Problems in the U.S. Healthcare System - Research Paper Example

PROBLEMS IN THE U.S. HEALTHCARE SYSTEM Table of Contents Background 3 Problem Definition 3 Literature Review 4 Problem Analysis 5 Possible Solutions 7 Solution and Its Implementation 8 Conclusion 9 References 11 Background The health care system prevalent in United States has faced with lot of criticisms in the recent years because of the various issues related to it. There have been two extreme opinions regarding this issue in US. One argues that US is having the best health care system in the world because of the high standard of medical technology available in the country. On the other hand, the other extreme adjudges the US healthcare system to be inefficient and fragmented because of the fact that despite huge spending in the health care sector of the US economy, the country suffers from various issues related to administrative waste, uneven quality and un-insurance on a huge scale (Chua, 2006). If we look at the US health care system’s organizational structure, it can be found that the private insurers play a dominant role in the system and the majority of Americans are served through employer-insured private insurances. The health care system in US is observed to be deteriorating in relation to various factors such as increased costs, decreasing access, bad system performance and unacceptable quality as compared to other health care systems existing in various industrialized western nations. Various reform efforts have been undertaken by the US government but were not successful mainly because of strong opposition offered by the pro-market stakeholders. Hence, there are many concerns related to US healthcare system, which have been addressed in this research study, and possible solutions by which existing problems can be overcome have also been discussed. Problem Definition For long, there have been various problems that engulf the US health care systems. Many healthcare reform initiatives have also been undertaken but none have been completely successful in addressing all the concerned issues. Hence, this research study would try to answer to the question “How the health care system in US can be reformed in an effective way?” Literature Review A lot of research studies have been conducted by various research scholars concerning the different types of issues related to US healthcare system and how the previous reforms taken up in the country have been unsuccessful to effectively combat the situation. In one of the research studies by Geyman (2003), various myths have been identified as being responsible for providing barriers to all the previous healthcare reform initiatives taken up in United States. Six myths that have been identified by Geyman (2003) include (1) “Everyone gets care anyhow;” (2) “We don’t ration care in the United States”; (3) “The free market can resolve our problems in health care”; (4) “The U.S. health care system is basically healthy, so incremental change will address its problems”, (5) “The United States has the best health care system in the world”; and (6) “National health insurance is so unfeasible for political reasons that it should not be given serious consideration as a policy alternative.” It is true that all these myths that have been identified by Geyman lack evidence and the US healthcare system is in a precarious situation at present. Odier (2010), on the other hand, argues that the US healthcare system is characterized by being market based and requires reform mainly because of the facts that despite the higher costs involved in the US healthcare system, its quality is poor and covers only a smaller proportion of the countrys population as compared to other healthcare systems found in other European nations. The main difference in the healthcare system between the United States and the European models has been identified as the European nations having a governmentally centralized system as opposed to the decentralized system found in US, which is mainly operated through contracts with the private healthcare institutions. Odier (2010) has proposed a new method of reform in US healthcare system, which is primarily focused on reducing costs and introduction of a regulatory mechanism in the system which is comparable with the existing healthcare systems found in most of the major European nations. In one of the research studies by Kemfert and Reed (2011), there have identified various issues related to the enforcement of Health Information Technology for Economic and Clinical Health (HITECH) Act and Health Insurance Portability and Accountability Act (HIPAA) in United States. The security and privacy provisions in HIPAA have been criticized on a wide scale because of its inadequacy to provide effective protection and security against improper use, access and disclosure of protected health information (PHI). In addition, the compliance regulations of HIPAA are also feeble in nature and non-compliance does not impose significant fines. Squires (2012) has undertaken a research study to analyze the high spending in the US healthcare system as compared to 12 other industrialized nations of the world. The findings of study suggest that the US surpasses all 12 nations in the amount of money spent on its healthcare sector, but the quality is significantly low as compared to other nations which spend much lower amounts in health care sector. Three primary reasons have been attributed towards high spending, which include greater obesity, medical technologies which are readily accessible, and high prices. Problem Analysis The review of existing literature presented above suggests three main issues concerned with the healthcare system in United States. They are: a) high spending in healthcare, b) low quality of healthcare, and c) higher proportion of US population suffering from obesity. The total spending on healthcare was around $2.6 trillion in 2010. It meant that 17.9% of the gross domestic product (GDP) of United States was spent on healthcare, which amounts to around $8,402 per person (CMS, 2011). The health spending in United States is mainly found to be concentrated in four primary sources of funds which include: a) Medicare, b) Medicaid, c) Private health insurance, and d) Out-of-Pocket. Next, if we compare the spending on healthcare in US and other major industrialized nations of the world for the period of 1980–2009, it can be observed that US spending is significantly higher than its counterparts (Figure 1). Figure 1 Spending on Healthcare Source: (Squires, 2012) The elderly population in a country is generally considered to be a major factor behind high spending in healthcare. However, this is not the reality in case of US because most of the other industrialized countries have a high younger population than US. One of the primary problems that can be identified in case of United States, which has resulted in its high spending in healthcare, is its increasing population suffering from obesity. Obesity is, thus, one of the reasons of high spending in US. Next, if we look at the quality of healthcare provided in United States, it should correspond with the high spending in healthcare. However, it is not the case and the results are opposite. Utilization of healthcare services in United States are comparatively low than in many other nations which spend much lower amounts in healthcare. The other major concern for the US healthcare system is the price of the products and services associated with it, which is comparatively much higher than in many other industrialized countries. Lastly, one more major area of concern that can be identified in the US healthcare system is the greater percentage utilization of medical technologies which are highly expensive in nature. Possible Solutions There can be a number of solutions which could be helpful in addressing the major problems of high spending and low quality as observed in the US healthcare system. There is a need to reform the existing healthcare system and it can be very well achieved through the implementation of various means by comparing with the healthcare system that is prevalent in other major industrialized nations of the world which have been successful in imparting high quality of health care services to the country’s population with lower spending than US. Three such possible solutions which can handle the existing problems in the US healthcare system have been discussed below: One possible solution to the problems identified in the US healthcare system could be to bring about a reform in the existing healthcare system in such a way that it corresponds with the healthcare systems prevalent in major European nations such as UK, France, Germany, etc. The primary motive of the reforming activities would be to reduce costs and provide better quality of healthcare services in US. However, the major drawback of this solution are the barriers to successful implementation of such a drastic change in the system quickly. Hence, this can be a possible solution but it would take significantly a longer time to be implemented successfully. Another possible solution to the problems can be to increase the government intervention in the healthcare system of United States through the implementation of higher regulatory reforms in the existing system. This can address the issue related to higher prices charged by the private insurers through the introduction of price limits on services being offered by them. Lastly, one of the other possible solutions to the problems could be improving the existing public healthcare system in US. It can be a good solution because this could result in the decrease in dominance of private insurers in the US market. Solution and Its Implementation Based on the existing literature, the analysis of the major problems and the possible solutions that have been identified to relate to the US healthcare system and which have been presented in this study, it is recommended that a reform is necessary in the healthcare system. The best solution would be the one which could result in reduction in healthcare spending with increase in quality in an effective and efficient way. Prior to suggesting a solution and implementing such solution, it is necessary that all the stakeholders corresponding to the healthcare system in US must realize and be aware of the need of reform in the system. The reform can only be successful only if everyone concerned with the changes in the system agrees with the requirement of such changes. In accordance with the solutions identified in this study, it is recommended that reform is made in the US healthcare system, which is a combination of those three solutions. Government has to play a vital role in bringing about an effective reform with the establishment of rules that would serve for the purpose of regulating the market in such a way that allows control of the market by the government. If in any case, the existing stakeholders and the private players who are a majority in the sector do not respond to the requests, the government should establish further supplementary regulations. A new health agency should be set up, which primary motives would be to plan and promote several healthcare initiatives, set standards for medical practices to be followed in the country, fix prices for medical products and services, monitor the insurance companies and their business activities. The health agency proposed above would be a centralized one. However, it is also recommended that health agencies be set up by the US government at state levels, as well for proper delegation of the tasks set for the central health agency. Another major reform that is recommended is the establishment of a separate public insurance program with the primary motive of providing insurance coverage to the people earning low income, who cannot afford to have high costing private insurances. The implementation of the suggested healthcare reform can be beneficial for the people in the country. However, it is expected that the private insurers who are a major stakeholder in the sector might create obstruction to such reform. Hence, it is suggested that the government must bring about the reform by taking into confidence all the stakeholders of the healthcare sector of the US economy. Conclusion The US healthcare is associated with several problems that have been identified in this study. Most of the previous reform efforts by the US government have been unsuccessful mainly because of the barriers offered by the private insurers who are the major stakeholders of the sector. The proposed reform that has been suggested in this study can effectively address all the major issues concerned with the US healthcare system. With the promotion of the public healthcare system, the dominance of private players would get reduced in the market. Moreover, with the stringent regulations in place, the prices of medical products and services would also go down, making health insurance affordable for most of the US population. The quality of health care would also improve because of tighter regulations and awareness amongst the people of the major problems concerning the US healthcare industry. References Chua, K. P. (2006). Overview of the U.S. health care system. Retrieved from http://www.amsa.org/AMSA/Libraries/Committee_Docs/HealthCareSystemOverview.sflb.ashx. CMS. (2011). National health expenditures 2010 highlights. Retrieved from http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/highlights.pdf. Geyman, J. P. (2003). Myths as barriers to health care reform in the United States. International Journal of Health Services, 33(2), 315–329. Kemfert, A. E., & Reed, B. D. (2011). Health care reform in the United States: HITECH Act and HIPAA privacy, security, and enforcement issues. FDCC Quarterly, 61(3), 240–273. Odier, N. (2010). The US health-care system: A proposal for reform. Journal of Medical Marketing, 10(4), 279–304. Squires, D. A. (2012). Explaining high health care spending in the United States: An international comparison of supply, utilization, prices, and quality. The Commonwealth Fund Publications, 10, 1–16. Read More