Comparison of the U.S. Healthcare System with the United Kingdom and Canada - Essay Example

U.S. Healthcare System Access to healthcare is dependent on many factors including economic status, availability of resources and social status, all of which are dictated upon by the healthcare policies available in a country. These and other factors cause variations of the extent of healthcare access among individuals and societies. A suitable healthcare system is one that ensures that most of the population’s needs are catered for, for example, well-paid healthcare professionals, and up-to-date medical equipment. Healthcare system is a crucial factor in a country’s economy, accounting for an average of 9 percent in the leading world economies, with the United States having about 16 percent. The aim of this paper is to analyze the healthcare system for efficiency in delivering quality and adequate services, in comparison to United Kingdom and Canada. Comparison of Healthcare Quality with Industrialized Nations Structure The United States healthcare is provided primarily by the private sector; the government provides about 65 percent of all the healthcare insurance while the rest is provided by the private sector insurance. The United States healthcare uses the highest amount of money in the world per person as compared to other countries, though its structure leaves over 16 percent of its citizens with no medical cover or policy. While the United States healthcare is decentralized, the United Kingdom has a semi-centralized healthcare system whereby each country has its own healthcare that is free to all residents. The United Kingdom healthcare has a relatively small private sector as compared to the public sector that spends much less than the United States, at 8 percent. Canada, on the other hand, has a fully centralized system funded by the government with the private sector only covering the medical procedures not covered by the government’s system. Though elaborate, Canada's healthcare system only accounts for about 10 percent of the gross domestic product, much less than that of the United States. Performance In the United States, 40 million residents are not covered by any healthcare insurance, in contrast with the United Kingdom and Canada, whose medical care is free for all; mainly because the latter two largely depend on taxes while the former depends on the contributions of individuals. According to residents of the three countries, Canada’s have the greatest level of satisfaction in their healthcare system, followed by United Kingdom residents while United States residents are the most dissatisfied. In addition, the United States healthcare is the most expensive among the three. Overall, the world health organization ranked the healthcare systems in the United States, Canada, and United Kingdom at 37th, 30th and 15th worldwide respectively. Therefore, though the United States healthcare takes up a large chunk of the gross domestic product, it lags behind when compared to the healthcare systems in other developed countries (Sultz and Young, 2011). Assurance of Quality Health Comprehensive Health Planning Act The comprehensive health-planning act of 1974 was legislation passed by congress as part of the National Health Planning and Resources Development Act. The Act was aimed at creating availability, equitability, uniformity and affordability, all of which were lacking in the system at the time. These shortcomings in the healthcare system resulted due to infusion of federal funds into the system that inflated prices without a corresponding improvement in quality, and mismanagement of the funds. Consequently, disparities resulted whereby some regions received more funds than they needed while others did not have enough. The effect was to create a balance between federal and state contribution, such that each state received the resources it needed and in the right quantities (Sultz and Young, 2011). Health Systems Agency The health systems agency is the agency whose chief duty is to improve access to medical cover to the disadvantaged, mainly those without an insurance cover, the poor, isolated or those with an increased likelihood of contracting diseases. The agency was formed 1943, serves all states, and concentrates on the vulnerable components of the population like women and children, and those struck by disasters, especially in isolated locations. In addition, the agency oversees all forms of body organ or tissue transfer, compensates victims of faulty vaccinations, and supports research programs against bioterrorism. The agency is a key player in improvement of quality of healthcare, elimination of disparities of healthcare among residents, and enhancement of disaster preparedness of the system among other functions (Sultz and Young, 2011). Medicare and Medicaid All government levels fund Medicaid but the state governments manage the fund, which is the main source of healthcare funding for most low income Americans. However, its main concern is poor adults, children, and people with disabilities. The people without medical cover get community Medicaid, whereby they pay some or all their medical bills. For people with other insurance covers, there is the Medicaid nursing home coverage that pays all the nursing home fees but the insured covers all other expenses, spending most of their earnings on the nursing home. Medicaid may result in healthcare disparities since the states follow a basic guideline but each decides how to implement the system, meaning some eligible individuals might be denied medical cover. Medicare, like Medicaid, is a government-sponsored project that aims at improving healthcare for disadvantaged individuals. However, Medicaid is only for those who are over 65 years of age, those under 65 but have certain disabilities, and those who are terminally ill among other eligibility criteria. In addition, Medicaid sponsors the training programs of most physicians in the United States. Therefore, Medicare and Medicaid are attempts by the federal and state governments to reduce or eliminate the disparities that exist in the provision of healthcare to United States residents (Sultz and Young, 2011). Measurement of Healthcare Delivery There is no other way that healthcare providers can ensure that they provide the best quality care, other than by analysis the current state of healthcare to identify areas for improvement. For instance, medical professionals may record data about their activities and happenings at their places of work, which can then be analyzed quantitatively. On the other hand, stakeholders may analyze performance semi quantitatively or qualitatively by considering the factors of service that cannot be measured in numerical values. Semi quantitative and qualitative analyses give an overview of the performance and help in identification of areas that need scrutiny (Scobie et al., 2006). Quantitative Measures Quantitative measures of healthcare quality can be at the institution, local, or international level and involve recording of data that is analyzed professionally to provide details on the trends in quality. Individuals or their superiors record data on mistakes, confusions and other occurrences, which is used together with data from registries to generate information for use in strategizing. In addition, institutions record performance indicators for comparison with accepted benchmark values to measure the extent at which the institution is in alignment with acceptable standards. The final quantitative measure is patients’ medical records that indicate factors like recovery rates, and disease recurrence (Scobie et al., 2006). Semi Quantitative and Qualitative Assessment Most standards by independent bodies are qualitative, such that there are no definite values for the quality level an institution should achieve. However, in some cases the standardization bodies may give semi-quantitative criteria by assigning numbers to various compliance levels. The organizing ability of an institution is another qualitative factor, considering the administration, culture, and the ability of employees to work together among other factors. In addition, institutions or other stakeholders may form focus groups to give opinions about the healthcare system, especially those focus groups with consumer interests at heart. Research may also include satisfaction and complaint surveys on customers or employees to determine the extent to which the institution caters for their welfare. Employees should know what the quality implementation strategy expects of them, and institutions should recognize exemplary performance of their employees to encourage quality assurance. Finally, institutions should always consider the many available courses of action and adopt one that best suits their quality goals (Scobie et al., 2006). Criteria Developed for Health Performance An institution, state or nation should consider its objectives and the current situation before adopting an assessment criterion. First, the identified phenomenon must be measurable using available methods and equipment and must be a phenomenon that is measurable on everyone regardless of race, gender, social or economic status. Secondly, the phenomenon should cause relevant implementers to do their duty, primarily by being comprehensible to them. If action is taken, the parameter measured in the analysis must change to indicate improvement or deterioration such that decision makers can know the way forward. Before implementation, the quantitative, semi quantitative or qualitative analysis must be feasible, considering the available skills, resources and other limitations (Scobie et al., 2006). Participation in Hospital Peer Reviews Types of Disciplinary Proceedings For a medical practitioner, two main areas an individual would find oneself in front of a disciplinary panel are payer contracting arena and medical staff setting. In both cases, a practitioner is screened for eligibility using similar criteria, and breeching the working terms of both has the comparable consequences. A disciplinary committee may forgive, train or counsel an individual to resolve the dispute, or have a disciplinary action taken against him or her. Disciplinary action takes several steps, giving the culprit a chance to reform including several formal and informal, oral and written warnings before final dismissal, which is the last line of action (Bradford, 2002). Chart Audit The main use of a chart audit is to ensure that medical staffs adhere to laid down standard operating procedures. For instance, if a recurrence of a certain illness in patients is reported, then senior staff or department heads should conduct a chart audit to find evidence of negligence or other anomalies in the system (Bradford, 2002). Due Process Guidelines Before dismissal or suspension, every errant physician has the right to go through a peer review process, and the physician should inform the payer of the suspension in order to succeed in posting an appeal. In addition, the due process requires that a physician be notified of the charges facing him or her, and scrutiny of a physician’s medical records to provide evidence for the charges. However, it is almost impossible to succeed in an appeal if the suspension followed the due process, except if the physician can prove a violation of laws, and where a decision was made arbitrarily without adhering to the due process (Bradford, 2002). Credentials of Managed Care Organization For its own protection, every institution must attempt to abide by laid down standards to reduce risks and decrease its liability in case something goes wrong. An institution can reduce the intensity of liability it incurs by being accredited, doing risk management, and doing positive marketing. All these three improve the public image of an institution, such that it has a stable backing when faced with uncertainties. Risk Management An institution does this by identifying possible risk factors, seeking possible solutions, and incorporating risk management into its strategic plan. In this case, even if the firm is not fully compliant on the risk management front, at least the inspecting body will consider the fact that the institution has risk management covered in its goals (Sobelman, 2001). Accreditation Accreditation not only assures the public of high quality services, but it allows some flexibility such that an institution can make mistakes with fewer consequences than when it is not accredited. In addition, accreditation bodies help institutions to identify the benchmarks for quality, such that if the institution makes it beyond the laid down guidelines, then it can know that its services are of high quality even without doing additional analysis (Sobelman, 2001). Positive Marketing Positive marketing makes existing, and prospective clients to view the institution from a positive perspective, ignoring any shortcomings the institutions might have. In addition, positive market not only creates positive bias to an institution by outsiders, but it also causes employees and managements to rethink their strategy and live according to the image portrayed to the public. Consequently, positive marketing results in improved healthcare and better adherence and superseding of standards (Sobelman, 2001). Communication of Healthcare Providers with Patients Communication plays a central role in treatment since patients are mostly alone during the treatment period and have to do most things by themselves. It is, therefore, important that messages pass from the healthcare provider to the patient in a clear manner free from ambiguity. Medical Technology Affects A physician may choose to use electronic modes of communication to relay instructions and medical guidelines to a patient. Of all electronic media of communication, email is the most preferred as it retains a record of communication and is clear concerning instructions compared to oral communication. In addition, a practitioner can include links on educational or informational material on a topic of interest to a patient, giving a patient the chance to acquire more information on the topic (America Medical Association, 2012). Involvement of Care Communicating with a patient makes one feel part of the healing process and can express how he or she feels, allowing the physician to alter medication for maximum effect and minimum side effects. In addition, it keeps the patient informed on the goings-on and gives him or her additional information that is helpful for healthy living (America Medical Association, 2012). Comprehension of Terminology Though patients these days are more informed about their health than before, most medical terminologies and jargons are still beyond the understanding of a layperson. Therefore, it is essential that a physician explains all the terminologies to a patient before using them in communication; a better alternative would be to avoid their use unless it is necessary (America Medical Association, 2012). Conclusion The United States healthcare system is doing well in some cases while failing in others. For instance, the government must figure out a way of keeping the cost of healthcare down, and including more people in national healthcare cover. Healthcare providers must ensure quality to clients through estimation of the quality and quantity of their service, participation in peer reviews and seeking accreditation among other approaches to quality assurance. Finally, healthcare providers and patients should communicate to ensure that quality service is in accordance with patient’s needs. References America Medical Association. (2012). Guidelines for physician-patient electronic communications. Retrieved from http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/young-physicians-section/advocacy-resources/guidelines-physician-patient-electronic-communications.page Bradford, R. T. (2002). The basics: What every physician needs to know about medical staff and other types of disciplinary proceedings. Retrieved from http://www.peerreview.org/hospital/what_every_physician_should_know.htm Scobie, S., Thomson, R., McNeil, J. J., & Phillips, P. A. (2006). Measurement of the safety and quality of healthcare. The safety and quality of healthcare: Where are we now? 184. Retrieved from http://www.mja.com.au/public/issues/184_10_150506/sco110566_fm.html Sobelman, J. S. (2001). Managed care credentialing of physicians. Retrieved from http://www.physiciansnews.com/business/601sobelman.html Sultz, H., & Young, K. (2011). Healthcare USA: Understanding its organization and delivery. 7th Ed.. Sudbury, MA: Jones & Bartlett. Read More