Local Institutions, There Are Efforts to Systematize

¶ … local institutions, there are efforts to systematize healthcare through an integrated offering of services. A patient can receive treatment for cancer, for example, in a multi-faceted way. Counseling for the emotional turmoil created by cancer treatment can be paired with radiation, chemotherapy, and other forms of physical treatments for a variety of types of cancers. There is also a variety of health-promotion programs at many local hospitals, along with efforts to treat illnesses from a purely medical perspective. Fitness classes for seniors, support groups for overeaters, and various health 'expos' that offer on-site testing for heart disease and cholesterol attempt to create a truly integrated healthcare system that addresses the causes as well as the symptoms of unhealthy behaviors.

However, as laudable as these efforts may be, there are still many notable instances of fragmentation. Miscommunication between physicians treating the same patient still occurs, even within the same hospital, despite the existence of electronic records. Often, organizations are so overwhelmed, critical information is not available at every point of care. Perhaps the most obvious example of fragmentation is the degree to which health insurance companies determine the type of care that is disseminated. Doctors prescribe testing and treatment based upon what insurance companies will cover, not the patient's individual needs. Patients with better insurance get better care, and those who receive more treatment are not necessarily the sickest or the most in need of screening, but are simply the patients with the most comprehensive coverage. Patients may find that their insurance company does not cover tests done by a particular lab within the hospital, even though other types of treatment are authorized by the hospital. This creates waste, confusion, and inefficiency. Insurance companies often support "narrowly evidence-based care of individual diseases, rather than higher level integration of care for prevention, mental health, multi-morbid conditions, and acute concerns" and this influences how care is provided (Strange 2009).

Part II

Perhaps the most common overriding concern in the debate about healthcare in America today is the question of how to reduce expenditures on healthcare while increasing the number of Americans with healthcare coverage. America has more uninsured citizens and higher costs per patient than any other industrialized nation on earth. "The gap between the highest and lowest life expectancies for race-county combinations in the United States is over 35 years" (Murray et al. 2006: 260). Individuals with the lowest life expectancy and poorest health tend to be African-American males living in high-risk urban areas, although rural portions of the United States are also critically underserved (Murray et al. 2006: 260).