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To analyze and compare the U.S. healthcare, internationally, it is important to know what really constitutes a good health care system. The U.S. Institute of Medicine describes this quality as, "the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge." This system, in its broad sense, should comprise of two main branches of preventative and curative medicine, both of which should cover different aspects of health, such as travel medicine, school health, occupational health, mental health, reproductive health and so on. Furthermore, a well established health care system does not act independently but in co-ordinance with other industries, such as the agricultural industry. Therefore, since a well developed nation has better access to proper sanitation, housing and adequate nutrition, it is more likely to have a better developed health care system. Other factors, such as affordability, accessibility, acceptability, coverage and benefits also play major roles in the society and can form the basis of failure or success of a system, in a well developed country. The eradication of many diseases, such as, small pox, polio, diphtheria, tuberculosis and leprosy to extinction or near extinction, from most countries provide good examples where great coverage and its acceptability in most societies paved way for this medical miracle. (Docteur & Berenson, 2009)
A great deal of commonality in this regard has also been observed in the evaluation of eighty other countries, with an existing health system. In addition to effectiveness, the researchers identified 14 other dimensions: acceptability, accessibility, appropriateness, care environment and amenities, competence or capability, continuity, expenditure or cost, efficiency, equity, governance, patient-centeredness (-focus) or responsiveness, safety, sustainability, and timeliness. (Docteur & Berenson, 2009)
In order to make an informed assessment about the quality of care in one health system vs. another, it is important to analyze certain indicator. In an article published by Mark Duell, America has the worst maternal mortality rate compared to other industrialized countries. Moreover, the risk of maternal death amongst black women in the United States is about four times higher than the average white women. Furthermore, regarding maternity leave policy (in terms of work duration and wages paid), the United States ranks the lowest when compared with other developed nations. (Atrash, Alexander, & Breg, 1993)
(The World Bank, 2008)
The less than five death rates in the United States are 8 in every 1,000 births, which rates behind forty other countries. This means that an American child is twice more likely than a child in Finland, Sweden or Singapore to die before the tender age of 5. Only 58 per cent of children in the U.S. are enrolled in pre-school, which makes it the fifth-lowest country in the developed world on this indicator. (The World Bank, 2008)
The major cause of neonatal mortality rate in the United States is because of Low Birth Weight. However, studies show that Low Birth Weight neonates are more likely to survive in the United States than anywhere else. (The World Bank, 2008)
Infant mortality rate has been universally accepted as an important indicator of health status. A major goal in healthy people 2010 was to reduce infant mortality rate to 4.5 infant deaths per 1,000 and increase access of health care. In 2008, infant mortality was fifty percent greater than this goal and the gap between the United States and countries with the lowest infant mortality rate, seems to be still widening. (The World Bank, 2008)
(The World Bank, 2008)
In terms of these indicators, the top seven countries -- in order from first place - were Norway, Australia, Iceland, Sweden, Denmark, New Zealand and Finland.
Fifty five percent of Americans surveyed in 2008 said that American patients receive better quality of care than do natives from other nations. However, only forty five percent said they thought that the United States had the world's best health care system. Moreover, Studies conducted in the past also reveal that some Americans are receiving more care than they need while still a majority is receiving lesser care than they need. The first and foremost goal that needs to be adopted by this system should be equity, which means, according to need. (Docteur & Berenson, 2009)
Furthermore, this system needs to emphasize more on the preventative aspect as compared to the curative. Alcohol and tobacco abuse is on the rise leading to an increase in the number of deaths attributable to alcohol and tobacco, which utilizes a significant proportion of health costs. Even though the American health care system spends more per patient than any other developed nation, the mortality rate is still far from acceptable. An article published in the 'health reform' attributes these statistics to medical errors. An estimated figure of 100,000 patient deaths annually have resulted from medical errors, which give rise to resistant strains of bacteria. At the same time, health hygiene and safety precautions amongst health care personnel seem to be worsening at the rate of one percent per year since the past decade. If these infections could be prevented, an estimated cost of 28 to 33 billion dollars could be saved. The Michigan Keystone ICU project has proved this by saving over fifteen hundred lives and about 200 million dollars by maintaining emphasis on healthcare hygiene, thus reducing health care associated illnesses and the number of days of hospital stay. (Kurt, 2008)
Another major problem in the healthcare system is that the greater majority of inhabitants are uninsured, approximating 45.7 million, according to the U.S. Bureau of the Census 2007. Through the years from 2005 onwards, adults aged 18-64 who delayed needed health care has considerable increased amongst the uninsured. (AAFP, 2011)
This hampers a design of an efficient system that emphasizes on the need for 'health for all.' The key to change is to reinvigorate primary health care facilities, and to redesign primary health care at a cost affordable to the community and with a system acceptable to the society. Currently, primary health fails in the United States because of the way it is financed.
An added issue with health care in the United States is that its quality is not constantly being measured, reported, understood or used in decision making. Maintaining an updated health management information system, where indicators are constantly revised and various variables are thoroughly discussed, will prove to be a useful solution.
A few existing studies on patient care prove to be useful measures of healthcare delivery outcome. Efforts to measure quality and routinely report data would allow the system a more definitive evaluation of the status of the country's health care system and would enable professionals to target the areas in need of improvement. Moreover, it would help them make better and more informed decisions about what kind of medical care is appropriate, for whom and when, and what method or methods should be reimbursed. Simple averages drawn out from different studies show that fifty percent of people received, recommended preventive care; seventy percent, recommended acute care; thirty percent, contraindicated acute care; sixty percent, recommended chronic care; and twenty percent, contraindicated chronic care. Researches, like this one and many more, clearly show that the health care delivered to patients in the United States does not touch the certified mark. Insurance companies, employers, state and federal governments and consumers are all depending on outcome research for information that will help them make better decisions about what kind of medical care is appropriate (and should be reimbursed), for whom, and when. (McGlynn Mark A & Brook, 1998)
Traditionally, studies have measured health statuses in terms of laboratory results, ICU admissions, complication rates, mortality and so on. However, these variables do not provide data on health coverage, hence are not representative of a nation's natural trend. Data in areas such as compliance and cost will provide more useful information to the government and other health agencies in terms of cost benefit and cost effectiveness. It will also conclude the variations in medical practice patterns and its effectiveness in terms of approach and good coverage.
It may be true that only physicians should judge the quality of hospital medical care as they are the ones with direct medical outcome exposure. Medical ethics demands that physicians provide to their patients, the best health care possible and to provide outcome feedback is an important means of improving this care. However, participation in such hospital peer review activities may be complained to be a disagreeable option as this lacks a clear incentive.
Medical errors and the injuries produced by it has been a recent development in quality improvement and have derived immense attention. This duty on part of the physician requires complete honesty, which may require more than mere exhortation, as the emphasis is mainly on self blame rather than a 'nofault' system which harmonizes the balance between error and compensation.
Some doctors claim that it is irresponsible or unethical to consider cost while making a clinical decision. However, others, on the…[continue]
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