The Future of the Healthcare Industry - Research Paper Example

The Future of the Healthcare Industry The provision of medical services with an aim of maintaining and improving the mental and physical of individuals is what is referred to as health care. On the other hand, health care delivery system is an organizational structure composed of both the public and private sector (Miao-Sheng & Yu-Ti, 2008). The public sector is composition of hospitals that have been established and funded with the government. The private sector is made up of hospitals which are privately sponsored by an organization or an individual. The health care system is a composition of profitable and non- profitable individuals. This paper will look at the quality of health care delivery systems in the United States. The government in the US is in charge of insurance and the health care delivery systems. The insurance payment systems are under standardized; this affects the nature of quality patients receive. In addition, the health care system is controlled by different individuals. Hagan and Encinosa (2008) noted that, sectors which are private are in charge of health care delivery, insurance and payments. Furthermore, it offers largest insurance covers, services involving payments and health care delivery. Most employees have health insurances from the private sectors as well as individuals who have medical insurance, and they are attended to by private heath facilities. On the other hand, the health care insurances are provided to citizens of a nation by its through Medicaid, Medicare and other institutions controlled by the government. Citizens who are classified as low income individuals have access to the government’s health insurance policies. As a result of the steep competition between the public and the private sector has made it hard for individuals of a nation to access health care. For instance, both the insurance services and the health care costs are high. Due to this the government offers health care services to its citizens through public county clinics and government hospitals (Hagan & Encinosa, 2008). In spite of citizens in the US paying extra for their health care, the US has been ranked last on various measures of performance in the health system compared to Canada, Netherlands, Australia, Germany, United Kingdom and Germany. US is sixth when it comes to health accessibility, quality, efficiency as well as ability and equity of its citizens to depend on. Furthermore, the US stands out of acquiring good heath care dollars in spite of having room for its improvement for her to be ranked last in the health care levels after spending $7,290 per capita in the year 2007 compared to Netherland which spent $3,837 per capital and was ranked first. However, it has been stated that US citizens often get sick compared to other industrialized countries hence spending more for their health care services and they do receive through treatments (Live Science Staff, 2010) In addition, patients in the US with chronic diseases do report to have been received wrong medication or medical doses which are wrong, and are delayed to know or be notified on their medical results which are abnormal. US being ranked last in her efficiency are as a result of low level on administrative expenditures, utilization of information technology and re-hospitalization. On the other hand, adults in the US with chronic diseases do visit the department of emergency rather than see a regular doctor who can treat them compared to patients in Germany and Netherland. Furthermore, it is tough for the citizens in the US to afford health care since 54 percent of her adult citizen with chronic disease had problems of accessing tests which are recommended compared to 7 percent in Netherlands. Infant mortality in the US and death of her citizens before the age of 75 years is also a challenge yet there was potential from preventing such death cases. For US to stem the challenges in the health care system is to improve on the health care bill ‘The Affordable Care Act.’ This act is expected to extend health insurance cover to more than 32 million of its citizen who are uncovered. Offering equitable health is also another key for US to serve its citizens; the US should study the difference in health and health care quality across its population. The study may include differences in diseases presence, outcomes of health or health care access across its socioeconomic groups, races, ethnicity and sex orientation. This is also a problem in the developing world where its citizens are not in a able to access health equity. US should have a priority of improving its patient health care with an objective to acquiring high level of its citizen’s satisfaction. For this change to be effective, the US should ensure there is greater public awareness, increasing levels of better care demands, increased rate in litigation of medical malpractice as well as having concern about the poor outcomes. Setting up of quality infrastructure is essential for determining patients in the nation receive quality services, having employees who are well trained, having personnel who are competed and operational systems which are efficient. The US should adapt a system which is patient oriented, it boosts the patient quality care services. Furthermore, problems which exist in the health care sector as a result of the non-medical and the medical elements as well as a system which is comprehensive that improves the two aspects should be implemented. Individuals who are employed in the system should realize that patients are the most relevant individuals in the care systems in medical. As a factor which is single, it will make a difference in the hospital on patient care. Financial constrain is a challenge for individuals to seek medication, introduction of cost recovery management system will aid too curb such cases in the US. The US should first create an affordable system which attracts patients to pay for services of high quality, which will later be expanded to be non paying patient system. It will be an advantageous system since it will be of cost recovery and patients will receive quality medication (Rao, 2011) Collection of data will not only give information of on specific area such as outcome of patience, national data compliance for chronic diseases as well as comparative costs, but it will also is a .measure which is acceptable since policy makers in the healthcare will rely on the data to plan, develop and implement an effective service delivery healthcare system and payment policies. In addition, the data will give a report on outcomes of a patient based on accurate statistics from the clinics and information on demography. US adopting a privacy and security technology which are enabled, patients will be able to access their personal medical health records and they will be willing to maintain it confidently as well as keep on updating their health care personal information. Having the exchange and information network will have a significant opportunity for influencing decision making in the new Evidence-Based paradigm. This can be done by integrating the individual care system of delivery across a diverse yet particular sets of demography to a more holistic and accurate care delivery address and decision making on treatment (Hagan & Encinosa, 2008). Furthermore, having the data can help identifying individuals treated with a specific illness and region in the country and the individual is within a specific age bracket or race can be compared to their counterparts treated with the same by a series of health care payers and providers as well as a protocol of medical lists and steps taken to diagnose and treat the same illness. As a result of the data, the providers are enabled to determine when they are giving appropriate charges, offering practices in the clinic as expected as well as how effective they are competing with existing health care organization. The level of transparency and access to information will have the same proportional value to its payers thereby allowing them to see the charges of other providers and the way payers are being reimbursed. The transformative thing here is that the patient is central and the decisions that are made are based on EBM drive but not how usual or expensive are the procedures. The net result will therefore depend on taking down the costs through measures which are competitive among the payers and the providers instead of between payers and providers. In addition, the dynamic that exists between the payers and the providers can be factual centered on the real outcomes of a patient (Hagan & Encinosa, 2008). Affordability in the health care depends on the interventions of prices in the health care and the financial status of an individual or an organization paying for the services. Interventions cost should be kept low through an effective business practices for instance having high productivity with no waste. Health care in a country can be paid for in different ways such as through the government, by a family or by another individual or company. These organizations having the ability to pay for health services will influence the level of health care services across the nation. It is not easy to subsidies care cost if it is to be free in few sectors in the society. In some instances either the family or the government caters for the expenses for free. As a result of these the society is bound to pay more to for the health care services, this will led to subsidized services for individuals who are poor via the multi-tier system structure of payment. Cost on the other hand can be subsidized by the Local or International NGDOs, however is maintenance is less in long terms. Degrees of qualities are available, an organization or hospitals should be in a position to identify quality needs that need to be improved and determine whether the improvements made are affordable to the society. Affordability of a particular quality is not always about the costs. The most relevant thing is on cost effectiveness and the best resource utilization. When poor services are being offered by an organization or a hospital then resources are being wasted and may lead to absent if services. Not all improvements need extra money or resources, but do need the team of individuals to change its mode of functioning hence, necessary to consider the holistic situation (Chicago, 1992). Credentials are seen as necessary evil by the physicians and the administrators, since it is a plan to participate in management. Management care organizations are expected to identify, select and retain health care qualified providers who will be offering quality services to their providers. Creditability is defined as the act of selecting and retaining the service providers. It involves the process of reviewing as well as verifying of health care information to providers who are interested of being part of Managed Care Organization (MCO). The main purpose of credential is to ensure that the applicants meet the least requirements for the status that have been requested and at the same time determine whether the credentials of the applicants are appropriate for the privileges that have been requested for within the MCO. The MCO handles a good number of applicants a part from hospitals as a result of these credentials are done quickly and inexpensive. It has led to the MCO to change the way they administer their credentials for them to respond to the overwhelming demands of the changes that are constant in the health care systems. One advantage of the credentials is that it caters for the risks; MCOs are liable for any of their subscribers being exposed to any injury to an unqualified service provider who has failed to properly review their credentials. In addition, they do take the risks of their subscriber’s term as damage when the individual is injured in the process of malpractice of a certain provider who is deemed to have been unqualified. It also exercises care which is reasonable in monitoring and credentialing there service providers to reduce risks of malpractices done by an individual who is their member. However, the credentials processes are not easy and they need to be standardizing according to the insurers format. This allows the physicians to sustain all information in their database in a standardized format, which allows them to have the same information as well as send it to its applicants to manage each of the care organization. As a result of these physicians are expected to lobby for credentials legislations which are uniform via their states and their local agencies. It is a single decision yet it requires drastically curtail of long hours to be spent by physicians to complete the credentials for applications as well as compiling information. The Patient Protection and Affordable Care Act (PPACA), is statute which is federal and has been signed by the US president in accordance to the US laws. It focuses on the reforms that are needed in the private market of health insurance, to provide coverage’s that are better for organizations with pre-existing conditions as well as improve drug prescription coverage in the field of Medicare and extent its life to at least 12 years of Medicare Trust Fund. It is an issue which is guaranteed and the rating of the community is nationally implemented, this will ensure that the ensures are expected to offer premium to all applicants of the same sex, age and the geographical setting as well regardless of the conditions which are pre-existing. On the other hand the Medicaid has been expanded to carry on board all people and families of who their income is up to 133 percent of the level of poverty. The exchanges of the health insurance are expected to be operational in every state while offering a place of market where individuals are allowed to compare prices, policies and premiums as the wish to buy their insurance willingly. In addition, low income individuals and families are who are above the level of Medicare and are up to 400 percent of the level of poverty are to receive sliding scale at a subsides level, if the individual choose to buy an insurance through the an exchange. The small business on the other hand are able to receive subsides by buying an insurance via an exchange system. Furthermore, the law has introduced standards which are minimal to the policies of health insurance and has removed all of its annual and coverage caps which are life time. A two-tiered health care is referred as it is a system in the United Kingdom and other parts of Europe use it, and it is where a health care which is public provides care which is guaranteed to all citizens but has a parallel system where individuals can buy care faster always in an environment that is pleasant. It is conflicting to an individual as to which service provider system offers better quality. The US has a single-tiered system which is supplemented by the funds from public sectors for the provision of care to all the elderly and the poor patients in the community. It is a recommendation that the private sectors related to such private care delivery have attracted the attention from the public. Politicians and the press have had negative comments about the system because of there two-tiered medicine. However, the physicians have the right to choose as the often do either to work in the private or the public sector Physicians generally have the right to choose, and they usually do, to work in the private facility and the public system. Indeed, given our current human resource shortfall, it would represent another challenge if this was not allowed. Although interpretations may vary, I find it difficult to accept that any of these situations represent two-tiered medicine. However, if private insurance coverage is allowed, then a two-tiered system may result unless great care is taken as to what can be insured and under what circumstances – otherwise, we could morph into universal coverage for all – but faster service for those who can afford private insurance. Putting the community in the fore front on the issues of health care is relevant not only for the purposes of stabilizing the countries health status but also sustain and improve the rates of development in the economy. References Chicago: AMA; 1992. American Medical Association. Policy Compendium; p. 315. Hagan, M., & Encinosa, W. (2008). Health care markets: Concepts, data, measures, and current research challenges. Inquiry - Excellus Health Plan, 45(1), 15. Live Science Staff (2011). U.S. Last in Health Care Among 7 Industrialized Countries. Retrieved on 17 April, 2011 from http://www.livescience.com/8356-health-care-7-industrialized-countries.html Miao-Sheng, C., & Yu-Ti, S. (2008). Pricing of prescription drugs and its impact on physicians' choice behavior. Health Care Management Science, 11(3), 288 Rao, Gullapalli (2011). How can we improve patient care? Retrieved on 17 April from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1705904/ Sobelman, S. Jerry (2001). CPA, is a principal of Margolis & Company P.C. Retrieved on 17 April, 2011 from http://www.physiciansnews.com/business/601sobelman.html . Read More