Comparison between the US and Omans Health Care Delivery System - Case Study Example

Comparison between US and Oman’s Health Care Delivery System Introduction The health care system of the US and Oman is often compared with each other by both government as well as public health analysts as Oman despite being a developing country provides healthcare facilities that can rival any developed country like the US. Thus, through this paper, I attempt to compare and contrast between these two healthcare systems and formulate a cooperative delivery model that can address various key health care issues. Four most important paradigms are considered for this paper—which includes cost, quality, accessibility and continuity—and their impact on major healthcare system’s stakeholders. The key problem that this paper would address through the comparison between the US and the Oman health care delivery system is the issue of job satisfaction in medical professionals. Therefore, in this paper, I would find out the differences as well as similarities between both these healthcare system and attempt to create a cooperative delivery model. Comparing the healthcare systems Although, being a developing country, Oman with a population of around 2,340,815 according to the 2003 census (Ministry of National Economy, 2006), has very high standards of healthcare delivery system. Further, it is estimated by the Regional Health Systems Observatory that Oman would have a population of around 2.5 million in 2006. Further, healthcare services are being provided free of charge by the Omani government to all its citizens as well as non-citizens. Such services are given to government sector employees as well. The healthcare service standards of Oman are even higher than that of many industrialized countries as well (Oman Ministry of Information, 2008). Furthermore, the health care system in Oman follows the policy of universal coverage, i.e., health care is provide to all the citizens, however, in the US health care for all citizens is not guaranteed by the country. Oman’s citizens can access to the country’s universal all-inclusive health care services that are medically necessary due to the country’s adoption of a single payer healthcare system. Such a coverage system also allows the citizens to use rationing and global budgeting (Nauert 2005). It has been found that the health system of Oman ranks higher than most of the developed nations as well, according to a report by the World Health Organization (2000).  This report also reveals that the performance of the Omani health care system has become rapid as compared to the situation in the 1970s. During the 1970s, the healthcare system of Oman was very low due to the availability of few health care provision and hospitals that provided fee-for-services. Study of MoH (2009) statistics finds that Oman just had two hospitals in the 1970s, which increased to 59 by 2009, indicating a strong development of the sector in the country. Further, the morbidity rates and mortality rates of children have decreased considerably in the last few decades due to the improvement in medical care standards in Oman (Al Bulushi and West, 2006). All this indicates that strong government involvement and initiatives led to the development of the sector in the country. The healthcare system in the US on the other hand is largely privately sponsored, which is mostly financed by employer-based health insurance market (Rodriguez and Wiens-Tuers 2000). This type of insurance market gives coverage to around two-thirds of the population that is under 65 years of age. However, the US provides universal insurance to people of over 65 years of age (NCHS 2004). Also, it has been commonly seen that the insurance given by the employer is a part of the salary package offered to the employee. However, for this type of coverage, the employee is generally provided with a tax incentive, and health benefits are most not taken as taxable income. However, despite so many incentives, around 14 per cent of the population still remained without insurance coverage in the US in 2002. Notwithstanding the differences, the healthcare systems of these two countries individually offer many benefits to its citizens. Therefore, in the next section, I would attempt to create a coordinated delivery model based on my study of both these systems. I have divided my model in terms of accessibility, cost, quality and continuity of care. Accessibility Experts believe that accessibility to health care system is one of the major considerations for determining the efficacy of a healthcare system. In terms of accessibility, my research found that the health care delivery system in the US does not have a universal health care policy. This translates to the fact that the US citizens are not given the guarantee of receiving necessary healthcare services. However, the US government has created and undertaken many initiatives to provide healthcare services to the people with disabilities, old people, destitute and unemployed youth (CMS, 2008a). Together with such programs, the healthcare delivery systems in the US also include initiatives that are put into practice due to the “Emergency Medical Treatment and Active Labor Act” (E.M.T.A.L.A.). All these programs guarantee that even people who require emergency medical services can avail such services irrespective of their financial capacity (CMS, 2008b). In comparison, the healthcare delivery system of Oman guarantees that every citizen is given healthcare services through its policy of providing universal all-inclusive health care services. However, even such healthcare coverage is not very comprehensive. For instance, according to a study by Gosh (2006), due to the increase in attrition rate of doctors and nurses from 1955 to 2003, the healthcare system could not reach to everyone in the country. The report revealed that the attrition rate of doctors went up to 38.9 per cent from 0.11 per cent in 1995 to 0.25 per cent in 2003. The nurses’ attrition rate, on the other hand, saw an increase of 51.4 per cent from 0.09 per cent in 1995 to 0.28 per cent in 2003 (Ghosh, 2006). Therefore, although the healthcare system of Oman guarantees access to every citizen, reports reveal the reality, i.e. not every citizen in Oman has access to regular healthcare facilities. Therefore, in my healthcare delivery model, I have combined the best aspects of both these systems. In my system, I recommend that a country should provide universal healthcare coverage, which would ensure that all its citizens receive similar treatments. However, to ensure that every citizen is given regular healthcare facilities, I recommend that individual or group based coverage such as old-age healthcare or unemployed youth healthcare benefits should also be provided. This would mean that every individual would receive healthcare in the times of emergency. Cost The US spends more money on healthcare as compared to Oman. The US spent around US$ 2,862 per person in healthcare in 2005, whereas, in the same year, Oman only spent US$ 332 per person (WHO, 2008). Further, the private expenditure on health as percentage of total expenditure on health in the US was reported as 54.9 per cent in 2005. On the similar parameter, Oman’s private expenditure was only 15 per cent (WHO, 2008). Additionally, in 2005, around 15 per cent of the US gross domestic product (GDP) was assigned for healthcare. However, for the same year, just 2.1 per cent of the Omanian GDP was assigned for healthcare (WHO, 2008). Oman Indicator Value (year) External resources for health as percentage of total expenditure on health 0.0 (2005) General government expenditure on health as percentage of total expenditure on health 85.0 (2005) General government expenditure on health as percentage of total government expenditure 6.1 (2005) Out-of-pocket expenditure as percentage of private expenditure on health 64.40 (2005) Per capita government expenditure on health at average exchange rate (US$) 266.0 (2005) Per capita government expenditure on health(PPP int. $) 332.0 (2005) Per capita total expenditure on health (PPP int. $) 390.0 (2005) Per capita total expenditure on health at average exchange rate (US$) 312.0 (2005) Private expenditure on health as percentage of total expenditure on health 15.0 (2005) Private prepaid plans as percentage of private expenditure on health 14.7 (2005) Social security expenditure on health as percentage of general government expenditure on health 0.0 (2005) Total expenditure on health as percentage of gross domestic product 2.5 (2005) . United States of America Indicator Value (year) External resources for health as percentage of total expenditure on health 0.0 (2005) General government expenditure on health as percentage of total expenditure on health 45.1 (2005) General government expenditure on health as percentage of total government expenditure 21.8 (2005) Out-of-pocket expenditure as percentage of private expenditure on health 23.90 (2005) Per capita government expenditure on health at average exchange rate (US$) 2862.0 (2005) Per capita government expenditure on health(PPP int. $) 2862.0 (2005) Per capita total expenditure on health (PPP int. $) 6350.0 (2005) Per capita total expenditure on health at average exchange rate (US$) 6350.0 (2005) Private expenditure on health as percentage of total expenditure on health 54.9 (2005) Private prepaid plans as percentage of private expenditure on health 66.3 (2005) Social security expenditure on health as percentage of general government expenditure on health 28.8 (2005) Total expenditure on health as percentage of gross domestic product 15.2 (2005) Although the US healthcare providers face similar legislative regulation just like the Omanians, the spending that the US providers insure differs considerably. This is especially due to higher costs of maintenance and higher salaries in the US. However, as compared to the US, Oman has lesser job satisfaction rate among its medical professionals. As per the Ministry of Health Directorate General of Planning (2008), due to the increase in the attrition rate of Omani doctors and nurses, the present Omanization project for 2010 has decreased to less than 43 per cent for doctors and 79 per cent for nurses. The Directorate of Human Resources (2009) describes that this rise in attrition rate is due to the lack of job satisfaction among nurses and doctors in Oman. Therefore, just as the healthcare systems of the US, even I recommend to incorporate healthcare as one of the major expenses in the budgets for my delivery model. However, for my model, I would try to follow the lessons learnt from the Oman’s healthcare system that job satisfaction among doctors and nurses should be put on highest priority. Quality Quality in a healthcare system can be measured in terms of the actual results that the healthcare system is able to provide and the professional knowledge displayed by the healthcare professionals. In both the US and Omanian healthcare systems, healthcare professionals are highly knowledgeable and qualified. Further, both the systems stress on the significance of continuing professional development and education through seminars, conferences, technological implementations and formal training (Arah, 2003). However, when it comes down to actual results, it has been found that the quality of the healthcare system in Oman is significantly higher than that of the US. Nonetheless, in terms of job satisfaction among doctors and nurses, the US ranks much more higher than that of Oman, According to a study conducted by Harris Interactive titled ‘Working in America: What Employees Want Working in America Survey’ (2006), it has been found that although healthcare services are important for creating a healthy society, it is also important to look at the satisfaction of the care providers. Thus, job satisfaction of nurses and doctors is directly linked with the quality of healthcare services provided to the public. However, most developing countries such as Oman continue to find low job satisfaction among doctors and nurses (Buchan & Sochalski, 2004). Therefore, in my healthcare model, I propose that quality should be a very important parameter to measure the success of the system. I would not only hire qualified healthcare professionals but would also look after such professionals’ continued training requirements. Further, I would also monitor their performance regularly and analyze whether their performance matches up with the actual health condition of the people. Continuity of Care While comparing the continuity of care, the US healthcare system provides better level of continuity that the Oman’s healthcare system. This also means that the continuity of healthcare delivery is dependent on efficient tracking of patients, streamlining the communication system, establishing a well-rounded information transfers/retrieval system, minimizing the costs, looking after the patient’s convenience and providing comprehensive services (Asch, 2006). Further, strict legislations such as HIPAA of the US government and Personal Information Protection ensure that the patient records are accurate and secure. Such integrated services also means that it is easier for patients to follow-up with their physicians for further appointments easily and ensures continuity of healthcare services from the same healthcare providers. It is interesting to note that the US has recently enhanced its healthcare system by adopting managed care. Due to this change around 90 per cent of the US citizens are now covered under the managed care plans (Health Decisions, 2008). However, in Oman, due to high attrition rate among the doctors and nurses, it is difficult to provide continuous services to the patients. This also affects the consumer satisfaction index. According to a study by Bates et al (1995), it has been found that there is a complex relationship between the job satisfaction of nurses and doctors and that with the patients. As increased attrition affects compliance and continuity, it eventually also puts stress on customer satisfaction. Another study by Cooper (2008) suggests that job satisfaction of caregivers would help in increasing the consumer satisfaction as well. In my model as well, I recommend to follow the policy of continuity of care. Just as US, I would also create a comprehensive database of the patients and their caregivers, which would ensure that each patient is assigned a particular healthcare professional throughout his or her treatment period. This would ensure not just continuity but also better and faster treatment. Conclusion In this paper, I attempted to understand the healthcare system followed by the US and Oman. Through my research, I found that both the healthcares systems are equally comparable and provide excellent basis for formulating a coordinated delivery model. Therefore, I studied both these systems closely and drew a few recommendations for a coordinated delivery model. This model is based on four major principles – accessibility, cost, quality and continuity of care. Therefore, in my healthcare delivery model, I recommended that a country should provide universal healthcare coverage, which would ensure that all its citizens receive similar treatments. However, I also recommended that individual or group based coverage such as old-age healthcare benefits should be provided. This would mean that all the citizens would receive healthcare in the times of emergency. In my model, I recommended to incorporate healthcare as one of the major expenses. Further, I proposed that quality should be a very important parameter to measure the success of the system. I would not only hire qualified healthcare professionals but also would monitor their performance regularly and analyze whether their performance matches up with the actual health condition of the people. I also proposed to follow the policy of continuity of care. Similar to the US model, I recommended creating a comprehensive database of the patients and their caregivers, which would ensure that each patient is assigned a particular healthcare professional throughout his or her treatment period. Further, the most important aspect of the paper is addressing the issue of attrition among doctors and nurses. The research found that attrition plays a major role in affecting customer satisfaction. Therefore, learning the lessons from Oman’s healthcare system, I would focus on providing better job satisfaction to the caregivers and thereby, ensure better customer satisfaction among the patients. References: Al Bulushi, H,. & West, D. (2006). Heatlh System Reforms and Community Involvement in Oman. Journal of Health Sciences Management and Public Health. Retrieved February 9, 2010 from http://medportal.ge/eml/publichealth/2006/n1/2.pdf Arah, OA, NS Klazinga, DMJ Delnoij, AHA Ten Asbroek and T Clusters (2003). 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