Future of Health Care Delivery

¶ … Future of Health Care Delivery in the United States

What are your three most important recommendations?

My three most important recommendations for the future of health care delivery in the United States would be that there needs to be an increase in the quality of care, a decrease in the cost of care and an increase in the use of technology in order to facilitate the first two recommendations happening. It is important to leverage the technology that is available in order to facilitate improvement.

A high-quality health care delivery system must focus on improving health outcomes in the population it serves, supplementing episodic care and production of services with an epidemiological perspective and disease prevention strategies. In order to do this, information on the health status, risks, and problems of the population it serves must be readily available. It needs longitudinal complete patient records and the ability to analyze those records in order to identify opportunities for effective intervention while improving patient safety.

A good health care delivery system must creates information systems that facilitate clinical decision making by tracking alternative treatments, resource use, and clinical outcomes. Examination of this information can help the identification and timely adoption of improved practices. Successfully basing clinical decisions using this information produces better care for patients. The goal is to provider practitioners with the most up-to-date information there is.

In order to make these things happen it is important to have real time data to support patient care. There is a need for systems that offer medical science as well as medical records. Systems that link patients to doctors, doctors to doctors, doctors to nurses and care team members, laboratories to databases, imaging centers to databases along with monitoring equipment to oversee systems that provide a new safety net and support structure for care. All of these things are important in order to improve patient safety and quality of care.

2. How will the stakeholders listed in chapter 1 be likely to react to them?

The stakeholders, who include health care providers, hospitals, clinics, and patients, are likely to react positively to these recommendations due to the fact that each one will help to improve quality of care while reducing costs. The technologies that can be used in order to carry out these recommendations include the Electronic Medical Record. The use of EHR's reduces errors in medical records. There is no uncertainty that handwritten records are subject to lots of human errors due to misspelling, illegibility, and differing terminologies. Paper records can be easily lost or destroyed by fires, floods and other natural catastrophes. Digital records can be stored nearly forever and can be kept long after the physical records are gone. EMRs also help keep records of health information that patients tend to forget with time, such as inoculations, previous illnesses and medications.

EMRs unite all data in one place. In the past, paper-based records were positioned in different places and getting access to all of them takes a lot of time and money. Providers often wasted time and money trying to get access to records from other places and from other providers. In some instances, medical tests that have already been done are being done again, thus incurring needless costs to the patients and the health care system.

The synchronization between primary care providers and the hospital care of patients has always been a problem. It has been found that the transfer of information between primary care physicians and hospital-based physicians is often lacking. Discharge reports that come from hospitals often do not get to the family doctor in a timely fashion, resulting in reduced quality of care after hospitalization. In addition, the reports are often inaccurate and incomplete, often lacking relevant data about tests and new medications. It seems that leveraging technology is the best for all stakeholders involved.

3. How can you work with these stakeholders to take advantage of opportunities and overcome constraints?

Gaining a complete picture of an individual's health history is a cornerstone of the ability to improve treatment and outcomes. Having complete and accurate information is one of the five key requirements that are needed to accomplish the goal of anytime, anywhere medical care information and decision support. The technology that is desired to create easy to get to, inclusive, and longitudinal electronic medical records is becoming a reality.

In order to get all the stakeholders on the same page it would be important to launch an educational campaign aimed at health care professionals and patients in order to stress the importance of using technology to make improvements in our health care system. The technology is available but not everyone has bought into its usefulness yet. Once everyone realizes the potentials that these types of technological systems have they would then be able to tackle the constraints that exist.

Constraints that would have to be dealt with include the costs of implanting these systems and the training that would have to be done so that everyone would know how to use them. Another issue revolves around the security concerns that come up with putting Protected Health Information on electronic devices. It is of vital concern that all HIPPA regulations be adhered to when implanting these types of systems.

The best plan of attack to dealing with the opportunities and constraints to harnessing technology would be to convince those involved that the benefits of using technology such as EMR's far outweigh any implantation issues that make arise. The goal is to improve patient safety and quality of care and utilizing technology is the best way that this can be done. It is important to standardize as many processes as possible and using things like EMR's really helps to be able to implement best practices across many different areas and many different people.

4. What are the leading causes of waste in the health care system?

Every year billions of health care dollars are spent on unnecessary treatments and services, administrative waste, and overpriced, sometimes harmful, medications. By figuring out ways to cut waste in its health care system and to reform an incentive structure that encourages overspending, this country can decrease the burden that health care costs imposed on our economy. The high cost of health care inflicts an increasing load on households, businesses, government, and the economy.

There are three chief categories of unproductive spending. These include: overuse of enveloping treatments, excessive administrative costs and prescription drug marketing that persuades the use of more drugs, more expensive drugs, and drugs with a less established record of safety. Treatment that does not result in better outcomes for patients is not useful at all. Regardless of who pays for this care, it does not aid patients to live better or longer, while driving up health care costs without providing any real benefits.

A lot of administrative costs within the health care system are the consequence of efforts to move costs from one payer to another, for example from the insurance company to a hospital, or from a physician to a patient. This paperwork raises overall costs without making better the outcomes for patients. Intricate billing and insurance requirements raise administrative costs. The process by which physicians have to reveal to insurance companies and others that they are capable of providing high-quality care is time concentrated and duplicative.

Americans spend a lot of money every year on prescription drugs that are no better than cheaper alternatives or even have dangerous or unrecognized side-effects. Intense promotion to consumers and to physicians by pharmaceutical companies is a key reason that these lucrative drugs get prescribed as much as they do.

5. What are the key difficulties in creating standardized electronic medical records?

A patient's medical records are generally fragmented across multiple treatment sites, posing an obstacle to clinical care, research, and public health efforts. Electronic medical records along with the internet are providing a procedural infrastructure on which to build longitudinal medical records that can be integrated across many sites of care. Choices about the arrangement and ownership of these records will have insightful impact on the accessibility and privacy of patient information. Disturbing trends are obvious as proprietary online medical record systems are developed and deployed. The technology that promises to unify the currently different pieces of a patient's medical record may actually threaten the accessibility of the information and compromise patients' privacy.

Electronic medical record systems need to be developed so that they can trade all their stored data according to public principles. They need to give patients the power over access to view their record as well as creation, collation, annotation, modification, dissemination, use, and deletion of the record. This is key to making sure that patients' have access to their own medical information while shielding their privacy. Many electronic medical record systems that already exist, part medical records by adopting incompatible means of acquiring, processing, storing, and communicating data. Record systems should be able to recognize data whether is historical, radiological or laboratory from multiple sources including physician's offices, hospital computer systems, laboratories, and patients' personal computers. Because consumers are administering their bank accounts, investments, and purchases online, and many turn to the web for gathering information about medical conditions and will expect the same level of control to be extended to online medical information.

6. What can we learn from other countries in formulating recommendations to improve the U.S. health care system?

Despite having the most costly health system in the world, the United States consistently underperforms on most dimensions of performance, relative to other countries. When comparing the United States to nations such as Australia, Canada, Germany, New Zealand and the United Kingdom, our health care system ranks last or next-to-last in five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives. The U.S. is the only country that does not have universal health insurance coverage, partially accounting for its poor performance on access, equity, and health outcomes. The inclusion of physician survey data also shows the U.S. is behind in adoption of information technology and use of nurses to improve care coordination for the chronically ill. The U.S. health system is the most costly in the world, but relative analyses again and again shows that the United States underperforms in relation to other countries on most dimensions of performance.

What the United States must learn from these other countries is that they need to do things more efficiently in order to reduce the cost of health care overall. They must work to improve quality and access. Everyone should have access to good, quality healthcare at a price that they can afford. This country needs to leverage information technology in order to help improve in the areas that they are lacking so that they can become competitive with other countries around the world.

For a country that spends as much on health care as we do there is no reason that the quality and outcomes of health care should be what they are. We have the technology we just need to figure out to make it as useful as possible in order to benefit as many people as possible.

7. Why not allow health care costs to continue to grow until they reach 20% or more of the gross domestic product?

Allowing health care costs to continue to grow will do nothing except hurt everyone in the country in the end. The American people have seen their out-of-pocket expenses climb, health care costs rise, and premiums double at a rate four times faster than their wages have. Currently, half of all personal bankruptcies stem from medical expenses. Too many Americans are forgoing routine check-ups that they know they should get, or going without that prescription that would make them feel better, or finding some other way to scrimp and save on their health care costs.

What has become a growing emergency for the American people is also turning into an unsustainable burden for America's businesses. Increasing health care costs are controlling more and more of the money that companies could be using to innovate and grow, making it harder for them to contend around the world. These costs are causing the small businesses that are accountable for half of all private sector jobs to drop coverage for their workers at a disturbing rate. The explosion in health care costs has put the federal budget on a disastrous path. This is largely due to what we're spending on Medicare and Medicaid, which is expected to continue climbing in the years ahead as baby boomers grow older. As a nation, are now spending a far larger share of our national wealth on health care than we were a generation ago. At the rate we're going, we are expected to spend one fifth of our economy on health care within a decade. And yet we're getting less for our money. In fact, we're spending more on health care than any other nation, even though millions of Americans don't have the affordable, quality care they deserve, and nearly 46 million Americans don't have any health insurance at all.

8. What should be the role of state governments in health care? Discuss the arguments pro and con for standardizing Medicaid across states.

The history of health care regulation in the United States begins with the state level of government. The state has traditionally had jurisdiction over physicians, nurses, and other health care professionals, as well as hospitals and clinics, and sanitation, disease surveillance, food safety and other general health matters. This is for two reasons. First, most health care functions were limited to local populations, so it was logical for the state to regulate them. But, more importantly, the state government has legal jurisdiction over local matters of public health and safety. Each state government has the general power to protect the health, safety, morals and order of the population within its geographic boundaries. This power gives the states very broad authority to pass many kinds of laws to protect the health and safety of its residents, as long as the laws do not interfere with the rights of individuals that are guaranteed by the constitution.