Attributes of Modern Healthcare Systems and Their Challenges - Essay Example

Health Economics Introduction Health care delivery systems affect each person one way or another. The healthcare systems are very complex and multi-faced with a wide range of impacts. Attainment and maintenance of these systems involve colossal amounts of money especially those in the industrialized states where the expenditure may be as much as 8.5 percent of the gross domestic product. The World Health Organization (WHO) has paid attention to the health care delivery systems worldwide. It has defined the healthcare system keeping in mind the organizational form, the funding arrangement and the provision of services. The healthcare system consists of all the people and the action they undertake, whose primary effort is to improve citizens’ health of a particular state. The potential scope of a healthcare system may include the public and private sectors as well as a spectrum of providers as well as funders who may improve health. A full range of organizational form is more likely to be visible in a developed world healthcare delivery system (Aspalter, Uchida & Gauld, 2012, p.2). Attributes of modern healthcare systems and their challenges Modern healthcare systems are not all about delivering personal healthcare. The institutions that govern the provision of healthcare are concerned with mechanisms in which the individuals can access healthcare such as the earned insurance settlements and the social citizenship. They are also concerned with the mechanisms responsible for deciding the amount of resources allocated to financing the provision of health care services such as setting regulatory frameworks as well as governing via public management. Institutions governing the provision of healthcare include mechanisms for regulating hospitals such as a mix of differently owned hospitals and the amount of public regulation as well as regulation of doctors. This is especially different forms of private interest government (Giarelli, 2010). This is a reflection of the centrality of hospitals and doctors when it comes to the provision of healthcare (Giarelli, 2010, p.189). All the modern healthcare systems face common challenges. These challenges are due to globalization, rapid technological advancements, medical progress and changes in demography. Consequently, these systems have no option but to change the organization in the way they it is governed and provide healthcare (Walshe & Smith, 2011, p.145). Background The health care system in the UK initially followed an insurance health model introduced in 1911 by Lloyd George (Walshe & Smith, 2011). At the time, many systems covered only the industrial workers and not their families. Moreover, the system was limited to primary care and provision of drugs only. The National Health Service (NHS) formed in 1948 with the intention of replacing the existing system (Walshe & Smith, 2011). Its formation encompassed provides a full range of healthcare services to all residents. The NHS underwent several major reorganization and fundamental changes over the years so that it could provide excellent healthcare to its citizens (Walshe & Smith, 2011, p.147). Principles of National Health Service The NHS was founded on a set of values and principles that binds the people it serves, the public and the patients, and those who work for it (Diamond, 2009). The constitution is responsible for establishing the principles that govern the NHS in England. There are seven key principles that are responsible for guiding the NHS in everything that it does. These principles underpinned by its core values that were derived from discussions with patients, staff and the public ensure its effectiveness (Diamond, 2009, p.517). The first principle is that the NHS is responsible for the provision of a comprehensive service that should be available to everyone. This principle is for everyone irrespective of disability, religion, belief, race, gender, gender reassignment, pregnancy, sexual orientation, age, and marital status (Renga, 2010, p. 52). The service core intend encompasses diagnosis, treatment and improvement of both mental and physical health. The NHS has a duty to all citizens and must respect everyone’s human rights. It also has a very wide social duty of promoting equality via the provision of services and the payment of particular attention to various sections or groups of society where the life expectancy and health and behind when compared with the other citizen in England (Diamond, 2009, p.518). The second principle is that the NHS services are accessible to anyone with a clinical need and not only those individual who are able to pay. The NHS healthcare services are therefore free of charge, apart from some limited circumstances that are sanctioned by Parliament. The third principle is that the NHS aspires to have very high standards of professionalism and excellence when it comes to providing safe high quality care that is effective and that focuses on the patients’ experience. The NHS also aims at having high standards of professionalism in its management and leadership, its employees support, training, education and the development of its staff. Compassion, dignity, respect and care must be at the base of the treatment of patients and staff not only because it is right but also because of patient safety, outcomes and experience. This is improved when staff are supported, valued and empowered (Great Britain, 2009, p.49). The fourth principle is the NHS aspiring to put all the patients at the core of everything it does. It supports all individuals to manage and promote their own health. The NHS services must be coordinated and tailored to the preferences and needs of the patients, their caregivers and their families. The patients, their caregivers and families are involved in all decisions regarding the patient’s care and treatment. Feedback from the patients, public and staff is actively encouraged, welcomed, and used in the improvement of its services. The fifth principle is that the NHS must work across the boundaries of the organisation while collaborating with other organisations with the interest of the patients and the wider population at heart. The NHS is bound together by the Constitution. It is committed to working together with other authorities and a wide range of private organisations to deliver and provide improvements in health (Great Britain, 2009, p.49). The sixth principle governing the NHS is its commitment to the provision of the best value of England’s taxpayer money and a fair, most effective and sustainable use of all resources that are finite. The public funds for healthcare provision are devoted solely for the benefit of the citizens. The last principle governing the NHS is that it should be accountable to the patients, the public and the community at large. The NHS is funded via taxation the government sets its framework. The accountability and responsibility system for making decisions must be clear and transparent to the public and staff (Mason, Leavitt & Chaffee, 2014, p.300). Organization reform An important plank of healthcare reform in the 21st century outset has been the suggestion that a greater degree of patient choice in the location and timing of treatment should be achieved (Bradby, 2009, p.167). Before the NHS reform, it was a monolithic organization. The 1980s reform aimed at achieving efficient management but the 1990s reforms took things much further. An attempt of creating market like structures in the NHS, internal markets, was at the heart of the reforms. In order to accomplish this, the NHS had to be broken down structurally into smaller units that could compete with each other. For the principles of supply and demand to apply, there had to be parts of the NHS that supplied services and parts that demanded these services. Because of this reason, the NHS reforms were an introduction of the purchaser/ provider split (Brotherton & Parker, 2013, p.197). Scarcity of resources Evidence suggests that the resources available for healthcare in the UK are scarce because the NHS is underfunded (Morris, 2014, p.17). The NHS foundation was based on a fallacy. The fallacy was that the amount of ill health in the population was finite and once it was removed, it would result in a cheaper maintenance and provision of healthcare with the drop in number of people requiring the health care. This was not the case. The success of the NHS made people to live longer due to decreased mortality rates thus an increase in the population. This increased the need for healthcare, as the population’s potential to become ill increased. This led to the consuming of more resources making the resources scarce (Jackson, 2013, p.36). The society needs to wake up, recognise the scarcity of resources, and manage this scarcity. The NHS used to be very good at managing resources but with more money flowing into the system in recent years, the managers and medical personnel have become less skilled when it comes to this. This is a very bad situation for the NHS to be in as it represents a bad image to the public and is the biggest threat to the sustainability of healthcare that is publicly-funded in the next 60 years (Donaldson, 2011, p.16). Opportunity cost Before the recent NHS reforms, the NHS accounts did not account for the opportunity costs and depreciation of using the capital assets. The NHS operated and owned most of the facilities that provided the hospital services. There was no capital or rent paid to use the facilities and thus the opportunity costs were not calculated. Capital was considered an expense only in terms of the initial costs used to purchase the capital; the cost of using its money to purchase hospital capital instead of paying for supplies and other services was not considered (Jonas, 2011, p.593). After 1991, the scheme for charging for the use of hospital facilities was introduced. The cash flow generated by the capital assets does not leave the NHS. The goal was to levy from hospital depreciation costs and the opportunity costs of funds tied up in hospital capital stocks so that more accurate price signals are conveyed to the providers and the purchasers (Greener, Holden & Kilkey, 2010, p.66). Equity and efficiency Early NHS funding policies were concerned with controlling costs but lacked progress for achieving equity and efficiency when it came to funding. The 1980s governments sought to add efficiency by squeezing the budgets. This led to funding problems in the late 1980s. The result was an NHS internal market, which promised efficiency with the introduction of purchaser-provider split and a system with provider competition where the money would follow the patient (White, 2010, p.123). The concern for efficiency improvements has resulted in threats to equality and need-based service delivery. This is because its aim of generating revenue is not in accordance with the principles governing the NHS whereby the provision of health services is based on need and not ability to generate revenue (Ezenyili, 2012, p.149). Main approach to economic evaluation Economic evaluation offers clear analytical frameworks for decision-making. Where there are fixed healthcare budgets and limited resources, the economic evaluation provides a transparent approach underpinned by explicit social value judgements for choosing how the scarce resources are to be allocated. Two philosophical approaches underpin the economic evaluation. They include the welfarist approach and the non-welfarist approach. The welfarist approach expected outcome is the individual’s satisfaction and is typically measured using the willingness to pay. This reflects on the maximum amount a person would pay for an intervention. The non-welfarist approach focuses on some other measure of outcome that reflects on the decision-makers objective such as the quality adjusted life year (Culyer, 2014, p.218). There are four main approaches for undertaking the economic evaluation. The first approach is cost-minimisation analysis. This particular form of economic evaluation is used in situations where before the investigation; there is no reason to expect that there will be a therapeutic difference in the outcome of the procedures under consideration. The second main approach is the cost-effectiveness analysis, which is used where the outcomes of different interventions or programs are expected to vary. The third approach is the cost-utility analysis, which is a special case of cost-effectiveness analysis. The outcomes are expressed in generic units that are able to represent the outcome for different conditions and treatments. The fourth approach is the cost-benefit analysis, which is a type of evaluation that places a single value, usually in monetary terms, upon the benefits and outcomes from different programs of healthcare (Paterson-Brown, 2014, p.35). Rationing within other health care system Even though a variety of rationing occurs in every country, different healthcare systems place emphasise on particular forms. The countries with national health services have an easier time when controlling the supply of resources using rational mechanisms that are more explicit. In countries with socially determined health budgets, the constraints in one area can be justified on grounds that the money will be spent on higher-priority services. The lack of a fixed budget for government funding or the overall national healthcare spending makes it hard to say where the money saved from rationing will go (Blank, 2014, p.94). The basis of comparing health care systems The comparison of healthcare systems can be a political act. Given the complexity of these systems, it is very hard to find the superiority of one system. The reports by the World Health Organization are an example of the complexity in ranking the health care systems. To compare the different health care systems, the system responsiveness to the citizens they serve are assessed. The cost of healthcare provision and its efficiency is also a factor used in comparison. The equity of distribution and ease of access is also used when comparing (Fierlbeck, 2011, p.220). Differences in the organisational framework in which health services are financed and delivered The NHS is structured as an organization. By virtue of an organization’s characteristics, there are other healthcare organizations both outside and within the healthcare provided by the state system. The healthcare organizations that are found within the NHS do not consist of hospitals only but also other organizations like the Primary Care Trusts, Health Protection Agency, National Blood Service, just to name a few (Larkin, 2011, p.190). The American health care system is not really a system in real sense. However, it is referred to as a system when reference is made to its components, features and services. The health care delivery in the United States is very complex (Shi & Singh, 2012, p.3). Several individuals and organizations are all involved in the American health care, ranging from medical suppliers, payers, insurers, research and educational institutions as well as the health care providers. When the UK and the US are compared, the UK has a predominantly public system (Willis, Reynolds & Keleher, 2012, p.124). Advantages of the NHS The advantages of government–run single payer systems are clear. It is ideal, as it is a universal coverage with very limited costs to the patient. This system is more effective in managing and controlling costs when compared to other systems in developed nations. The UK health system has an advantage over the other national health systems because it is a single public health care system that, to a certain extent, it has been able to mandate uniform adoption of systems and standards (Kabene, 2011, p.217). Disadvantages of the NHS Since the government runs the national healthcare system, financial shortfalls and other issues are bound to affect the quality of healthcare provided. It also becomes very difficult to implement long-term changes that benefit patients when a subsequent government after an election may dismantle all the changes proposed (Mahmud, 2011, p.68). The formation of a two-tier system has potential disadvantages to NHS patients including risks. The concerns have been expressed by several organizations (Klein, 2010, p.286). Moreover, the UK health care is very socialistic. Critics use this to portray an image of failure, bureaucracy and incompetency (Budrys, 2012, p.124). Advantages of the American health care system The American health care system provides Medicaid and Medicare, which provides medical care to the people without discrimination. It is very convenient and has many benefits. In addition, the American healthcare system has very many benefits including benefits for veterans and Indians (Levine, 2009, p.94). Disadvantages of the American health care system The excessive healthcare system causes very many people to lose jobs. The American businesses suffer significant disadvantages in international markets due to their health care costs and related time off costs for their employees. The excessive healthcare also causes a continuously growing number of uninsured patients (Kardatzke, 2010, p.176). References Bottom of Form Bottom of Form Bottom of Form Bottom of Form Bottom of Form Bottom of Form Bottom of Form Top of Form Bottom of Form Top of Form Top of Form Bottom of Form Top of Form Top of Form Bottom of Form Top of Form Top of Form Top of Form Top of Form Top of Form Top of Form Top of Form Top of Form Top of Form Top of Form Top of Form Top of Form Top of Form Top of Form Aspalter, C., Uchida, Y., & Gauld, R. 2012. Health care systems in Europe and Asia. London, Routledge. Bernat, J. L., & Beresford, H. R. 2013. Ethical and legal issues in neurology. Edinburgh, Elsevier. http://lib.myilibrary.com?id=539039. Blank, R. H. 2014. The price of life the future of American health care. New York, Columbia University Press. Bradby, H. 2009. Medical sociology: an introduction. Los Angeles, SAGE. Brotherton, G., & Parker, S. 2013. Your foundation in health and social care. Budrys, G. 2012. Our unsystematic health care system. Lanham, Rowman & Littlefield Publishers. Culyer, A. 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