The issues on health care reforms started long time ago. In Czech Republic, health care reforms started in way back 1990; three proposals were conceived, but it was not until December 1990 when one of the proposals was accepted; and it proposed that “the market, government, and the civic sector would play distinct roles in health care” (Pot%u016F%u010Dek, 1999, p.115). Many nations all over the world are currently working out policies to initiate reforms on health care system to develop a more effective and efficient system that would improve the lives of citizens. Researchers have proposed several reforms but many nations are yet to reach to an agreement on which system to adopt.
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The reform agenda that nations are currently focusing on is: the system of funding health care. One of the system that has been tested and proofed successful is the, “private insurers and progressive/regressive financing” (Flood, 2003, p.103). In this system, government ensures that a lot of funding is enhanced and therefore the citizens get comprehensive cover on their health including services such as out patients and inpatients care. The system is able to provide medical cover for patients’ who require treatment for a long period of time. In Netherlands where this system has been used and is still being used, it has proofed beyond reasonable doubts that the system is most effective.
Flood (2003), reiterated that Netherlands has been successful because of their strong commitment to the health care reforms and, he wrote in his book that “Netherlands has strong commitment and solidarity of ensuring universal access on the basis of need as opposed to ability to pay” (p.104). Flood (2003), suggests that the system of market oriented reforms has not worked well in United States because of the lack of commitment, and he gives an analogy of US health care system by saying “US health care system is allocated like cable TV service, i.e., if you can pay for it then you will receive it,” (p.104). However, there are also shortfalls to this system, where by sometimes private insurers compete for profits by identifying and isolating individuals who are potentially high-risk or alternatively, imposing high premiums charges which is beyond reach of the patients’. Nevertheless, a model has been developed which is able to curb such discriminations; the model is able to do this by making sure that the system is adequately funded; and also promotes competition on private insurers while punishing those involved with discriminative isolation of individuals (Flood, 2003).
It has been found that good health care system is based on two factors, ‘comprehensiveness and integration’ (Flood, 2003, p.108). The US healthcare system is a good model that describes explicitly the consequences of lack of adequate financing. Integrated system advocates for good structure of financing unlike the system of shifting cost. Basically, for good health care system, adequate incentives should be allocated for funding exclusively health care services as well as medical consultancy services; and therefore, it eliminates the behavior of some selfish employers deducting the income of their employees to pay off their medical expenses. Comprehensiveness complements the integrated system by recommending adequate cover on outpatients, i.e. supporting services like “house keeping and food preparations” (Flood, 2003, p.109). Other states in United States “a statewide health care alliance” is being considered that will provide financial relief to employers who are obliged by law to offer health care cover for their workforce (Griffin, 1995, p.332).
The root course of poor performance of many health care systems is the growth of ineffective health care services. To eradicate such kind of health systems the following steps should be practiced: First, the priorities should be made to bring to equilibrium the needs of the patients with the needs of the society. Secondly, the services that suite specific health needs of the patients are chosen cost-effectively. Finally, professional and efficient technical health care systems are formed. Governments also have taken initiative to advise insurers to minimize wasteful spending and therefore eliminating the likelihood of shifting cost to other people.
The question on the accountability and transparency is very important in purchasing of health care services. The responsibility of purchasing of health care services has been bestowed to the insurers; however, most of these purchasers are not performing their duties within their jurisdiction: purchasing health care services that are strictly of interest to the patients’ and society. Remarkably, governments have stepped in to tame this kind of behaviour by some insurers, by putting pressure on them and also carrying out Audits on their work.
For a case in point, UK and New Zealand governments pay the appointed purchases from their budget. When the purchasers (insurers) receive the money, they buy the health care services that are needed by the people; incase the insurers fail to exercise their rights of purchasing health care services that are strictly of interest to the people; the government punishes them (Flood, 2003). Before punishment is done, audit is carried out to find out evidence or proof of the purchases violation. With the audit report it is easy to identify and isolate those who selfishly misuse the health care funds. This form of initiatives by current governments is good since it will eradicate irresponsibility while on the other hand nurturing the habit of accountability and transparency within health care system.
Similarly, governments should focus on formulating laws that will govern health care system and allow the monitoring of the activities of health care providers. One of the important steps is establishing of an audit commission which its main mandate being to oversee and audit the activities of the health authorities. More on this point, the government should also set up legislations that will ensure transparent management of contracts by the purchasers. For example in “ UK and New Zealand the central government publishes annual guidelines setting out the purchasers’ objectives in general terms”, (Flood, 2003, p.132). To ensure that the set out guidelines are observed by purchasers, the government should spell out ramifications clearly to those who choose not to follow; and this should be heavy penalties whereby there is forfeiting contracts.
Some of the key points highlighted by flood (2003) on the accountability of government in effective and efficient healthcare system are: allocating of incentives to health care system by making sure that a state of equilibrium on the expenditures on health care services versus other wants is reached; Providing health care services for all while maintaining priorities on cost-effective services; offering services that suite customers needs and also ensuring that they are cost effective; maintaining high technical standard of service creation; monitoring of health care services to ensure that peoples’ expectations are met by continuous delivery of quality services by stakeholders; ensuring that the patient’s needs are factored in during the decision making processes.
In conclusion the government should be fully committed in ensuring universal access of health care services on the basis of need as opposed to ability to pay for health care. Consequently, they should encourage private funding as well as allocating adequate funds in their national budget to finance the health care services. Market-oriented reforms which have outstandingly delivered good results in other nations such as Netherland should be adopted. This system allows competions of the insurers while upholding quality production of services. To encourage accountability and transparency, the government should enact legislation, which will strictly set out guidelines on purchasing of health care services and wipe out corruption. Finally, the interest of the patients’ and the society should be factored in during any decision making process.
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