The US Health Care System
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When it comes to health matters, everyone becomes attentive. People believe that with good health, one can virtually accomplish anything that they desire. This is the reason to as why health is given all the attention. It is important to have a clear understanding of the meaning of the term health, healthcare and systems that are put in place to facilitate healthcare.
From the definitions of health given, one can either be in good health or in unhealthy. Therefore, it is important to know one’s health status so that preventive care can be offered immediately. This can only be affected when proper health care system and policies are put in place.
Healthcare can then be described as an activity or act geared to maintain health. This could be through the provision of medical services or any other services that aim at maintaining good health. Healthcare is not necessarily provided when a person becomes sick or loses health, but is progressive and should always be provided as a preventive measure. Healthcare system is the organization of people, institutions and various resources, which help in quality service delivery to the intended population. Therefore, it can be said that these are systems put in place to meet healthcare needs of a particular population. There are several systems worldwide and in this case, the main focus of this discussion is on the US Health care system (Kassirer 19).
In this paper, we are going to handle the high cost of healthcare in America as a problem in the healthcare system and further look at the research done and suggestions to improve the situation.
Significance of Healthcare Systems
Healthcare systems are put in place, so that they can meet and satisfy the healthcare needs of people in a geographical area. They have the mandate to deliver healthcare services to the intended group or population and ensure fair contribution of finances. The set up of these systems vary from one country/state to another, though they seem to have similar goals since they are geared towards promoting and maintaining the best quality health care service delivery to the citizens. The systems play a major role and should therefore be maintained and supported if people are to achieve the desired standards in healthcare services delivery. This include proper design and plan of the structures, which include the participation of the government, charities, trade unions, employers, religious groups, and all coordinated bodies to deliver the intended healthcare services to the intended populations (Kassirer 23).
Stakeholders in the Healthcare System
There are several factors that determine the effectiveness of health care system. These factors include, but not limited to cost, quality, and ease of access, cultures and workforce. It is clear that all these factors affect the stakeholders in the healthcare system.
The stakeholders in this field vary from the private sector to the government. The players in the private sector include the insurance companies, device manufacturers, pharmaceuticals and medical practitioners. The government is majorly involved in policy making levels and is responsible for making sure that there is the best quality and affordable service delivery to its citizens with other stakeholders who are involved in the health care system being the physicians (Ventres 43). Physicians play a big role in the whole of the healthcare system, since they are the ones who interact with the patients and policies formulated by the government.
Lastly, the main group largely affected by the systems put in place is the patients. The patients are the base and foundation of developing all the systems relating to healthcare. All these stakeholders play unique and major roles in ensuring the need for better healthcare systems within the United States (Ventres 52).
Current Healthcare System Situation
Currently, all the countries of the world have problems with their healthcare systems and the United States is not an exception, as there are many issues affecting the healthcare system with the US system being declared “broken” in the year 2000 (Kassirer 27). This has never changed since then, and the situation is becoming worse, since many Americans are not getting the health insurance cover. These problems emanate from the stakeholders in the healthcare system. “American healthcare system is riddled with inefficiencies due to a lack of an integrated system that could promote an optimal mix of personal medical care and population health measures”(American Associates 1) The Journal further claims that “the major innovation of this plan would be to incorporate existing private health insurance plans into a national system that rebalances health care spending between personal and population health services and directs spending to investments with the greatest long-run returns” (American Associates 1). If citizens are given a choice of both public and private mix, then it is obvious that this will be a preference to pure government system.
Currently there are restrictions where people have to take up insurance covers based on their employers’ demand and not their own choice of health insurance cover. The major innovation to this plan would be to incorporate existing private health insurance plans into a national system that rebalances health care spending between personal and population health services and directs spending to investments with the greatest long-run returns (American Associates 1). Moreover, the physicians often have problems in accessing the patients’ records. Lack of consistency in measuring the quality of healthcare and using the findings in decision making is another problem (Louis 59).
One of the significant problems in the healthcare system today in the United States is majorly finance. Healthcare has become very expensive and the prices are skyrocketing every day. It is true that guaranteeing fundamental health care for everyone will be expensive. According to Louis 68, the fees for “covering the uninsured would cost an estimated $88.6 billion in today’s dollars” (68). The current situation of healthcare system indicates that there are many problems that need to be fixed. Other highlighted issues can be handled by change of policies. For the future generation, there is a need to ensure universal coverage for all. This will ensure every American citizen is registered in an essential health plan of their choice.
High Cost of Healthcare
It is true to say that the United States system of healthcare is quite unique (Shi Leiyu and Douglas 12). In fact, the system is characterized by presence of subsystems, imbalanced access to healthcare services as a result of lacking insurance cover for all, existence many players and absence of central bureau to preside over the system and many other features that affect healthcare delivery in the country (Louis 71).
In this study, more focus is put on cost as a factor that affects the health care system. Cost is a wide topic of discussion and the main focus is in ways of reducing the skyrocketing costs, since it is obvious that the cost of healthcare in the United States has shot and is continuing to rise with time. It is said that in the year 2010, the expenditure of health neared $ 2.6 trillion in the United States alone (U.S Healthcare Costs 4). This figure is more than ten times that spent in 1980. This is still expected to grow faster than the national income over the foreseeable future (Stephen, Raymond and Karen 118).
It is true that “the notion of cost-effectiveness is used in other countries, but the Americans have been unwilling to accept the denial of medical care on that premise” (Stephen, Raymond and Karen120). In fact; experts believe that much of the healthcare services being offered in the United States are a tax burden on the states’ budget expenditure (Rettig 13). Everybody can agree that health issues are sensitive, and all the necessary measures have to be put in place to ensure quality. However, the notion that in an attempt to be cost-effective would result to quality undermine could be misleading and these are some of the reasons why the cost of healthcare in the United States of America has always been on the rise. According to Beeuwkes, Buntin, Haviland, Mc Devitt and Sood, this can be associated with unnecessary pride where the rich and the most influential people, such the political elites and the most successful business people fight to keep the access to health services unreasonably high in the name of quality when the poor are languishing without coverage of health insurance and generally access to proper medicare facilities (45). It is an irony that as the world struggles to attain cost effectiveness in its service delivery to the citizens; this does not apply to the health sector, and especially in the United States (Beeuwkes, Buntin, Haviland, Mc Devitt and Sood 47).
The very first step is to embrace the fact that the citizens can still achieve better health services at a cheaper cost, thereby getting the most cost effective services. According to Madeline, most medical treatments lack evidence that they are effective (Madeline 42). The U.S Congress, in the American Recovery and Reinvestment Act of 2009, set aside $1.1 billion to jump-start research on which interventions are not worthwhile (Institute for Health Metrics and Evaluation, University of Washington, Seattle and the Harvard School of Public Health, Boston 2). This implies that the cost has been on the rise yet most of the treatment is actually non effective at all. Therefore, confirming the previous belief that high cost does not necessarily mean better and quality delivery of healthcare. Madeline further gives a case study of Texas City and El-Paso which is 800 miles away (Madeline 57). In McAllen, Texas Medicare expenditure hovered around $15000 per person enrolled while in El-Paso, the amount was half as much (U.S Healthcare Costs 4). The major concern is that the two cities are only 800 miles away from each other and thereby the discrepancy is not explained by the figures. “Compared to patients in El Paso and nationwide, patients in McAllen got more of pretty much everything – more diagnostic testing, more hospital treatment, more surgery, more home care” (Atul 1). This observation clearly indicates that a better healthcare system is what delivers quality services and at a cheaper cost as compared to incurring much resource expenditure with little benefits if any. “Many studies have demonstrated that NPPs can provide both high-quality and cost-effective medical care, because they show greater personal interest in patients” (Shi Leiyu and Douglas 86).
Kassirer concludes that the discontent of many physicians is attributable to frustrations in their attempts to deliver ideal health care, restrictions on their personal time, financial incentives that strain their professional principles, and loss of control over their clinical decisions (Kassirer 39). Research has also established that disclosure of physicians’ financial incentives highlights the tradeoff between the legal and ethical solutions to conflict of interest in professionalism.
These studies reveal that in the cost of healthcare in the US is generally high, but without some valid reasons, and these are some of the challenges that need to be looked into. There is a need to carry out some thorough investigations so that the root causes of the health care problems in the United States can be found out. It is from the investigated findings that some tangible solutions can be reached. Importantly, there is some glimmer of hope, if all the stakeholders and policy makers in the US health care system agree to hold meetings to reach at some amicable solutions. Therefore, some level of change can be achieved. This change can be achieved if all the involved stakeholders in the healthcare sector collaborate and work together (Retting 53). Looking at employers, they can play a big role in working towards a better healthcare provision. Every employer should be focusing on ways of improving the standards of health status of their employees and at the same time promoting the quality and cost of healthcare provision. In efforts to save the common people from the high and rising costs of healthcare, President Barrack Obama and the Congress has paid more concentration to the cost involved.
“Instead of employers offering core insurance benefits, all residents would select a health plan or physician through a regional insurance exchange. The contribution would be pooled by the NHT into a global budget for health spending” (American Associates 1) The fact that about 45 million Americans are uninsured is shocking and these results into patient’s having to hassle as a result of high rise of premiums (U.S Healthcare Costs 5).
It is time American citizens embraced the concept of cost-effectiveness by looking at drugs and technologies from the economic point of view and do comparison to available alternatives. The major concerns should not only be what cost will be incurred, but also the worth of the cost; is it worth? With this in mind, then we can say that it is not necessarily that expensive treatments are always of bad value, since some costly breakthroughs bring about better outcomes, and for this reason worth the investment (Christopher, Murray, Phil and Julio 72).
It has been found that in some cases, very expensive tests and surgeries are carried out and at the end of the day, they are found to have been unnecessary, these means that cost has been incurred without returns. This is not just in complex cases involving tests and surgeries, but also in general medical treatment.
According to the Institute of Medicine (IOM), half of medical treatments delivered lack the clear evidence of their work. In June 2009, the part of the National Academy of Sciences and IOM, issued the report that listed one hundred different areas where the popular medical interventions have to be rigorously compared. In the previous case of disparity in cost of healthcare in Texas and El Paso, the main cause of McAllen’s extreme costs was found to be overuse across-the-board of medicine with the effect that patients end up intoxicated and become worse instead of improving as expected.
A study from the Dartmouth Medical School, which suggests that often patients in highly-cost areas get much more expensive treatment of the marginal value, but less quality. The study showed that patients from high-cost areas were they less likely to receive preventive cheap priced services, such as pneumonia and flu vaccines, waited in line to a doctor’s and emergency room, and were less possibly to receive a primary-care physician. According to Madeline, “they get more of the expensive, but not more of help they needed” (Madeline 49). The observations pose questions to as whether expensive equals quality. Its high time health matters get serious attention instead of imitating the famous Veblen goods, such as cars and jewelry whose preference increases with increase of their price citing superior status. This is health, and it cannot be compared to any other good in the market, so people ought to know that the cheaper healthcare services become, the better it is for all citizens. Other cases relating to finances include an imperfect market situation, presence of third party insurers who come in as intermediaries linking the aspects of financing and delivery of health care, new and costly medical technology and emphasis on quality enhancement. It has been discovered that the more we get intermediaries in the business, the more expensive the services and goods are to the consumer. However, a policy would be adopted connecting the healthcare providers and people in need of these services directly instead of having to go through a pool of intermediates ending up with unbearable rates to bear (Retting 39).
It is still possible to tame the rising costs of healthcare and provide the Americans with the best at good rates. It all starts from individuals having the will. The healthcare system is may be described as broken but all is not lost. Everybody wants a relaxed working environment and this extends to those staff in the healthcare department as well. They should be given adequate incentives and a better working environment in order to deliver the best to the patients in general. It is obvious that it is important to ensure everyone has access to affordable healthcare. It is sad that even those who have health insurance are increasingly facing affordability problems in terms of paying for their health care. This is because analysis identifies families and individuals as underinsured, if they are forced to spend at least ten percent of their income on health care from their pockets. As citizens look forward to having a better system, there is some hope that all the stakeholders concerned will work together towards achieving better terms.
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