Health Care System Evaluation Frameworks - Report Example

Health Care System Evaluation Frameworks Introduction In relation to the modern phenomenal development of the global healthcare systems, countries are often observed to renew their interests towards developing performance indicators to assess, monitor and manage healthcare arrangements and achieve efficiency, quality, effectiveness and equity (Arah et. al., 2003). Emphasizing the current development of performance indicators in the healthcare systems by the global countries, the primary objective of this essay is to evaluate the modern healthcare system frameworks implemented by different countries to streamline the performance of their wide-ranging healthcare services. In order to bring an in-depth understanding regarding the primary objective, the essay also tends to identify few numbers of important health problems faced by the countries stressing on their implications by using appropriate statistical data and information. In this context, the implication of the health problems by the countries have been perpetually distinguished and evaluated by implementing the Murray and Frenk framework. Moreover, the discussion also critically demonstrates the funding and delivery procedures of the healthcare system, identifying whether any area, group or individual community exists in the country, where the healthcare system is less than ideal with appropriate evidence and justification. Proceeding towards its conclusion, the essay critically compares the healthcare system of the US with the current healthcare system in Australia, elaborating on the problems and the evaluation frameworks used to increase efficiency and quality of the healthcare services. 1. Identification of the Major Health Problems that Facing the Country The healthcare delivery system of the US has been voluntarily involved in response to the considerations regarding the accessibility, quality, along with cost of the health insurance services (Jones & Bartlett Publishers LLC, 2008). According to the current healthcare system of the country, the Federal Medicare generally caters the elderly and disabled Americans, whereas the Federal-State Medicaid healthcare programs cover individuals with low-income level and physically challenged population (Arah et. al., 2003). However, the country has been witnessed to face few major obstacles, as a form of problems for the healthcare system. In this regard, three of the major problems faced by the US healthcare system can be identified in terms of accessibility, cost or affordability, from the viewpoint of the service recipients, when obtaining health insurance services and consolidation of the institutions in the US healthcare industry. Accessibility to the Healthcare Services Accessibility to the healthcare services has long been recognised as a key issue in the US healthcare system. According to the present developing measures of the healthcare insurance facilities, both the government and non-government insurance agencies are highly focused to develop their offerings in order to accomplish a significant growth for their institutions. The consolidation amidst the health insurance service providers in the nation, have been raising issues associated with accessibility due their unabatedly increasing price and availability of quality based service facilities (Kaiser Family Foundation, 2014). The tables presented in Appendix 1 herewith demonstrate the current number of population registered under Medicaid and Medicare along with insured and uninsured population across different states of the US. The illustration depicts the recent scenario of the insured individuals by the Federal Medicare and Medicaid services across the different US states. In relation to the statistics, it has been identified that the states have been emerged a higher rate of uninsured individuals throughout the last few years. Cost or Affordability Regarding Health Insurance Services Costs associated with the Federal Medicare services can also be considered as a major problem that engages a number of issues for the healthcare service providers in the US. With reference to an in-depth understanding of the recent facts, Medicare services provided by the institutions are likely to involve higher pricing strategies that often raise major issues for the population with minimum or considerably less income level. For instance, during the year 2006, the US Census Bureau declared that more than 45 million US citizens were excluded in the health insurance schemes within the nation. It was also reported by the Census Bureau that more than 36% of US households, who lived below poverty line were not insured. With reference to the total spending on healthcare and its insurance beneficiaries, the US spends approximately USD 2 trillion every year that can be apparently affirmed as higher than other countries of the world (Wilper et. al., 2009). In this regard, it is evident that the costs or affordability to the healthcare services is one of the major problems persisting in the US, causing negative impacts on the people with minimum or low-income level groups. Consolidation of Healthcare Institutions Consolidation amidst the public and privately held institutions has also been identified to create major hurdles for the US population to obtain quality and affordable healthcare services. The consolidation of the public and private institutions is generally expected to create a competitive environment within the healthcare industry, which might further impose major difficulties for the US population to gain quality based healthcare services in an affordable and accessible manner. The country further spends almost 31% as administrative costs in order to offer healthcare services. Accordingly, the average overhead costs of the US private health insurance can be identified as 11.7% for Medicare and 3.6% for conducting healthcare programs (Sicko, n.d.). Furthermore, with reference to healthcare facilities in the US, it has been stated by the Census Bureau that the number of people adopting healthcare insurance policies had augmented to 260.2 million during the year 2011, approximately by 84.3% of the total population (American Health Lawyers Association, 2012). In this regard, it is often observed to create a major hurdle for the organisations along with the service recipients as well. 2. Health Care System Evaluation Frameworks Leading to Compare Healthcare Performance of US with other Nation The healthcare-system evaluation framework of the country involves a wide range of healthcare-system performance frameworks wherein majority of the models are observed to be in a developing stage, in the current phenomenon. To be noted in this regard, the major frameworks in the healthcare system of the US include (a) Population Health Improvement Model; (b) National Health Care Quality Report; (c) Consumer Assessment of Health Plans Study (CAHPS); (d) Health Employer Data Information Set (HEDIS®) and (e) national healthcare-system improvement framework. Contextually, the performance reporting initiatives, such as CAHPS and HEDIS® are widely used by the US healthcare systems currently. However, both the prominent performance-reporting initiatives are non-national and are highly prioritised only by the privately held institutions. The national healthcare-system improvement framework can also be identified as a proposed performance reporting initiative, which is still in its developing stage, designed to measure performance of the institutions based on the quality and reliability of the institutions while delivering healthcare services to the targeted individuals or groups (Arah et. al., 2003). The country also incorporates a number of other healthcare-performance assessment models such as Quality Improvement Organisation (QIO) initiative operated by the Centers to improve Medicare and Medicaid Services, emphasising quality measures of the Foundation for Accountability and the ORYX healthcare programme performed by the Joint Commission on Accreditation of Healthcare Organizations (Arah et. al., 2003). Comparing the Health Care System Evaluation Framework of the Country with Murray and Frenk Framework The framework developed by Christopher JL Murray and Julio Frenk, in the year 2000, primarily aims to offer an apparent conceptualisation regarding the healthcare system performance in terms of their goals and functions. Murray and Frenk’s framework involves a number of models that enable critically identification and measurement of any healthcare system performance from within the states or nations (Papanicolas & Smith, 2013). The following pictorial representation describes functions associated with the goals and functions of the health system of a particular health system institutional framework. Source: (Papanicolas & Smith, 2013) In relation to the fundamental concepts and principles of the Murray and Frenk framework, the healthcare-system measurement framework considers the issue associated with the boundaries, wherein the healthcare system of a country or state exists. The consideration of the boundaries associated with healthcare system tends to raise a big question for the policy-makers and the marketers, as the system encompasses a broad array of structure with multiple functions attributed to healthcare services. With reference to the Murray and Frenk framework, the healthcare system functions and goals in the US incorporate a set of weak coherent national approaches that significantly raise a number of issues relating to the measurement of the healthcare system within the country. Nevertheless, the multi-faceted determinants within the healthcare-system measurement functions in the US can also be considered to impose stress on the overall development of major difficulties in order to attribute the appropriate outcomes relating to the actions of each healthcare service (Murray & Frenk, n.d.). The healthcare services in the US also involves a number of boundaries that often cause fragmentation and ground different types of analytic complexities, attributing overall results of the services (Green & Moehr, 2000). 3. Healthcare Funding and Delivering Process in the Country The healthcare system in the US is primarily driven by the private sector and is intensely combined with federal and state regulatory policies. The pluralistic structure of the healthcare system in the US involves a consolidated arrangement, which is mainly funded by the privately held institutions (Arah et. al., 2003). The healthcare sector of the country is also observed as financed by a variety of ways, in which individuals are likely to pay for different types of healthcare services, excluding the insured population who are covered with tax-free benefits from their existing employment. The elderly population are further observed as highly depended on the Federal Medicare system, while individuals with low-income groups, women, children and disabled are likely to receive healthcare services through the Medicaid system (U.S. National Library of Medicine, 2013; Shi, 2012). In relation to the recent unabated amplification of stakeholders, including health partnership amidst the international institutions along with bilateral donors and other global agencies, have also been observed to contribute a major support in financing the US health sector. The stakeholders from different institutions and agencies are often observed to increase their funding support, especially in monitoring and evaluating healthcare services in the present US healthcare sector (Jones & Bartlett Learning, 2008). Although, the healthcare system of the country involves many unignorable complexities, the funding mechanisms in the sector are observed to include a wide range of activities in order to make continuous improvements in the system evaluation framework in the US. In this regard, the key funding activities in the US healthcare system include major initiatives to strengthen, monitor and evaluate systems to achieve appropriate outcomes associated with each healthcare service in the nation (Chua, 2006). In the context of recent observation, the financing activities in the US healthcare sector intensely focuses on developing effective frameworks, principles, tools and data generation methods. The system of investment in the sector enables critical identification and permits access to the current performance of the healthcare sector, enabling the recipients to monitor progress in line with their commercial goals and objectives (Hahn et. al., 2008). Moreover, the sector also involves performance-based funding system to be practiced by the agencies and institutions. The system of funding, in accordance with performance of the healthcare services, accordingly facilitates a considerably higher rate of premium and obtain quality based data and outcome information for each individual service provider as well as recipient in the country (Johnson & Johnson Services, Inc, n.d.). 4. Identification of a Particular Group of People, where Access to Healthcare is less than ideal According to the recent pace of privatisation in the US healthcare sector, a large group of individuals from middle or low-income groups have been widely accepted to face major challenges to access effective or adequate services. The evolution of private organisations along with their enormously increasing funding system have formed a challenging environment for this particular group of individuals, where access to effective healthcare facilities has become less than ideal (Nugent, 2008). Due to the competitive scenario amidst the institutions and agencies, the healthcare services within the country have ignited an unaffordable condition, especially for the middle and low-income groups of Americans across its different states (World Health Organisation, 2010). Although the country can also be regarded to have a wide range of healthcare resources across its different constitutional areas, the continuous upsurge of price has become more challenging for the low income-level groups to acquire healthcare services. The continuous pace of the service providers along with their penetrative pricing strategies can be considered as one of the major issues leading to major risks for the low income-level groups while seeking any type of healthcare services (Marmor & Wendt, 2012; Stewart 2012). Moreover, concerns associated with healthcare insurance services can further be stated as a major issue leading to the imposing of severe hurdles for majority of the Americans to access healthcare services. According to the observation, majority of people in the US fail to obtain adequate insurance coverage due to a number of reasons along with political consensus regarding the way to resolve issues of uninsured individuals, which have been faced by its recipients since the past two decades (Kovner et. al., 2008; U.S. Department of Health and Human Service, 2004). 5. Comparing Healthcare System of the Country against the Healthcare System in Australia The following characteristics incorporate a set of few attributes relating to the key problems towards accessing healthcare services, healthcare-system evaluation frameworks, ways of funding and delivery channels of healthcare services and identification of the areas where access to healthcare is less than ideal for both the countries. Problems towards Accessing Healthcare Services According to the analysis of the healthcare services sector in the US, it has been identified that accessibility, cost or affordability along with consolidation among the institutions and agencies are few of the key barriers to its overall development. However, the federated and shared roles of the national and state healthcare-service providers have enabled the country to make continuous developments of the sector. Contextually, the mixed funding system in the Australian healthcare sector can also be considered as a major difference observable in comparison with the US (Arah et. al., 2003). Healthcare System Evaluation Framework The performance framework in the healthcare system of Australia can also be considered as a major determinant as compared to the frameworks used in the US healthcare sector. The performance frameworks implemented in the Australian healthcare sector involves evolving coherent models and indicators that help to obtain a clear view of the outcomes associated with each healthcare service provider. However, the performance framework used in the US healthcare sector tends to produce a complex reporting structure with respect to the services provided by the public and privately held institutions (Arah et. al., 2003). Funding and Delivering of Healthcare Service According to the above discussion, it has been observed that the healthcare sector in the US is primarily funded privately with a lower integration of government held public institutions or agencies. On the other hand, the Australian healthcare sector is funded by an effective mixed approach, which enables both private and publicly held institutions to make continuous development of their services. The sector is also driven by both public and private institutions, which has facilitated the country to provide a wide range of service facilities to different groups of individuals, irrespective of their income or wage levels (Arah et. al., 2003). Identification of an Area, where Access to Healthcare is Less than ideal According to the current scenario observed in the modern healthcare sector of the US, the middle and lower income-level population may be identified as the major group of individuals offering them with limited or restricted healthcare services as compared to other groups, causing disparity in the paradigm. However, the healthcare services provided in Australia encompass a wide range of population, irrespective of their income levels indicating another vital difference amid the two nations (Arah et. al., 2003). Conclusion Healthcare services in the US can be considered as one of the major elements in contributing towards the country’s overall Gross Domestic Product (GDP). The segment is also regarded as an efficient source for the people of America being a major employment generator. The increasing investments in the healthcare service sector have been observed as one of the major contributors in the US too, developing its economic structure at large. Moreover, the healthcare insurance institutions, operating in both the government and private sectors of the country, are significantly focusing to keep up the pace of adopting various policies in order to provide more effective and beneficial outcomes for each of the insured people in the nation. Based on the aforesaid discussion, it has been critically identified that the healthcare sector of the US is one of the most concerning areas, due to its major barriers along with the evaluation frameworks used by the institutions or the agencies. 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The United States: Jones & Bartlett Learning Southern California Evidence-based Practice Center. (2007). Global Health Evidence Evaluation Framework. Agency for Healthcare Research and Quality, C-01 – C-73. U.S. Department of Health & Human Services. (2003). Health care in America – Trends in utilization. Retrieved form http://www.cdc.gov/nchs/data/misc/healthcare.pdf U.S. Department of Health & Human Services. (n.d.). The effect of health care cost growth on the U.S. economy. Retrieved from http://aspe.hhs.gov/health/reports/08/healthcarecost/report.pdf Appendix 1. Health Insurance Coverage of the Total Population Source: (Kaiser Family Foundation, 2014) Read More