US Healthcare System - Research Paper Example

Introduction: One of the factors that determines the dynamism and strength of a nation is the overall level of the health of its population. It is not enough that a country has a large number of doctors capable of treating patients who have the financial resources and time to avail of medical assistance. Each country should have a national health policy that aims at providing health assistance irrespective of the financial status of its citizens. It is true that this policy of unbiased health assistance exits in most developed countries on paper. But in many instances, the reality of the actual situation is quite different from the policies enacted. This could happen due to many reasons like, lack of vision, lack of cooperation among the different agencies involved in health care, or due to the lack of sincerity and honesty within such agencies. The health care system in the United States is no different in the sense that it is one with many paradoxes. The country is a leader in the development of medical research and has a national health care policy on which government spending is the highest in the world. But the health care system is considered to be quite inefficient because of fragmentation, lack of uniformity, and the existence of a large number of people who are not covered by health insurance. The system is also overburdened due to an ageing population and lack of qualified personnel. Any organization, whether it is formed for the purpose of social care or for profit has a responsibility towards the society and individuals in which it operates. This is true for a health care system also. This paper is an attempt to study the concept of organizational responsibility issues that exists within the health care system in the United States. In the process, it will look into issues like the ageing population of the country, the unhealthy habits of its citizens, absence of health insurance, increasing number of illegal immigrants and the ethical dilemmas that may exist in the overstretched health system. Overview of the health care system in the United States: As mentioned earlier, the health care system in the country is full of paradoxes and contradictions. “At one extreme are those who argue that Americans have the “best health care system in the world”, pointing to the freely available medical technology and state-of-the-art facilities that have become so highly symbolic of the system.” (Chua, 2006, p.1). At the other extreme, the system is accused of massive lack of health insurance, fragmentation, difference in health policies of individual states, waste of resources, high costs, and inequality in implementation. The main components in the system are private and government run hospitals (and clinics) and medical insurance. Treatment is extremely expensive in the country and many people rely on public and private insurance to cover the costs in case of any eventuality. Medical insurance consists of government run schemes and those offered by private corporations. Due to high cost of treatment, insurance is the only option available to most individuals in the country. Hence, this paper will cover the insurance sector and its organizational responsibility (given as a separate section) in more detail. Government medical insurance and aid in USA: There are primarily two government run insurance programs in the country which are Medicare and Medicaid. The former is aimed at citizens aged 65 and above, but also includes disabled persons in some cases. In paper the scheme which is totally financed by the government covers all individuals in the specified age group mentioned above. There are four parts in the system named as A, B, C, and D. Part A pays for hospital expenses while Part B covers the physician fees and other expenses. Part C only provides the advantages that are provided by the scheme. Part D is expected to provide the costs of prescription drugs taken by patients. But the scheme is far from being comprehensive since it does not provide coverage for skilled nursing services and preventive care. The scheme also does not provide coverage in dental, hearing, and vision care. Senior citizens are forced to take separate insurance paying money from their own pockets for covering the costs of the above maladies to the tune of more than 20% of their income on an average. The costs incurred by Medicare are financed by federal income tax and a mandatory share from employers and employees. To avail the advantages of Part B and D, individuals have to pay a separate premium. Medicaid on the other hand is aimed at universal coverage of the low income population. But the problem is that it is up to the individual states to implement and make policies regarding the system. The only direction that all states must follow is that, pregnant women, the aged, the child population, the disabled, all of whom can be categorized as poor be covered. States can individually increase coverage if they wish to do so. In effect there is a separate Medicaid policy for every state in the country. Funding is equally shared by the state and Federal government. In some of the poorer states, the Federal government share may be more than what is spent by the state. There are issues of poor disbursement, delays, and misuse of the system by ineligible people. But the system does provide coverage on a wide range of health issues including prescription drugs. There exists another government scheme for families whose income levels do not qualify them for Medicaid but is too poor to buy private insurance. Called the S-CHIP (State Child Health Insurance Program) which was started in 1997 is aimed at child insurance. The rules, regulations, benefits, financing, and coverage more or less follow those provided by the Medicaid program. Like most countries, the United States also provides many facilities and benefits to retired military personnel. The scheme called Veterans Administration is funded totally by the Federal government and provides very low cost treatment to such personnel primarily in state run veteran’s hospitals and clinics. Tax payer money is used to meet the expenses of this scheme. Private insurance: The schemes under private insurance are offered by privately owned corporations (profit and non-profit based). There are two broad classifications namely employer sponsored policies and individual policies. In the case of the former, insurance is provided to employees as a part of the employment agreement and the premium is paid by the employers. There are also group insurance schemes whereby larger companies directly pay the hospital and health expenses on behalf of their employees. Usually such companies have individual agreements with those taking policies. The overall view of the financing of the health system along with all players are provided here as a diagram. (Chua, 2006, p.4). Organizational responsibility: In any society there are certain rights and responsibilities attributed to individuals and organizations. Ideally, if every individual and organization (which includes the government) takes the responsibility part seriously there will be a peaceful, prosperous, and healthy society. The government has many roles to play in the welfare of the society, and responsibility towards providing good health care to its population is one of the most important ones. Along with the government, all private and publicly owned agencies and also the individuals involved in health care should display a similar attitude. Organizational responsibly in a society involves the following factors and components. First of all, the organizations involved should be in compliance with the rules, regulations and statutes that are passed by the government in this regard. All parties involved should have transparent policies and practices with regard to its operations. There should be sense of accountability towards the society, the sick, and the government. In most cases resource allocation is done indirectly from the citizens through taxes and directly from the government in the form of grants and budget allocations. If any voluntary work is involved, all those who have volunteered become a part of this collective responsibility. Being a volunteer does not absolve the person from discharging duties or shirking responsibilities. Another important area is the concept of ethics and ethical behavior. Ethics “derived from the Greek "ethos" meaning "way of life” is a branch of philosophy that studies and recommends the fundamental principles and basic concepts of what is considered morally good and bad, right and wrong in human conduct.” (Philosophy: Ethics glossary, n.d). Health care needs are diverse in nature and an element of flexibility within the boundaries of law should exist for efficient operations. In an era of rising environmental concerns, the concept of sustainability is important. Health care should be based on the sustainable development practices as a part of its responsibility to the environment. With regard to the individual operation of the organizations involved in health care the following factors should be present. This is because responsibility towards employees and volunteers involved are also important. Respect of human rights within and outside the organization is very important. In this case, policies as seen in the Universal Declaration of Human Rights or the directives published by organizations like the International Labor Organization can be implemented. Practices that are considered to be unfair both morally and legally should not exist within the organization. Since health care is primarily a government responsibility, there could be lapses in the control and audit mechanism. Practices such as accepting bribes and showing favoritism should be avoided. Organizational governance as a whole should be of a high quality. Finally all organizations and individuals involved should be aware that their aim in health services is service to the society and social development. The next section is a review of problems that may exist in the health care system of the United States. This will be discussed with regard to issues like ethical dilemmas, labor and funding shortages, problems caused by an aging population, lack of universal insurance coverage, and illegal immigrant population. (Preliminary working definition of organizational social responsibility, n.d). Essentials of a good health system: “The World Health Organization (WHO) released a groundbreaking report in 2000, with data on the health systems of 191 member countries. In this analysis, WHO develop three primary goals for what a good heath system should do.” (King, 2001, p.1). The three goals are good health, responsiveness and impartial and fair funding. The WHO states that good health policy should be aimed at the population as a whole without leaving any sections of the society. This is particularly true for the more vulnerable sections that are uninsured and otherwise unable to pay for any eventual medical treatment and emergencies. The health care system should be able to respond to the various health care needs of the population. Due to its inherent nature, health care needs can be unpredictable and hence the system should be flexible enough to respond to such emergencies. The system should also ensure fairness in funding (according to the income level of different sections of the population). No section of the society should be left out especially those unable to bear the costs of uninsured treatment. Problems and issues in the US health care system: A review of literature on the state of the US health care system reveals that there are too many things wrong with it. According to an article in the New England Journal of Medicine, the system is under heavy strain. “For roughly 40 years, health care professionals, policymakers, politicians, and the public have concurred that the system is careening toward collapse because it is indefensible and unsustainable, a study in crisis and chaos.” (Brown, 2008, p.325-327). The article states three main areas of extreme concern which has led to the current situation steadily over the years. The first is the lack of any sort of insurance coverage for nearly 47 million citizens. The next major concern is that the country has the highest spending (including government) on health care costs in the world on the Medicare, Medicaid, costs of insurance and medical expenses of government employees, and other areas mentioned above. Nearly 16% of its GDP at an average of $6,400 per person (of the total population) is spent every year on health care costs. France on the other hand covers nearly 100% of the population with a spending of only 11% of GDP. Thirdly, the article states that the US health care system is in fact a non-system with a confusing mix of public sector, private sector, and safety nets. The safety net includes Medicare, Medicaid, government owned hospitals, community health centers, charity work done by physicians, and clinics and hospitals run by not-for-profit organizations. The safety net policies except for Medicare and Medicaid vary a lot from state to state, ignoring the principle of universal health care policies for the country as a whole. In the case of insurance, the private sector insurance companies are forced to charge high premiums due to the high cost of treatment in the country. They also resort to this practice to increase their own profits. This in turn forces employers to ask for contribution from employees to the premium paid by the former. Some employees cannot afford to do so and hence remain uncovered. It is estimated that nearly one million new uninsured persons are added to the current total of 47 million. The safety net is also far from satisfactory. One is that most of these organizations need emergency last minute funding to stay afloat. In the case of ordinary illness, the safety net is fine, but in case a patient needs treatment for serious diseases, he or she will have to wait due to shortage of staff and facilities. A system of rationing exists in which the lucky few get to avail expert medical treatment. Organization responsibility and the health care system: Many of the problems faced by the US health care system have been mentioned in the above section. The prohibitive costs in medical treatment where private hospitals and individuals do not care to provide no-profit based treatments to poor patients are an ethical issue. This also goes for insurance companies whose sole motive is profit. Without insurance coverage the prohibitive cost of direct treatment in the country is out of reach for most citizens. The US healthcare system is plagued by shortage of qualified labor. This has resulted in payment of higher salaries to those willing to work in this sector contributing to the rising costs of treatment. It also contributes to patients not getting adequate or being subject to delayed treatment. Both these are ethical issues which should be solved with the cooperation of everyone concerned. Another problem adding to the current worries is the aging of America. The baby boomers will soon reach retirement age while the growth rate of current population has decreased. It is estimated that the number of people over 55 will number 107 million from the current 60 million in thirty years. Those above 65 years will number 70 million from the current 34 million in the same period. In other words, both these age groups will nearly double in this period. Older people will have more illnesses and diseases requiring medical assistance. The rise in lifestyle diseases in the country adds to the current strain in the system. (Fact sheet on aging in America, n.d, p.1). (Fact sheet on aging in America: Percentage of Americans Age 65 Expected to Survive Age 90, n.d). While these issues are unavoidable or difficult to control there are other ethical and moral issues that need to be corrected immediately. They include fraud and patient dumping/transferring. Even though fraud cases are not common, the US health care system is not immune to it. One of the biggest cases of fraud involved the HCA Inc, a company engaged in health care. The company “has agreed to pay the United States $631 million in civil penalties and damages arising from false claims the government alleged it submitted to Medicare and other federal health programs, the Justice Department announced today.” (Largest health care fraud case in US history settled HCA investigation nets record total of $1.7Billion, 2003). An article in the Washington Post states that losses due to fraud from players in the health care sector cost the taxpayer nearly 60 million USD in 2006. (Johnson, 2007, p.D01). More recently in 2009 two medical practitioners and two suppliers were caught while trying to defraud Medicare and insurance companies. These unrelated cases involved either phony or inflated bills. Another area of concern is patient dumping which means refusal to provide free treatment to a poor patient even if he or she is eligible for it. “Patient dumping violates the federal Emergency Medical Treatment and Active Labor Act (EMTALA) .” (Kahntroff & Watson, 2009, p.49-53). Two cases of patient dumping were reported to be carried out by healthcare agencies in 2009 alone. Both these cases involved reputed health service or charitable agencies. There are also instances of unethical patient transferring due to reasons like non-payment of bills or lack of care of healthcare agencies. Conclusion: It can be seen that many problems exist with regard to organizational responsibility within the US healthcare system. Some of the problems like patient dumping and fraud can be regulated by law enforcement authorities and also through self-regulation of the concerned healthcare agencies. For example, many hospitals now offer free primary care to patients who may develop serious illnesses in future. This free primary care may prevent the onset of the disease in the first place. It will also help to bring down treatment costs in the future in such cases. Another welcome development is the more active involvement of retired persons in the society. The current generation of such people is not content to sit at home, but want to engage themselves in some constructive activity. Such persons can be encouraged to lend a hand in volunteer or paid work in the health sector. But the main issue lies in the healthcare system as a whole. The existence of private players does not in any way help to bring down the costs because of their profit motive. There have been feeble efforts to bring a change, in spite of rising concerns among the public and the healthcare providers. But successive governments have not done anything constructive probably because of the fear of the effort, resource and time involved. Only a fresh and comprehensive policy with higher government and voluntary involvement and lesser private participation can bring a long term solution to this issue. Otherwise this healthcare sector will move in the same direction as the current social security sector in the country. Only a superhuman effort will help the sector to become healthy again once it collapses in its current structure and form. References Brown, Lawrence. (2008). The amazing noncollapsing US health care system. The New England Journal of Medicine, 358 (4), 325-327. Retrieved February 16, 2009 from http://content.nejm.org/cgi/content/full/358/4/325 Chua, Kao Ping. (2006). Financing of the US health care systems. 4. Retrieved February 16, 2009 from http://www.amsa.org/uhc/HealthCareSystemOverview.pdf Chua, Kao Ping. (2006). Overview of the US Health Care System: Introduction. 1. Retrieved February 16, 2009 from http://www.amsa.org/uhc/HealthCareSystemOverview.pdf Fact sheet on aging in America: Percentage of Americans Age 65 Expected to Survive Age 90. (n.d.). Experience Corps. 1. Retrieved February 16, 2009 from http://www.experiencecorps.org/images/pdf/Fact%20Sheet.pdf Fact sheet on aging in America: US 55+ Population, 2000-2005. (n.d.). Experience Corps. 1. Retrieved February 16, 2009 from http://www.experiencecorps.org/images/pdf/Fact%20Sheet.pdf Johnson, Carrie. (2007). US Targets health care fraud abuse. The Washington Post. D01. Retrieved February 16, 2009 from http://www.washingtonpost.com/wp-dyn/content/article/2007/07/18/AR2007071802461.html Kahntroff, Jeffrey., & Watson, Rochelle. (2009). Refusal of emergency care and patient dumping. Virtual Mentor, 11 (1), 49-53. Retrieved February 16, 2009 from http://virtualmentor.ama-assn.org/2009/01/hlaw1-0901.html King, Martin Luther. (2001). The US health care system: Best in the world, or just the most expensive. The University of Maine. 1. Retrieved February 16, 2009 from http://dll.umaine.edu/ble/U.S.%20HCweb.pdf Largest health care fraud case in US history settled HCA investigation nets record total of $1.7Billion. (2003). Department of Justice. Retrieved February 16, 2009 from http://www.usdoj.gov/opa/pr/2003/June/03_civ_386.htm Philosophy: Ethics glossary. (n.d.). Bentley University. Retrieved February 16, 2009 from http://www.bentley.edu/philosophy/ethics_glossary.cfm Preliminary working definition of organizational social responsibility. (n.d.). ISO. Retrieved February 16, 2009 from http://www.iisd.org/pdf/2003/standards_definition.pdf Read More