Resolving Americas Health Care Crisis: The Impact of a Fragmented Health Care System - Essay Example

? Resolving America’s Health Care Crisis: The Impact of a Fragmented Health Care System al Affiliation: Introduction The United s health care system is dominated by a high level of fragmentation across its many sectors; these fragmentations are a huge barrier to the development of value. Weak connections among the multiple component sections are the main feature of a fragmented health care system. Simple tasks such as the assigning responsibility for payments are made much more complex by fragmentation. The more difficult tasks such as family support, social services offered after a hospital stay, and the coordination of home health care are made more complex by fragmentation because they need following many distinct sets of contradictory rules (Institute of Medicine, 2011). The system of health care delivery in America has been characterized by fragmentation at all levels whether national, community or state level. The United States health system is almost getting into crisis due to the increasing fragmentation. This crisis results fro the increasing health care costs, health insurance premiums. Many people are surviving without health insurance, many are in fear of losing their coverage and others are straining to meet the cost of the coverage. Lack of national policies or entities which guide health care system has contributed to this fragmentation. As a result the effects of this instability and high costs of insurance coverage are tremendous in the United States. The Impacts The fragmented health care system in America has affected health care costs making them expensive. The increase in health care costs pressures the sustainability of the America’s voluntary employer based system due to the increasing health insurance premiums. Since majority of employers aspire to provide health care services to their employees they can only provide up to nine percent in a year due to increasing health care costs. If the rise in cost increases, this leads to employers passing part of the health care cost to employees hence reduction in the employee salary. In other cases the employers shift part of the cost to employees and then decrease their coverage. This leads to a situation where the health insurance costs increase rapidly than the wages and thus workers find the health insurance coverage unaffordable for them. Fragmentation has also affected accessibility to health care services for the uninsured as suggested by Malhotra (2009). Due to the increasing cost of health care coverage, many uninsured people have inadequate access to health services especially preventive health care services. As a result, they usually experience poor healthcare outcomes. The uninsured bear the trouble of the rising financial risks and insecurity. Different care delivery services have different funding decisions; this creates a tension in the delivery of medical care for the poor and the uninsured. Unequal and biased access to health care services is another effect o healthcare system in America. Since not all individuals have access to well equipped hospitals due to lack of funds many end up receiving Inadequate medical care from the less equipped hospitals. The comprehensive and the integrated care offered in such hospitals are less efficient and effective due to lack of resources. Those unable to go for the costly and well equipped hospitals end up living in poor health conditions. Thus access to medical care continues to be challenging due to fragmentation in health care delivery. Fragmented healthcare system in America has affected the investment of incentives for future health of the population. One of the factors leading to this is the inadequate preventive health care mostly to those with chronic diseases. Often, only few of the adults suffering from such diseases are provided with the recommended preventive care but the clinical guidelines. The complications related with these conditions accumulate with time making no difference for the future health. The deficient incentives which are outcomes of short-term insurance coverage are encouraged by the health care fragmentation as suggested by Jonas (2003). The reduction of insurance policy holder’s period for those suffering chronic diseases may also lead to less investment for future health. Employees tend to spend more on their health services yet they receive less preventive care due to fragmentation in the healthcare system. The fragmented hospital governance structure in the United States leads to impediments to quality improvement of health care. For instance, if the America’s health policies allowed hospitals to employ physicians directly, then hospitals would structure their job responsibilities better. However, given the prevailing policy status, a surgeon employed in fulltime basis in a hospital needs compensation for the lost income gained from outside activities. If the country would reconsider the health are system, and achieve participation constraint which is an element of fragmentation, the high commitment can be achieved in the hospital structure. Fragmentation in the health care system has largely led to the slow implementation of current information technology in hospitals. The President’s Information Technology Advisory committee has argued that the America’s health care system does not generate practical ways of sharing critical information about patients. In the fragmented health care system there has been poor integration of patient information due to lack of information technology systems. The lack of common standards of data coding and lack of data network to connect various health organization has resulted from the fragmented healthcare system. Fragmented health care system has lead to misdirect and unsafe health care delivery. In as far as misdirected care, health services tend to revolve around curative services. As a result primary prevention of diseases and the promotion of health living is neglected. This s because the major aim of the fragmented health care system is to the financial gain. Concerning the unsafe health care delivery the fragmented health care system has proofed unable to provide safe and hygienic heath care. As a result many people end up contracting infections in the hospitals due to medical errors. This is bound to cause underestimated death and ill-health to patients. The resultant effect is that majority of the people give up on these services rather than make use of them because these services are entitled to them. The origin of hospital fragmentation can be traced to the American pluralism, the hybridization of charity and business, and historical accident. There are three areas of fragmentation in the United States health care system; (a) the United States health insurance system, (b) care provision, (c) and the incapability of health information systems to permit continuous flow of information between providers, insurers and the hospital (Institute of Medicine, 2011). There is disengagement between the private and public services, between the patients and the providers, between the training offered to the providers and what is needed by the patient, between the services provided and the health requirements of the nation, and between those who have been insured and those not insured (Institute of Medicine, 2011). From this statement, it is clear that there is inequality in the United States health care system and this is attributed to its fragmented nature. These are among the many impacts of the United States health care system. Communication between the providers has become very difficult and care offered is redundant because no means exist to share the results. For example, a patient suffering from diabetes and is covered by Medicaid may experience difficulty finding a physician to assist him manage his blood sugar levels. If he is capable of finding a physician, the individual may not possess admitting privileges at the health care facility to which the patient is taken after a hypoglycemic response. After admission to the emergency room, the new unit of physicians responsible for him (the patient) lack information about “previous blood sugar determinations, other medications he is taking, or other health problems” (Institute of Medicine, 2011). The condition of the patient is stabilized and an arrangement is made for discharge; however, the patient is not legible under his insurance plan for settlement for further education in glucose and diet control, referral to the ophthalmologist and materials such as glucometer as indicated by the new team of physicians. The patient requires home follow-up but the visiting nurse agency is only certified to offer two visits when the patient can utilize five. The discharge information or planning is not shared because no one calls the early primary care physician (the initial physician for the patient). The patient is not offered by anyone a summary of his visit to the facility in order to take it to that physician. Because of the patient’s status as a Medicaid, the ophthalmologist cannot accept the patient (Institute of Medicine, 2011). This case reveals the agony the patient undergoes in the fragmented health care system. The realization of the nurses’ value has been affected by the fragmentation of the health care system. The contribution of the nurses within this system has been doubly hidden. Majority of the health care organization and hospitals accounting systems are designed to differentiate or capture the economic value offered by the nurses. Thus, all the nursing care offered is “treated equally in its effect on revenue” (Institute of Medicine, 2011). Nurses’ work is assumed to vary by 15% to 40% for any particular diagnosis-related group (DRG). The impact on health care provision is not easy to document, but staffing ratios give some suggestions to some of the effects. Lewin Group analysis suggests that the health care facilities cannot comprehend the full economic value of services that are offered by the nurses; nurses have an economic incentive and whether these facilities like it or not, they need to staff themselves “at levels below where the benefit to society equals the cost to employ an additional nurse” (Institute of Medicine, 2011). Barriers to realizing and measuring the economic value produced by the nurses also exist outside the hospital environment. In majority of the states, payment to APRNs (Advanced Practice Registered Nurses) is not made directly but it must be reimbursed by the physician with whom a collaboration agreement exists. In other words, the payments are made through the physician’s provider number and the nurse gets salaried. For many years, the professional nursing organizations have attempted to counter this inequitable concept of fee-for-service payment system by lobbying for the increment of the forms of services in which NPs (nurse practitioners) can independently bill Medicaid, Medicare and other service providers (Institute of Medicine, 2011). The economic value of the nurses has been undermined by this fragmented health care system; this is a negative effect that has been brought by this form of health care system. The payment system is not favorable to the nurses because they are not capable of billing the health care service providers (such as Medicaid and Medicare) directly. In the United States, the technical planning process nature is affected by the fragmented health care delivery system. Science of planning entails collection and utilization of data. The form and quantity of data required depends on the existing levels of planning knowledge and health knowledge, the specific health care delivery element being planned for, and the nature of the larger social framework from which it is found. Without the planning data, a baseline does not exist from which an individual can measure the effect of the implemented program (Jonas, 2003). The insurance company health care policies that cover individuals, federal and state employees, and businesses are fragmented at high levels. It is estimated that there are over 1,500 insurance companies within United States. These companies provide complicated lists of plans which have differing charges for co-payments, deductibles, and premiums. The attorneys who write these plans are the only ones who understand some of the languages used in these plans. The resultant impact of this type of fragmentation (insurance coverage fragmentation for the citizens) is enormous volumes of paperwork and disputes. Some of the tedious paperwork may those for Medicare (Malhotra, 2009). The differing charges present a case in which there is no equality in the services being offered by these health insurance companies. Those who do not have health insurance cover are exposed to health risks because their care is delayed more than those who are covered. Most of the times these people require hospital treatment that they could have avoided; these people are frequently diagnosed with cancer at a later stage. This increases their likelihood of dying in the hospital more times than those who have a health insurance. Because of the lack of a health insurance, the low income families often depend on the fragmented and complex to us public health care system. Regular preventive care including immunization, well-child care, and prenatal care are sometimes more difficult to get or obtain; its availability is not well understood (Edelman and Mandle, 2005). Accessing health care services and getting quality health care services is difficult for the individuals who are not covered by a health insurance. It is imperative to note that the cost of these services is not affordable to the low income families. Most of the uninsured individuals do not have jobs that offer health care cover and “the cost of individual private health insurance is usually high” (Edelman and Mandle, 2005). The nursing and health home workers spend almost three quarters of their period writing notes for each patient. They cram numerous handwritten notes into small writing so that the needed information fits well in the spaces offered. Thus, they can’t have much time left for their patients (to care for their patients). Registered Nurses (RNs) are not an exception, they spend most of their times completing notes or filling in forms. This is among the many reasons why nursing has lost its desirability as a profession (Malhotra, 2009). Time is of paramount importance to the improvement of the patient’s health. Less time spent on the patient means that the patient gets low quality care. These notes and forms are brought about by the many health insurance companies. These numerous health insurance companies have been brought about by the fragmentation of the health care system. In conclusion, the health care system of United States is in a crisis and this is due to its fragmented nature. Fragmentation has affected all the key and minor areas of the health care system. The quality of care and its accessibility; the quality of care has gone down significantly and those who can access quality care are the ones insured. However, it is important to note that there is inequality in the provision of care to those insured as explained in the diabetes patient case. The economic value of the nurses is important in the health care facility; the value of the nurses in the provision of care is not recognized. The amount of paperwork required to be read and the forms to be completed by the nurses is enormous and this has contributed to neglect of the patient. These and many other effects have affected negatively the United States health care system; the cause being, the fragmentation of the health care system. References Edelman, C. L. & Mandle, C. L. (2005). Health promotion throughout the life span. Philadelphia, PA: Elsevier Health Sciences. Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. Washington, DC: National Academics Press. Jonas, S. (2003). Introduction to the United States health care system. New York, NY: Springer Publishing Company Malhotra, M. U. (2009). Solving the American health care crisis: Simply common sense. Lincoln, NE: iUniverse Inc. Read More