Barriers in the United States Health Care System - Essay Example

? Barriers in Health Care of Introduction The United s’ health care system faces a number of challenges and/or barriers with regards to service quality, availability, accessibility, cost and appropriateness among other aspects of the sector. Barriers in this sense refer to the obstacles that delay and prevent target populations, especially the vulnerable groups such as the disabled, women, children, and the elderly from accessing, affording, and utilizing the much needed health services. In addition, barriers to health care also make these at-risk people get inferior health services compared to the advantaged sections of the population (Purnell & Paulanka, 2008). The existence of these barriers calls for stakeholders, especially providers and regulators such as government agencies and private providers to design and implement policies and strategies by which these barriers may be reduced or eliminated. Similarly, patients should also be aware of the potential barriers to their accessing and utilization of health care in the country (Purnell & Paulanka, 2008). The main reason these barriers should be aptly and exhaustively addressed and eliminated is that their continued existence will inevitably result in claims of discrepancies and disturbing levels of racial, ethnic and geographic discrimination and disparities in health care delivery, status and outcomes (Purnell & Paulanka, 2008). Although financial barriers to health care are the most easily identified and talked about, the nonfinancial reasons by far exceed the financial ones in their enormity and effects on the health system, health care, and health outcome. Examples of nonfinancial barriers encountered in the health care system are physician/health service accessibility, lack of medication time off from work, untimely appointments, and poor attitude to health care due to cultural factors (Purnell & Paulanka, 2008). This paper explores the many barriers that the United States health care system grapples with on a daily basis. Health Care System Barriers A major category of barriers to the health care industry is patient/population-related barriers. These barriers are often sub-classified as patient/population characteristic, health behavior, environment, and health outcomes (Purnell & Paulanka, 2008). Under patient/population characteristic barriers are barriers related to health care needs, predisposing features, and enabling features while health behavior barriers encompass barriers related to personal health practices of populations (Purnell & Paulanka, 2008). On the other hand, health outcome barriers are the characteristics of health care providers. Finally, environmental barriers could encompass the structural and organizational factors of the system and the health care providers therein. It is apparent from the above categorization that barriers in the health care system may be presented as patient-level, provider-level, and system level barriers. These barriers thus affect different aspects of the system. Barriers to Change and Change Management Among the aspects of health care particularly affected by barriers are change, its implementation and management. To ensure quality and indiscriminate delivery of health services, it is of the essence that change is embraced and managed via the effective overcoming of the identified barriers to change and delivery of health services (Purnell & Paulanka, 2008). The generally cited reasons for failure to overcome change barriers in the health care system are absence or little acceptance of change, poor realignment in thinking by the system’s stakeholders, and lack of appropriate knowledge and guidance on change implementation and management (Purnell & Paulanka, 2008). Additionally, the system and many health care facilities under it do not have clearly established and explained strategies and tactics for maintaining long-term change and change management. Although controversies and debates surround the concept of change and its implementation and management in the health care system, many a stakeholder concurs on the fact that the system needs some changes in strategies and policies to eliminate the barriers that result in inconsistent quality and inefficiency in health care delivery. Quality, Safety, and Financial Challenges Several indications of the dire need for change in the health care system have been identified and they include barriers of patient safety and the quality of health services. The health care system has also met barriers in its quest for excellence in service delivery with regards to its core values, cost, quality, and performance. Thus, the reality of the importance of excellence should prompt health care stakeholders such as regulators and providers to seek and implement solutions that would ensure or promote the growth and the survival of not only the sector but also the numerous health care providers (Purnell & Paulanka, 2008). Importantly, these solutions must be geared towards making health facilities such as clinics and hospitals centers of excellence rather than mere health care facilities. Aspects of clinical quality and patient safety that need to be addressed are medical errors and the resultant patient deaths. The other indication of the need for change in the health system is the move towards digitization by other sectors. Similarly, the health sector requires adopting and implementing digitization to help improve patient and worker safety as well as the efficiency of medical procedures and equipment. Additionally, to improve service delivery, the system should adopt information technology (IT) systems, which will result in less paper work thus saving time and improving information dissemination and storage (Purnell & Paulanka, 2008). Demographic changes and workforce issues are the other aspects of the health system marred by numerous challenges and barriers that ought to be addressed rather fast for quality and efficient service delivery. For instance, there are some regions, neighborhoods, and areas of medical specialization that lack enough personnel, resulting in the non-ending straining of the system’s equipment, personnel and other resources. The staff shortages identified in the system includes clinical staff, radiologists, cardiologists, and obstetricians among others (Purnell & Paulanka, 2008). These staff shortages have affected the health care system’s capacity to provide adequate and appropriate care to the increasingly demanding clients besides having an adverse effect on the quality, levels, and the profitability of the system and the services offered therein. Consequently, health care facilities have not been able to ensure efficiency in their operations and to create an enabling work environment for the purposes of attracting and retaining workers and clients (Purnell & Paulanka, 2008). Consequently, the best talents in the profession have moved to the more lucrative regions/countries where conditions are a bit better. As mentioned, shifting demographics is the other barrier to the provision of accessible, affordable, and quality health care in the health care system. This shifting demographics and the trend in which the aging population is continuously on the rise have particularly impacted on the system’s specialties such as cardiovascular services. Finance is the other key challenge the health care system faces as providers suffer financial pressures due to the increasing demands and revenue collection and reimbursement uncertainties. To address these financial pressure issues, it has generally been recommended that interventions and projects dealing with cost and revenue management for quality services are designed and implemented. Organization Cultural, Lifestyle, and Socioeconomic Barriers All the mentioned barriers and others not mentioned point to the fact that the health care system must seek and implement comprehensive interventions, achieved via a new approach and thinking by the stakeholders. However, this new thinking and approach to managing health care has been hampered by the slow pace of change and other factors. Some barriers to the implementation of changes in the health system and industry are cultural in nature (Purnell & Paulanka, 2008). Worse still, some of these cultural barriers are unseen and thus their effect of derailing the implementation of health care reform strategies take shape rather slowly. That is, the mere fact that these organizational cultural barriers are not easily identified and addressed in their early stages and processes hampers their elimination. Nonetheless, it is the prerogative of all stakeholders to ensure that these mostly unseen cultural barriers are identified early and solutions sought in time (Purnell & Paulanka, 2008). The first among these barriers is lack of leadership support, which should be solved by the facilitation of interconnection among stakeholders and peers in the industry for the apt deployment of the right methodologies. The second cultural barrier in the health system is staff resistance and skepticism towards new and innovative ideas. To counter this barrier, health care managers and leaders should develop and apply team-based approaches to solving problems besides developing stakeholder analysis tools (Purnell & Paulanka, 2008). The third cultural barrier bedeviling the health system is hesitancy among investors and stakeholders to invest money and time in health care. One strategy of addressing this barrier is by the creation of health business cases that are supported by research and data, focused on specific and sound goals such as reduction of infections. Additionally, all the costs and other requirements associated with such an investment should be well planned, implemented, documented, and stored. Change implementation in the health care system is also affected by shortage of the right type and amount of resources to design, lead, and implement change initiatives. To counter this barrier, stakeholders ought to consider enlisting outside assistance, drive, or/and opinion to start health care projects such as training and mentoring initiatives for professionals about change and its implementation (Purnell & Paulanka, 2008). The other barrier to change in the health system is uncertainty on stakeholders’ roles and/or absence of accountability. For the elimination or reduction of these challenges, the system should implement management approaches, structures, and systems, which interconnect health care projects, implementation, and performances with the short-, medium-, and long-term strategies and objectives of the system and the organizations therein. Although these barriers could appear insurmountable to many, it may only require good and strong leadership and leadership-driven change initiatives and implementation to counter them and their negative implications on the system. For instance, desisting from the strict adherence to obsolete approaches to the provision and management of health care in the U.S may be quite handy in the creation of increased efficiency in the system and the reduction of the gap between optimal health care and the standards of the services actually offered. Thus, the two areas in which the health care system lacks footing are in the proper allocation of resources and the installation of proper workforce leadership (Purnell & Paulanka, 2008). Although capable executives exist in the health care system, the problem lies in their tendency to strive to maintain the status quo, which will not work in the best interest of the system and its clients. Although starting initiatives to impart a culture of change and innovativeness is the system seems a rather daunting task, several tools and techniques have been developed to help leaders and other stakeholders in the system to implement and benefit from change and innovativeness. Among the benefits the system will likely enjoy if such change and improvement initiatives are successful include fewer medical errors and increased returns and enhanced reimbursements (Purnell & Paulanka, 2008). In addition, the system will enjoy an enhanced use of the latest, fastest, and most sophisticated technologies. In return, the system will experience faster returns on investment. Change initiatives also yield improved capacity for shorter wait time for patients, patient in/outflow and accessibility. Besides client satisfaction, change and innovativeness also benefits health care facilities internally as seen in their effects of improved organizational communication and staff expertise and satisfaction (Purnell & Paulanka, 2008). Besides organization-level barriers, there are patient-level barriers to the U.S. health care system. Potential Barriers at Patient Level Quite many barriers in the U.S health care system appear at the patient level. These patient-level barriers include but are not limited to gender, age, marital status, and societal structures and variables such as ethnicity, educational background/status, and socioeconomic status/living standards (Purnell & Paulanka, 2008). One’s age may act as a barrier depending on his/her ethnicity and cultural background. For instance, there are cultures in which teenage pregnancy is loathed and young pregnant girls are stigmatized, making them seek prenatal care at only at later stages of pregnancy thus endangering their lives and that of the unborn babies. This stigmatization due to early pregnancy thus hinders the delivery of the all-important prenatal care to pregnant teenagers. Despite the fact that male and females suffer from similar diseases and face same life experiences and opportunities, gender and marital status remain rather huge barriers to equal and equitable health care in communities where males and females have different positions and roles (Purnell & Paulanka, 2008). The different roles and positions makes and females play in certain communities, especially in minority ethnic groups expose them to different health risks. Marital status also acts as a barrier to health care for many populations more so with regards to the predictive powers of childbirth and pregnancy as points of entry into health care. In other words, being single could be barrier to entry into a health care facility or program, albeit to a small extent. Among the social structures and variables that act as barriers to health care are ethnicity, educational background/level, and socioeconomic status. For example, low levels of education have been found to act as barriers to health care and health care awareness and publicity campaigns (Purnell & Paulanka, 2008). Similarly, lower socioeconomic status could be a barrier to health care more so due to communication breakdown among people of different social status such as a health care provider and an uneducated patient or a patient from a minority ethnic group. Social status has particularly been found to affect populations’ attitudes and perceptions of health care. A patient’s living conditions and the conditions of the environments within which health facilities are situated could also be barriers to health care utilization and accessibility. For instance, conditions in slum dwellings are rather unclean and insecure, implying that vulnerable people in such a neighborhood such as women, young girls, children, and the elderly may find it dangerous and hazardous to visit health facilities at late hours. Thus, health facilities attendance figures in such environments are often lower than the figures in safer neighborhoods. To reverse these safety-related situations, it is highly recommended that stakeholders such as care providers and the government implement security measures that would promote and ensure a safe and secure environment to help raise health care attendance figures (Purnell & Paulanka, 2008). Closely related to living condition is the barrier of lifestyle, which has resulted in poor health status for poor people living under dire conditions in slums and similar neighborhoods. Lifestyles and habits such as drug and substance use and addiction have also been identified as barriers to health care and proper health more so among the youth, pregnant youth, prostitutes, homosexual among other vulnerable groups and individuals. The other aspect of lifestyle that could be a barrier to health care is eating habit. In other words, a lifestyle may force one to form eating habits that do not conform to certain medications that may be prescribed from time to time depending on one’s conditions. For example, one may consume high fat or high sugar dishes while a medication may not allow or recommend the consumption of such foods. Lack of or insufficient family and social support is the other lifestyle barrier to sound health care that needs to be addressed. Families are particularly required to give their loved ones emotional support so that they are encouraged to seek treatment (Purnell & Paulanka, 2008). This kind of support is particularly important for people whose cultural inclinations and attitudes may be opposed to specific health care programs or medications. Patient Culture as a Barrier Culture is the other major patient-level barrier in U.S. health care system. In this regard, peoples’ cultures may influence their perceptions towards and understanding of certain diseases and symptoms. Due to cultural diversity, health care professionals should place individual patients and families in their appropriate cultural contexts while handling their cases. This requires an astute understanding of and conversance with the wider cultural contexts of clients, implying that the background data for carrying out patient assessments and planning medications and therapies should be made available and thoroughly understood (Purnell & Paulanka, 2008). Specifically, information on the ethnic features of the relevant communities such as their customs, values, beliefs, and thought patterns should be accorded priority so that patients are not repulsed by certain medical practices and advice (Purnell & Paulanka, 2008). Culture is thus a critical barrier in the U.S health system; more so with regards to how people perceive diseases and how a culture understands, receives, and manages different kinds of diseases. There are also other ways in which a culture may be a barrier to health care (Purnell & Paulanka, 2008). For instance, different cultures identify, interpret, and express diseases and symptoms in various ways. Furthermore, pain and discomfort may be expressed in different modes in different cultures. In addition, different cultures and family backgrounds could also present symptoms in different ways, rendering diagnoses insufficient in certain cases. Since the health care system caters for diverse populations, the system should consider some aspects of these diverse cultures as potential barriers to care and endeavor to reverse this situation by using the information available on these barriers to chart the direction the system should take. Hence, regulators and health professionals/providers should be competent in dealing with the relevant specific cultures they deal with by getting well informed and skillful in tripartite cultural assessment, cultural intervention, intercultural communication, and in the selection of the type, level, and intensity of cultural interventions (Purnell & Paulanka, 2008). In other terms, professionals should be sensitive to the cultural needs of clients and be neutral, innovative, and transformative in dealing with multicultural clients. The other strategies of dealing with cultural barriers to health care are adoption of community partnership and patient education and awareness projects. Conclusion The U.S. health care system has the potential of establishing a rather bright future for itself if only the right leadership and interventions, which focus on the elimination of the myriad barriers it faces, is put in place. These envisioned leadership and interventions should then appreciate and address the many cultural, non-cultural, financial, and nonfinancial barriers the system faces and institute interventions to contain these barriers for long-term purposes. In eliminating or reducing these barriers, the system’s leadership and structuring should exploit the ever expanding medical/health technologies and treatment options for the benefits of its clients and for its own improved efficiency, accessibility and cost-effectiveness. It would thus be suicidal for the health care system to allow the current impediments to its success to reign supreme over its capacity and drive to provide quality and cost-effective services to its clients. To deliver quality services to the satisfaction of its clients, the health system should emphasize a culture of patient and worker safety and overall excellence. However, this status can only be achieved via a leadership and a workforce that seeks to transform the system so that health care is owned by society rather than a few individuals who might be out of touch with the needs of the population. It should also be clear to society that each person has a role to play in unfolding a bright future for the health care system, patients included. Nonetheless, that overcoming these barriers in the health care system is a hectic task cannot be denied. However, the difficulties of overcoming these barriers should never be an excuse for not trying to implement the recommended strategies towards the elimination of the said barriers, a role that all stakeholders should embrace. Reference Purnell, L. D., and Paulanka, B. J. (2008). Trans-cultural health care: a culturally competent approach, third edition. F.A. Davis Company. Read More