Health Systems Issues and Strategic Planning The delivery of high quality healthcare services requires a sophisticated health system infrastructure that provides a multidisciplinary team approach. This health system infrastructure varies from country to country, but there are some common features that characterize health systems that can be used to identify best practices and current trends in healthcare delivery and administration in general and for an elderly American patient in particular. As the United States becomes an increasingly multicultural society, there will also be an increasing need for informed and culturally sensitive approaches to healthcare delivery. Everyone gets older, though, and there will also be an increasing need for health systems that provide the range of services needed by the elderly. In this regard, this study identifies health systems issues for such a typical elderly American patient, including a review of the relevant peer-reviewed and scholarly literature concerning these issues and an analysis of the implication of these issues for health systems. A strategic plan for addressing these implications is followed by a summary of the research and important findings in the conclusion.

Review and Discussion

The provision of public health services is defined by Bagley and Lin (2008) as "The organized response by society to protect and promote health, and to prevent illness, injury and disability" (p. 721). Therefore, health systems are the framework by which the delivery of healthcare services is accomplished, and as Bagley and Lin point out, "Without a 'system,' there can be no 'organized response'" (2008, p. 721). According to Sarisky and Gerding (2011), the need for efficient health systems has never been greater, and the demand of healthcare services is projected to increase significantly in the coming decades as a result of an increasingly elderly population that will require an enormous amount of health support in the years to come. In this environment, identifying efficient and effective health systems has assumed new relevance and importance (Sarisky & Gerding, 2011). Moreover, a wide range of market factors are affecting the manner in which healthcare is organized, delivered, and financed (Myers, Paulk, Dudlak & Mehlman, 2001). According to these authorities, "While the cumulative effect of these market forces is difficult to predict with certainty, we believe that the collection of these forces will transform healthcare from a 'seller's market' (e.g., provider driven) to a 'buyer's market' (e.g., consumer driven). As in other buyer's markets, the basis of competition increasingly will be to offer products and services that are better, faster, and/or cheaper than the competition" (Myers et al., 2001, p. 3).

From a public health system perspective, the U.S. Department of Health and Human Services defines the public health system as being ". . . The complex network of organizations that work towards fulfilling the public health mission of assuring conditions for a healthy population" (cited in Sarisky & Gerding, 2011, p. 25). Although health systems vary from country to country, all countries of the world have a mixed health system in place that is characterized by a significant governmental presence (Hoggett, 2003). To help develop a set of criteria that can be used to evaluate the performance of these different health systems, the World Health Organization (WHO) has formulated a series of criteria that focus on various aspects of performance (Wallace & Villa, 2003).

The WHO reports that effective health systems are characterized by several commonalities, including first and foremost the ability to provide quality healthcare services to everyone in need of them. According to the WHO, "The exact configuration of services varies from country to country, but in all cases requires a robust financing mechanism; a well-trained and adequately paid workforce; reliable information on which to base decisions and policies; well maintained facilities and logistics to deliver quality medicines and technologies" (Key components of a well functioning health system, 2010, p. 1). Other common characteristics of well functioning health systems include the following:

1. They improve the health status of individuals, families and communities;

2. They defend the population against what threatens its health;

3. They protect people against the financial consequences of ill-health;

4. They provide equitable access to people-centered care; and,

5. They make it possible for people to participate in decisions affecting their health and health system (Key components of a well functioning health system, 2010, p. 1).

Just as it is impossible to point to a single factor that is the most important in the provision of high-quality educational services, it is also impossible to isolate any single key component of a high-quality health system, but it is possible to identify those key components that typify a well-function health system as set forth in Table 1 below. To help guide the implementation process, WHO has published a set of quality indicators for well functioning health systems that can be used to formulate elderly- and site-specific goals and target dates for completion, a process that is consistent with health system development for the past several decades which are provided at Appendix A.

Table 1

Key components of a well functioning health system

Component

Description/Implications

Leadership and governance

Each country's specific...

A well- performing workforce is: (a) responsive to the needs and expectations of people, (b) fair and efficient to achieve the best outcomes possible given available resources and circumstances. Countries are at different development levels with respect to their health workforce; however, common concerns include improving recruitment, education, training and distribution; enhancing productivity and performance; and improving retention.
Essential medical products and technologies

Universal access to healthcare is heavily dependent on access to affordable essential medicines, vaccines, diagnostics and health technologies of assured quality, which are used in a scientifically sound and cost-effective way. After salaries, medical products are the second-largest component of most health budgets and the largest component of private health expenditure in low and middle income countries.

Service delivery

Health systems are only as effective as the services they provide.

Source: Adapted from WHO Factsheet: Key components of a well functioning health system (2010)

As can be seen from Table 1 above, the quality of leadership and governance are essential considerations in the delivery of healthcare services in a health system. This assertion is congruent with the body of literature to date which indicates that leadership "is a critical element," but "there is significant unresolved debate about what leadership is and does, and how the leadership ability of individuals might be predicted and enhanced" (Bagley & Lin, 2008, p. 722). With respect to health system financing, although Arnett (2010), a private hospital CEO, reports that, "Cost reduction has been moved to the top of priorities in most healthcare institutions" (p. 37), Clark, Savitz and Pingree (2010) also emphasize that, "Opportunities exist in many hospitals and health systems to consistently provide an extraordinary patient care experience while reducing operating costs" (p. 20). This approach, though, requires an ongoing and vigorous top-down emphasis on adding value and eliminating waste at every opportunity. In this regard, Clark and his associates also note that, "Recognizing and appreciating that structure follows strategy, the organization that builds a continuous learning and performance improvement culture is in a better position to design an organizational structure that sustains progress toward clinical and operational improvement goals" (p. 20).

These are tall orders for the healthcare community and policymakers alike, certainly, but according to Conrad and Shortell (1999), there remains some serious debate concerning which health system model is best suited to address the changing needs of American society today and in the future to address the needs of the elderly. Just as innovations in information and telecommunications technologies have fundamental changed the way patient data is collected, analyzed and acted upon, merged and consolidations of hospital chains have also created new operational capacities that affect the elderly and these issues are discussed further below.

Health Systems for the Elderly

According to Kim, Miller and Schofield-Tomschin (1998), advances in modern medicine mean that babies born today have a 50-50 chance of living to be 100 years old, but the more immediate concern for policymakers today is the fact that 75 million baby boomers reached their 65th birthday in 2011 representing the beginning of a wave of in elderly population growth. There are some interesting gender- and race-related differences involved in the percentages of this elderly population growth, though, that will affect the optimal type of health system that will be needed for the elderly by mid-century as shown in Table 2 and depicted graphically in Figures 1 through 3 below.

Table 2

U.S. Life Expectancy in Years

Mortality

1970

1980

1989

1990

1996

Life Expectancy in Years

Life Expectancy at birth

70.8

73.7

75.1

75.4

76.1

Men

67.1

70.0

71.7

71.8

73.1

White

68.0

70.7

72.5

72.7

73.9

Black

60.0

63.8

64.3

64.5

66.1

Women

74.7

77.4

78.5

78.8

79.1

White

75.6

78.1

79.2

79.4

79.7

Black

69.4

73.6

74.9

75.2

76.1

Source: Baum, Jennings &…