registered. It is more, than in any other year (since 1973).

On the fourth place — a disease of a respiratory organs; on the fifth — digestive organs; on the sixth — endocrine system, frustration of food and disbolism.

Among causes of death of children till 1 year anoxic and hypoxemic states (464,8 on 100 thousand live-born, at boys — 551,3, at girls — 373,9), on the second place — congenital anomalies (285,4 on 100 thousand live-born, at boys — 302,8, at girls are on the first place — 267,1), congenital anomalies of heart, other congenital anomalies of the blood circulatory system (127,4 on 100 thousand live-born, 139,6 and 114,5 respectively at boys and girls) follow further, to pneumonia (111,9 on 100 thousand live-born, 123,7 and 99,4 respectively at boys and girls).

According to certain researchers and on materials of periodic medical examinations, judgment of incidence of the population of chronic diseases can be made.

The important place in it is taken by psychological and venereal diseases, detectability and registration to-rykh in the conditions of a private-capitalist form of the organization of medical aid is complicated. Distinctiveness of distribution of these groups of diseases is their social conditionality. They are destiny of preferential needy segments of the population. The problem алко^шизма and drug addiction is closely connected with mental incidence. Damage caused to the country by mental diseases is estimated at 40 billion dollars a year, drug addiction — more than 10 billion dollars a year. Many social problems, including prostitution, crime, epidemic of suicides, are closely connected with problems of social and mental health of the American society.

In the USA there are no official data characterizing disability. According to estimated data (1970), in the country there were 23,6 million people, work to-rykh as a result of a chronic disease or an injury was limited. The leading diseases resulting in resistant disability are diseases of system blood circulations, mental diseases (schizophrenia, etc.), pulmonary tuberculosis, emphysema of lungs, traumatism, diseases of bones and joints.

Copper to-sotsi aln and I am the help. The uniform system of social insurance and providing in national scale in the USA still does not exist. Persistent fight of workers for the rights, and also economic interests of the bourgeoisie forced to keep labor for receiving profits forced the U.S. Government to go for certain reforms and concessions in this sphere. In a result in a crust, time in the USA elements state take place. social security, it includes: 1) provision of pensions — on an old age, disability and loss of the supporter, a cut is carried out by federal bodies of social security; 2) social insurance — on unemployment and from industrial accidents; it is carried out by bodies of social security of states; 3) the so-called collateral social security («public aid») which is also carried out by bodies of social security of states. Retirement age for men and women — 65 years. Award of pension and from 62 years is possible (in the reduced size). The size of pension depends on average monthly earnings, fluctuating approximately from 25 — 30% to 60%.

Pensions on a case of loss of the supporter began to pay since 1940. They are appointed to widows on reaching them by 62 years, and also to widows at any age if they have children dependents aged up to 18 years (up to 22 years — during the training). Receiving pension stops when children reach 18 years or respectively 22 years, and is not resumed until the widow is not 62 years old.

In 1956 the law on payment of disability pensions was adopted. The right for pension was acquired by persons, to-rye by 50 years were full disabled people. Since September, 1960 50 years began to grant disability pensions to persons younger. Under the law on social security of states by the governments creation at the expense of contributions of businessmen of special funds is provided, from to-rykh then doles are paid.

At partial and temporary disability of pension according to the general program are not paid at all.

The role of the state is limited to fund raising and award of pension. The means the state does not participate in formation of the insurance pension fund (except for nek-ry special programs). These means at the U.S. Department of the Treasury are centralized.

Programs of «public aid» were adopted by the law on social security in 1935 at the federal and regular level. Delivery of grants according to these programs is carried out by bodies of social security of states. Aid programs concern to them: aged, to blind people, the needing children (because of disability of the father, not having the father, in connection with unemployment of the father), to constant disabled people, poor. At the request for public aid Americans are exposed to extremely humiliating procedure of check on needs. «Public aid» is intended in case of extreme need, for persons, at to-rykh there is no livelihood left.

Medical care in the USA is constructed on the principles of private business; the general state system of rendering medical aid is absent. For most of citizens medical aid is paid. At the same time throughout existence of the American society the bourgeois government owing to historical need held a series of events for ensuring certain categories of the population with free medical aid. Introduction of the medical service of seamen of merchant marine fleet financed by the federal government was the first federal law adopted about it by the congress of the USA. This act laid the foundation for formation of the public health sector. Then the congress granted the right to medical aid at the expense of the federal government to employees of the coast guard and aboriginals of Alaska (Aleuts, Eskimos), military personnel and veterans of wars, and also the prisoners who are in federal prisons and reformatories. Since 1956 the state medical service was extended to dependents of the military personnel. Since July 1, 1960 the system of insurance of health at the expense of the federal government of government employees and their dependents is entered and the federal help for medical service mentally sick and suffering from tuberculosis is approved.

Since 1966 the Mediker programs (medical aid to old men) and Medikeyd took effect (medical aid by poor). The Mediker program extends to all persons at the age of 65 years and is more senior irrespective of their material resources and is financed by increase in the taxes on social security raised from the working Americans. To acquire the right for medical service according to the Medikeyd program, the person in need is obliged to submit documents on revenue and number of members of the family to bodies of social security of the state. Figures of the income allowing to apply for privileges according to the Medikeyd program in different states various, as well as the volume of the medical aid paid from funds of the program.

According to the Mediker program also medical aid by the serviceman and to their families is carried out. It provides (in addition to the state medical aid) wide use by military of civil medical institutions, allows rendering the extra hospital help to the military personnel and their dependents by civil doctors and technicians and expands the volume of medical service of the military personnel in resignation, their wives and children. Other big group of the population using privileges according to this program are veterans of war. Aggressive policy and military adventures of the U.S. Government force it to expand constantly privileges for serving and consisting in a crust, time in the forces of persons. All suspects (communists and so-called disloyal Americans treat their number) undergo testing and join in the program only after it becomes clear that they do not consist in lists of «blasting» persons.

The program provides two types of insurance of health (parts A and B of the Mediker program): part A covers hospital insurance, part B — insurance on medical assistance. According to the main part of the program (part A) on persons at the age of 65 years is also more senior, receiving benefits through social security, the program of hospital insurance automatically extends. A certain share of cost of hospital service, dental help, drugs and nek-ry other expenses is paid for this type of insurance. Part B is the voluntary part of the program intended for persons at the age of 65 years and is more senior, to-rye expressed consent to bring a monthly contribution (its sizes are annually reconsidered). This part of the program includes medical assistance, radiodiagnosis, a lab. researches, an electrocardiography, a roentgenotherapy, treatment by radioactive materials, surgical bandagings, delivery of medical accessories in temporary use, production of prostheses, a domiciliary care (medical and sisterly). This help does not include payment of expenses on acquisition of points and hearing aids, payment stomatol. help, acquisition of orthopedic footwear, etc. Part A of the Mediker program took effect in July, 1966, part B — in January, 1967 Mediker pays 80% of total cost of the services rendered according to the program.

The Mediker and Medikeyd programs are only a partial concession, the compulsory measure directed on a nek-swarm improvement of medical service aged and poor. Medical aid, requirement in a cut at the population of the USA grows from year to year, first of all encounters the problem which is difficult solved in the conditions of the capitalist state — a problem of payment of medical service, edges cannot be separated from the solution of a question of the social help in general, social security and social insurance in particular.

In total in the USA can use services of public health care about 1/P, the total number of the population, provided with the full or partial help in the medical and other medical institutions subordinated to the federal and regular authorities.

Aggressive policy of the U.S. Government, growth of expenses on the military purposes lead to reduction of allocations for the specified programs of medical aid.

Management of health care. The main body knowing questions of health care of the USA yazlyatsya the Department of Health and Human Services (which was earlier called as Depar-takhment of health care, educations and welfare). Questions of health care enter competence of three more departakhment (ministries) — work, defense and agriculture, and also three independent organizations (Management for veterans of war, the Commission on affairs of federal civil servants, Council for affairs of railroad workers).

The powerful medical AMA (American Medical Association) organization founded in 1847, edges exerts direct impact on activity of health care in all its links, protecting the principles of private medicine, actively participates in definition of policy in the field of health care and medicine. Besides, it has political influence on the government of the country.

Questions of public health care enter competence of states and local governments, federal bodies bear only the general coordinating functions to which performance, in addition to the main structure of a federal operating controls, serves institute of special consultants, in particular the National advisory board of health care and separate groups of advisers for various questions, a number of the commissions and committees. There is also an institute of regional directors (in each of nine regions, on to-rye divide the territory of the USA in the statistical publications) responsible for implementation in states of the region of policy of service of public health care, use of federal grants to states on construction of hospitals, sanitarnotekhnichesky constructions and for coordination of actions for strengthening of a health service of civil protection.

Their main objectives are:: sanitary protection of borders, hygiene chesky control of state of environment, the account and the statistical reporting in the field of health care, the management of national institutes of public health, coordination of activity of local bodies of health care (municipal, communal) and local research medical institutions, improvement of medical service of civil protection. Tasks of the federal ministry include also the organization of the international cooperation in medicine on two - and a hmno-gostoronny basis.

On federalnokhm level the service of public health care is responsible for observance of quarantine laws and rules, carries out medical survey of immigrants, performs the general management in the field of environmental control and epidemiol. wellbeing, provides the technical and advisory assistance to bodies of health care of states and other administrative regions, develops and distributes instructions for prevention of diseases, gives permissions to production of biological drugs, collects and spreads the medico-statistical information, keeps their special analysis. In Atlanta (State of Georgia) there are centers of service of public health care of the USA for fight with inf. diseases. Their task includes conducting epidemiological experimental work, methodical work on instructing of the corresponding personnel in departments of health care of states, the help of health care of states to departments in case of epidemics or disasters. In the same place monthly and weekly statistical bulletins on infectious incidence in the country are published.

The federal service of public health care of the USA is closely connected also with military interests of the country, with problems of civil protection. The medical department of civil protection created in 1941 functioned in 9 regions corresponding to military districts. It put the task training of the population on a case of threat of air bombing, chemical and bacteriological attacks. The organization of hospitals of first aid in national scale was assigned to this department. The medical service of civil protection created during World War II at that moment was not used since on the American continent there were no military operations; nevertheless activity of this service is stirred up in the USA from year to year. The service of public health care of the USA studies possible effects of impact of strategic bombings in modern war on the civilian population and the industrial enterprises of the large inhabited centers. These researches are conducted in the following directions: first aid, hospital help, activity of the Red Cross, organization of defense and burial of iogibshy.

In national scale medical aid to Indians and inhabitants of Alaska is carried out. At the same time paramedical personnel and workers of traditional medicine are widely used. In recent years according to appropriate programs several categories of workers of support personnel under the leadership of the doctors giving consultations by phone and radio within the communal program of medical aid were prepared. Duration of similar preparation makes 12 weeks. They provide residents of villages with primary health care under radio observation of doctors in field hospitals. Local and Indian inhabitants are used as activists of public health care. Working according to contractual agreements with the organizations of tribes, they provide service of transfer and transportation of patients, give help in implementation of programs a dignity. education and prevention. Councils of health care of Indians are created at all levels — communal, the state and national. Other activity occupied the local operating controls health care of the USA presented in each state by own department of health care, the head to-rogo submits to the governor of the state. Considerable variability of functions of departments of health care of states is noted. He is not engaged in the direct leadership in medical service of the population. Its field of activity generally includes questions a dignity. anti-epidemic protection, edge at all levels of health care of the USA it is integrally connected with laboratory service. Laboratories of states, districts and communities provide serological and early klinikotsitologichesky researches. Nek-ry laboratories make and distribute serums and vaccines, control quality of biological drugs. Departments of health care of states work in close contact with medical service of civil protection of the USA, in particular concerning design, construction and placement of medical institutions and scheduling in the conditions of an extraordinary situation.

A local link of service of public health care is its organization in the cities and districts. Municipal public health departments have more rights, than district. Local (municipal and district) public health departments carry out registration of demographic data and inf. incidences, fight with inf. diseases, tuberculosis, venereal diseases, watch sanitary state of environment, know laboratories of public health care, conduct work on protection of motherhood and the childhood and direct a dignity. education of the population. In the USA the network of the so-called centers of health care — the institutions which are carrying out advisory, sanitary, preventive, patronage activity, but, as a rule, not leaders of medical work is created. The staff of these institutions consists generally from a dignity. workers and paramedical staff.

The bureau for children is engaged in studying of programs and recommendations about such questions as birth rate, child mortality, children's crime, traumatism among children, use of child labor, and also such problems as prematurity, epilepsy, mental retardation, children's stomatology, distribution of federal grants for medical aid, etc. As for protection of motherhood and the childhood, it is limited to sisterly service of public health care. Medical service at schools will be organized by department of education. Medical supervision of school students is conducted generally by nurses.

In the USA there is no system of medical service of the working industrial enterprises, any an imagem connected with service of public health care. A number of labor unions has the medical institutions. The companies or the enterprises sign agreements with the doctor on service, special nurses work at a number of the enterprises. However activity both doctors, and sisters at the industrial enterprises it is limited to medical examinations and consultations. They practically do not conduct medical work.

Hospital help. In recent years the federal government adopted the program of development of hospitals, the program of creation of the centers for fight against oncological and cardiovascular diseases, etc. However the main role of federal health service in implementation of these programs consists only in creation of indicative projects and distribution of financial means between states, at the level to-rykh the organizational problems connected with implementation of these or those federal programs are resolved. In the USA there are 3 types stationary to lay down. institutions: the hospitals which are financed various religious organizations and charitable societies; the hospitals belonging to one owner or a group of persons; state hospitals. About 70% of all hospitals make the group hospitals and so-called «profitless» hospitals existing at the expense of various organizations. In the USA there are also hospitals financed federalnsh by the government or the authorities of states and a local operating controls. The federal government has about 10% of bed fund of the country and in the medical institutions belonging to it works apprx. 8% of doctors. The hl is under authority of states apprx. 50% of all bed fund of the country. obr. psychiatric, tubercular, obstetric and gynecologic beds. Hospitals for poor people are among the public medical institutions, but the number of such hospitals is limited and cannot satisfy all persons in need.

In the USA the system of so-called sisterly hospitals (rather new type of institutions) was widely adopted. Their personnel consist hl. obr. from nurses and support personnel. They are equipped only with those technical means, to-rye are necessary for postoperative recovery and treatment of chronic patients. The cost of stay in such hospitals is much lower, than in hospitals with medical service.

In 1964 the number of sisterly hospitals reached 14,6 thousand, in 1977 — 18,9 thousand. The number of the persons staying in houses of sisterly and personal (pansionny) leaving in 19G4 of g made 554 thousand, in 1977 — 1 million 303 thousand (white — 1 million 201 thousand, black — 102 thousand). As of 1977, the number of persons aged up to 65 years among patients of sisterly hospitals made 177 thousand. Men at the age of 85 years are also more senior made 92 thousand people, women at the same age — 358 thousand. Capacity of hospitals tends to growth; it is expressed in reduction of an average term of hospitalization and in increase in total number of patients that is connected with existence of financial barriers to receiving the medical help in full. Only for 1980 the payment for hospitalization increased for 15%. E.g., according to official figures, the cost of obstetric aid made in 1978 — 1980 2800 dollars, appendectomies — 1600 — 1800 dollars, operations on heart of 10 000 dollars, stay in hospital without surgery (1 day) — 225 — 250 dollars etc. Increase in turnover of bed fund of hospitals is promoted also by growth of average providing one hospital place with resources (increase in number of medics counting on 1 patient, broader use of the modern diagnostic and medical equipment, effective pharmaceuticals).

In recent years creation in hospitals of departments for short-term stay of patients was widely adopted that in a certain measure is dictated by the market nature of medical services.

Extra hospital help to the population of the USA is given, as a rule, by private medical practitioners, to-rye conduct receptions in the offices and give help to patients at home. Payment for medical aid is made painful directly to the doctor. The sizes of the fee are established by the doctor, the minimum sizes of the fee are determined by the American medical association. Working alone, the doctor is not able to provide to the patient comprehensive examination and treatment, consultation at all necessary specialists that is possible only at polyclinic type of service. In the conditions of a scientific and technological revolution the system of a private practice ceased to meet modern requirements: the private office cannot be equipped with all necessary devices and devices for diagnosis and treatment at the modern level. The high cost of the equipment, furniture and equipment of a private office, the routine organization of work lead to the fact that overhead costs in practice of the average doctor reach about 40%.

In recent years group practice gains ground. Top of concentration of private doctors for group practice is some kind of medical concern Mayo in Rochester (Minnesota) where hundreds of doctors work in clinical center of Mayo, providing not only comprehensive inspection of patients in policlinic, but also highly skilled medical service in city hospitals. Large specialists of concern are his main shareholders. It creates a number of favorable conditions for doctors since at such system they have the firm salary, fixed working hours, they are granted the paid leave, trips on scientific conferences etc. are paid. These associations attract also the population as in them it is possible to receive the polyclinic help of higher quality for the same or even smaller payment. Group practice gets support also from the U.S. Government in the last decade. Lack of effective control from the state and impossibility of the patient to regulate the cost of the services rendered to him turns into the USA a medical profession in one of the highest paid. As well as in economy, in this sphere of social life of the USA laws of monopolization and concentration of the capital, the law of receiving the maximum profit dominate that disturbs all segments of the population. Americans see the solution of this crisis problem in expansion of forms of the state health care through system of national insurance of health of the population.

Mental health care. More than 6,7 million people from structure of the population of the USA receive the help within system of mental health care. In the report of the presidential commission on mental health care prepared in April, 1978 it is specified that apprx. 15% of the population need this or that form of mental health services, especially such small serviced groups as children, teenagers, aged, racial and ethnic minorities, the poor and migrating pages - x. workers. About 88% of scientific research in the field of mental health care get federal support, 4% — from private funds and 8% — from administration of states. In 1973 the national center for the prevention of cases of rape and the center for studying of mental health aged is created, scientific research and training were the main activities to-rykh. Efforts for a solution of the problem of mental health care of children, problems of crime, in particular crime of minors, and a problem of mental health care of ethnic minorities continued to be made.

the 70th years are celebrated by development of national system of treatment of alcoholism. Lately considerably the number of officially registered medical institutions for alcoholics and number of the trained consultants for problems of alcoholism increased. In September, 1974 the National institute on problems of drug addiction was created.

Pharmaceutical business. The existing numerous private companies of insurance of health usually do not provide provision of medicines in the USA. Even in case of emergency the population of the USA lripeno of the effective medicinal help since recipes on drugs are written out at visit of the doctor, and the cost of visits grows from year to year. The Mediker and Medikeyd programs provide the population with the medicinal help in the limited sizes. The medicinal help to members of labor unions through the trade-union organizations is also insignificant. Due to the aggravated social conflicts and requirements of workers before the U.S. Government there was a question of reorganization not only systems medical, but also provision of medicines. Since 1971 the bills providing various options of the state system of medical insurance with providing with drugs insured with the indication of a source of financing were repeatedly submitted for consideration of the congress (or the state, or partially at the expense of the population).

Pharmaceutical matter in the USA reflects the main tendencies in economy (anarchy of production, the competition, inflation, etc.) - In the USA there is an attendance system of opening of drugstores. Placement of drugstores over the country differs in irregularity, happens without needs of the population for medicinal service, especially rural; drugstores are concentrated by hl. obr. in the large cities where there is the greatest number of doctors. The prices of the same drugs in different drugstores can fluctuate considerably. All this provides high profits to owners of drugstores. In a crust, time they reached in total several billion dollars a year. Profits of insurance companies are estimated in hundreds of millions of dollars. In a pursuit of profit pharmaceutical firms, both national, and transnational, sometimes neglect elementary requirements of evaluation test of received. new drugs, their experimental reliable check that leads quite often to deaths at the patients using the noxious to health advertized drugs. Cruel competitive fight reduces sense of responsibility at heads of firms for health of the nation.

Directed by pharmaceutical matter in the USA there is no unity.

In the USA there are generally 5 types of drugstores: the traditional drugstores of commercial character (drogstor) trading except pharmaceuticals, other goods in big assortment, including ice cream, various drinks, snack, magazines, cosmetic, tobacco and other goods; the so-called professional drugstores placed usually in clinics and selling only drugs, objects of sanitation, hygiene and patient care; the so-called pharmaceutical centers different from other drugstores a strict interior, lack of show-windows, etc., to-rykh are included into the range of goods only pharmaceuticals, objects of sanitation, hygiene, objects of patient care, etc.; the branded drugstores like drogstor belonging to the companies and supplied on a centralized basis by medicines and the various range of goods, including and not medical prescription; the hospital drugstores which are releasing drugs stationary and an ambulatory. The first four types of drugstores belong to retail drugstores. Not only druggists, but also doctors can be owners of drugstores. Management of a drugstore is in hands of the specialist druggist. Due to the lack of pharmaceutical shots and growth of expenses on hospital service of the USA the researches on improvement of provision of medicines of inpatients including questions of the scientific organization of work, automation of a control system, etc. are conducted. Unprecedented concentration in hands of major companies both pharmaceutical production, and retail chain stores is characteristic of all statement of pharmaceutical matter in the USA. The pharmaceutical service in the USA should be considered as an integral part of political, economic and social structure of the American society. Level of provision of medicines in the country depends mainly on payment ability of separate segments of the population.

Sanatorno - the resort help. The organization of the turnaround manager-but-resort help to the population has purely enterprise character. The most known balneological resorts of the USA are Anderson, Errou-hed, Hot Springs, Barlett Springs, Richardson Springs Mineral, Saratoga Springs, Glen Springs, Clifton, the Panacea Springs, Stimbol Springs, Solt Leyk Hot Springs, Whyte Salfer Springs, Trench-Lik, Rolston-Spa, Ekselsior-Springs, Maunt Clements. Climatic stations are located on the coast and on islands of the Atlantic and Quiet oceans, and also in mountain and desert districts. Seaside climatic resorts: Newport, Long Brunch, Bich-Heyven, Spring-Leyk, Atlantic City, Santa Cruz, Monterrey, Senta-Barbara. On the peninsula Florida winter seaside resorts are located: Miami, Palm-Bich, Dzhupiter, etc. From climatic resorts of a zone of deserts the largest is the resort of Tucson. Mountain stations are located in various geographic latitudes at different height above sea level and are used mainly for treatment of various forms of tuberculosis. The stations located on picturesque coast of mountain lakes are popular.

Medical personnel. Total number occupied in health care in 1979 made 4 812 thousand people (in 1975 — 4,041 thousand people), of them women of 74,5 thousand, black — 15,9 thousand. Total number of doctors — 787 thousand, dentists — 131 thousand, druggists — 135 thousand, the diplomaed sisters — 1 223 thousand, administrators — 185 thousand. The number occupied for 1950 — 1979 increased in health care by 4,8 times, and annual average rate of a gain made 5,6%. So high rates of increase in a manpower were provided first of all with growth of number of an average and support medical staff, office employees and technical officers of health care. The number of doctors increases much more slowly that is connected, on the one hand, with the policy of control of training of doctors in the USA pursued by the American medical association; on the other hand, with the fact that the considerable number of medical functions is performed in the USA not by doctors, but specialists of lower qualification (assistants to doctors, the diplomaed nurses); besides the American doctors resort to telephone consultations more often (instead of visit of patients at home), than it practices in other countries.

In a crust, time deficit of general practitioners takes place, the share to-rykh steadily decreases. The «market» nature of medical aid led to the fact that the number of doctors considerably increased, the specialty to-rykh yalyatsya prestigious and profitable, napr, doctors of a surgical profile. It causes catastrophic decrease in number of general practitioners. The share made them in the total number of doctors in 1977 42%.

The same year 198 doctors and 465 nurses were the share of 100 thousand population. Deficit of medical assistance, as well as sisterly, is aggravated with their uneven distribution over the country that is connected about the tendency which is available among doctors to concentrate in numerous highly profitable areas to the detriment of economically poor and rural areas. From poor urban and rural areas doctors disappear, the doctors who remained there, seniors on age, lower qualification. Along with it the number of specialists sharply increases in such areas as plastic surgery, chest surgery, anesthesiology, etc.

Medical education. At the end of 1977 in the USA there were 120 medical schools having the right of assignment to students of degree of the doctor of medicine. By this time the number of teachers was equal 41 394 people, the number of students made 57 276 persons. 1,4 students were the share of each teacher. Representatives of ethnic minorities made in 1976 — 1977 8,3% among first-year students and 7,1% of total number which ended education in this academic year. Among graduates there were only 19,2% of women. The profession of the doctor is a prerogative of men in the USA. In questions of the higher medical education tell the following data about discrimination of women: among professors of the woman make 2%, among teachers — 7,7%. For health care of the USA, especially for the last decade, increase in percent of the doctors who got a medical education outside the country is characteristic. They make about 20%. Especially many doctors come from the countries of Asia; in 1970 from this continent 5 thousand doctors immigrated in the USA.

Sanitarno - epidemiological service. Sa-nitarno-edidemiologicheskaya the service of the USA is decentralized. Its activity is limited also withis found in the basic to performance of quarantine actions, control of quality of foodstuff and hygienic supervision of quality of water. In nation-wide scale management of sanitary and hygienic service is performed of system of public health care, the Department of Health and Human Services. For pollution control of air and water basins, soils in 1970 are created federal EPA. There is no nation-wide sanitary legislation in the country.

Medical science. The USA has the high scientific potential, qualified personnel of researchers. The country has material and technical resources for scientific development of fundamental medicobiological and clinical problems. Scientific research is provided with the medico-tool and instrument-making industry. The main contribution to financing of medical researches is made by the federal government. All money is allocated for carrying out federal programs of scientific research from sanctions of the congress of the USA. A number of not medical departments also carry out financing of scientific research (departments of defense, agriculture, power, work, internal affairs, transport, justice, etc.). The main objectives of institutions of a medicobiological profile of the USA are: coordination and carrying out scientific research, collecting and distribution of scientific information, publication of scientific works, holding congresses, conferences, management of programs of training of doctors, control of quality of medical service, participation in development of bills.

The central scientific institution in system of medicobiological researches is the National Institute of Health Care (NIHC). 11 research institutes, 4 departments, Clinical center with hospital on 546 beds, national medical library, the International center of Fogarti are its part. The leading laboratories, clinics, services, nursery for animals and other specialized divisions the BOTTOM are located in the suburb of Washington by Bie-tezde (State of Maryland). The national institute of hygiene of the environment is in Triang-Parke (State of North Carolina). The research center of National institute of gerontology and the Baltimore center of national institute of cancer — in Baltimore (State of Maryland), Roca's Laboratory of Mountain of National institute of an allergy and infectious diseases — in Hamilton (State of Montana), Department of field and epidemiological researches of National institute of arthritis, metabolism and diseases of digestive organs — in Phoenix (State of Arizona). In the state the BOTTOM about 12 thousand employees, more than 1000 from them doctors. Except permanent members of staff, researches are conducted by the invited American and foreign scientists. About 1200 institutions in the country and abroad, cooperating about the BOTTOM, receive from it on a contractual basis of a subsidy (grants) as contracts or is regular, mainly on initiative research and development.

The relations between the BOTTOM and most scientific centers of the country develop as follows. The laboratory gets out, edges defines the project and the program of future research. For the purpose of establishment of value of the offered program the customer carries out within 6 — 12 months by means of the special advisory commissions three-stage scientific and technical examination of the project. In case of his statement addressed to responsible for a research the grant for a period of 1 year is allocated, at a long research the grant renews from year to year at constant control from the customer. Formally any American scientist has the right to address for a subsidy, however the tendency of gradual restriction by federal departments of providing grants was in the late sixties noted by the certain scientist.

The international center of Fogarti was created in 1968 for the purpose of coordination of the program of cooperation of the USA in biomedical researches and developments with the capitalist countries and for coordination of all international relations the BOTTOM. In activity of the international center of Fogarti it is possible to allocate several main directions: the organization of the international conferences and seminars, training of specialists through residency, a training of scientists, reception of foreign scientists. All activity of the center is carried out under the direction of the Advisory board of the International center of Fogarti, to-rogo are a part the chairman and to 10 members chosen from among outstanding scientists and the BOTTOMS administrators.

In addition to the American medical association taking active part as well in medical scientific research in the country some other the organizations, such as the American hospital association, the American association of medical colleges, Specialized information centers of the American hospital association, National medical library functions. University association, the American federation of clinical trials, the National organization by training in the field of health care (private non-profit organization), etc. In addition, in the USA there is such kind of societies which are called funds. The foundations which are set up by the industrialists allocating funds for scientific research receive subsidies not only from private sources, but also from the federal government.

Along with the national organizations in the USA also considerable number of the international science foundations and associations participating in fight against the most serious illness, e.g. functions. The international society on cardiovascular diseases (New York), the International association on studying of pollution of reservoirs (Berkeley, the State of California), etc.

Budget of health care. The main part of expenses of public sector on health care are the share of medical care, and the largest specific weight belongs in them to the federal programs «Mediker», «Medikeyd» (see above) and a nek-eye another. Taxpayers pay about 60% of all medical services, the state gives 40%. Patients pay with cash the main part of expenses on drugs, points, prostheses, services of dentists etc.

Table 1

the NATURAL MOVEMENT of the POPULATION of the USA for 1920 — 1979




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O. P. Shchepin, L. I. Vladimirova.