Factors Influencing Health Policy

¶ … Health Policy

government is under pressure to offer quality and affordable health care services to its citizens. Various reform efforts in the country have adopted various approaches with the aim of ensuring that health care system perform well. These strategies include competition in service delivery, downsizing, partnerships, performance indicator and measures, citizen participation privatization and competition. All these approaches have converged in emphasizing accountability as the prime aspect in improving system performance and implementing health reform (Ivanov & Blue, 2007).

The current debate on health systems and accountability reflects a number of factors. Notable is the dissatisfaction with the performance of the health system. In the United States, discontent and debates have focused on these same issues, accompanied by equitable distribution and availability of basic services, corruption, and lack of responsiveness and abuses of power. Citizens and policymakers always expect the health care providers to deliver responsibilities correctly and professionally according to norms and regulations and with respect for patients (Warwick-Booth, Cross & Lowcock, 2012).

Second, accountability has assumed the highest level of importance because the scope and size of healthcare bureaucracies, along with the specialized knowledge requirements, accord actors in the healthcare system substantial power to affect an individual's well-being and life. Proper accountability for the use of such amount of money is a crucial priority because health care constitutes significant government expenditure (Hinshaw & Grady, 2011). If the above classifications of accountability apply to health service delivery, it will create a clear picture of the accountability issues that arise. In fact, these issues might be addressed based on three functions of accountability (Mackenbach & in McKee, 2013).

The first function is to regulate the abuse and misuse of public authority and public resources. This is directly related to financial accountability. The second is to give a guarantee that authority is exercised, and resources are used according to legal and appropriate procedures, social values and professional standards. This function applies to all the three types of accountability. The third is to promote and support better service management and delivery through learning and feedback. The focus is primarily on performance accountability (Warwick-Booth, Cross & Lowcock, 2012). These three functions overlap to some degree, but sometimes the pursuit of one could lead to conflict with the other. Notably, the most recognizable tension is between accountability for improvement and accountability for the control.

In the healthcare sector, achieving these accountability functions has encountered a number of challenges. First, health services are characterized by powerful asymmetric across service users, providers and oversight bodies in terms of expertise, access to services and information. In terms of information, central oversight bodies tend to influence challenges in monitoring performance because providers tend to control the necessary information (Mackenbach & in McKee, 2013). Regarding expertise, for instance, service users are likely to be ignorant of medicines and treatments, which might harm them and hence, require some form of protection. Despite access to care, providers are expected to practice significant gatekeeper authority, for instance, regardless of office procedures, determining which individual receives what care. Beneficiaries of health services especially the lower class cannot confront this power (Hinshaw & Grady, 2011).

Secondly, there are often disparities between private and public interests and incentives that could constrain efforts to increase accountability. For instance, the private and the public sector might be sharply recognized in terms of speed by which consumer feedback can affect performance, production and job tenure. When services are poor or under-provided in the public paradigm, negative customer feedback tends to take significant time, via public opinion polls, changes in political platforms through voting and media coverage. All this means a lagged procedure in which public management officials might be misinformed about customer demands for some time (Hinshaw & Grady, 2011).

Because some elements of the health care system are expected to remain in the public realm despite the ambitiousness of privatization, feedback meant for accountability will not be efficient as a completely private model. Thirdly, institutional capacity gaps have constrained and undermined efforts to enhance accountability for all the three functions. The health facilities are unable to report and track on budgets, pharmaceutical purchases, and collection of fees and supply of inventories, equipment and vehicles and limit chances for accountability for assurance and control purposes. This leads to waste in the health system and creates fertile grounds for corruption (Warwick-Booth, Cross & Lowcock, 2012).