Research professionals, politicians, and lay-persons alike have identified areas within the U.S. Healthcare system, which may be improved upon. This report address some major concerns of our system as it function in a manner, which is not financially sustainable. Considerations also include, the overall quality of care delivered, and broadening access so that each individual may actually receive care. Further analysis will review the role of Government in the provision of Healthcare. Finally, examination of relevant healthcare systems both domestically and internationally, reveal the Government as a vital parter.
The U.S. Healthcare system may in fact have the highest number of trained personnel and medical doctors of any nation. Further, evidence has shown advanced technology useful for both diagnostics and intervention procedures. However, one systematic problem inherent within the US Healthcare system is in the area of access. As such there are certain underserved populations that are restricted when it comes to enjoying such benefits (Continuous Quality Improvement, 2001).
It is this observation that fuels the need and desires for accomplishing change in the overall system. From the outset the problem appears to be solely restricted to access. However, when analytics are applied to the overall delivery system, one will note that the sustainability of our U.S. Healthcare system is troubling.
Construction of new facilities and state of the art equipment occurs at a rapid rate, while new therapies and drug products are “fast-tracked” through the regulatory approval process. In the meantime there are frequent instances of inequitable distribution of medical resources, causing an increasing number of patients to lack sufficient care (DeVoe et.al, 2008). Spending rates are locked in at approximately $7,500 per person, equating a value of $2.2 Trillion per fiscal year. It is also important to note that many of these “private sector” companies depend and exploit the government through rebates in order to cover their costs (DeVoe et.al, 2008).
This report will comprehensively analyze the efficiency of our U.S. Healthcare system, assessing fiscal and other considerations. Central to the true value of the healthcare system is how well it services the primary stakeholder, the patient. In other words, the focus of the entire system should always be the patient as the final stakeholder. All procedures and process impacting the system must ensure the highest and most appropriate patient care. The reduction of medical errors and adverse events is equally critical.
Multiple non-profit organizations currently exist with the sole function of performing third-party assessments of our healthcare system from both the micro and macro perspective. One such group includes the Agency for Healthcare Research and Quality (AHRQ). Functions include support for procedural enhancements in research, improving the quality of care, reducing cost, and broadening access to essential services. These groups indicate that the level of delivery does not meet the actual demand (Continuous Quality Improvement, 2001).
They also purport the fact that facilities and care exists but that it is not reaching the persons it should reach. One sad but true example includes the recent government related controversy at the Veterans Affairs Office. In one facility at the heart of the scandal, a Columbia, S.C. hospital was cited for only using $200,000 of the $1 million of government designated funding for actual delivery purposes. The remainder of the funding did not function to impact delivery in any way. Further, there is a direct correlation between the death of six patients and the misappropriation of government funds. Expanding access for Healthcare and optimizing delivery will require enormous cooperation. This includes collaborative efforts from insurance companies, hospitals, legal firms, and government agencies.
Additionally, the acceleration of the innovative care procedures can further enhance the US Healthcare system. This means that both the public and private sectors should focus additional resources into developing innovative technologies. The main objective of such technologies is the establishment of enhanced safety, efficacy, and lowered cost (National Institute for Healthcare Management, 2003).
Examples of inefficiencies may include funding from the NIH for research projects that will in no way impact healthcare in any way. In contrast products that are derived from multi-disciplinary technologies including pharmaceutical sciences should be incentivized. The current cost for developing one new drug averages out to be between $700 million and $1billion (Shaw et. al, 2012). Such exorbitant costs are transferred to the consumer resulting in a reduction in healthcare quality. Subsequently associated costs enable insurers to further raise premiums of various healthcare plans. The result is the establishment of a cost driven system combined with a reduction in related healthcare quality.
In analyzing the US Healthcare system it is equally important to reference other systems, especially when Government is involved. In 2007, Denmark experienced the most radical healthcare reform since 1849. Critical components of such reform were the development of a hospital edifice and the principle health agreements. In 2004 the Danish Government established a commission for the purpose of reforming local Government. Subsequently a year later Parliament passed a Healthcare law. There are approximately three levels of government within the Danish Political system. Portions of the health sector are aptly managed at the regional level whereas other areas are addressed at the State level (Scandinavian Journal of Public Health, 2009).
The objective of the Danish health agreement includes coherence and quality improvement for regional and municipal cooperation. Updated each year the health agreement focuses on six principle areas. These six focal areas are issued and approved by the National Board of Health. They include the following.
Source: (Scandinavian Journal of Public Health, 2009)
Additionally within the six primary areas there is specific division of demands relative to each area. There are subsequently success indicators that could have significant impact on associated policies and guidelines. Also, there is a detailed description of designated tasks associated with various information channels and sectors. Critical to the systems success is the methodology associated with communication between various shareholders including patients, healthcare workers, and government (Scandinavian Journal of Public Health, 2009).
According to another article there are seven countries, all market-based economies that are addressing healthcare implementation. The countries provide a broad spectrum of analyzing the healthcare landscape as they represent a diverse mix of systems in Australasia, the European Union, and North America. They include Australia, New Zealand, England, Germany, The Netherlands, Canada, and the USA. One of the characteristics of the U.S. system relative to the other countries is an elevated rate of total health related expenses. This is combined with a minimal quantity of public versus private expenses (Gauld et al, 2007). Commonality exists in countries such as Australia, Canada, New Zealand, and England, where healthcare systems are tax-financed. Although tax-financed, one unique feature of Australia’s Medicare system is it’s resemblance to social insurance (Gauld et al, 2007).
Although several healthcare systems are financed through insurance, the way each system is structured varies. For example Germany leverages social insurance comprised of a standard rate and payment schedule. In contrast the Netherlands employs a structure of required insurance offered through a competitive free market system. The United States healthcare system covers various groups through a blend of public and employer offered insurance. In the U.S. system although the majority of citizens are covered approximately seventeen percent remain uninsured (Gauld et al, 2007).
Three countries including England, The Netherlands, and New Zealand have a political system where the executive, legislative, and judicial branches are centralized. In contrast the other four countries (Germany, Australia, Canada, & the USA) operate with varying degrees of centralized government. The majority of the countries (five) have a principal gatekeeping model. The primary care physicians functions as the first point of patient engagement, and refers them to appropriate ancillary services. However, only New Zealand, the Netherlands, and England have national guidelines for incentivizing patient enrollment. This serves the objective of a populace-centered methodology to health services (Gauld et al, 2007).
The US is the lone country not offering universal access to primary care. In each of the seven countries the fee-for-service model paid at the point of service is standard. Understandably there are sundry challenges associated with each specific healthcare system. The two principle categories where challenges exist include care quality and patient protection. Although the implementation of technology such as (EHR) are trending implementation varies. Specifically Australia, New Zealand, England, and the Netherlands display the most comprehensive EHR usage (Gauld et al, 2007).
In Poland the role of the Government is in the financing of the Healthcare system. This responsibility is divided between the National Health Fund (NFZ), State, and local government budgets. The allocated State budget ensures the ongoing operation of selected health services, insurance premiums, and related infrastructure. The local government operates within a functional capacity, as the supplier of relevant health services (Bem, 2013).
However, the Government’s role is not solely limited to finance, as ensuring equitable access to care is equally important. As consumers pay general health insurance premiums, the collected premiums are used by the NFZ to fund vital health services. Additionally, the State budget supports auxiliary services and health policy programs. At the local level management of healthcare centers is the primary role (Bem, 2013).
Clearly given the pattern of government engagement in healthcare its involvement appears vital. However, each government must ensure there is sufficient investment in healthcare services to ensure appropriate operation. It is often difficult for there to be stability within the healthcare sector due to social and public pressure. Typical areas of reform include resource management, and often a reduction in State funding. According to Wegrzyn when States adopt new funding rules they can often transfer costs to healthcare service recipients (Bem, 2013).
Within the US system there has been an expansion in the role and influence of the Government in healthcare. However, even with the passing of laws such as the Affordable Care Act (2010) challenges exist. Per capita spending in the US on healthcare related costs far surpasses other countries. In fact currently (GDP) Gross Domestic Product costs related to healthcare represent the greatest sector of domestic GDP cost. Yet resultant outcomes according to the organization for economic co-operation and development are underwhelming (Straube, 2012).
In the last fifty years the role of the Government on healthcare has steadily increased. Pivotal milestones include the formation of Medicare and Medicaid in 1965. In addition in the 1980’s and early 2000’s expanded healthcare legislation provided increased access. In 2008, public healthcare programs resulted in an outlay of costs of approximately $1.1 trillion dollars (Straube, 2012).
Another important benefit of the government being actively involved in healthcare is the ability to educate consumers on preventive services. Educational awareness includes sharing how disease prevention mitigates exorbitant costs. One example of cost containment is in the way that Government health programs are developed. For example until the 1980’s the Medicare program did not authorize preventative screening tests. In the 1980’s with the implementation of a preventive screening benefit, preventive services became more common. Additional preventive services have since been added (Straube, 2012).
One such preventive benefit includes the (MIPPA) Medicare & Medicaid Improvements for Patients and Providers Act (2008). Additionally, congress authorized additional preventive services to be integrated as part of the (NCD) National Coverage Decision CMS (Center for Medicare & Medicaid) process (Straube, 2012).
The most comprehensive federal healthcare legislation is the Affordable Care Act (ACA). This was a central legislation to healthcare reform and includes ten focal areas. Title four addresses the prevention of chronic disease and improvement. Although disease prevention is a primary function the modernization of associated systems is also a goal. Title four is also concerned with the expansion of patient access to clinical and community based preventive services. As the government is simultaneously focusing on system improvement, community outreach is equally critical. Engaging the community through the promotion of outreach campaigns and the implementation of wellness programs occurs (Straube, 2012).
In summary, effectual healthcare is central to the promotion of each individual’s quality of life. The role of the government is most effective when focusing on system improvement, quality control, and cost containment. The establishment of laws such as the Affordable Care Act ensures appropriate protocols and processes for governance. Relevant dangers and potential downfalls exist when there is miscommunication between the organizational stakeholders.
Equally vital to the process is the continued evaluation of health related outcomes. If there is a huge disparity between health cost and outcomes, that is an issue. For example in the U.S. if a trillion dollars is spent on improving the healthcare system, patients should have sufficient access. Although structural facilities and technologies are important, cost containment is critical. Without sufficient cost containment the various government entities will be unable to sustain ballooning costs with tax fee’s alone. Therefore, they will eventually transfer additional costs in the forms of premium rate increases to the consumer.
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Gauld, Robin, Jako Burgers, Mark Dobrow, Rubin Minhas, Claus Wendt, Alan Cohen, and Karen Luxford Luxford. "Healthcare System Performance Improvement A Comparison of Key Policies in Seven High-income Countries." Journal of Health Organization and Management 28.1 (2014): 2-20. Print.
Straube, Barry. "A Role for Government: An Observation on Federal Healthcare Efforts in Prevention." American Journal of Preventative Medicine 44.1 (2012): 39-42. Print.
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