The healthcare is believed to be the largest industry in United States with expenditures hitting $1.4 trillion, representing 14 percent of GDP. Despite this large spending, many Americans remain uninsured and have less access to quality healthcare services. Ranking by the World Health Organization in 2000 placed it at number 37 out of 191 countries worldwide (WHO 2000). The healthcare system was found to have high-cost delivery system with poor operational processes and performance measures that provides highly uneven quality of care and limited geographical coverage. Physicians were found to focus on patient relations whereas healthcare administrators focused on cost control and productivity of the business. This divide undermined the performance of both parties.
The healthcare industry is very large, complex and disorganized. This makes it very inefficient in service delivery. The Institute of Medicine puts forth budding complexity of science and technology and poorly organized delivery system as key underlying reasons for inadequate quality of healthcare in the U.S.
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In addition, the healthcare system has been experiencing rapid increase in cost for healthcare provision. It faces growing cost pressures and extreme fragmentation. Millions of people do not have access to medical care because of the cost. Statistics show that Americans spend $2.4 trillion a year on healthcare, and by 2012 it is projected to reach $3.1 trillion, a figure four times higher than the money spends on national defense (Brandeau, Sainfort, & Pierskalla, 59). The proportion of GDP spend on healthcare is 20% and yet millions of people live without good healthcare. This increase in cost is a critical concern. To reduce healthcare costs, the government can offer subsidies to service providers.
The system is also characterized by a dysfunctional financial and payment system, which is expensive to maintain. Though a few Americans have health insurances to pay for their bills when they become sick, most of the people do not. They thus face tremendous financial risk whenever they fall sick. In addition, the way hospitals and other service providers are paid is very complex due to intermediary roles played by insurance. There is no reimbursement incentive for providers to adopt electronic communication or implement electronic patient records. The government should provide such incentives to boost care provision.
The sheer volume of new healthcare science and technologies has advanced more rapidly than U.S ability to use and deliver them in a safe, efficient and effective manner. The government as well as private sector has heavily invested in pharmaceutical and medical research. Healthcare itself is a high-technology, science-based profession that is persistently supplemented with knowledge from medical researchers. The healthcare delivery system, however, has not kept pace with these advancements in science and technology proliferating new knowledge and skills into the field. It has been found to be making less use of technology in its processes. Not all healthcare applications are web-based.
Research on the quality of healthcare delivery in the US reveals that the current system neither adequately translates new medical knowledge into clinical practice nor applies new technology safely and appropriately (Institute of Medicine 2001 report, 78).The system has no strong clinical informatics that could collect, store and interpret healthcare data. It should thus incorporate current advancements such as genomics, sensor technologies, nanotechnologies and information communication technologies such as telemedicine and e-health into its system. The system should integrate technology applications in its services. Information on consumer health, clinical care, administrative and financial transactions should be computerized. This will enable quick access to medical databases, computer aided decision making, reduce medical errors and enhance patient-doctor communication. Healthcare providers should be required to implement and utilize certified electronic health records that meet functional, operational and security standards, and to participate in health information exchange across providers.
In relation to organizational structure, the current system is highly complex, nonlinear, dynamic and vague. It is further complicated by large number of agents and several stakeholders with conflicting goals and objectives. The system has many rambling set of activities and enterprises working unsystematically to achieve diverse goals. The whole system lacks accountability, suffers from inefficiencies rooted in multiple layers of processes with ill-defined services. It has wrong objectives and poor strategies. The delivery process is complex and difficult to monitor and control. There should be a reform designed to address these fundamental issues and allow for a well-structured and competitive delivery system. There is immediate need to reorganize all practices to meet the ever changing needs of patients. Systematic attention should be paid to the informational and behavioral change in patients’ needs. A good structure will allow for easy access to necessary clinical knowledge and expertise information. This entails focusing on the organization of the healthcare providers. They should work in team-works so as to adopt systems that are likely to reduce blunders of misuse and improve overall coordination of healthcare.
In conclusion, it is worth noting that the first step in improving the healthcare delivery in the United States is to first acknowledge that the present system has many flaws that must be addressed. Many people who are not directly involved in the care of patients are making a lot money. This excess dollars used in auxiliary industries should be channeled directly to care of patients. A good example is the insurance industry that accounts for more than 20% of healthcare dollars. This reflects a true administrative waste of money. Good management would also help effectively allocate resources, thereby increasing service quality and productivity.
Moreover, good health provision depends on highly trained and motivated workforce, current and accurate information, and technologies that enable health professionals to use information in the right place, in the right way and at the right time. People, knowledge and the means for their application are the foundations upon which an efficient, high quality health system rests. Utilizing this invaluable intellectual capital is a critical success factor for changing the healthcare delivery. It is worth noting that innovation lies at the heart of redesigning and improving healthcare delivery.
Policy makers should take adequate move that would make the healthcare services affordable and accessible to all. Healthcare is a social concern and thus should not be made a political issue. According to President Obama’s Blueprint, A New Era in Responsibility, he states that economic stability, job creation and housing need immediate and drastic action, and that there will be no solution to the crises facing US unless and until there is health care reform. This is a clear evidence of the important role played by policy makers in altering the facade of healthcare delivery system. There should be a national healthcare program that not only takes care of the old people but also considers everybody. Population has become widespread, and thus it is only the government that can provide universal healthcare which is well coordinated, unlike years back when it could be offered by charitable organizations.
The government should create a conducive regulatory environment that facilitates clinical integration among providers. If the healthcare system is well managed, amenable mortalities would not occur. Life expectancy would heighten upwards due to timely and effective care services. Individuals should be made to understand that their health is personal responsibilities. They should thus practice healthy lifestyles and foresee the need to change their diets.
Since the current payment practices do not encourage or support provision of high quality services, new payment methodologies should be devised. These new payment systems should give opportunity for consumers and purchasers of healthcare services a chance to access affordable and effective modes of payment. It should provide payment structures that provide incentives to clients depending on how they pay. The predominant fee-for-service payment system has been accelerating the fragmentation of healthcare delivery system. It is recommended that payers move away from the traditional fee-for-service system to bundled payment systems that reward coordinated, high-value care. Besides this, the pay-for-performance programs should be expanded to reward high-quality, patient-centered care. All patients should be given incentives to choose to receive care from high-quality, high-value delivery systems. This, however, will require performance measurement systems that adequately distinguish among delivery systems.
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