Martens Pim 200 Health Transitions Term Paper

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There are no deductibles and no user fees nor limits to contributions on the plan. There are also no restrictions on services to be used and no premiums to pay for basic care coverage other than taxes, a far cry from the high deductibles, co-pays and other fees associated with health care in the United States.

Key to this point is the idea that Canadian health care costs less because a large portion of it is publicly financed. The author's note that since Canada adopted their universal healthcare system the Canadian Health Act has implemented a policy of public administration which keeps the cost of health care spending lower and maintains the government's ability to provide health care services to the entire population. The authors argue that public administration is a more optimal choice for keeping health care expenditures down because administration is inexpensive.

U.S. hospitals keep more details of everything used than Canadian hospitals according to the report. The Canadian system suggests that it would be wasteful to 'go to the trouble of allocating the cost of insignificant items like toothpaste tubes to individual patients" (Armstrong, 1998, p. 8). In Canada instead of itemizing items per patient, the hospital simply orders supplies in bulk and distributes them as necessary.

The method therefore through which Canadian medical facilities keep costs down from an administrative perspective is avoiding keeping detailed accounts for each patient and avoiding having to send detailed accounts of each patients needs to a private insurer (Armstrong, 1998). Canadian hospitals also don't have different standards for sending fees to different private insurers, and don't have to worry about collecting on their bills, because they are always paid. In the United States, there is reason to be concerned that some bills may not be paid, covered or approved, further complicating the health care issue (Armstrong, 1998).

In the United States, hospital administrative operations are very different, and administrators are required to keep extensive records of all patient consumption in order to facilitate billing to insurance companies and patients, part of this in "anticipation of malpractice suits" (Armstrong, et. al, 1998, p. 8). In addition the overhead in the United States is much higher.

A survey of one Canadian doctor also revealed that people were less likely to seek medical care for routine problems in Canada, and more likely to come to a hospital only when the need was truly urgent.

Another difference highlighted is the notion that in Canada there is no effort allocated to separating eligible patients from ineligible ones, and no forms that patients have to fill out to determine whether they qualify for insurance. Time is conserved rather than wasted filling out forms and generally "scrutiny to assess eligibility" is not an issue in Canada (Armstrong, 1998, p. 8).

Lastly the authors attempt to determine whether health care is better in Canada than in the United States. They find on such measures as basic health care services quality, the Canadian system is superior. This is based on the notion that in Canada, the infant mortality rate is much lower as is maternal mortality rates, which were double in the United States compared with Canada (Armstrong, 1998). Canadians are also cited as having a longer life expectancy and more Canadians live free from disability than individuals in the United States. Canadian patients also enjoy the ability to select which physicians or specialists they want to see at any time.

The conclusion of the study is that the Canadian system is superior to that in the United States, and offers more flexibility.

3: Topic - Dynamics of different healthcare systems

Pavarini, Peter a. & Shaffer, Anthony D. (1997). "Resolving Conflicting Laws and Policy in Integrated Delivery Systems Development." Journal of Law and Health, Vol. 12, Issue 1, pp. 85-120

In this journal article the dynamics of different health care systems are evaluated with particular regard to the problems health care providers are having with the current system utilized within the United States. Aspects of health care systems that are good and bad are examined in relation to Integrated Systems Development. The author's main emphasis is on suggesting that the dynamics of many health care systems revolve around conflicting laws and management styles.

Shaffer & Pavarini begin by discoursing on the historical implications of the health care services provided in the United States, noticing that the care is delivered by providers that have been largely organized as separate 'economic and legal entities" further noting that thus far the system is complicated because hospitals, physicians and other allied health professionals work in distinct roles rather than as a whole, reducing the efficiency of the system (Pavarini & Shaffer, 1997, p. 85). This compared with health care delivery systems in other countries which generally are funded at whole or in part by government entities. This key difference in and of itself suggests that they dynamic of the United States health care system is very different from that in other countries.

The article notes that in light of ever increasing health care costs, health care systems face many dynamic elements that influence not only providers and patients but also health care purchasers, public organizations and other individuals that demand re-evaluation of services in order to reduce costs and improve qualities (Pavarini & Shaffer, 1997). The U.S. is not alone in facing rapid costs, other countries are also facing challenges when it comes to funding national health care. In other countries however, these challenges are often met through incentives and additional taxation, which is largely opposed in the United States.

There are several different systems examined in this article including managed care systems where consumers have access to care but have to first consult with a primary physician, often referred to as a 'gatekeeper' in order to acquire approval (Pavarini & Shaffer, 1997). This system is utilized primarily in the United States where health care is privatized. The authors take time to analyze the dynamics of several different systems that might improve the current system being utilized in the United States. There aim is to point out that different structuring might improve not only patient satisfaction but also relieve the burden on independent physicians, suggesting that the current system is a burden to patients and physicians alike (Pavarini & Shaffer, 1997).

The authors note that particularly with regards to the American health care system, massive changes are in order in part due to uncontrollable costs that continue to rise. There has been extensive examination of health care delivery systems, and a trend in many areas is developing toward moving away from hospital centered systems. In addition trends are noticed that providers are moving away from fee for service reimbursement to a system that allows the "sharing of financial risk" with other providers (Pavarini & Shaffer, 1997, p. 89). This perhaps is a result of increasing trends toward lawsuits and malpractice suits, which increase the cost of health care service particularly in the United States.

Also noted is a trend toward hospitals and physicians forming networks that integrate delivery and insurance functions so that providers can have the opportunity to sell their services directly to interested buyers (Pavarini & Shaffer, 1997).

The idea of managed competition theory is also introduced, associated with a health care delivery system where consumers are given a range of enrollment options among various private health plans which "compete in the marketplace to provide the maximum value for subscriber's dollars" (Pavarini & Shaffer, 1997, p. 86).

Also introduced is the notion of integrated health care delivery systems, which would furnish patients will varying levels and types of health care services and integrated coordinated case management (Pavarini & Shaffer, 1997). Further the authors propose that a movement in the United States toward a more integrated industry will need to include affiliations and alliances between physicians and hospitals. The idea is providing consumers with a package of goods including hospital, physician and ancillary health services that can offer "one stop shopping" for all health care needs (Pavarini & Shaffer, 1997, 92). In the current managed care system environment patients often have to seek out services from separate entities.

The authors propose that a lesser integrated model for delivery is a PHO or physician hospital organization where a local group of physicians affiliate with a hospital to attract managed care contracts. This relationship would provide basic managed care organization functions but would not be directly responsible to the payer for the delivery of services (Pavarini & Shaffer, 1997, p. 97).

Another system discussed is Management Service Organizations or MSO, which could provide management services to physicians and physicians groups, and affiliate with an integrated delivery system of hospital system (Pavarini & Shaffer, 1997, p. 100). Usually this type of system would be investor owned or jointly owned by both hospitals and physicians, and could offer turnkey management services to physicians (Pavarini & Shaffer, 1997, p. 100). Physicians could select the management services needed and thus be relieved of administrative…[continue]

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