Where, they will have the responsibility for determining how all of the different health care solutions should be integrated on the local level. In this case, these committees could follow the state's integration plans and then augment the various services that are being provided with a structure that will work well for each community. (Fisher, 2009, pp. 219 -- 231) For example, the state could provide guidelines about how the different health care solutions need to be integrated together as one single plan. The way that this occurs on the local level, will determine the kinds of services that are offered by the various organizations. At the same time, it will depend upon how the community feels these kinds of solutions that need to be delivered. In this aspect, this kind of approach could involve the use of private health providers that are augmented with programs from: the municipal / county government and nonprofit organizations. This will give communities, the power to determine what kind of health care services should be provided and the way they are addressing these issues. The state will have the various Long-Term Care Committees monitor: the effectiveness of these services on the local level and if they are within state guidelines. (Fisher, 2009, pp. 219 -- 231)

If this kind of approach can be used, it will reduce the underlying issues that could affect integration (over areas of responsibility) by giving communities the power to create health care solutions that make sense for them. This will keep cost low and it will provide better services to Virginians. While, the increased usage of Long-Term Care Committees will help to ensure that there is proper oversight of these boards on the community and at the state levels. Over the course of time, this will help to reduce the underlying costs that are spent every year on health care services. This will have positive impact on the standard of living for many communities and it will make the state more attractive to businesses. This is because the plan has been able to effectively deal with health care costs and demand. These two factors will help many employers to carefully look at the state for the benefits that it can provide their businesses. (Fisher, 2009, pp. 219 -- 231)

This kind of approach has been used in Vermont to address rising health care costs. What makes our strategy so unique is that various peer reviewed publications, are supporting integrating health care services into to one system. Evidence of this can be seen with a study that was conducted by New England Journal of Medicine. They found that health care costs would decline under an integrated system, while the amounts of services would increase. Commenting about these findings researchers observed, "The Vermont single-payer plan will never be as efficient as Taiwan's or Canada's because it must work within the bounds of federal laws and programs and the realities of porous state borders. Nevertheless, it can produce substantial savings to fully fund universal coverage, reduce health care costs for most businesses and households over time, and reform a fragmented delivery system." (Hsiao, 2010, pp. 188 -- 1190) The below table is highlighting the saving that will be realized from these kinds of integration plans for the State of Vermont.

Impact of Integration Plans for the State of Vermont (in millions of dollars)

Category

2015

2016

2017

2018

2019

Savings

1,100

Costs

(Hsiao, 2010, pp. 188 -- 1190)

This is significant, because it shows how this kind of approach can address the challenges that are facing health care system of Virginia. The only difference is that greater control and transparency are being provided at the local level.

The Financing Programs and Services that should be Offered

The current system that is being used by the state is similar to the basic model that is utilized across the country. This involves the patient receiving different services through private and nonprofit health organizations. The government will play a limited role in the kinds of services and assistance that is being provided. As, any kind of assistance will depend upon the needs of each individual in the program. This means that plans such as Medicare and Medicaid will pay out a certain amount for health care expenses. The rest of these costs should be paid for by the individual and private insurance coverage that they are receiving. Over the course of time, this basic model has meant that costs for health care services have increasing. The reason why is there are gaps in coverage and many individuals are being forced to pay a larger amount of health care expenditures. This is having an impact on the kinds of services that are being utilized and the type of Affordable Care Act (which is using this principal to help reduce costs nationally). (Cutler, 2010, pp. 1131 -- 1135)

At the same time, efficiency needs to be improved in these areas. One way that this could be accomplished is through integrating various technology solutions. As part of the tools that are being used such as: electronic medical records. Over the course of time, this will increase productivity and will provide better solutions for dealing with the various challenges facing the system. (Cutler, 2010, pp. 1131 -- 1135)

Over the short-term, this would cause health care costs to increase higher than the national average. The reason why is because, these kinds of changes will require upfront expenditures by the government and health care organizations. To achieve this objective, you must have a creative health solution that could be implemented. One possible strategy is to increase the excise taxes on: tobacco, alcohol and food items that could be contributing directly to obesity. Numerous studies have confirmed that these factors are the main causes that are contributing to raising health care costs. This is because various conditions related to lifestyle choices will require increased amounts of spending. If you are placing some kind of a sales tax on these items (such as $.02 cents), you are raising money to support these expenditures (within the portion of the population that is helping to fuel the increase). This kind of tax could be utilized on the state and local levels, with $.01 cent going towards each entity. In both the short- and long-term this would raise tremendous amounts of money that can be used to fund and improve the efficiency of the health care system. For example if over 300 million of items were sold over the course of two-month (i.e. someone purchasing a soda or a pack of cigarettes) this would generate $20 million in new revenues every two months. This could be used by the state and communities to help support upgrade of the health care system. (DeCicci, 2008, pp. 918 -- 929)

Utilizing this kind of strategy requires providing consistent financing by: taxing those products that are considered to always be in demand and having the people who are causing costs to increase the most (to pay more for the lifestyle choices they are making). At the same time, there will be an emphasis on the having many patients utilizing their primary care doctors and engaging in preventive medicine. This is when you are having patients focus on how their lifestyle choices could have an impact on their underlying levels of health. The way that this is accomplished is through: conducting routine physicals and encouraging patients to make changes in how they are living their lives (i.e. dietary and physical activity). (Landon, 2010, pp. 827 -- 834)

Over the course of time, this strategy would produce lower costs and it will increase the quality of services that are being provided. Evidence of this can be seen with a study that was conducted by Phillips (2010) he found that short-term spending increases of 10 to 12% in primary care infrastructure will result in long-term decreases in prices. The reason why is because, these expenses are helping to improve efficiency and they are changing the culture inside many facilities. Once this occurs, it means that there will be various procedures in place to address growing demand for these services. At the same time, this is allowing for the system to shift the majority of patients to primary care doctors (based on the fact that they do not require the use of a specialist). These different elements are important, because they are showing how the health care sector would be more able to adapt to changes in the future and improve treatment options. (Phillips, 2010, pp. 806 -- 810)

How this can be implemented on the Local Levels?

Like what was stated previously, the program that we are going to be enacting…