Social, Cultural, and Political Influences in the Healthcare Services - Assignment Example

 Social, Cultural, and Political Influences in the Healthcare Services A Situational Analysis The state of the American health care system is among the three top issues that the American public would want policymakers to address. Its importance increases as economic insecurity continues to grow. The most frequently cited problems are gaps in coverage, the quality of care that patients receive and the high cost of insurance. Over 45 million Americans do not have health insurance because of high coverage cost, availability of employer coverage, individual priorities and health market inefficiencies like access barriers in the individual market. The idea of too-little-too-late health care is usually as a result of lack of insurance and it has life-threatened health consequences. Notably too, is that many people have insurance but it is manifestly inadequate because it either lacks coverage for key services like prescriptions drugs or is accompanied by steep copayments and deductibles. For instance, the number of the underinsured has risen by an alarming rate of 60 percent since 2003. The high cost of health care has adversely affected not only individuals but also the economy. Consumers face burdensome out-of-pocket expenses for healthcare access, which adds another burden to illness. The high health care costs have continued to claim a larger share of the economy, now consisting of the gross domestic product, and still rising at a rate at least twice that of general inflation. There are also grave concerns on the quality of health care delivery and the management of risk in health care. A comprehensive study following about 7000 patients over a period of two years found that the received only 54 percent of the care significantly recommended for their conditions. The Institute of Medicine approximates about 100,000 deaths per year as a result of injuries to patients in hospital care. There are significant inequalities in effectiveness and quality of care delivered across different ethnic and racial groups. Compared to other developed countries like Germany, the United States lags behind in terms of information technologies, organizational design and other systems that can manage risk and improve quality. Patient safety, quality and risk management Protecting the patients and the health care management organization from risk is one of the top goals for all health care providers. Risk management entails reducing the likelihood of errors, particularly those costly in terms damage, disability, discomfort or distressing to a patient. This is achieved through detection, reporting and correction of the actual or potential deficiencies in the process of care that, though minor, could lead to significant and costly mistake. Healthcare quality entails more than just technical and professional performance. Much care can be said to be a series of compromises, tradeoffs and choices, made in the best conditions, by well-informed patients guided by knowledgeable healthcare professionals in safe and relaxed surroundings. Quality of care can be classified into three important categories that provide a useful framework for discussing quality of health care. The first is the basis of work on quality improvement, is Donabedian’s classification of health care into its structure, process and outcome components as targets for quality assessment (Donabedian, 1966, p.166). The second encompasses six dimensions of quality developed by Maxwell in a discussion on the need for an integrated quality improvement based on a systematic assessment. This has the following quality dimensions: Effectiveness Efficiency Appropriateness Acceptability Access Equity The third is also on the work on Donabedian and it considers health care in three main parts: the technical aspects of healthcare, the interpersonal aspects of care, and the amenities or the environment in which health care is provided (Donabedian, 1980, p.49). It is agreeable that these classifications may overlap, but all of the three define the quality of care differently, thus a more concrete picture than each alone. Social influence and delivery of health care services Substantial disparities in health status exist across different income groups, ethnic groups and social classes. In spite of the notion that there should be equal opportunity to health maintenance, the issues of inequalities in health status are a key current challenge facing the health sector. In principle though, the existing health care system can only address inequalities to a certain degree. A big portion of this this inequality is driven by social factors such as ineffective education systems and poverty. Social environment is an imperative factor influencing health, health choice and health care delivery. The social components like norm, beliefs, values and economic affect an individual’s health. At times, they also become major inequalities for health choice and health care delivery. Therefore socio-economic, educational and environmental conditions are important thoughts in planning and implementing programs that are receptive to the needs of specific communities and groups. Communities’ actions have been shown to involve both individual empowerment to influence and control the determinants of health and quality of life (Steinberg, 2006). Various social factors have been shown to have a direct influence on mortality and morbidity in recent years. Similarly, the quality and delivery of care is also influenced. Many studies have linked the major non-communicable and infectious diseases to poverty of material conditions. In addition, there is evidence that a range of adult and childhood disorders and evidence on the state of mental health is generally in high, middle, and lower income countries (Yearwood, 2010).      It has been established for years now, that social factors affect the health in both individuals and populations. Just as an ailment cannot exist as a single entity but only in individual person, each person must live within a society. A change to that social group produces a change within persons which is reflected in changing patterns clearly demonstrated by association between illness and drug use. For instance, evidence for the relationship between smoking or alcohol intake and illness in both individuals and populations is undisputable. As drug use increases in the society, so will problems increase resulting in more illness and more presentation to public health professional and doctors (Owens, 2007). Finances This is the most common barrier to access of health care services in the United States. People without insurance coverage or those that are underinsured are more likely to wait until their illness has become less treatable, than those that are fully covered. Even with health insurance, some cannot meet the expenses of the medicines they need or co-payments. If baby-sitting costs or reduced pay because of time off from work are too big a financial burden, access to medical care also suffers. Language Persons who have limited English knowledge or proficiency are less likely to have a steady source of primary care and therefore for less likely to receive preventive care. They are also less satisfied with the level of care they receive and are more likely to report problems with care. The incapacity to understand the instructions a patient receives from health care providers increases the likelihood of them not taking the prescribe medicine properly or even follow the treatment plans as may be required of them. Geography About one-fourth of the U.S. population lives in rural areas. A comparison between the urban and rural residents show that rural residents have higher poverty rates, a larger percentage of elderly, tend to be in poorer health and experience more difficulty access health services. The notion of where one lives has an important overall effect on the number of primary-care doctors, specialists, hospitals and other health resources available. In rural communities, lack of a means of transportation and the distance to an emergency facility or a hospital can be key barriers to receiving immediate treatment. Local communities find it a problem obtaining and keeping medical and dental practitioners. Specialty services, such as treatments for rare diseases or expensive diagnostic equipment, are alternative areas where lack of available resources is a concern. Personal and Ethnic Beliefs If patients think medical providers will discriminate against treating them appropriately because of their race, religion, gender, ethnicity or country of origin, they are less likely to seek care in a timely fashion. If they think home remedies will work better than medical treatments, they may not see their beliefs as a deterrent to health care. If one is afraid of vaccinations because he or she believes they cause autism, he may deny his child the preventive care he needs. For a variety of social and psychological reasons, many young people and some males avoid seeking routine health and prevention services. An EMT may refuse to transport a woman to an abortion clinic, citing personal beliefs. A nurse ordered to administer a large dose of morphine to a terminal cancer patient in pain declines, saying the medication could hasten death. A doctor turns away a gay patient, apparently on the basis of his sexual orientation. Are these scenarios cases of healthcare workers asserting their right of individual conscience, or are they unethical, perhaps illicit denials of patients' rights to receive medically appropriate treatments? This is a very difficult question to answer, but they have a huge impact on the quality of health services delivery and risk management in an organization. Cultural influences and delivery of health care services Culture is a set of symbols, which are learned, shared and passed on through generations of the social group. It has a huge influence on how people perceive the world around them, and assists them to make certain decisions. In the United States there is a mixture of people from different cultures. Aside from the American Indians, most Americans came from elsewhere and brought with them their culture. In this country’s major cities, the culture may change drastically from neighborhood to neighborhood, while in sparsely populated areas, the cultural differences might be less noticeable. Everyone has a culture, though, and it influences how they think, see and feel; and it influences how they interact with their healthcare provider. Culture and cultural assessment Although rich, United States spends more money on healthcare compared to other developed countries. With the current changes, managed care has taken over the corporate ‘driver’s seat’ and is taking a new route. These changes have not been welcomed, by both consumers and providers, but one thing that has come out of the managed care environment is the notion of clinical competency. To be clinically competent, a provider should be able to demonstrate that he or she has the proper training to provide the care, and the outcomes of the care have been measure and found to be favorable (Kleinman, 1978, p.251) Culture and health care Over time delivery of health services in the United States has become a culture of its own. For the immigrants to the U.S, or for those with a very diverse culture, the healthcare system can be a bit confusing and frightening. The following list illustrates some of the ways in which different aspects of culture and healthcare can collide. Conversational Style: Health care providers (especially physicians) are often confident, bold and outgoing, and these qualities may be demonstrated by their style of speech. While this style may be necessary in some cultures, it may be offensive in others. Many cultures consider it offensive to talk loudly, quickly, or emphatically, and a patient may contemplate this as a sign of anger on the part of the provider. Equally, silence or softspokenness on the part of the patient may be misinterpreted by the provider as a sign of inattention or disinterest, rather than respect. These simple qualities of conversational style can lead to many problems across cultures (Qureshi, 1994). Eye Contact: Certain cultural traditions may cause people to avoid direct eye contact or to look at others with only a transitory gaze. This can be done out of respect, as an effort to avoid another’s personal space, or because of gender as an effort to evade inappropriate contact with the opposite sex. This can be misconstrued by the provider as an undesirable personality characteristic, or by the patient as inappropriate behavior or aggression. Personal Space: Each culture has its own rules for personal space. In those cultures where the circle of personal space is large, a provider may easily invade that space and insult the patient. In cultures where that space is tiny, the patient may invade that of the provider. Touch: Each culture has norms about who can suitably touch whom, and which parts of the body can be touched at which times. In cultures that emphasize modesty, touching the abdomen, chest or pelvis of a stranger or of someone of the opposite gender is very uncomfortable. In some cultures, touching the head is considered disrespectful, while the feet and genitals are seen as unclean, and ought not to be touched before other parts of the body. In many cultures, related people of the same gender openly hold hands, hug or kiss, but the same is not done with strangers. In the United States, this behavior may lead providers to incorrect assumptions about the patient. Time: some cultures measure time by the clock, and appointments and schedules are important tools of interaction. In other cultures, however, time is measured by events and interactions, and disruption of those events because of the “clock time” is unheard of. This can cause problems with expectations about when appointments will start and when they will end. Language: Until one is in a foreign country where the native language is not understood, it is hard to imagine how strange and frightening our system of healthcare can be without communication. Paraphrasers can help, but exact translation is a difficult task, and many of the local colloquialisms and medical jargon don’t translate well at all. Dominance Patterns: Relations between the genders, the old and young, or between the leader of a family and the other members is extremely influenced by culture. For instance, expecting a young female patient to make a decision about her own health care may be appropriate in some cultures, but may be very wrong in others. Dietary Customs: Culture will dictate what kinds of foods are tolerable and which are not. Providing patients with inappropriate foods can be very insulting to them, while expecting them to follow certain diets may be completely unrealistic. Religious Customs: Patients from some cultures may need time for prayer and may request to use oils or fragrances to aid in this prayer. These practices can obstruct with the routine of allopathic medicine, and can cause great conflict with the patient and the family. Religious culture may directly impact medical care, by forbidding certain medications, blood products, surgical procedures, or post-postmortem examinations. Beliefs about healing: While some cultures rely only on allopathic medicine to heal the sick, most cultures integrate other means as well, including prayer, touch, traditional medicine, or even magic. Almost everyone recognizes the strong effect that the mind has on the body, so beliefs about healing are a very important consideration. Culturally Specific Disease Patterns: People of dissimilar cultures may have different diets, may live and work in different environments, and may be subject to different endemic ailments. Knowledge of where they are from, what illnesses are endemic to that area, and what other health practices may affect them will help a provider avoid overseeing an important disease process or making a misdiagnosis. Culture research Baldwin (1996) developed a substance abuse/AIDS prevention program precisely for American Indian youths that was much more successful than previous programs. The study determined that culturally sensitive approaches work better. A similar methodology was taken by Parker (1996) in coming up with a smoking prevention program for black and Latino youth. It was established that the most efficacious programs were ones delivered by people of similar cultural background who happened to be sensitive to issues within that culture. A populace of women in New York was studied (Naish, 1994, p.12) and it was revealed that a population of Bengali, Turkish, Urdu, Punjabi Kurdish, Turkish, Urdu, Punjabi, and Chinese women did not take advantage of available cervical cancer screening services. Institution of a culturally sensitive education program improved the use of these services by the target group. In Orange County, California, it was found (Chavez, 1995, p.67) that the breast cancer awareness program that was effective in white women was not effective in Mexican and South American women. The reason is that the Hispanic women did not believe that risk factors such as age and family history were as important as “breast trauma” or “bad behavior”. It was resolved that a program that addressed those beliefs within that culture would be more effective. A group from Melbourne in Australia interviewed foreign-born women to see whether they were satisfied with their hospital care during delivery (Yelland, 1998, p.80). They found explicitly that Fillipino, Vietnamese and Turkish women were not satisfied with the care they received, and established that there was a cultural factor to this satisfaction. The study suggested that the hospital explore ways to be more culturally sensitive to these groups. Formenti (1995) did a study on women who did not complete cervical cancer treatment, because the success rate when the treatment protocol is followed is very high. They failed to understand why anyone would not complete such a treatment program, and risk having their cancer return. The study also found that the only thing that foretold whether patients would complete treatment was their race. Hispanic women were the ones who were not following through with treatment, and the study endorsed that a culturally sensitive educational program be immediately introduced with this patient populace to ensure that they received the treatment they needed. In Minnesota, organ transplant coordinators came up with a program to increase organ donation among American Indian populations (Danielson, 1998, p.79). They established that if a potential donor’s family was approached by a health care worker from their same culture 81 percent were willing to agree to organ donation (a much higher percentage than found even in white populations). They recommended that same-culture healthcare providers should be used to deliberate this option with family members whenever possible. In a similar study, Morrison (1998) found that certain cultural groups did not complete advanced directives when hospitalized. Similarly, it was found out that if same-culture providers were to discuss advanced directives with the patient, which the results may improve. Numerous researchers used case studies to demonstrate the effectiveness of cultural sensitivity. Cooley (1998) profiled two African American men undergoing treatment for prostate cancer to illustrate how cultural differences could be assessed and integrated into the patient’s care to generate positive outcomes. Amirali (1998, p.222) studies a case of psychiatric ailment in an 11-year-old immigrant boy whose care had to be significantly altered to account for the cultural differences of his family. The treating physician was able to provide successful treatment, but felt that his standard approach to this problem would not have worked. Political influences and delivery of health care services Some of the constraints involved in improving delivery of health care services are politically motivated. Sharp disagreements exist about how to improve efficiency and effectiveness in the health care system. Some people support market principles that rely on economic incentives, competition and the laws of demand and supply to allocate resources in health. According to them, the government is negative force in guaranteeing that the health care system operates effectively. Other policy researchers, however, health care is totally different than other commodities in ways that make market forces ineffective in logically allocating resources. They believe that with the governments’ intervention, more government financing, and reliance on nonprofit systems, efficiency could be improved. Despite pretense from politicians who argue that American healthcare is the best in the world, it is a known fact that the country comes short of important measures such as infant mortality, longevity. Another less well known fact is that America’s rate of medical errors is inadmissibly high. A Commonwealth Fund study in 2005 established that of the six countries studied i.e. Australia, Germany, Canada, United Kingdom and the United States, the rate of medical errors was higher in the United States than in any of the others. Studies continue to report huge levels of preventable errors in the U.S. Conclusions and recommendations Good quality care is more than average or simply care free of mistakes. There is no single technology that claims to improve the quality of care that can encompass the many dimensions of quality. Some issues of quality are more easily targeted by clinical audits and others by risk management. Others are unlikely to be the focus of either program. Some issues affecting health-care delivery are correlated to an individual's circumstances. These include finances, capability of the doctor and patient to communicate, where medical resources are situated in relation to the individual's location and gender, race and ethnicity. Other manipulating factors are related to personal beliefs about medical care and medical care practitioners. References Donabedian A. (1966). Evaluating the quality of medical care. Millbank Memorial Fund Quarterly, 44, 166-206. Donabedian A. (1980). The definition of quality and approaches to its assessment. Ann Arbor, Michigan: Health Administration Press. Maxwell R. (1992). Dimensions of quality revisited: from thought to action. Quality in Health Care, 1,171-177. Kleinman, A, Eisenberg, L, & Good, B. (1978). Culture, Illness, and Care: Clinical lessons from anthropologic and cross-cultural research. Annals of Internal Medicine, 88, 251-258. Qureshi, B. (1994). Transcultural Medicine (2nd Ed.). Boston: Academic Publishers. Baldwin, J et.al. (1996). Developing culturally sensitive HIV/AIDS and substance abuse prevention curricula for Native American Youth. Journal School of Health, 66, 322-7. Naish J, Brown, J, & Denton, B. (1994). Intercultural consultations: investigation of factors that deter non-English speaking women from attending their general practioners for cervical screening, BMJ, 1126-8. Parker, V, et.al. (1996). Qualitative development of smoking prevention programming for minority youth. Addict Behavior, 21(4), 521-5. Chavez, L et. al.(1995). Understanding knowledge and attitudes about breast cancer. A cultural analysis. Arch Fam Med, 4(2),145-52. Cooley, ME & Jennings-Dozier, K (1998) Cultural assessment of black American men treated for prostate cancer: clinical case studies. Oncol Nurs Forum, 25, 1729-36. Amirali, E. et.al. (1998). Culture and Munchausen-by-proxy syndrome: the case of an 11-yearold boy presenting with hyperactivity. Can J Psychiarty, 43, 632-7. Yelland, J et.al. (1998). Support, sensitivity, satisfaction: Fillipino, Turkish and Vietnamese women’s expectations of postnatal hospital stay. Midwifery, 14(3), 144-54. Danielson, B. et.al. (1998) Attitudes and beliefs concerning organ donation among Native Americans in the upper Midwest. J Transpl Coord, 8(3), 153-6. Formenti, S et.al. (1995) Inadequate adherence to radiotherapy in Latina immigrants with carcinoma of the cervix. Potential impact on disease-free survival. Cancer, 75, 1135. Read More