Healthcare Landscape: Challenges, Reform, and Resource Allocation

Introduction

It has been widely publicized that the healthcare industry is rapidly evolving across many dimensions, including technological progress, administrative efficiency, and the regulatory and political environment. One of the central considerations in any series of reforms should be how to create value and improve quality within an increasingly dynamic healthcare industry. Many of the competencies required to adapt to this new environment are multidisciplinary and draw on best practices from strategic management, financial management, project management, and human resources, among other fields.

For example, many technologies have enabled new levels of treatment that were previously unimaginable. However, at the same time, massive inequalities persist in the system, and many individuals remain effectively excluded from receiving even basic care. This analysis examines some of the current challenges facing the healthcare industry and discusses key shifts that are taking place within it.

Current Challenges in the Healthcare System

The challenges that have emerged within the healthcare system can be viewed at several levels: (a) the macro level, where policy is established by governments, health authorities, and insurance plans; (b) the meso level, where organizational budgets are determined by administrators; and (c) the micro level, where care is delivered directly by clinical providers (Jones, 2015). At the national level, the politics and economy of a nation often dictate the shape of its healthcare system. The United States is only slowly progressing toward a more inclusive system that provides expanded access to its citizens.

By contrast, nearly all other developed countries offer some form of publicly funded healthcare that guarantees many services in order to promote a healthy quality of life for all citizens. One of the primary advantages that publicly funded systems gain through this structure is that it is easier to focus on preventative care, such as wellness and prevention programs. Such programs are generally sound investments for society by virtually any measure, from financial returns to health outcomes. In a for-profit system, however, the incentive rests more heavily on the treatment of acute cases, since those cases often offer significantly greater opportunities to produce a return on investment compared to preventative measures, which are far less costly.

All healthcare organizations are required, to a greater or lesser extent, to deliver broad access to health services, continuously improve quality of care, and simultaneously control costs. Increasing competition within the industry is often cited as a means of achieving these ends (Dash & Meredith, 2010). However, when it comes to creating value in the context of public health, it is important to consider multiple perspectives—not just that of investors primarily interested in financial returns. Organizations must allocate their assets selectively in the face of limited resources, which introduces many ethical challenges at every level of the process. It is not only nations that must make decisions about how to fund national programs; individual doctors and nurses must also make daily judgments about where to allocate their time, balancing professional values with organizational objectives.

Healthcare Evolution and Resource Allocation

The idea that healthcare must ration some of its services often generates negative publicity, evoking images of patients denied life-saving treatment for bureaucratic reasons. However, in many cases rationing is a necessity, as there are simply not enough resources to provide every patient with the best care currently available. Furthermore, such decisions are not always consciously made. For example, implicit rationing of nursing care—defined as the withholding of or failure to carry out all necessary nursing measures due to a lack of resources—has been linked to nurses' perceptions of their professional environment, negative patient outcomes, and increased risk to patient safety (Papastavrou, Panayiota, Hartini, & Anastasios, 2014). Deciding how the healthcare system prioritizes its assets is therefore a practice that occurs at every level, whether or not it is explicitly recognized as such.

Determining where to ration care due to limited resources is a perplexing moral and ethical challenge that is far more common than most people realize. Healthcare rationing has been extensively discussed in the medical profession and is understood as the withholding of beneficial interventions, mainly for cost-effectiveness reasons, at all levels and in all healthcare systems around the world (Papastavrou, Andreou, & Vryonides, 2014). It is common for an individual nurse or doctor to decide which patient should receive priority, but such practices are also inherent in the decision-making of executives, managers, and administrators who face similar challenges on different scales. For example, a hospital may only be able to afford a limited number of healthcare workers and must determine the best way to allocate its resources based on established priorities and the particular demands of its local community.

Conclusion

There are many different levels at which one can examine the issues that currently face the U.S. healthcare system. On an individual level, this analysis discussed how many doctors and nurses are forced to prioritize or ration their resources in order to focus on the greatest needs present. Although the rationing of care is a difficult and often uncomfortable proposition, it is a necessary process in any organization facing limited resources, whether the decision is made consciously or not.

At the national level, the politics and economy of a nation largely dictate the structure of its healthcare system, and the United States faces significant challenges in making the best use of its resources. Numerous reforms are attempting to both increase access and reduce costs—particularly through the better utilization of new technologies that can improve efficiencies across the system. Progress has been made, but substantial work remains to ensure that all Americans have access to the quality care they need.

Works Cited

Dash, P., & Meredith, D. (2010, November). When and how provider competition can improve health care delivery. Retrieved from McKinsey: http://www.mckinsey.com/insights/health_systems_and_services/when_and_how_provider_competition_can_improve_health_care_delivery

Jones, T. (2015). A descriptive analysis of implicit rationing of nursing care: Frequency and patterns in Texas. Nursing Economics, 144–154.

Papastavrou, E., Andreou, P., & Vryonides, S. (2014). The hidden ethical element of nursing care rationing. Nursing Ethics, 583–593.

Papastavrou, E., Panayiota, A., Hartini, T., & Anastasios, M. (2014). Linking patient satisfaction with nursing care: The case of care rationing—a correlational study. BMC Nursing, 13–26.