The Challenges of Providing Equity in the Health Care Systems - Essay Example

Introduction Health care systems are faced with challenges of providing equity at the expense of economic growth. There is competition in the health care based on the need to maximize output and efficiency by lowering costs in order to increase the number of patients seeking medical care services in the health facility. This is likely to compromise quality of the medical care. This aims of this paper is to look into effectiveness and efficiency of embracing equity care and its long term effects on increasing equitable access to health, improving quality and responsiveness of the services and role of collaboration and partnerships in sustained quality medical care. The characteristic features of the health care system that I am involved in are: The population has a wide domain. It is composed of a majority, 85% , of low income earners , who have little knowledge on control and prevention of diseases. Due to poverty levels and illiteracy, they don’t know the diseases they are likely to expose themselves to. Many of low income earners work in factories where safety regulations are not up to the required standards and suffer respiratory related illnesses. There is the medium income earners who are members of national health insurance fund. And a few high income earners who have comprehensive medical insurance covers. There are patients who suffer from terminal illness like diabetes and cardiovascular related diseases; this is confined to the medium and high income earners. 95% of the low income suffer from problems related to nutrition like protein energy malnutrition, anemia, osteoporosis, dementia; water borne diseases like cholera, dysentery and typhoid. 40% of the middle income earners and high income earners suffer from diseases predisposed by their eating habits like late onset diabetes, high blood pressure, cardiac arrest , that are predisposed by obesity, alcohol use. The body mass index of the low income earners is below 14-16 while that of the high income earners is 28-31. The organizational structure: The health planning works on strengthening health planning in a way that focuses on the responsibility of both sides that is providing necessary resources on the one hand and achieving the stated goals and outputs on the other. The financial management is a resource based management and enables timely disbursement of funds and timely and accurate accounting. The budget is linked with the annual inputs through the health plans and expenditures with the outputs achieved. The monitoring and evaluation is a support system that assists the hospital manager to make informed decisions that contribute to better quality planning and management. The transport system is satisfactorily and ensures smooth operation. It includes ambulance services that provide first aid and emergency medical care for patients that are referred to our health facility from secondary and tertiary health facilities. It’s also involved in transport of materials and supplies. The communication system in place is dependent on level of administrative responsibility and medical care. The administrative responsibility lines of reporting in place are horizontal and vertical. The medical care communication system handles needs for referral of emergencies. Quality assurance and standards ensures development of clinical standards, protocols, guidelines to strengthen patients’ rights; and revitalize and strengthen the relationship between the hospital and other professional bodies. The medical care approach is patient centered. The basic need approach in principle helps the marginalized group, including the low income earners and terminal illness patients to have access to medical services while the human right approach is satisfied through sharing of existing resources more equitably so that everyone has access to the same services. This has involved building of community capacity for people to understand their rights, to claim them, and to make meaningful contribution to realizing their rights. The funding partners are mainly government through the tax payers, non governmental organizations whose staff are attended here and donors. Each of the partners has a variety of aims, interventions, technical and reporting requirements and funding modalities. The hospital continues to harmonize different modes of co operations with its development partners. Many of the funding partners are committed to simplifying procedures and systems like performance indicators, harmonizing their procedures to make them same or similar , aligning with the hospital budget cycles and disbursements , sharing information and being more transparent, strengthening capacity and supporting leadership in aid co-ordination and finally taking part in joint annual performance reviews. The partners are also involved in joint annual planning, joint monitoring and evaluation and joint funding arrangements. The hospital has enjoyed a good political climate. As a referral facility located near a slum, whose 99% of population is living below a dollar a day, has contributed greatly to funding based on political milestone to forge for sustainable low medical care and subsidized funding from politicians in order to court the electorate towards their ambitions to create an environment where all have equal access to medical care. The opposition parties have forged for more allocation of funding from the government. This has in turn revolutionized the government’s role through the ministry of health to have “a hands off but a eyes on” approach as it disseminates its role for policy formulation, regulation, resource allocation and performance monitoring. Through the political influence, the hospital embraces equity principles in medical care. The hospital addresses the downward spiral of health status and has reduced health related inequalities. These health inequalities are due to opportunity gap between the rich and the poor and are related to gender, level of education and financial disability. This gap of inequity is bridged by involving the population in decision making on priority setting and consequent allocation of resources. The health care system relies much on collaboration and partnership with all stakeholders whose policies and services have an impact on health outcomes. Health in this hospital is defined in its broad sense, as not only the absence of disease but general mental, physical and social well being of an individual. The hospital takes initiative to access the environment the people live, including access to nutritious food, safe water, sanitation, education and social cohesion. This is done through campaigns and education programs to the community as social research is carried out. The health output is therefore a contribution of all, activities whose primary purpose is to promote, maintain and restore health. Comparison and contrasting features The health care in place compares with health issues centre (Draper, 1993) by facilitating continued quality care, collaborating with other referral health facilities, addressing competently the need for primary care, involving the patients in the decision making process concerning their illness and embracing equity care. Provision of incentives like lower medical costs, however have not led to reduction in medical care quality (Donaldson and Gerard, 1993) because there is continued need to improve quality care. Transport issue is important in smooth operation and is not neglected (walker, 1993). The medical system recognizes importance of transport in delivering efficient and effective medical services. The transport fleet management is accounted for in the health planning. Decisions are not based on uncertainty or probability (Miles Little, 1995: 26) but are a product of clinical diagnosis and critical planning that are guided by the clinical operational guidelines, protocols and procedures. The medical care services are consistent in delivering quality services ( Geigle and Jones, 1990). The patients are fully informed on proper management of diseases and outcomes they should expect regarding their diseases. The informed choice is a result of proper diagnostic procedures. The care is built on patient driven system where the patients needs receive the first priority. The hospital has published publets on different diseases. It also has video disks that are used in education the patients to enable them to effectively manage their illness. This agrees with need for a focus on the service rendered (Collins et al, 1994:249) The health facility collaborates with other hospitals and research institutions in proper diagnosis of diseases. It compares notes with other medical facilities to determine the main cause of a particular disease in different parts of the country. It also partners with international organization and medical facilities like International Aids Vaccine Initiative (IAVI). The health facility works on ethics of providing efficient and effective medical services and embraces the outcome of a quality medical care (NSW health department: 1994) as opposed to inequity in medical care (National health mother s forum: 1994). It works on achieving goals, missions and visions (Nutbeam et al, 1992). The facility doesn’t necessarily consider treating health budgets as an investment opportunity (Braithwaite, 1994a) but perceives health planning as a way towards adding value to the health of a person. This has increased the waiting list and in turn led to overstretching of the facilities. Efficiency is dealt with in terms of reduction of wastes and lowered costs. This has led to increased clinical outcomes in terms of operational and technical efficiency. The facilities allocative efficiency is based on equity care (Shiell et al, 1993) and doesn’t embrace the dynamic efficiency. The facility is at the forefront of being a model to continually improve on quality and responsiveness of services, constantly improve on efficiency of services delivered and increasing equitable access to health. The facility factors in the need for good medical outputs (Mooney: 1993) in order to utmost have best of use of resources to maximize health. The facility doesn’t value cutting costs in order to attend to a considerable higher number of patients (Mooney et al: 1994). The facility is reimbursed according to its output (VGDHCS: 1993; SAHC:1994; Queensland health: 1994; CDHHLGCS : 1993). As a referral hospital, medical care is not formulated on basis of cost but as a measure to combat the disease. The facility values need for proper diagnosis and all procedures are meant to highlight the basic cause and underlying cause of the disease so as to help the patient efficiently manage the disease and have informed choice and decision. More activity in the medical care doesn’t translate into more inappropriate treatment (Park et al, 1986; Kahn et al, 1988; Westbrook et al: 1993). The patients are admitted based on their sickness diagnosis as opposed to hospital resources (Eckstein, 1982; Harvey and mathers, 1989; Gibberd, 1990; Raid, 1985). The life of the patient is important and thorough investigations are carried out before arriving at a diagnosis as opposed to observation made by institute of medicines (1985). The health resources in the facility are in line with medical intervention procedures that can produce the best outcomes (lazans et al: 1995; Braithwaite et al, 1995) and no medical services are rationed. Rationing of medical services is not an ethical practice in equity care. Strategies for nurses to support There are a number of strategies that nurses can support or develop to provide quality health services include: providing care based on the need of the patient, the nurse should educate the patient on the disease to empower them to manage the disease well. They need to reduce wastage and create an environment of improved level of technical efficiencies. There should be proper diagnosis in treatment of diseases by seeking to determine the patients’ activities that followed development of the disease especially a 24 hour recall or the lifestyle and eating habits. The effective diagnosis would help to minimize cases where patients are treated for the diseases that they don’t suffer from. The nurses should not be governed by political climate but by the need to serve the call of their duty. The nurse should embrace health issues centre proposals and offer continued integrated care, involve patients in decision making, and focus on equity. The nurses should also strive for collaboration with other health facilities for referral services. It is the medical care services of a facility and its satisfactory levels to patients that create a room for patients to prefer it. The nurses should also seek for sustainable transport facilities for materials and emergency situations like ambulance facilities. Potential barriers The transport: The transport facilities are faced by the challenge of realistic maintenance plans and recurrent funds to keep the transport fleet operational. Lack of enough money to run the health facility: Without continuous funding, the hospital may go out of business due to lack of fund to purchase necessary material, drugs or pay for essential services like garbage collection. Implementation of the education program: The patient can be educated but may fail to implement what they are told. If the disease requires the patient to increase consumption of a nutrient, it would be a good advice but what if the patient is not able to afford? The hospital facility might be a private. The manager might not want to collaborate with other competitive players because he is there to make business and his operational ethics might not be equity but opportunity care for people who are able to pay or are insured. Political climate can have a negative impact on development of a health facility. Politicians can have a health facility closed down or produce negative statements about it which might make the owner opt to sell it out. In Conclusion, Health care system should be centered on the needs of a patient and should be efficient and effective in providing equitable access to health care. Better service delivery efforts should be geared towards supporting systems that function efficiently and effectively so that the necessary money, human resources, drugs, and other essentials commodities benefit the recipients in a timely way. Government funding should be increased and health facilities should collaborate with other referral facilities. 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