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The results of this analysis highlight the need for hospitals to fine-tune their discharge process to reduce readmissions, and support the expenditure of additional resources for this purpose as a cost-effective intervention; as an example, author cites a hospital in Iowa that implemented a rigorous post-discharge planning process for patients with heart failure and 30-day readmission rates were reduced by 3-9% during the 3-month period following implementation.
The research showed that many elderly patients who suffer from congestive heart failure also suffer from a wide range of comorbid conditions, including diabetes and hypertension. These patients can be reasonably expected to require periodic or even frequent treatment in emergency departments and/or hospitalizations for these conditions, making the need for effective and seamless post-discharge planning especially important. In this regard, the research also showed that there are some valuable evidence-based practice guidelines available, though, that can help clinicians better coordinate post-discharge…
Health Care Cost and Quality
The objective of this study is to examine the relationship between health care cost and quality. This study will select one public agency and one private agency and differentiate their roles and major activities in addressing cost and quality in health care and analyze current and projected initiatives to improve quality while simultaneously controlling costs. This study will additionally conduct a synthesis of indications for staff nurses and advanced practice nurses, including evidence-based practice, relative to cost and quality.
There are many initiatives presently underway to meet the growing need of health care for a population that is greatly under-insured and many that are uninsured.
U.S. Department of Health and Human Services eport
According to the U.S. Department of Health and Human Services (2014) "Medicare is improving the way it pays for physician services. The Center for Medicare and Medicaid Innovation (Innovation Center) is exploring…
Advanced Practice Nursing: A New Age in Health Care (nd) American Nurses Association. Retrieved from: http://www.nursingworld.org/functionalmenucategories/mediaresources/mediabackgrounders/aprn-a-new-age-in-health-care.pdf
Health Care Costs (2014) Agency for Healthcare Research and Quality. Retrieved from: http://www.ahrq.gov/research/findings/factsheets/costs/health-care/index.html
A 21st Century Health Care Workforce for the Nation (2014) U.S. Department of Health and Human Services. Retrieved from: http://aspe.hhs.gov/health/reports/2014/HealthCare_Workforce/rpt_healthcareworkforce.pdf
Financing Health Care in the 21st Century
Cost Containment: the United States government
Unlike virtually every other industrialized country in the world, the United States provides medical care to its citizens through the private workplace, primarily financed through private insurance. Expenditures on such public programs as Medicare and Medicaid have increased the government's portion of the nation's healthcare burden since orld ar II. Still, the majority of health care funding still comes from the private sector. This has left millions uninsured whom are too 'wealthy' or young to qualify for public assistance, but do not work at places of employment where they receive benefits. It has also left many Americans underinsured for their healthcare needs. (News batch, 2003)
Although the United States spends far more on health care in actual dollars and as a percentage of the GDP than any other country of the world, the U.S. ranks low among…
News batch. (2003). "Health Care."
Retrieved on July 24, 2003 at http://www.newsbatch.com/healthcare.htm
Open Secrets. (2003). "Managed Care."
Retrieved on July 24, 2003 http://www.opensecrets.org/news/mcare/index.htm
The delivery health care system takes into account the assimilation of physicians, healthcare facilities, together with other medical services with plan to facilitate the provision of the total continuum of medical care for its consumers. In a whole incorporated system, the three fundamental components including physicians, medical facilities and the membership to health plans are counterpoised in terms of equating medical resources with the necessities of patients and purchasers (Coddington, Moore, and Fischer., 1994). One of the key concerns in the present delivery of healthcare is cost. Increasing costs of healthcare has been a major worry in the past number of years, making the United States to have one of the most expensive systems of healthcare. The main objective of this paper is to analyze the different costs linked to healthcare delivery system, and delineate the manner in which these costs impact different populations and how it also affects…
Healthcare Quality and Cost
Despite the fact that there is a comprehensive policy agreement that both cost control and quality enhancement are vital, the relationship between health care costs and quality is one of contention in debates in health care policy. One conceivable aspect is that enhancement in quality necessitates infusion of investments or on the contrary, reductions on cost could diminish quality. On the other hand, improvements in quality could decrease costs by diminishing intricacies or healthcare facility readmissions. As a matter of fact, the relationship between cost and quality possibly lies between these two ends, so that some kinds on health care costs are linked with high quality and others with poor quality. The impact is reliant on the areas the funds are expensed (Hussey et al., 2013).
Select one public agency and one private agency and differentiate their roles and major activities in addressing cost…
Centers for Health Care Strategies. (2016). About Us: What We Do. Retrieved from: http://www.chcs.org/about-us/what-we-do/
CMS. (2013). CMS Strategy: The Road Forward 2013 -- 2017. Retrieved from: https://www.cms.gov/About-CMS/Agency-Information/CMS-Strategy/Downloads/CMS-Strategy.pdf
Hussey, P. S., Wertheimer, S., & Mehrotra, A. (2013). The association between health care quality and cost: a systematic review. Annals of internal medicine, 158(1), 27-34.
Malnyk, M. (2016). Improving healthcare quality, patient outcomes, and costs with evidence-based practice. Reflections on Nursing Practice.
The ACA and the U.S. Health Care System
· The Affordable Care Act (ACA) was meant to promote greater quality care through increased implementation of preventive care; but as Lichtenfeld (2011) and Moynihan (2015) have shown, the health care industry remains committed to a course of treatments and tests because both are generally subsidized by the federal government—and, frankly, preventive care does not ensure that customers will keep coming through the door to make the industry money.
· The problem with the ACA has been that it has done little to reduce the putting of profits before people mentality that plagues the health care industry.
· It idealistically identified the right objectives—increasing access to care, increasing quality of care, lowering the cost of care, and increasing preventive care (Obama, 2016).
· However, in practice it failed to ensure that a mechanism was in place to actually enable the achievement of…
In addition the effect of bill has changed the documentation awarded through the state as of a certificate toward a license and authorizes a doctor to pass on duties to a PA with the purpose of managing physician's scope of performance however Another effect of bill has enabled Indiana's doctor assistants to widen their area of the health care services and also provided an innovative average of patient care (Stephanie, Matlock (27 April, 2007). Health care bills gives right to patient to know what health care should be known by the plan as well as several limits on care, kinds of health care be not enclosed, any treatment diagram required to endorse in advance. Yearly planning about on disburse to physician and health providers, file a complaint regarding any, disagreement between patient and the plan, and also procedure to make complaint, allowance to access emergency room twenty four hours a…
American-Speech Language Hearing Association. (2007) Characteristics of Licensure Law. Retrieved on November 29, 2007 from www.asha.org
New York State. (April 2007) Managed Care Bill of Rights. Retrieved on November 29, 2007 from www.health.state.ny.us
Federal Trade Commission. (October 21, 2002) FTC staff opposes Ohio Bill to Allow Physician Collective Bargaining. Retrieved on November 29, 2007 at http://www.ftc.gov/opa/2002/10/physicians.shtm
Girardin, Pierre. Internet Health Services: A Case Study. Retrieved on November 29, 2007 from https://www.isoc.org/inet96/proceedings/h5/h5_2.htm
Care work or social work akin with any other human endeavor has a host of different perspectives that are used either in unison or in combination to direct it.
Its dominant perspectives are the following:
This is the view that all systems interact and that when, for instance, one works with a patient one needs to involve the family and community too and take all of the patient "s life into consideration for each impacts the other. The whole works as a holistic whole and, for instance, the child's school can effect the child as much as the child can the teacher and so forth. ystems have interrelated parts, and tend towards equilibrium.
Care workers use this system in a practical way by forging networks between the different ecosystems (for instance between child's school, community, and family) and by drawing ecomaps and genograms for understanding the dynamics of…
OVERVIEW OF THEORIES OF HUMAN BEHAVIOR & THE SOCIAL ENVIRONMENT
Another example of pure job costing is web development, where the processes themselves vary hugely from project to project, meaning the cost and time involved also varies.
Dosch & Wilson (2010) do seem to do a good job of defining job and process costing, and the person who posted this seems to have understood these definitions fairly well in the abstract -- that is, the definitions provided seem reasonable and the application of these definitions to businesses chosen by the poster are explained in a way that clearly links them to these definition. At the same, the poster seems to have had some trouble accurately identifying companies where job costing might be employed, despite grasping the abstract technicalities of the definition of job costing. While it is likely that an individual laborer might be able to identify that they worked on a particular section of an airplane or wall…
Chan, Y. (1993). Improving hospital cost accounting with activity-based costing. Health care management review 18(1).
Dosch, J., & Wilson, J. (2010). Process Costing and Management Accounting in Today's
Business Environment. Strategic Finance, 92(2), 37-43. Retrieved from EBSCOhost.
"Studies of the relationship between managed care penetration in the health care market and expenditures for Medicare fee-for-service enrollees have demonstrated the existence of these types of spill over effects" (Bundorf et al., 2004).
Managed care organizations generate these types of spillover effects by increasing competition in the health care market, altering the arrangement of the health care delivery system, and altering physician practice patterns. Studies have found that higher levels of managed care infiltration are linked with lower rates of hospital cost inflation and lower physician fees are consistent with competitive effects. "Other studies demonstrate the impact of managed care on delivery system structure including hospital capacity, hospital admission patterns, the size and composition of the physician workforce and the adoption and use of medical equipment and technologies. More recent evidence has linked market-level managed care activity to the process, but not the outcomes of care" (Bundorf et al.,…
Altman, D.E. And L. Levin. (2005). The Sad History of Health Care Cost Containment as
Told by One Client. Health Affairs, 24(1).
Bodenheimer, T. (2005). High and rising health care costs. part 1: Seeking an explanation.
Annals of Internal Medicine, 142(10), 847-54.
Health Care Reform
FDR's New Deal and Lyndon Johnson's Great Society were early attempts for the United States government to play a broader role in creating more extensive social policies. More recently, when a recession pushed inflation to an all-time high, Ronald Reagan led a popular political campaign in which he pronounced that the federal government should have a smaller role in American society. He believed that socialism was an evil worth fighting. This sentiment undoubtedly caused the Clinton Presidency to fail when trying to enact a series of measures to reform Health Care. The debate has regained momentum with Obama who has enacted a health care reform bill known as the Affordable Care Act. Republicans who been vocal critics of the bill and have vowed to overturn in before its inception. This paper will introduce some of the economic mechanics that are responsible for fueling the debate.
The final legislation should have incorporated provisions to boost the IVD industry. On its entirety, the Patient Protection and Affordable Care Act must have benefited the IVD industry. This would have increased sales in a span of five years that it is otherwise seen in the absence of the law. Most significant IVD sales drivers will result from the legislation as an expansion of in the number of insured citizens and new coverage of prevention and wellness programs. If various key provisions are included in the PPACA, coupled with the population demographics, IVD product sales will be stimulated. This industry will die or live based on the number of the test procedures and hence increase in the number of persons with healthcare coverage will be appropriate for IVD. The Patient Protection and Affordable Care Act is a sophisticated legislature, virtually affecting all aspects of healthcare and the majority…
Law, J. (2009). Big pharma: How the world's biggest drug companies control illness. London: Constable.
Parks, D. (2012). Health care reform simplified: What professionals in medicine, government, insurance, and business need to know. United States: Apress.
Ross, B.M.C., & Ross, B.M.C. (2013). Beating Obamacare: Your handbook for surviving the new health care law. Washington, D.C: Regnery Pub.
Schweitzer, S.O. (2007). Pharmaceutical economics and policy. New York [u.a.: Oxford Univ. Press.
Social, Cultural, And Political Influence in Healthcare Delivery
Social, cultural, and political inequalities are detrimental to the health and healthcare system of the U.S. This is because the U.S. is one of the most multicultural, overpopulated, diverse and undergoing rapid economic growth. The federal government has embarked on efforts geared at addressing unsustainable costs of health care in the U.S. With the leadership of the current president, Barrack Obama, initiatives of containing health care costs will evaluate and explore strategies to contain the growing costs of health care based on a system-wide while enhancing the value and quality of health care (Ubokudom, 2012). The apparent system of health care is rife with opportunities of minimizing waste, delivering coordinated, effective care, and improving well-being and health of all Americans. The government in collaboration with care providers must prioritize cost effective containment strategies with the greatest possibility for political success and non-partisan…
Albrecht, G.L., Fitzpatrick, R., & Scrimshaw, S. (2013). Handbook of social studies in health and medicine. London: Sage Publications.
Armstrong, E.G. (2011). The health care dilemma: A comparison of health care systems in three European countries and the U.S. Singapore: World Scientific.
Bale, J.R., Stoll, B.J., & Lucas, A.O. (2013). Improving birth outcomes: Meeting the challenge in the developing world. Washington, DC: National academies press.
Buseh, A.G. (2008). Empowering resilience: Improving health care delivery in war-impacted African countries: a case study of Liberia. Lanham, Md: University Press of America.
experienced a significant increase in the cost of health care. In 2004, 16% of the Gross Domestic Product (GDP) was spent on health care. In 2010, President Obama signed the "Affordable Health Care for America Act (HR 3962)" that has been a topic of heated debate since discussions began decades ago. Health care funding and design has been a major issue for U..
Provide a discussion that demonstrates you have an understanding of the impact the cost of health care has on the economy. Be sure to discuss the Gross Domestic Product (GDP).
According to Forbes (2012), America does not have a debt problem; it has a healthcare one. The price of health care is eating up the economy.
Health care spending is growing to almost 1.5 times the rate of growth of its gross domestic product (i.e. The market value of all its goods and services within a certain…
Forbes. (2012)The U.S. Does Not Have A Debt Problem ... It Has A Health Care Cost Problem http://www.forbes.com/sites/toddhixon/2012/02/09/the-u-s-does-not-have-a-debt-problem-it-has-a-health-care-cost-problem/
Focus on Health Reform
Joan & Bartlett, (2012) A Distinctive System of Health Care Delivery www.jblearning.com/samples/076374512X/Shi4e_CH01.pdf
Healthcare and Economics:
Health care costs have continued to increase in the past few decades despite of the numerous health reform initiatives. Currently, these expenditures account for more than 18% of GDP in the United States, a percentage that is expected to continue rising significantly. Actually, it's projected that the share will rise to 34% of GDP by 2040 if health care costs continue to increase at historical rates. The increased health care costs have considerable impacts on households, insurance companies, and government budgets. For instance, households with employer-financed health insurance will have a progressively minimal portion of their total compensation in the form of take-home pay. On the other hand, a progressively larger fraction of compensation will be in the form of employer-provided health insurance. Governments will be forced to cater for more than 50% of health care expenditures if they continue to increase at historical rates. Therefore, the…
Harrington, L. (2011, May). Career Scope: Balancing Quality and Costs During Economic
Downturns. Nursing Management, 42(5), 46-48. Retrieved from http://www.nursingcenter.com/lnc/JournalArticle?Article_ID=1163319&Journal_ID=54013&Issue_ID=1163211
Philipson, T. (2013, October 31). Obamacare or Not, Healthcare Costs are Set to Soar. Forbes.
Retrieved December 3, 2013, from http://www.forbes.com/sites/tomasphilipson/2013/10/31/obamacare-or-not-healthcare-costs-are-set-to-soar/
overwhelming connections between healthcare costs and the macroeconomic performance of the U.S. economy. The impact of healthcare industry on the macroeconomic performance is evident from the fact that in 2009 healthcare expenditure of the U.S. was 18% of the gross domestic product (GDP) of the country. It was also estimated that should the healthcare costs continue to grow at historical rates, 34% of the U.S. GDP will compose of healthcare spending by 2040 (Whitehouse, 2009). The major sources of funding the healthcare costs are the Federal, State, and local governments of the U.S. Medicare is a healthcare program that subsidizes healthcare for citizens above 65 years of age. Medicaid subsidizes healthcare delivery for people below a certain income level. Approximately 50% of the healthcare expenditure is bore by governments at the federal, state and local level. It is also estimated that Medicare and Medicaid spending of Federal and State governments…
CMS. (2013, Nov). National Health Expenditure Projections 2012-2022. Centers for Medicare & Medicaid Services. Retrieved from: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsProjected.html
Kolstad, J.T., & Kowalski, A.E. (2012). Mandate-based health reform and the labor market: Evidence from the Massachusetts reform (No. w17933). National Bureau of Economic Research.
The Whitehouse. (2009). Deficit-Reducing Health Care Reform. The Whitehouse. Retrieved from: http://www.whitehouse.gov/economy/reform/deficit-reducing-health-care-reform
CBO. (2011, March). The Economic Case for the Health Care Reform. Congressional Budget Office: Executive Office of the President Council of Economic Advisers. Retrieved from: http://www.cbo.gov/publication/22077
National Health Care Spending in the United States
For several years now, health care spending in the U.S. has been on the rise. In that regard, containing the situation has become a major headache not only for the government but also for consumers and employees looking for ways of keeping up with raising costs. In this text, I explain my position on the national health care spending in the U.S. In so doing, I will review the current health care expenditures at the national level and whether the same can be said to be sufficient or insufficient. Further, I will also make recommendations on where in my own opinion additions or cuts seem necessary. Next, I will discuss how the health care needs of the public are paid for. This paper will also provide a forecast of the various health care system needs going forward and why it is necessary…
Chantrill, C. (2011). U.S. Healthcare Spending. Retrieved September 22, 2011, from http://www.usgovernmentspending.com/us_health_care_spending_10.html
Healey, B.J. & Lesneski, C.D. (2011). Transforming Public Health Practice: Leadership and Management Essentials. John Willey and Sons.
The Tax Foundation (2010). Net Cuts to Medicare, Increased Medicare Tax on High-Income Earners Comprise Bulk of Funding. Retrieved from http://www.taxfoundation.org/research/show/26067.html
U.S. Health Care Reforms
Objectives of reform of the health care system should align to improve quality, access and cost in health care. The intricacy of the health care system necessitates balancing the three variables while considering the individual's viewpoint. To achieve this equilibrium, health care programs ought to satisfy safety, actuarial and economic principles that should be under proper application and management for successful reforms. Evidently, there exist various problems within the system. These include poor price controls, over-insurance, lack of transparencies in health care cost and delivery, inappropriate actuarial risk classifications and improper safety net structures. This explication highlights health care reform principles and discusses incremental solutions for quandaries in the American health care system.
Health care reforms ought to strive to encourage the fundamental economic principle of demand and supply. Over-insurance, increase of mandated benefits, control of prices, increased malpractice costs and dependence on third…
Evolution of Health Care Information Systems
The objective of this study is to compare and contrast a contemporary healthcare facility or physician's office health care facility or physician's office operation of 20 years ago and to identify at least two major events and technological advantages that influenced current HCIS practices. The physician's office and health care facility of 20 years ago was a paper-based operation. All records were paper records, appointments were written on calendars and prescriptions were handwritten, notations on the patient's health records was done by writing on the physical paper record and all hospital orders were written by hand. During the 1970s hospital growth and expansion occurred and the expenditures for Medicare and Medicaid were on the rise. At this time mainframes were still in use and microcomputers became available and not only were they smaller but they were also less expensive. However, transformation did not come…
Costs and Benefits of Health Information Technology (nd) Evidence Report/Technology Assessment Number 132. Southern California Evidence-based Practice Center, Santa Monica, CA. Retrieved from: http://www.ahrq.gov/research/findings/evidence-based-reports/hitsys-evidence-report.pdf
Friedman, S. (nd) Facts About Health Care Information Systems. eHow Retrieved from: http://www.ehow.com/about_6117257_health-care-information-systems.html
History and Evolution of Health Care Information Systems (nd) Chapter 4. Retrieved from: http://www.slideserve.com/paul/history-and-evolution-of-health-care-information-systems
Forces of Healthcare
Numerous forces have changed the way healthcare has developed. Rising healthcare costs, service fragmentation, variable access and quality, poor health, high costs for disadvantaged, social and political conflict, infections, chronic diseases, and emotional and behavioral aspects have all been forces in the development of healthcare in the U.S. (Cunningham, 2003). Consumer awareness, high costs of insurance as well as health services, and chronic illness have been major contributors to the way healthcare has developed over time.
Consumer awareness has raised questions to the service quality of healthcare, more especially compared to the rising costs of the services. As a result, healthcare institutions are being challenged with the way healthcare services get delivered to the patient. Consumers are now more aware of healthcare standards and the way illness should be treated, which challenges the healthcare system in the way that service is delivered in treatment settings. This includes…
Cunningham, W. (2003). The Development of the U.S. Healthcare System and It's Problems. Retrieved from UCLA Schools of Medicine/Public Health: http://www.ph.ucla.edu/hs/hs_100_4_02_lecture_cunningham.pdf
Singh, J. (2013). Importance of technology in hospitals. Retrieved from Importanceoftech.com: ttp://importanceoftech.com/importance-of-technology-in-hospitals
Flows in Health Care
Since the government had started the practice of handing over major departments to private sector like health care and education, these areas are now more focused on employing techniques that can draw major profit flow. On examining the three crucial aspects of profit earning such as the number of patients, quality of staff and management, we come to a conclusion that all three areas go side by side and need to be checked upon regularly (Michael, 2006 ).
The numbers of patients are important, to a hospital; patients are the customers who are taking advantage of the health care services provided by that respective hospital. Another item that is associated to the number of patients is the type of patients coming in which is directly associated with the services that a hospital is providing at that particular time. In order to earn more profit in this…
Del. Donna M., Christensen M.D. (Oct 2003). Women on the Cutting Edge of Health Care and Research. Ebony, 82.
Funtleyder, L. (2008). Healthcare Investing: Profiting from the New World of Pharma, Biotech, and Health Care Services. McGraw-Hill Professional.
Harry A. Sultz, Kristina M. Young. (2010). Health Care USA. New York: Jones & Bartlett Learning.
Leiyu Shi, Douglas A. Singh. (2011). Delivering Health Care in America. Jones & Bartlett Publishers.
health care profession is undergoing fundamental change due in part to new laws and regulations. These laws and regulations, although well intended may result in unintended consequences for the nursing profession overall. In the future, the role of a nurse will be fundamentally altered. For one, regulation such as the Affordable Care Act will result in an entire population of insured patients needing care. As such, the role of a nurse will ultimately be predicated on a more individualized basis with specialization in certain aspects. Caring for diabetes is no different in this regard. The public is particularly prone to diabetes primarily due to dietary and lifestyle considerations. As such, the topic of proper care and prevention of this issue is paramount to community health. The population at risk, due in part to regulation, is now society as a whole. This presents interesting challenges and opportunities for the overall health…
1) Mahan LK, Escott-Stump S (2000). Krause's Food, Nutrition & Diet Therapy. 10th Ed., WB Saunders Co. Philadelphia; Reuters (2010)
2) Polonsky, K.S. (2012). "The Past 200 Years in Diabetes." New England Journal of Medicine 367 (14): 1332 -- 1340
3) Stewart WF, Ricci JA, Chee E, Hirsch AG, Brandenburg NA (June 2007). "Lost productive time and costs due to diabetes and diabetic neuropathic pain in the U.S. workforce." J. Occup. Environ. Med. 49 (6): 672 -- 9
On the contrary, a comprehensive medical care solution that tackles the main issues driving up health care costs in America is possible. The main problem experienced by the average American is that health insurance premiums are cost prohibitive for the middle-class, but being uninsured can bankrupt a family forced to deal with even a minor catastrophic illness. Therefore, a national health insurance program has to be part of the solution. However, one cannot overlook the role that unpaid medical bills and exorbitant malpractice premiums also play in the modern healthcare crises. As a result, the solution must include a way to reduce malpractice premiums through tort reform, and a way to reduce the percentage of medical bills that go unpaid. The proposed three-prong approach would tackle all of those issues, without forcing any unwilling person to participate in a nationalized healthcare program.
American Tort Reform Association. "Medical Liability…
American Tort Reform Association. "Medical Liability Reform." ATRA Issues. 2007.
American Tort Reform Association. 6 Nov. 2008 http://www.atra.org/show/7338.
Kershaw-Staley, Tracy. "Miami Valley Hospital Files Lawsuit Over Unpaid Medical Bills."
Dayton Business Journal. 2008. Dayton Business Journal. 6 Nov. 2008 http://dayton.bizjournals.com/dayton/stories/2008/01/07/story5.html .
The subject of healthcare reform set the country ablaze last year, proving to be one of the most contentious issues that has swept through American political discourse in recent decades. One reason that healthcare reform might have proven to be such a contentious issue -- bringing out the worst and shrillest elements of the American public -- was that healthcare is one of the most important issues in the lives of many and even most Americans (Christensen and Jason, 2009).
All of us will face serious illness at some point in our lives, whether our own or that of a loved one. The fact that so many Americans do not have any healthcare at all or have very limited access to healthcare makes the issue a personal one, and this alone should have made it central to the public discourse. However, while the above was no doubt the…
Christensen, Clayton and Jason, Grossman. The Innovator's Prescription, New York: McGraw Hill, 2009.
Mahar, Maggie. Money-Driven Medicine: The Real Reason Health Care Costs So Much. New York:Harper/Collins, 2006.
Reid, T.R. The Healing of America: A Global Quest for Better, Cheaper and Fairer Health Care. New York: Penquin Books, 2009.
Second Opinions for Tough & Smart Care
FLA, FECA, H2457
The federal government (under most current administrations) has tried to address the issue of the nation's need for better healthcare by focusing on improving what is already in place. Two of the regular efforts at this are the FLA (Family Leave Act) and the FECA, or Federal Employees' Compensation Act (DOL, b). The purpose of the first is to provide structured and economically efficient ways for people to be able to leave their positions, without risking their jobs, when they are dealing with either the birth of a child or a critically sick immediate relative. It is also seen as one effort to seek to protect men and women against the problems of gender injustice that can come about if women are challenged in keeping healthcare because of the choice to have children. FECA, on the other hand, seeks to…
DOL.gov. The Family and Medical Leave Act. United States Department of Labor, Wage and Hour Division. Department of Labor. Web < http://www.dol.gov./whd/regs/compliance/1421.htm >.
DOL.gov (b). The Federal Employees' Compensation Act. United States Department of Labor. Web. < http://www.dol.gov/compliance/laws/comp-feca.htm >.
GovTrack.us. H.R. 2457 (111th): Right to a Second Medical Opinion Act of 2009. < http://www.govtrack.us/congress/bills/111/hr2457 >.
R. Kuttner. Market-Based Failure -- A Second Opinion on U.S. Health Care Costs. New England Journal of Medicine, 2008; 358:549-551.
Healthcare Economics Evaluation
This report is about a proposed healthcare economics investigation. Some early research has been done and will be described based on what was found and how it was found. The report will conclude with a proposed plan for further economic evaluation on that same topic with a great deal the expected and proper form and function of that research to be described in that section. A conclusion will wrap up the report.
Critical Appraisal of the Evidence
The author of this report has chosen how to make health care affordable and have the most amount of people possible covered in the United States as this is one of the more omnipresent issues and matters in American society in the modern time. Health care being at the forefront of the American news cycle is nothing new as it is has been a huge part of the…
Berkowitz, E. (2008). Medicare and Medicaid: The Past as Prologue. Health Care Financing Review, 29(3), 80-93.
Bovbjerg, R.R., & Schoenbaum, S.C. (2004). Malpractice Reform Must Include Steps To Prevent Medical Injury. Annals Of Internal Medicine, 140(1), 51-54.
Budget problems, Medicaid expansion main topics at SAMHSA meeting. (2012). Alcoholism & Drug Abuse Weekly, 24(32), 1-3.
CDC. (2013, March 19). CDC Online Newsroom - Press Release: October 17, 2011. Centers for Disease Control and Prevention. Retrieved March 19, 2013, from http://www.cdc.gov/media/releases/2011/p1017_alcohol_consumption.html
Healthcare Delivery System Challenges
The American healthcare system has been criticized as favoring the middle and upper classes while ignoring the lower classes. Based on these speculations, the federal government has constantly tried to institute reforms in the healthcare sector though some of the proposals have failed to overhaul the industry. With rising insurance costs, the number of citizens barred from accessing quality healthcare has increased to more than 45 million uninsured Americans. On the same note, it is hypothesized that with time, the problems currently witnessed in the industry are likely to increase and finding solutions to them will be a tall order for the government (Stolberg & Pear, 2010). Despite the advent of new technology in the sector, which is likely to improve service delivery over the years, it is speculated that the cost of new tests and treatments will outweigh the savings. With the better technology, physicians…
Stolberg, S.G. & Pear, R. (March 24, 2010). Obama signs health care overhaul bill, with a flourish. The New York Times: p. A19. Retrieved March 1, 2013.
Woolhandler, S. & Himmelstein, D.U. (1997). Costs of care and administration at for-profit and other hospitals in the United States. The New England Journal of Medicine 336 (11): 769-774.
Swanson, E. (July 30, 2009). Health Care Plan: Favor / Oppose. Huffington Post.
Blumberg, L.J. & Holahan, J. (2009). The Individual Mandate: an Affordable and Fair Approach
U.S. & Norway Healthcare Systems
healthcare system has many advantages and disadvantages which are most revealing when compared to the other health care systems of the world. An analysis between the U.S. healthcare system and a government run healthcare system of Norway provides a deeper understanding of the similarities and differences in the two systems.
Almost every other developed nation in the world has some form of universal coverage which reduces this disparity in care. However, many of these systems are purportedly ridden with their own issues such as high cost and long waiting times. By comparing the U.S. system with the universal system like that of Norway, I can investigate the effectiveness of each in terms of the quality of care provided and the equality of distribution of that care.
A Comparison and Analysis of Healthcare Systems in the United States and Norway
A. United States
The healthcare system…
Goldman, Dana P. And Elizabeth A. McGlynn. (2005). U.S. Healthcare Facts About Cost, Access and Quality [Online]. Retrieved from http://www.rand.org/pubs/corporate_pubs/2005/RAND_CP484.1.pdf
Johnsen, Jan Roth. (2006). Health Systems in Transition: Norway. Retrieved from http://www.euro.who.int/__data/assets/pdf_file/0005/95144/E88821.pdf
Tanner, Michael D. (March, 18, 2008). Policy Analysis: The Grass is Not Always Greener: A Look at National Health Care Systems Around the World (policy number 613). Retrieved from http://lib.trinity.edu/research/citing/APAelectronicsources.pdf
The University of Maine. (2001). The U.S. Health Care System: Best in the World, or Just the Most Expensive? [Online]. Retrieved from http://dll.umaine.edu/ble/U.S.%20HCweb.pdf
Healthcare spending by the New York State persistently surpasses its earnings. That difference continues to be expanding and is also anticipated to broaden unless of course there happen to be severe, continuous modifications in spending budget actions. Lieutenant Governor ichard avitch, in "A 5-Year Strategy to Deal with the State of New York's Spending budget Deficit" released during March 2010, approximated this structural disproportion within the state's spending budget to become no less than $13 billion. The structural inequality isn't simply the consequence of the economic downturn that started during 2007, and a commonly strengthening economic climate is not going to get rid of it.
To help the State of New York in providing the solutions and dedication to quality that its residents rely on, structural modifications are needed. The aim of this paper is actually to summarize one particular realignment - solving an outright inequity involving the state as…
California Public Employees' Retirement System, "Facts at a Glance: Health," September 2010, http://www.calpers.ca.gov/eip-docs/about/facts/health.pdf .
Citizens Budget Commission, Out of Balance: A Comparison of Public and Private Employee Health Benefits in New York City, December 2009, http://www.cbcny.org/sites/default/files/REPORT_Survey_12162009.pdf .
City of New York Office of Labor Relations, "New York City Summary Program Description, Health Benefit Program," 2010, http://www.nyc.gov/html/olr/downloads/pdf/healthb/full_spd.pdf.
Government Finance Officers Association, "Recommended Practices, Health Care Cost Containment 2004," http://www.gfoa.org/downloads/corbaHealthCareCostContainment.pdf .
Transitional Care of Older Adults Hospitalized with Heart Failure Experiment
Naylor, M.D., Brooten, D., Campbell, R.L., Maislan, G.,, McCauley, K.M. Schuartz, J. Transitional Care of Older Adults Hospitalized with Heart Failure: A Randomized Trial.
This article has an interesting approach to summarizing the experiment that was conducted. Instead of a formal abstract, the article instead summarizes the design and outline in several sections. These sections include objectives, design, setting, participants, intervention, measurements, results, and conclusions. The sections that are listed replace the standard format for an abstract that condenses the design and the findings into one formal section. Personally, I prefer the organization of this format better as it more clearly illustrates all of the factors in the research in a clear and easily identifiable format.
Analysis of the Introduction
The authors of this research do state the problem that they are researching in a clear and coherent manner. The…
Economics of Healthcare
The Economics of Health Care
The healthcare in the United States is a system of economics that has been referred to as a Ponzi scheme and most assuredly, the economics of the U.S. healthcare system are unsound at best. The United States is the only industrialized nation in the world that fails to provide universal access to basic health care and according to the work of Kilchevsky (2004), 'the absence of universal health coverage has been called 'one of the great unsolved problems facing the United States at the onset of the 21st century." (p.1) This work intends to examine the economics of health care in the United States.
Department of Health and Human Services (HHS) reports that national health expenditures for 2009 totaled $2.5 trillion, which is stated to be $58,086 per person. (erdine, 2011, p.1) The estimated total for health expenditures in 2008…
Berdine, Gilbert G. (2011) The Economics of U.S. Healthcare. Luwig von Mises Institute. 8 Aug 2011. Retrieved from: http://mises.org/daily/5496/
Boyapeti, Vijay (2010) What's Really Wrong with the Healthcare Industry? Ludwig von Mises Institute. 26 May 2010. Retrieved from: http://mises.org/daily/4434/
Kilchevsky, Amichai D. (2004) Universal Coverage: A Bridge Too Far? Economics. About.com. Retrieved from: http://economics.about.com/cs/moffattentries/a/universal.htm
Access to Healthcare:
For the last two decades, access to healthcare is an issue that has played a crucial role in leading the charge for health care reforms. Access to quality and comprehensive health care services is a crucial aspect for the realization of health equity and for enhancing the quality of health for every individual. Generally, the access to these services means the timely use of individual health services in order to accomplish the best health outcomes ("Access to Health Services," 2012). The achievement of the best health outcomes to access to personal health services requires three major steps i.e. gaining entry into the health care system, identifying a trustworthy health care provider, and accessing the services where they are needed.
Components of Access to Healthcare:
Access to personal health care services incorporates four major components i.e. coverage, workforce, timeliness, and services. Health care coverage is mainly provided through…
"Access to Affordable Healthcare." (2012, November 12). American College of Healthcare
Executives. Retrieved April 4, 2013, from http://www.ache.org/policy/access.cfm
"Access to Health Care." (n.d.). The Everett Clinic. Retrieved April 4, 2013, from http://www.everettclinic.com/About_Us/Legislative_Advocacy/Current_Health_Issues/Access%20to%20Health%20Care.ashx
"Access to Health Services." (2012). HealthyPeople.gov. Retrieved from the U.S. Department of Health and Human Services website: http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=1
Ethical Analysis of Healthcare Rationing
The topic of health care rationing has been the subject of debate in the U.S. The last few years as government expenditures on health care have far exceeded budgeted levels. Central to the concern is the ethical issue over whether it is better if fewer Americans profit with a greater amount of health resource allocation or if the majority benefit to a lesser degree for an equity in health care benefits. In the essay, "We've Got To Ration Health Care," (author unknown) the position is taken that America would fare better to follow the course of health care action seen in other western countries, where it is considered better to ration medical procedures to the extent that a system provides "the highest possible level of basic health care that can be delivered to all the people." With the growing concern over health care rationing, and…
Cook, D & M. Giacomini. 1999. "The Sound of Silence: Rationing Resources for Critically Ill
Patients." Critical Care. 3: R1-R3.
Devettere, RJ. 1993, Feb. "Clinical Ethics and Happiness." Journal of Medical Philosophy.
Devettere, RJ. 2000. Practical Decision Making in Health Care Ethics: Cases and Concepts, 2nd ed. Washington, DC: Georgetown University Press.
Beard, C., Weisberg, .B., & Primack, J. (2012). Socially anxious primary care patients' attitudes toward cognitive bias modification (CBM): a qualitative study. Behavioural and cognitive psychotherapy, 40(05), 618-633.
This study shows how traditional methods of approaching patients with information can cause confusion and thus create barriers to accessing patient knowledge in primary care settings. The study focused on working with primary care patients suffering from anxiety and how they reacted to cognitive bias modification (CBM) for that anxiety. Upon initial discussion of the treatment, most participants showed that they understood. However, it was clear by the end of the treatment that the program was not clarified enough to patients prior to treatment and that created a knowledge barrier that caused the treatment not to work as successfully as previously tested. Better methods for communicating the treatment within the primary care setting must be developed to bring down these…
Beard, C., Weisberg, R.B., & Primack, J. (2012). Socially anxious primary care patients' attitudes toward cognitive bias modification (CBM): a qualitative study. Behavioural and cognitive psychotherapy, 40(05), 618-633.
Beckman, H.B., Wendland, M., Mooney, C., Krasner, M.S., Quill, T.E., Suchman, A.L., & Epstein, R.M. (2012). The impact of a program in mindful communication on primary care physicians. Academic Medicine, 87(6), 815-819.
Cheung, P.T., Wiler, J.L., Lowe, R.A., & Ginde, A.A. (2012). National study of barriers to timely primary care and emergency department utilization among Medicaid beneficiaries. Annals of emergency medicine, 60(1), 4-10.
Crabtree, B.F., Nutting, P.A., Miller, W.L., McDaniel, R.R., Stange, K.C., Jaen, C.R., & Stewart, E. (2011). Primary care practice transformation is hard work: insights from a 15-year developmental program of research. Medical care, 49(Suppl), S28.
Second, poor health in the individual probably detracts from his or her capacity to contribute to society more directly than the harm to productive society represented by the cost of the individual's healthcare.
Furthermore, the vast majority of American healthcare dollars are spent on individuals in their later years, after their productive lives are already over, rather than on working-age people. Finally, while reducing healthcare costs is necessary for the optimal health of the American economy, it probably relates more directly to private economic matters rather than to consuming national resources that could otherwise be dedicated to technological development in a general sense.
Response to Statement #3: As suggested in Response #2, optimum public health is not necessarily a prerequisite for global competitiveness unless by "health" one means healthy enough to reach productive adulthood. On the other hand, the American population is undoubtedly on the verge of an obesity crisis,…
History Of Health Care Mandate
The signing of the Affordable Care Act (ACA) by President Obama must be considered a landmark event in the history of the nation regardless of how one views the constitutionality of the legislation. Passage of the legislation marked the end of a long and acrimonious debate and brought the United States in line with the rest of the developed world in terms of providing universal health coverage to its citizens (Orszag, 2010). Unfortunately, the debate over the constitutionality of the ACA did not end with Obama's signing of the legislation as within days several different states filed suit against the law's requirement that most Americans purchase health; against the health care mandate.
The health care mandate was first offered as an option by the conservative think tank, the Heritage Foundation, as an option to the single-payer system that had been historically supported by Democrats and…
Block, S. (2010, April 29). IRS Lacks Clout to Enforce Mandatory Health Insurance. USA Today, pp. www.usatoday.com/money/perfi/insurance/2010-04-29 healthirs28_CV_N.htm?loc=interstitialskip.
Jost, T.S. (2010). Health Insurance Exchanges and the Affordable Care Act: Eight Difficult Issues. Lexington, VA: Washington and Lee University School of Law.
Orszag, P.R. (2010, August 12). Health Care Reform and Cost Control. New England Journal of Medicine, pp. 601-603.
Ponnuru, R. (2012, March 27). The History of the Individual Mandate. Retrieved from National Review Online: http://www.nationalreview.com/corner/294585/history-individual-mandate-ramesh-ponnuru
Obamacare, or formally known as the Affordable Care Act, is a recent healthcare law that will reach its implementation stage in 2014. Healthcare is certainly a fundamental necessity and indispensable to a growing human population. he United States is known for its adequate healthcare, servicing low income people through Medicaid, and the elderly through Medicare. However, recent events have led to a shift in what can possibly negatively impact the healthcare system for the United States.
Obamacare has good intentions in having its purpose be to supply affordable healthcare to everyone within the United States, but certain clauses and modifications have turned it into a dicey and uncertain situation. Not only are the costs piling up, and continue to increase, but the distribution of healthcare services is primarily execute through health insurance coverage. his means that there will be a change in how the healthcare system functions at the core…
The way that Affordable Care Act works, however, is that plans that would have failed to meet the standards of Bronze plan can no longer be offered. Such plans were often popular with either poor people who could not afford a better plan, or young people who are unlikely to have to make a claim. For such individuals, the increase in their health premiums might be significant, and political opponents of the Act are making every effort to collect anecdotes from such people to use as scare tactics (Radnofsky, 2013). The reality is that most young people were almost always going to have to pay more, which in part explains why it is older people who have signed up for plans on the exchanges (Mangan, 2013).
Are there Risks to the ACA?
There also risks with the Act that could jeopardize the way the system works. John (2013) notes that if not enough people sign up, then insurance companies will make smaller profits. He does note that the signups at higher rates
Despite of the receipt of federal funding to assist in the set-up of an insurance exchange program, the Minnesota legislature is not cooperating with the Governor Drayton's plans to design a program. Instead, in a classic example of partisan politics, the legislature is going forward with its own plans to design an exchange program. In doing so, the legislature is placing the State of Minnesota in a position of possibly losing the grant provided by the federal government. According to the grant provisions, the state must show it can operate an effective exchange program by the end of calendar year 2012 or the federal government under the terms of ACA will impose a one size fits all exchange on the state. Even the state's most conservative political groups oppose this happening and advocate that the state's executive and legislative branches cooperate in formulating an acceptable state exchange program.
Berkel, Jessica Van. "HCMC fights back against Pawlenty's GAMC Cuts." 3 December 2009. Minnesota Daily . http://www.mndaily.com/2009/12/03/hcmc-fights-back-against-pawlenty%E2%80%99s-gmac-cuts . 7 April 2012.
Gray, Virginia. "Incrementing Toward Nowhere: Universal Health Care Coveragein the States." Publius (2010): 82-113.
Harrington, Scott E. "The Health Insurance Reform Debate." The Journal of Risk and Insurance (2010): 5-38.
Minnesota Department of Human Services. "General Assistance Medical Care." 11 September 2011. http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&Redirected=true&dDocName=id_006257 . 7 April 2012.
Then, when you combine this with the fact that Medicaid serves 53 million people with an annual budget of $329 billion, means that rising costs is severely affecting this program. ("Medicaid Reform," 2005) the inflexibility of this program has contributed to problem as a one size fits all approach is taken. Then, when you combine the different state programs offered through Medicaid, means that an uneven standard of inflexibility is used. An illustration of this can be seen by looking no further than the overall focus of Medicaid, where an emphasis is placed on addressing major health issues. This is problematic because like with Medicare, an approach must be taken of dealing with the patient once they are facing major health issues. Then Medicare has to engage in multiple functions to include: comprehensive acute / primary care, long-term care services (for those who qualify), a source of funding for uncompensated…
Medicaid Reform. (2005, June 15). Retrieved March 3, 2010 from National Governors Association website:
President Cuts Medicare, Medicaid to Help Reform Costs. (2009, June 15). Retrieved March 3, 2010 from California Health Line website: http://www.californiahealthline.org/articles/2009/6/15/president-outlines-cuts-to-medicare-medicaid-to-help-cover-reform-costs.aspx
Anderson, L. (2009, July 9). Research Project Finds Medicare Part D Increases Spending on Prescription Drugs.
(Menzel, 1990, p. 3) Fisher, Berwick, & Davis alude to the idea of integration in health care, with providers linking as well as creating networks of electronic medical records and other cost improvement tactics.
The United States and other nations over the last twenty or so years, have begun a sweeping change in health care delivery, regarding the manner in which health information is input, stored and accessed. Computer use in the medical industry has greatly increased over the last thirty years the culmination of this is fully networked electronic medical record keeping. (Berner, Detmer, & Simborg, 2005, p. 3) the electronic medical record trend began in the largest institutions first, as hospitals and large care organizations attempted to reduce waste and improve patient care, while the adoption has been much slower among physician's practices and smaller medical institutions. (Hillestad, et al., 2005, pp. 1103-1104) Prior to this time medical…
Resources, and Utilization
Drug costs have gone from 26% of health care spending by private insurance companies in 1990 to 44% in 2006 (Kaiser Foundation, 2008). This issue has not been adequately addressed by health care reform. Instead, a deal appears to be made for $80 billion in concessions from the pharmaceutical industry in exchange for its support of health care reform (Kirkpatrick, 2009).
The underlying trend in each of these major issues in health care reform is controlling the rising cost. Malpractice reform seeks to control the cost of insurance to health care providers, so that they can pass those savings along to consumers. The public option provides a plan for affordable health care coverage for uninsured and underinsured Americans. This is deemed necessary because private insurers will not offer insurance to those it feels will demand too much in terms of health care costs going forward. Reducing the cost of health…
Carey, Nick. (2009). Uninsured Americans hope reform brings health coverage. Reuters. Retrieved October 7, 2009 from http://www.reuters.com/article/topNews/idUSTRE58F0NO20090916
The White House. (2009). The Obama Plan: Stability and Security for All Americans. Retrieved October 7, 2009 from http://www.whitehouse.gov/assets/documents/obama_plan_card.PDF
New York Times. (2009). Malpractice and Health Care Reform. New York Times. Retrieved October 7, 2009 from http://www.nytimes.com/2009/06/17/opinion/17wed2.html
Kaiser Family Foundation. (2008). Prescription Drug Trends. Kaiser Family Foundation. Retrieved October 7, 2009 fromhttp://www.kff.org/rxdrugs/upload/3057_07.pdf
The bulk of quality improvement measures are working for managed care by providing insight as to what can be done to improve care therefore reduce mortality rates, and maintain a high level of customer satisfaction which in turn helps to build the managed care health business.
Population Health Focus
Population health refers to the physical, social, cultural, and economic environment in which we work and live (adzyminski, 2006)."
This has become a focus of many managed health care organizations as they work to reduce the risks to their local consumers by way of stress, environmental factors and other elements that have a direct impact on the consumer health concerns.
The goal of population health is to maximize the health of any given population. In doing so it contains elements of program development, development/evaluation of health care policy, and program and systems evaluation. It uses an approach that concentrates on…
Jacobson, Peter (1995) Washington State Health Services Act: implementing comprehensive health care reform.(Medicaid and State Health Reform)
Health Care Financing Review
Exton, Lee (2002) Defined contribution health plans: cutting edge? (an Advertising Supplement: Staffing & Employee Benefits).(cost containment strategies for employee health care) Los Angeles Business Journal
Fletcher, Meg (1995) Managed care use rises for workers comp plans.
Stated to be barriers in the current environment and responsible for the reporting that is inadequate in relation to medical errors are:
Lack of a common understanding about errors among health care professionals
Physicians generally think of errors as individual that resulted from patient morbidity or mortality.
Physicians report errors in medical records that have in turn been ignored by researchers.
Interestingly errors in medication occur in almost 1 of every 5 doses provided to patients in hospitals. It was stated by Kaushal, et al., (2001) that "the rate of medication errors per 100 admission was 55 in pediatric inpatients. Using their figure, we estimated that the sensitivity of using a keyword search on explicit error reports to detect medication errors in inpatients is about 0.7%. They also reported the 37.4% of medication errors were caused by wrong dose or frequency, which is not far away from our result of…
Discussion Paper on Adverse Event and Error Reporting In Healthcare: Institute for Safe Medication Practices Jan 24, 2000
Patient Safety/Medical Errors Online at the Premiere Inc. page located at: http://www.premierinc.com/all/safety/resources/patient_safety/downloads/patient_safety_policy_position_2001.doc
Medstat / Shortell, S. Assessing the Impact of Continuous Quality Improvement on Clinical Practice: What It Will Take to Accelerate Progress.
Health Policy Monitor (2001) A Publication of the Council of State Governments Vol. 6, No. 1 Winter/Spring 2001 PO18-0101
Contracts with doctors often contain a clause which doesn't allow the doctors to discuss
Health care 7 with their patients financial incentives to deny treatment or about treatments not covered by the plan (Glazer, 1996). This has caused many consumers, especially those with chronic illnesses, to form organizations with the American Medical Association and physician specialty groups to promote legislation forbidding "gag rules" (Glazer, 1996). One group, Citizen Action, has 3 million members and "has been lobbying in state legislatures for laws that would require plans to disclose how they pay their doctors; give patients the right to choose specialists outside the plan; and provide appeals for patients who get turned down for expensive treatments" (Glazer, 1996).
The doctor-patient relationship is also affected if a patient must switch to a new doctor under managed care. Having a longterm relationship with a primary doctor is important because he or she is…
Bennett Clark, Jane (1996, July). What you should ask your HMO.
Kiplinger's Personal Finance Magazine. pp. 92-93.
Glazer, Sarah (1996, April 12). Managed Care. CQ Researcher, 6,
Koop, C. Everett (1996, Fall). Manage with care. Time. pp. 69.
Health Care Reform Federal Deficit
The American Health Care Crisis and the Federal Deficit
The United States spends more than any other country on medical care. In 2006, U.S. health care spending was $2.1 trillion, or 16% of our gross domestic product. At the same time, more than 45 million Americans lack health insurance and our health outcomes (life expectancy, infant mortality, and mortality amenable to health care) are mediocre compared with other rich democracies. We spend too much for what we get.
Nothing is new about these sobering realities. The Nixon administration first declared a health care cost crisis in 1969. Four decades later, the United States still has not adopted systemwide cost controls because the politics of health care make it extraordinarily difficult to control costs. I explain below why this is so (Marmor, et al., 2009).
The starting point for understanding the politics of cost control is…
1. Eakin, Douglas and Michael Ramlet. (2010) "Health Care Reform is Likely to Widen Budget Deficits -- Not Reduce Them." Health Affairs, 29, no.6:1136-1141. Eakin and Ramlet examine the underpinnings of the Congressional Budget Office's projection that enacting the Patient Protection and Affordable Care Act will decrease deficits, and conclude that it is built on a shaky foundation of omitted costs, premiums shifted from other entitlements, and politically dubious spending cuts and revenue increases. A more comprehensive and realistic projection suggests that the new reform law will raise the deficit by more than $500 billion during the first ten years and by nearly $1.5 trillion in the following decade. This is an excellent article with regards to my article, written by two policy commentators at the forefront of their field. This article shows expertise in medical economics and offers compelling, clear arguments for the increase in the federal deficit due to the massive spending on entitlements as a result of passing the Patient Protection and Affordable Care Act. They project deficits, opposing the Congressional Budget Office, through their insightful analysis.
2. Marmor, Theodore, Jonathan Oberlander, and Joseph White. (2009) "The Obama Administration's Options for Health Care Cost Control: Hope vs. Reality." Ann Intern Med. 150:485-489. Controlling the costs of medical care has long been an elusive goal in U.S. health policy. This article examines the options for health care cost control under the Obama administration. The authors argue that the administration's approach to health reform offers some potential for cost control but also embraces many strategies that are not likely to be successful. Lessons the United States can learn from other countries' experiences in constraining medical care spending are then explored. This article offers evidence for the lack of cost containment in the Obama administrations' plans for health reform. It gives a good analysis of the international scene in health care as well.
3. Collins, Sara, Michelle M. Doty, Karen Davis, Cathy Schoen, Alyssa L. Holmgren, and Alice Ho. (2004) "The Affordability Crisis in Health Care." Commonwealth Fund Biennial Health Insurance Survey. Published in 2004, The Commonwealth Fund Biennial Health Insurance Survey, conducted from September 2003 -- January 2004, presents new and timely information on where the American public stands on solutions to reform the health care system. The survey finds widespread support for federal efforts to extend health insurance to more people, as well as a widely held belief that the financing of health care should continue to be a shared responsibility among individuals, employers, and the government. The survey also uncovered potential reasons for such strong support for health care reform. Among the insured and the uninsured alike, there is concern that health care security in the United States is eroding. People are experiencing reductions in insurance coverage that are threatening their financial security.
4. Etheridge, Lynn (1984) "An Aging Society and the Federal Deficit." The Milbank Memorial Fund Quarterly. Health and Society, 521-543. This article serves as early warning sign of the deficit battles to come. It argues that the conflict between the growing needs of an aging society and a federal budget which cannot afford its current commitments has become one of the nation's most difficult government policy dilemmas. Assistance for the elderly through Social Security, Medicare, and other programs-is already the federal government's largest fiscal responsibility. In 1985 these programs will require nearly half of all domestic program spending an estimated $256 billion. The future costs of these commitments will rise rapidly well into the next century, accounting-with national defense and interest costs-for virtually all of the spending increases in the projected $200 to $300 billion deficits. Etheridge asserts that the decisions about the nation's assistance to the elderly -- and about reaffirmation, reform, and/or retrenchment of these commitments-will thus be central to the coming budget debates.
egistered nurses are both qualified, educated, and certified to provide a high quality of various care services that an individual may need in a home setting or elsewhere. Hence, providing these practitioners with the power to certify and provide home care is a solution to an overwhelming problem that has plagued the health care environment in recent years. Nursing practitioners, as a result of the nature of their work, are closely connected to the needs of individual patients. This means that they, more than many other health care providers and institutions, are able to assess the needs of individuals, their households, and the level of care they require. This places them in a position to accurately determine the need and/or of such individuals to obtain long-term home care and when such home care becomes unviable. As such, registered nurses who serve individuals in the home setting are able to maintain…
AARP Public Policy Institute. (2013). FAQs. Retrieved from: http://assets.aarp.org/rgcenter/ppi/ltc/ltss_faq.pdf
Brassard, A. (2011). Removing Barriers to Advanced Practice Registered Nurse Care: Home Health and Hospice Services. AARP Public Policy Institute. Retrieved from: http://www.aarp.org/content/dam/aarp/research/public_policy_institute/health/removing-barriers-advanced-practice-registered-nurse-home-health-hospice-insight-july-2012-AARP-ppi-health.pdf
Doty, P. (2000, June). Cost-Effectiveness of Home and Community-Based Long-Term Care Services. U.S. Department of health and Human Services. Retrieved from: http://aspe.hhs.gov/daltcp/reports/2000/costeff.htm
Lynch, M., Estes, C., and Hernandez, M. (2007, June). Long-Term Care Policy Option Proposal: Consumer Controlled Chronic, Home, and Community Care for he Elderly and Disabled. Georgetown University Long-Term Care Financing Project: Working Paper No. 4. Retrieved from: http://ltc.georgetown.edu/forum/4lynch061107.pdf
sleeping under a rock the issue of health care in the United States has been on the minds of everyone. In a society where health costs have spiraled, employer sponsored health insurance is rapidly disappearing, and millions are going untreated the overall issue of health care has everyone concerned (ichmond, 2005). Virtually no one is untouched by its reaches.
Over the last several decades the federal government has become increasingly more active in the health care field and now it is being proposed that this involvement may become more extensive as federally funded health insurance is being proposed. This involvement by the national government began during the New Deal when Social Security was originally enacted and has increased gradually ever since (James G. Haughton, 1968). Some of this involvement is obvious such as Medicare and Medicaid but other forms of involvement are less obvious such as research funding and regulatory…
Baranoff, E. (2009). Issues and Global Trends in Social Security. In E. Baranoff, Risk Management for Enterprises and Individual. Irvington, NY: Flat World Knowledge.
Callan, P. (2007). Will Higher Education pass: A test of leadership. Change, 39.
Chan, S. (2010, April 7). Bernanke Says Nation Must Take Action Soon to Shape Fiscal Future. New York Times, p. B3.
Congressional Budget Office. (2006). Immigration Policy in the United States. Washington D.C.: U.S. Government.
At which point, the overall costs of care will be passed on to the tax payer in the form of higher taxes. This leads to a decrease in the overall quality of care and it will not slow the price increases, as the government seeks to restrict access to these services. Then, when the program becomes broken (such as: what is happening to Social Security) removing or reforming the bureaucracy is nearly impossible. (Messerili, 2010)
A second argument that many critics make about universal health care is: it will stifle innovation. Whenever, the government is running any kind of program, they will place a large number of restrictions and regulations on the industry. When this takes place, you are causing some of the best and brightest minds to seek careers in other fields, as the restrictions from the government are too cumbersome. A good example of this would be: the…
Trends in Health Care Costs and Spending. (2006). Retrieved March 13, 2010 from Kaiser Foundation website:
Andersen, R. (2007). Changing the U.S. Health Care System. Washington D.C: National Academy Press.
Gratzer, D. (2002). Better Medicine. Toronto, on: ECW Press.
Where, it will reduce the total amount by $138 billion in ten-year. This is despite, the fact that $950 billion is going to be spent implementing such changes. What this shows, is that when implementing the strengths of the French system with that of the American system, you can have high quality health care services and maintain costs.
Health Care ill to Cut Deficit. (2010, March 18). Retrieved April 12, 2010 from Reuters website:
Tired of Waiting for Your Doctor. (2006, November 20). Retrieved April 12, 2010 from MSNC website:
Dutton, P. (2007, August 11). France's Model Health Care System. Retrieved April 12, 2010 from oston.com
Foley, T. (2009, March 8). 5 Questions about French Health Care. Retrieved April 12, 2009 from Change.org website: http://healthcare.change.org/blog/view/5_questions_about_french_health_care
Foy, A. (2009, September 10). Give Me Liberty or Give Me Health Care. Retrieved April 12, 2010 from American…
Health Care Bill to Cut Deficit. (2010, March 18). Retrieved April 12, 2010 from Reuters website:
Tired of Waiting for Your Doctor. (2006, November 20). Retrieved April 12, 2010 from MSNBC website:
Not only do these practices discourage preventative care and monitoring, they also diminish the quality of the good that insured individuals are buying from the health insurance companies. Insured individuals are paying for insurance and paying for most of their healthcare costs in addition because of the exorbitant deductibles. PPACA's prohibition of these practices ultimately forces health care companies to raise the bar and give health insurance customers more value for money.
Public-Private Partnerships Prevent ureaucratization of Health Care
There are widespread misconceptions that the PPACA will provide health insurance through some government-run bureaucracy. Actually, PPACA is built on close cooperation between health insurance companies and the government. Under PPACA, the government does not operate hospitals nor does it provide medical insurance to individuals. Actually, it requires individuals to carry some form of private health insurance or suffer a penalty. The only time the government becomes involved is when an…
Patient Protection and Affordable Care Act. Public Law 111 -- 148. Available at http://www.gpo.gov/fdsys/pkg/PLAW-111publ148/pdf/PLAW-111publ148.pdf
Patient Protection and Affordable Care Act - Summary. http://thomas.loc.gov/cgi-bin/bdquery/z-d111:HR03590:@@@L&summ2=m&summary
"An Analysis of Health Insurance Premiums Under the Patient Protection and Affordable Care Act,
Letter to the Honorable Evan Bayh." Congressional Budget Office. Douglas W. Elmendorf. November 18, 2009. Available at http://cbo.gov/ftpdocs/107xx/doc10781/11-30-Premiums.pdf .
ased on the information currently available, the Canadian health care system is the more utilitarian and is, therefore, the better approach but those facing the need for advanced and expedient care would certainly argue otherwise. Therein lies the problem and therein lies the challenge for American society. Even the most ardent proponents of employer-based insurance plans would dare not argue that having great numbers of uninsured is the price that American society pays for having high-quality services but that is what has developed. Hopefully, a system can be devised that allows for more broad-based coverage while retaining the availability of quality care.
The United States health care system cannot continue as it has for the past several years. Costs are far too high and are escalating at a rate that is out of control. Relying on employer-based insurance plans must be abandoned and some form of public financing…
American Medical Association. (2010). Physician Characteristics and Distribution in the U.S. Chicago: AMA Press.
Boychuk, T. (1999). The Making and Meaning of Hospital Policy in the United States and Canada. Ann Arbor: University of Michigan Press.
Center on Budget and Policy Priorities. (2006, August 29). The Number of Uninsured Americans Is at an All-time High. Retrieved April 30, 2011, from Center on Budget and Policy Priorities: http://www.cbpp.org/cms/?fa=view&id=628
Eve, S.B. (1995). The Canadian Health Care System. Lanham, MD: University Press of America.
Maybe for some things are well enough, but for most Americans they are far from it. Most Americans spend their days worrying about being just one layoff away from joining the 50 million other men, women and children in the ranks of the uninsured. The average household income in this country is just about $50,000. This means that most people are not in a position to pay a fourth of their family's annual income, before taxes, just to cover health insurance premiums. More and more people face paying thousands more of our hard earned dollars in out-of-pocket expenses before the coverage we pay so dearly for actually kicks in (ichard, 2009).
In the past many Americans who have been enrolled in employer-sponsored health insurance plans have been able to rely on their employers to pay the biggest share of the premiums, but the truth is that fewer and fewer Americans…
Benefits of Health Reform. (n.d.). Retrieved February 19, 2010,from Organizing for America
Web site: http://www.barackobama.com/issues/healthcare/
Doctors Debate Universal Health Care: Pros and Cons From the Experts. (2010). Retrieved
February 19, 2010, from Organized Wisdom Web site:
A recent article touted the 6.1% growth of spending on medical care in 2007.
The same article cautioned however that, "most experts know that no matter what the numbers say, there is still a great deal of work ahead to reform a healthcare system that is still fundamentally broken -- and is facing one of the worst economic recessions in decades" (Lubell, 2009, pg. 6).
Government and industry officials have been working to reform the industry for more than a decade yet the problem seems to be getting worse rather than better. More and more individuals are finding that insurance takes too much of their income and are forced therefore to forego that expense. Government is leery of committing to the cost of such expense, and industry is reluctant to offer expanded coverage without the backing of the federal government. As the interested parties do the two-step the problem becomes…
Bentley, C.S.; (2005) the new healthcare system, New American, Vol. 21, No. 18, pg. 44
Blizzard, R.; (2002) the haves and have nots of healthcare, Gallup Poll Tuesday Briefing, pp. 8-9
Brown, J.; (2009) Obama healthcare plan would shut down private sector, OneNewsNow, http://www.onenewsnow.com/Politics/Default.aspx?id=414372 , Accessed February 10, 2009
Conn, J,; DerGurahian, J.; (2008) HIT budgets taking a hit: study, Modern Healthcare, Vol. 38, No. 50, pp. 10-11
Universal healthcare would benefit a large segment of the population, and it should be implemented as quickly as possible to ensure the nation's health and to save money.
There are some clear arguments against universal healthcare. One of the most well-known and cited is the idea that the Federal Government is not capable of efficiently managing healthcare, and they cite the problems with the Veteran's Hospitals and Medicare as a very real example of that mismanagement and inability to control costs and other aspects of universal healthcare. Many government agencies are indeed inefficient, understaffed, and mismanaged, so care must be taken to ensure this does not happen with any agency managing universal healthcare. There should be strict controls and measures in place to ensure the agency is managed efficiently and provides the best results, and there should be measures in place to ensure the quality and delivery of healthcare services,…
Chua, K-P. "Arguments and Counterarguments About Universal Health Care." American Medical Student Association. 2006. 7 July 2008. http://www.amsa.org/uhc/uhc_counterarguments.pdf
Canadian Healthcare System Fact Sheet." American Medical Student Association. 2006. 7 July 2008. http://www.amsa.org/studytours/CHS_FactSheet.pdf
Emanuel, E., & Fuchs, V.R.. Solved! It Covers Everyone. Washington Monthly, (2005, June) 37, 20+.
Orient, Jane. Fractured Healthcare: Americans Are Told That We Need 'Universal Healthcare.' The New American 8 Jan. 2007: 10+.
In fact Congress should pass a bill that gives that prescription drug benefit to Medicare patients.
QUESTION NINE: In the United States, healthcare is so expensive that over 45 million people are without health insurance. It is a broken system, leaving out many people, especially children. Recently the executive branch vetoed a bill that would have provided health insurance to millions of middle and low-income children, indicating a lack of government concern for the well being of the population. Bush said it was too expensive, yet it's not too expensive to continue spending billions on an unpopular war in Iraq. Meanwhile, for the past 45 years, Canada has had a "government-funded, national healthcare system..." based on these five principles, according to www.medhunters.com.One, it is universally available to permanent residents; two, it is comprehensive; three, it is available regardless of income; four, it is "portable within and outside" Canada; and five,…
American Association of Colleges of Nursing. (2007). Fact Sheet: Nursing Shortages.
Retrieved Feb. 7, 2008, at http://www.aacn.nche.edu/media/factsheets/nursingshortage.htm .
Duke, Elizabeth. (2004). Report to Congress. The Critical Care Workforce: A Study of the Supply and Demand for Critical Care Physicians. U.S. Department of Health & Human
Services / Health Resources & Services Administration. Retrieved Feb. 6, 2008, at http://bhpr.hrsa.gov/healthworkforce/reports/criticalcare/cc1.htm.
Statistics show that hospitals bore more than $5 billion in costs in treating uninsured patients. This creates a huge financial pressure on them and there is no alternative but to have the uncompensated care costs to be charged to the insured patients. As a recent article from the California healthcare foundations quotes "They prepare for this reality by: Setting prices for the insured that are higher than expected costs.." [CHA] These financial details clearly indicate that immediate action has to be undertaken in terms of restructuring the healthcare system so as to facilitate hospitals in managing the overwhelming burden they are expected to handle.
Diminishing Insurance Coverage
One further reason that contributes to the problem is the declining rate of insurance coverage offered by corporates to their employees. The trend seems to be worsening as statistics indicate. Job-based coverage, which stood at 60.4% in 2003 has dropped to 59.8% in…
State of California, "Gov. Schwarzenegger Tackles California's Broken Health Care System, Proposes Comprehensive Plan to Help All Californians," Accessed on Apr 15th 2007, Available at, http://gov.ca.gov/index.php?/press-release/5057/
Author not available, "Top 10 Indicators: California's Health Care System Is Broken," Accessed on Apr 15th 2007, available at http://www.chhs.ca.gov/docs/Top%2010%20Indicators%20010807.pdf
California Hospitals' Financial Condition: On Life Support," California Healthcare Association, June 2004
Dr.Barry Simon, "Emergency Rooms on Front Line of Health Care," Contra Costa Times, 12/22/06
S. healthcare structure do not include the unobserved disparities. This may sound very rudimentary, even silly to point out, but in by understanding that the numbers are actually worse than they appear, and that the rising costs of healthcare services re associated with both what we see and can't see, it is easier to understand how costs rise so quickly.
It is also a sobering fact that what we cannot observe is still out there, existing beyond the scope of the government and social programs designed to help people overcome obstacles to access to healthcare and health insurance. The ethnic group that is most unobserved within the bounds of many of the studies and statistics related to the disparities in the U.S. healthcare industry is non-Mexican Latinos (Bustamante, et. al., 2009). This group represents a major portion of the U.S. population that currently lacks access to healthcare. In understanding this…
Bodenheimer, T., Chen, E., and Bennett, H.D. (2009). "Reorganizing Care:
Confronting The Growing Burden Of Chronic Disease: Can The U.S. Health Care Workforce Do The Job?" Health Affairs. Vol. 28, No. 1. Pp. 164-174.
Braveman, P.A., Cubbin, C., Egerter, S., Williams, D.R., and Pamuk, E. (2010).
"Socioeconomic Disparities in Health in the United States: What the Patterns Tell Us." American Journal of Public Health. Vol. 100, No. 1. Pp. 186-196.
healthcare issues country. How solve ongoing problem Medicare Fraud Abuse government sufficient effective regulation enforce. If, resolve problem? recommendation ? It Economics Healthcare economically sound.
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…
Angell, M.,2002, The forgotten domestic crisis, The New York Times, http://www.nytimes.com/2002/10/13/opinion/the-forgotten-domestic-crisis.html last accessed on August 8, 2011
Cunningham, W., 2003, The development of the U.S. health care system and its problems, UCLA Schools of Medicine / Public Health, http://www.ph.ucla.edu/hs/hs_100_4_02_lecture_cunningham.pdf last accessed on August 8, 2011
Garson, A., 2000, The U.S. healthcare system 2010, Current Perspectives, http://circ.ahajournals.org/content/101/16/2015.full last accessed on August 8, 2011
Gratzer, D., Why isn't government healthcare the answer? Free Market Cure, http://freemarketcure.com/whynotgovhc.php last accessed on August 8, 2011
Managed Care Health eimbursement Systems in the United States
With health care costs skyrocketing consumers and health insurance companies alike are seeking solutions to the growing crisis in health care within the United States. This crisis revolves primarily around the lack of coverage that exists for millions of Americans. Employers are more and more dropping out of traditional health insurance programs and seeking new ways to provide employees with health care services. In response to the climbing costs of health care many reimbursement and health care cost containment programs are being developed.
There are many health care reimbursement programs available to patients that provide some form of medical care cost containment and coverage. Among the most popular of these or at least the fastest growing are managed care reimbursement programs. Managed care reimbursement programs are becoming more the norm rather than the exception to the rule.
Managed care programs have…
Barron, B.A. "The price of managed care." Commentary, 103(5):49
Camperell, K.J. & Mitchell, R.A. (1995). "Managed health care accounting." Journal of Accountancy, 179(4):68.
Cauchi, R. "Making the best of managed care." State Legislatures, 27(6):22
Dranove, D. (2000). "The economic evaluation of American health care: From Marcus
nationalized health care v. private insurers
During the past three decades, both Federal-funded healthcare programs like Medicare and private insurers have battled the rising tide of spending on personal health care with a variety of cost containment mechanisms. While other nations counter the fiscal onslaught with nationalized health care to provide universal coverage to its citizens, the United States struggles between partially funded nationalized care and a debilitating system of private insurance that denies patients proper care and undermines the moral codes of physicians. While the government continues to push health care towards the schism of corporate privatization, critics of the system unite with those un-served, proffering a viable transformation to medicate that would equal and exceed the private sector's ability to control the rate of spending growth, price aggressively for the services it covers, and provide health coverage to those citizens most desperately in need.
Currently, the United States…
Ibid, p. 935.
Ibid, p. 934.
Goel, Ashish. "For Whose Good?" Annals of Internal Medicine Online. June 7, 2005.