Healthcare Issues Country. How Solve Ongoing Problem

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Economics of healthcare

The population of the modern day society is faced with incremental pressures, but also incremental challenges, and these new issues impact all aspects of life, including the provision of healthcare services. For instance, the more and more technological developments made within the medical and pharmaceutical industries improve the quality of the medical services and as such the life expectancy of the patients. Then, the sustained academic research conducted also improves the quality of the services and the overall quality of the medical act.

In spite of the developments made, it must also be noted that the provision of healthcare services in the United States is a complex situation, with numerous ramifications and challenges. On a first note, it is revealed that the population of the modern day society is facing an incremental rate of heart and blood pressure diseases, as well as cancers. These put additional strains on the healthcare system, its financial administration and are linked to an unhealthier life style of the population. Then, it is also noted that the generation of baby boomers is starting to retire, meaning as such that as they come of age, they would require more services, but also that there are fewer individuals in the workplace to support the expenses of the medical care sector.

Overall, the healthcare system in the United States is challenged and continues to encounter numerous difficulties. The scope of the current endeavor is that of assessing the issues which currently face the system and the means in which the government deals with them. Based on the analysis conducted, several recommendations would be made as to how the issues could be approached and the general healthcare system could be improved.

2. Issues with healthcare in the United States

The healthcare system in the United States is weak and it has gradually transformed into a social and national problem. Ezra Klein (2007) forwards several reasons for the dramatic state of the current healthcare system. According to the author, the main problems of the medical system are pegged to the following:

High costs, actually the highest medical care costs in the world

Low wages for the medical staffs

High levels of population not getting treatment

People do not have a regular physician

The medical doctors seldom fully listen to what the patients have to say

The population faces high rates of chronic conditions, which are, sadly enough, not adequately treated

The population often falls victim to medical, medication or laboratory errors (Klein, 2007).

From a historic standpoint, it is noted that the healthcare system has improved, but it still appears as insufficient when compared to the needs of the current population. The table below reveals the evolution of healthcare and the adjacent problems since the 1850s through today, and estimates for the future.

Trends

18650-1900

1900 to World War II

World War II to present

Future

Predominant health problems

Acute epidemic infections

Acute trauma, infections

Chronic diseases: cancer, stroke

Chronic diseases: emotional, behaviorally related

Technology available

Virtually none

Beginning rapid growth of medical sciences, technologies

Explosive growth of medical science, technology

Continued growth and expansion of technology, with attempts to repersonalize the technology

Social organization; Policy

None; individual resources or charity

Beginning societal and governmental care for disadvantaged

Health care as a right; government responsibility to organize and finance care delivery

Greater centralization in federal government; organized systems of health and financing

Source: Cunningham, 2003

The issues encountered by the American healthcare system today are affecting the entire population and they as such cause concern and raise interest for the entire population. From an analytical standpoint, this means that opinions about what is wrong with the healthcare system are issued by all, from the people on the streets, to the individuals in the media and the very politicians. But the problems are complex and not to the full comprehension of all.

In order to create some light into the issues which to impact the American healthcare system, the lines below point out to some of the more stringent issues, as revealed by reliable sources. In a succinct enumeration, these issues refer to the following:

High number of uninsured individuals

Lack of flexibility with the employer-based insurance

High levels of bureaucracy

Lack of emphasis on the quality of healthcare

Fraud and abuse of the Medicare, and last

Insufficient governmental efforts to regulate and improve the system.

a) Uninsured

A primary problem is posed by the large number of people who do not have medical insurance. In 2010, it was estimated that 50.7 million Americans did not have medical coverage, and the figure was following an ascendant trend, which is expected to maintain its course unless immediate action is taken (Wolf, 2010).

The reasons as to why so many people remain uninsured are unclear, with some being represented by the high costs of medical insurance, the fact that not all employers offer it, the high unemployment rates among the population or the acceptance of the people to work illegally and as such not benefit from insurance. All these problems have worsened with the commencement of the economic crisis in 2008 and continue to worsen and pose new threats.

b) Employer-based insurance

Today, medical insurance is provided by the employer and the quality of the medical care and coverage depend on the employer and their company related scopes. And in the age of capitalism, employers will often seek the minimum cost medical insurance policies in order to preserve profitability. Aside from the employer, medical insurance is also offered by the Medicare, a social system implemented by the state through which specific categories of citizens -- such as those with disabilities or those older than 65 years -- are entitled to medical care. In both cases however, the individual has no control over the type of medical care coverage they receive.

c) High levels of bureaucracy

Another problem which currently characterizes the health care system of the American population is represented by bureaucracy, which in turn creates administrative inefficiencies for both insurance firms, as well as medical staffs. This ultimately impedes the efficient provision of medical services and creates patient dissatisfaction, and even jeopardy for the heath of the patients.

d) Emphasis on healthcare quality

The American healthcare system is currently found at an advanced level of degradation, where the medical staffs come to place less and less emphasis on the quality of the services, but simply focus on ensuring that these services are provided. The quality of the medical act is as such not assumed as a criterion for improving the sector, nor is it integrated as an element in the decision making process (Garson, 2000).

e) Fraud and abuse of Medicare

As it has been mentioned throughout the previous lines, a major problem of the American healthcare system is represented by the fact that it registers tremendous costs. And these costs are not always pegged to actual services, but the abusive and fraudulent use of the Medicare service.

"Medicare fraud is purposely billing Medicare for services that were never provided or received. For example, your Medicare number can be used to bill Medicare for services and supplies you didn't need or want, services and suppliers your doctor did not order, services and supplies you can't even use and services and supplies you did not receive" (California Health Advocates).

This virtually means that the state budget and/or the private insurance companies pay money to medical institutions for services that were not delivered to the patient benefiting fro the respective insurance package. In essence, while the medical institution bills the insurer (private or public), the patient does not benefit from the services, and the costs for the respective patient still increase. This false generation of costs deepens the financial problems of the healthcare systems and prevents it from recovering.

"Medicare fraud costs Medicare billions of dollars every year. It can cost you higher Medicare premiums, deductibles and co-payments. Losses due to fraud may also prevent Medicare from offering more services and better coverage" (California Health Advocates).

f) Governmental efforts

The government of the United States of America has long recognized the problems of the healthcare system and has developed and implemented measures and legislations in dealing with the problem. Nevertheless, these measures have proved insufficient as the issues of the healthcare system deepened. As more and more Americans become uninsured and possess fewer capabilities of medically providing for themselves, the federal institution is at a loss and requires assistance (Gratzer).

3. Recommendations

The main recommendation to improving the healthcare system in the United States is that of making it more flexible. This flexibility refers to the fact that the system would become more easily adaptable to features which impact the economy and the society, and would as such create an opportunity for the American citizens to receive better healthcare services.

At a more specific level, the following recommendations are forwarded:

1. Creating partnerships between the private and the public healthcare institutions

2. Making the insurance more flexible and allowing the employees to select their own packages

3. The creation of individualized offers for medical insurance

4. Focus on the quality of the medical services offered

5. Reduction of fraud and abuse of medical coverage packages

6. Reshaping the role of the government.

1. Public-private partnerships

One major problem of the healthcare system is that it is being provided by either state or private institution, due to the nature of the insurance possessed by the individuals. At this stage however, it is proposed that the private and the public institutions join forces and combine the services they offer in order to improve their quality and the population's access to these services. Such an objective would be attained through strategic partnerships between the private and public institutions, through the sharing of resources and responsibilities, as well as through an integrated managerial system.

2. Flexibility of insurance

A second recommendation was pegged to the fact that the medical insurance system in the United States is an employer-based one, meaning that the employee does not have any control over their medical coverage. Within this scenario, the recommendation is that of liberalizing the field of medical coverage insurance and allowing for more insurance companies to provide such services directly to the population, not only to the employers.

In such a context, the employers would offer their employees the money to be paid for medical coverage -- computed based on industry averages -- and the individual would be able to choose the type of medical coverage they desire. This would not only increase coverage, but would also support competition in the healthcare industry, eliminate redundancies and increase the efficiency of the medical sector by offering the exact services which are required. A young woman looking to start her family for instance would require a different medical coverage package than an older male senior citizen.

An economic problem which could be raised by this approach is obvious at the level of the employers, who would be forced to pay larger sums for employee based insurance, than they would pay in the context of the employer-based insurance. This is explained by the fact that when the employer purchases bulk insurances for all staff members, they will negotiation on a minimum price. However, when the medical coverage packages are individually bought by the employees, they are not sold at negotiated prices and they as such cost more.

This economic cost encountered by the economic agents is however lower than the current cost encountered by the society due to inadequate medical insurances. Additionally, the economic problem of employers could be addressed through internal; processes of increasing operational efficiency or even through governmental contracts that offer financial support throughout the transition period.

3. Customization of medical insurance

Another concern raised by the creation of individual coverage packages is represented by the fact that this would lead to economic inefficiencies for the insurance organizations. In other words, they would assume higher degrees of risk and they would be forced to cover wider areas of medical services, as demanded for each person. This limitation is however manageable through the same specifics of personalization, adopted this time by the insurance company.

In this line of thoughts, the insurance company would negotiate each medical coverage package with the individual clients. These would be subjected to medical check-ups and would be insured based on the results of the medical verifications. Specifically, if an individual is already suffering from asthma, the medical coverage for respiratory problems would be limited as the risks in this respect are higher. Also, it would be possible for the company to provide this coverage, but do so in exchange for a higher insurance premium.

The selection of the clients and the creation of the medical insurance to be provided would as such be based on a multitude of customer specific issues, the most important of them being their current health, as a generator of future risks. Still a determinant of future risks is represented by the assessment of current features which characterize the individual, such as their status of being smokers or non-smokers or of facing obesity. Correlated to the findings of this analysis, the company would create specific packages which integrated the economic principles of efficiency in the provision of health care.

4. Focus on quality

A fourth recommendation is represented by the decisions to place more emphasis on the quality of the medical services provided. Currently, the quality of the medical services does not represent a focal point, as accent is placed on the actual delivery of the services. Based on this realization, it is necessary to reintegrate quality as a primary force to creating patient satisfaction.

Aside from patient satisfaction, the incremental focus on quality would also be beneficial for the entire development of the medical system, as it would generate and support competition. In a context in which competition between the various providers of medical services and medical coverage insurance is intensified, these parties are forced to develop. They need to continually improve their product and service offer in order to generate satisfaction and the necessary revenues. In such a context then, the medical field would evolve.

5. Reduction of fraud and abuse of medical coverage packages

The problems of fraud and abuse are more common within the public system of medical coverage, as this system is wider and more complex, as well as it is more difficult to verify. In order to address this threat, higher levels of control should be implemented by both state as well as private institutions providing medical insurance.

At a more specific level, these agencies ought to verify if the services and supplies which are billed by the medical parties have in fact been offered and used by the person with the respective healthcare coverage number. This effort, however tedious, would reduce the numbers of fraud and abuse cases and would further discourage such behaviors.