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Question
Introduction to Health Policy and Management: The
Future Of Health Care Delivery In The United States
CASE STUDY:
You are a renowned health care consultant engaged by 2010 President Barack
Obama to make recommendations to Congress regarding health care delivery. The
president, who desires to improve Americans’ access to services, says that
“something must be done” to eliminate much of the waste in health care and
wants to encourage standardized electronic records and data exchange.
Answer 9 questions 300-350 words each
If you can please reference the textbook: Health Care Delivery in the United States 9th ed. by Anthony R. Kovner and Steven Jonas
Answer
Name of student:
Course name:
Class name:
Date assignment due:
Contents
1. What are your three most important recommendations?. 1
2. How will the stakeholders listed in chapter 1 be likely to react to them?. 2
4. What are the leading causes of waste in the health care system?. 5
5. What are the key difficulties in creating standardized electronic medical records?. 6
1. What are your three most important recommendations?
The first measure that the government should put in place is to set standards for healthcare system data and electronic patient health records. This could be the foundation of creating an integrated national health care delivery system that is easy to operate and which limits wastage in health care. This system can work very well as a complementary item to the traditional health care system.
It would be important for a decision-support approach to be adopted in which case health care experts draw upon deep systems expertise in order to ensure that quality is improved while at the same driving down healthcare costs as well as the costs that accrue in related areas as a result of inefficiency in the health sector.
The second recommendation involves the setting up of a national registry that deals with matters of healthcare safety, quality and efficiency. In Europe, such a registry has been observed to work very well especially when penalties and rewards are imposed on healthcare institutions depending on performance standards that these institutions maintain. The U.S system, which is more privatized, can be more accommodative of an efficiency registry since it is generally designed to eliminate all existing barriers relating to information sharing.
Many hospitals have continued to resist calls for the release of data relating to practice and outcome out of the fear that competitors might use it against them. in this regard, this recommendation should be in the form of ‘pay for participation’ framework, whereby hospital participation in efficiency programs is incentivized in order to make data available relating to processes and outcomes without the imposition of any penalties on poor outcomes that may have an inhibitory effect on participation.
The third recommendation is about dedication of funding towards research in areas of patient safety and efficiency in healthcare delivery. This would entail creation of a database that will make it easy for health care delivery systems to be easily analyzed for efficiency and wastage of resources.
2. How will the stakeholders listed in chapter 1 be likely to react to them?
The stakeholders in the healthcare system will react in different ways to the healthcare recommendations put forward here. In the case of the first recommendation, majority of stakeholders would be very supportive of measures that would ensure creation of standards in the way healthcare system data is handled. In most cases, wastage in this sector is often attributed to poorly maintained records even in the information age.
Many healthcare providers especially in the traditional setting would like to adopt measures that are aimed at ensuring a smooth transition into the new way of doing things. The recommendations would be useful for these stakeholders because any losses to be encountered, if any, would be felt across the system, and therefore no sector players would gain undue advantage over others.
The second recommendation may generate resistance among many, if not all, private sector players in provision of healthcare services because the information gathered may be used by some competitors for blackmail purposes. Some competitors may also use the weaknesses of other healthcare providers in order to run campaigns that exploit these weaknesses for commercial gains. This can lead to more wastage rather than efficiency in this sector.
Information sharing is an important practice in this day and age. However, stakeholders may see no sense in sharing information if policymakers and partners do not act upon this information for research and as well tasks related to increase in efficiency. Additionally, the American public may see no sense in incentivizing a system whose efficiency is still in doubt. Majority of the citizens would rather wait and see whether the other recommendations that have been put in place will lead to increased efficiency and reduction of wastage.
The third recommendation can also generate support from stakeholders. Research funding initiatives, if exploited and managed in the right way, can lead to savings in the American health sector. Without resources, there is no need of maintaining databases since the information gathered through databases cannot be acted upon in due time. The implication here is that without research, its usefulness ceases to exist.
3. How can you work with these stakeholders to take advantage of opportunities and overcome constraints?
As a healthcare consultant I would identify the best healthcare practices that can bring about additional gains by recommending government reimbursement rates and provision of financial incentives. These measures are very necessary for improvement of efficiency and quality of healthcare delivery. I would also bet on the acceptability of the National Safety and Efficiency Database as far as the task of tracking institutional efficiency metrics is concerned. The database, I would point out, also helps in ensuring that researchers and engineers always have access to all the information that they need in order to put in place successful practices for the benefit of all stakeholders in the healthcare industry.
The current health care system is such that consumers lack enough understanding, and consequently control, of the way in which health information flows and how it is utilized. Consumers are very crucial stakeholders in any sector. Without consideration of their health needs, the task of standardizing data records and information exchange systems cannot be successful in bringing about reduction in wastage of resources in the sector. in order to overcome this logistical and attitudinal constraint, informing the public on the important of reforms would be a priority area.
I would work with all stakeholders in order to ensure that health care information technology seeps into the psyche of all implementers in order to induce hope into the system. Before doing this, it would be important to demonstrate that the current high level of inefficiency in the country’s healthcare system is due to poor use of information technology tools available, resulting in wastage. Against this backdrop, it would be easy to take these stakeholders on a demonstration of how a properly systemized database system should function and the benefits that would be achieved. Where need be, I would request for incentives from both state and federal authorities.
4. What are the leading causes of waste in the health care system?
Bentley says that the cost of healthcare in the United States remains very much higher compared to that of other industrial countries that have a similar, if not a better health system performance (630). Wasteful spending raises the cost of health care in the U.S and many other developed countries that are grappling with the problem of wastage in the sector. According to o Bentley, the healthcare wastes can be divided into operational, administrative and clinical wastes.
Healthcare wastes are caused by medical uncertainties and health insurance. These two factors encourage the creation of a scenario whereby low-value and inefficient healthcare services are produced. Van Oyenrefers to the wastage caused through medical uncertainties as ‘process waste’ (4). This waste creates many problems, including unnecessary delays and excessive waiting in the care delivery. It manifests itself in wasteful use of the emergency department which is very expensive to operate. It also leads to wasteful use of many other tertiary care resources.
Other manifestation of process waste include inattention to effective processes and to workflow, meaning that a lot of time is wasted in the process of looking for equipment, transferring patient information, waiting for test results and providing key services during weekends.
Administrative wastage manifests itself in improper distribution of authority among multiple providers in an organization as well as multiple administrators and departments. All decisions are made piecemeal, based on departmental/local objectives, although they are generally lacking in terms of benefits. They tend to be irregular and are modeled on a system that cannot be relied on in the overall management of an organization or system.
In terms of data usage, wastage arises through inefficiency. This is mainly because the existing data systems are not designed for optimal performance by clinicians, researchers, patients, policymakers and managers. This is a rectifiable problem that requires a policy framework to guide the whole strategy implementation process
5. What are the key difficulties in creating standardized electronic medical records?
One of the difficulties encountered is ineffective use of data contained in medical records. For this reason, the existing records are not utilized in a way that they can be of the best help to clinicians, researchers, patients and policymakers. It is also difficult to create standardized electronic medical records since it is possible for process measures to be put in place within the existing system in order to make it look as if it is efficient when indeed it is not.
There is also the difficulty of maintaining communication and coordination among different stakeholders on all capacities apart from sharing records electronically. The main reason for this is opposition from the U.S citizens who are worried that putting medical records systems in electronic media translates into creating ways of exerting government control over personal health records of individuals.
Brokel & Harrison say that many people lack knowledge about existing electronic data records (83). Additionally, the public is unaware of many other improved ways of ensuring that their right to access efficient healthcare is safeguarded. For this reason, even if new electronic systems were put in place with greater emphasis being put on effectiveness and efficiency, the problem of ignorance and inaccessibility may render them ineffective.
Insurers, doctors, and most importantly, consumers have not completely embraced the shift towards electronic health records that facilitate task of gathering all individual’s health data right from childhood to the current moment in the form of a single digital record. Many prospective consumers of such systems are very afraid that consenting to such a system is tantamount to signing in for vulnerability to unauthorized exposure by people who may gain access to such a digital record. They are afraid that if the wrong people access their digitized medical records, they may lose health insurance as well as face workplace discrimination.
6. What can we learn from other countries in formulating recommendations to improve the U.S. health care system?
A study of four developed countries namely Canada, Great Britain (United Kingdom), Germany and France done by Brown shows that there are many lessons that the United States can learn in the process of implementing recommendations aimed at reducing wastage in the health sector as well as moving towards digitization of healthcare records system (5).
In all these four countries, all citizens are entitled to health coverage. Health care is not enough, in each of these countries, images of community, solidarity, and equity in matters of provision of healthcare matter a lot. There is utmost respect for human dignity such that citizens are never afraid that their digitized health history information will fall into unauthorized hands and used against the individuals.
In Canada, Great Britain (United Kingdom), Germany and France, unlike the United States, debates on what limits should be maintained on publicly defined coverage has been ongoing for a long time. For example, in Canada, home health drugs and care are outside the confines of the country’s public system. In the case of France, supplementary insurance is used to cover eye and dental care.
Continued innovation in the field of medicine in Canada, Great Britain (United Kingdom), Germany and France has led to the intensification of the debate on how best to define all the benefits that make it possible for national community responsibilities to be differentiated from those that should be borne personally by individuals and families. These deliberations tend to gain publicity and prominence and in this process, there is a widespread sense of awareness on the usefulness of reforms in the health sector.
In terms of funding, the national governments in Canada, Great Britain (United Kingdom), Germany and France have put in place statutory frameworks that facilitate a universal system of financing coverage. The only difference is how each country raises the monies for use in the healthcare sector. In Great Britain, the National Health Service is funded mainly by general revenues. In Canada, 70% of the health bill is funded by provincial and national general revenue. In Germany, a work-based social insurance plan is in place while in France, a stable social insurance regime is supported with the country’s general revenue that is tapped from the nation’s wide wealth base.
7. Why not allow health care costs to continue to grow until they reach 20% or more of the gross domestic product?
Allowing health care costs to continue growing is not a good idea. There are very dependent variables that would have to be considered. In other words, the healthcare wastage problem in United States goes beyond the simple of the ratio between healthcare costs and gross domestic product.
It is obvious that the ever-rising costs of healthcare a very huge cause of headache for the United States’ policymakers. However, the last thing they want to see happen is to see health care costs continue to rise. This is because, by proportion, wastage will continue to increase if the current healthcare system is not digitized and emphasis put on efficiency.
When Bill Clinton in 1993 proposed a harmonized cost control mechanism that ensured universal coverage through managing competition among different healthcare plans, it was rejected. This meant that the goal of cost containment was left in the hands of unchecked competition between health plans that differed in terms of efficiency and emphasis. To the surprise of many people, the plan managed to work for all the remaining years of the 20th century since costs dramatically dropped. However, things are very different in the 21st century; healthcare spending is on the rise once again and purchasers and policymakers are at a loss on what to do about the level of wastage that is by proportion as high as cost of healthcare.
Adopting changes similar to the ones that Clinton proposed in 1993 is a very good idea. It would bring the costs of healthcare down by forcing stakeholders to cut down on wastage. It would also eliminate many politically potent sources of healthcare waste. The healthcare market has in recent times shown a capacity to tolerate wastage, something that can only be changed through providing suggestions such as the ones President Obama is proposing. The healthcare policy would lead to reduction of wastage that often manifests itself through exorbitant salaries of executives, stockholders’ profits, efforts at selective enrollment, marketing costs, technology that is less widely diffused and lobbying expenses.
If wastage in the healthcare sector was reduced, both the growing and ageing populations, the two groups that are hardest hit by rising healthcare costs, would benefit. Additionally, the federal governments would cut spending on the sector, meaning that money can be diverted to other key sectors such as education.
8. What should be the role of state governments in health care? Discuss the arguments pro and con for standardizing Medicaid across states.
State governments have a very important role to play in the provision of health care to citizens. The history of healthcare regulation in the country traces its origin at the state level of government. Traditionally, the state has maintained jurisdiction over many matters, one of them being provision of healthcare services.
The state’s role in regulation of healthcare is threefold: setting up end enforcing the best healthcare standards, for the environment, professionals and organizations, purchasing services for the poor, and ensuring proper implementation of federal program through state-level administration.
When it comes to setting standards, the state makes use of its police power to ensure that the health standards it has set up are implemented b healthcare organizations, professionals and insurance companies that operate within the state. On the same light, it ensures that the right standards are maintained over areas that have a direct or indirect impact on health, such as local food supplies, environmental hazards, sanitation and sewerage disposal.
When it comes to provision of direct services, there are many healthcare organizations that are owned by the state. They are meant for all citizens, especially those who cannot afford to cater for their own health care costs. These healthcare organizations include specialty hospitals, general health clinics, general acute-care hospitals, and specialized clinics.
The state also administers federal programs, a role that is aimed at strengthening capacity at the federal level. This is mainly done through enactment of various federal laws relating to healthcare. One of the best examples of the administrative duty of state governments is the implementation of the Medicaid program.
The main pro of standardization of healthcare across states through Medicaid is that once the federal government has defined the class of people who should benefit from medical care, the task of identifying this class of people is left to administrators in various states. In other words, the states receive the express authority to oversee the administration of the program. The only problem with this principle is that it may lead to a situation whereby there are 50 different healthcare policies, one for each of the 50 states. State policies may end up being very inconsistent.
9. How can we improve government regulation of health care organizations, pharmaceutical companies, health insurers, and health care professionals?
The best way of improving regulation of health insurers, pharmaceutical companies, and healthcare professionals is to create a harmonized health care system such as the one that has been adopted by other countries such as Canada, France, Great Britain and Germany. Within a policy framework, it is easy to pick out a certain standard and ensure that it is adhered to by all players in the sector. For instance, a common problem that each of the stakeholders including insurers, pharmaceutical companies and health care professionals in private practice exacerbate is high costs for poor services offered. Within a harmonized policy, it is easy for the government to regulate the health sector for the benefit of the citizens.
In order to regulate healthcare, the government should ensure that an electronic health records system is put in place. Citizens should be enlightened about the usefulness of such a system in cutting down health care costs. The risk of authorized use of individuals’ medical history for discrimination purposes is real. For this reason, the government should enact strict laws that criminalize such acts. With such a fear having been dealt with, the government can easily regulate the competitive trends among health insurers, professionals and healthcare providers.
State governments have a very important role to play in ensuring that the federal government nets unscrupulous pharmaceutical industry players who collude with healthcare professionals and health insurers to promote unfair practices. In order to deal with the problem of inconsistency in state-made policies, the federal government needs to clearly spell out those health care needs that are local in nature and those that are a common concern in all states. Issues such as physician licensure and wastage of resources are common in all states and therefore, they require a single policy. On the other hand, factors such as unique demographic composition and vulnerability to certain diseases necessitates for state-specific healthcare policies.
Works Cited
Bentley, Tanya.“Waste in the U.S. Health Care System: A Conceptual Framework” The Milbank Quarterly, 86.4 (2008): 629-659.
Brokel, Jane & Harrison, Michael. “Redesigning Care Processes Using an Electronic Health Record: A System’s Experience” Joint Commission Journal on Quality and Patient Safety, 35.2 (2009): 82-92
Brown, Lawrence. “Comparing Health Systems in Four Countries: Lessons for the United States”, American Journal of Public Health 93.1 (2003): 52–56.
Van Oyen, Mark. 2008. Healthcare Reform Discussion Submission: A Call for a Government Healthcare Safety, Quality, and Efficiency Program Based on the public discussion held on 12/18/08 in Ann Arbor, MI. retrieved from http://www.engin.umich.edu/dept/ioe/HealthE/Healthcare%20Reform%20Ideas%201-30-09.pdf on April 18, 2010.
