The US Health Services System - Essay Example

The US Healthcare System Name Course Name and Code Instructor’s Name Date A healthcare system refers to the different pieces which aid in the delivery of both various products and services to clients, which may include among others healthcare providers, insurance companies, nurses, doctors, non-profit organisations, the government, suppliers, manufacturers, and the public. In order to deliver effective and specific health care solutions in a cost efficient manner to the consumers, all these factors should be combined and designed effectively. The healthcare system is affected through the various values and beliefs, and for instance in America, such ideas are normally based on the federal government’s size and personal freedom thus influencing the type of programs and the intensity of the debates which should be enacted (Institute of Medicine et al., 2011). The United States is a country known for its unique healthcare systems that span various geographical areas like counties, towns, states and villages. It is a fact the value system of a society, which includes its values and beliefs, affects greatly the society’s members regarding what is desirable for it thus helping such a value system to form foundations and perpetuate its systems, which also comprise of the healthcare systems (Johnson et al., 2010). The aim of this research paper is to examine the health care system of the United States through putting special focus on the definition of the “healthcare system”; the impact of the values/beliefs, provision of varies healthcare delivery models and the explanations of the solutions that are used. To many Americans, healthcare is a crucial aspect towards the quality and longevity of their lives and as a society as a whole. The importance of the health care system in US is evidenced by the increase of entities that operates and runs healthcare related businesses (Trouth et al., 2010). The unique aspects in the healthcare systems in the United States is based on the number of individuals using the system, many of whom are unable to pay for the health care services because they lack appropriate insurance policies. Due to the high number of Americans reaching the Medicare age at the same time, it is predicted that the US Healthcare system is going to be burdened because of the costs attributed to the services (Institute of Medicine et al., 2011). In addition, the US Healthcare system is prone to been overburdened because of the nature of US population since more resources will be allocated to more people as they grow older and these older persons developing old-age related health complications; which needs additional mediations and treatments. According to the current United States health care system, the baby-boomers comprise the top three most important issues (Greenwald, 2010). Individuals who do not have health insurance schemes burden the United States healthcare system. This is because most health insurance schemes in the US cost so much to the extent that most Americans are unable to afford it despite the fact that such individuals actually strive to obtain government insurance schemes like Medicaid. Eventually, these individuals will prefer continuing being uninsured until a simple medical problem develops into a complex one and thus seek to obtain urgent treatment at the emergency centres and thereafter end up struggling in the payment of their medical bills (Institute of Medicine et al., 2011). The health facilities end up losing more since it is a fact that they won’t be paid from treating such people since in the beginning; they did not have the cash to start with (Smith, et al, 2013). Given the fact that a value system is normally deep-seated, any fundamental change of an established system like a healthcare system is very difficult and thus will need a consensus among the American people regarding the basic ethics and values (Institute of Medicine et al., 2011). It will also be difficult to reform the United States healthcare system because of individuals’ resistance to change coupled with their tendency in overvaluing things that they own already. It is therefore genuine to ascertain that the American healthcare system is actually market-driven and it is a private enterprise that is primarily run (Schulte, 2012). The United States Health care system is faced with numerous challenges, which is a clear indicator that there is need for urgent reforms in the system (Trouth et al., 2010). As a result, most attention has been placed on about forty six million Americans who are not insured and on other Americans who are insured but who are at risk of encountering out of pocket costs and an increase in premiums (Institute of Medicine et al., 2011). As both the United States administration and Congress look for ways meant to invest funds in order to lower the number of American individuals lacking insurance coverage, it is prudent to also address the shortfalls arising in the efficiency and quality of healthcare, which result towards poor health outcomes and higher costs at the same time. This because by doing contrary to this, then it will imply that the current U.S healthcare system will not only continue having enormous gaps but will also cast doubt regarding both the feasibility and sustainability of expansion even for people who have access to insurance schemes or coverage (Kovner, et al, 2011). Despite the fact that the United States as country leads on the money its spends per individual on health care as opposed to any other nation, evidence points out that many American people do not actually obtain the needed health care. This is attributed to the fact that at most times; there is underutilization of preventive care thus leading to high costs being spent on the treatment of complex and advanced diseases. Patients having chronic illnesses like for instance heart diseases, hypertension and diabetes are not given effective and proven treatments, which can aid them to manage their delicate conditions effectively. This situation is genuine for the uninsured, insured and the under-insured American people (Institute of Medicine et al., 2011). These are problems, which actually arise because of poor coordination in the management of patients having chronic illnesses or diseases. Given the fact that most of the health care providers do not actually have payment support services or other tools which are required in order to effectively communicate and work in order to improve the management and care of such patients, then the fragmentation that underlies the US healthcare system do not come as a surprise (Roth, 2010). While many of the American patients do not get care that is medically necessary, other patients actually receive medical care that may not be required or even harmful to them (Trouth et al., 2010). Research conducted in the US has actually portrayed a tremendous variation in the number of days that in patients stay in the health facilities, procedures and tests, patient visits to other specialists and costs not only in various parts of the United States but also in various health facilities located in the same town. However, such variations do not have a direct effect on the health of the people that are being treated (Linden, 2010). The existing gaps in both the efficiency and quality of care in the US healthcare system are attributed to the fact that there is actually limited evidence pertaining effective procedures and treatments and on how best healthcare providers can be informed regarding the effectiveness of various treatments and the failures of detecting and reduce errors (Trouth et al., 2010). These are the important issues, which provide relevancy to any low-income Americans and to other individuals belonging to diverse demographic and ethnic groups who stand great risk of facing disparities in health care and general health care (Niles, 2011). In order to address the high costs of healthcare and poor quality of life together with increasing the number of the American population lacking health care insurance schemes, then it is essential to reform the American health care delivery systems since this will lead to enhancement of the value and quality of healthcare. Reforms in the US healthcare system should therefore focus on the improvement of access towards the appropriate health care at the right place and at the right time (Institute of Medicine et al., 2011). Reforms in the US healthcare system should therefore aim at keeping individuals healthy and prevention of any common and avoidable illness to the highest possible extent. Reforms in the US healthcare system, which are thoughtfully constructed, will result in greater access towards health care as opposed to the current healthcare system, which encourages more procedures, tests and treatments, which are worst harmful and even unnecessary. There is a wide range of delivery and payment system reforms, which are designed, with a view of improving both value and quality (Sultz, et al, 2010). Despite the fact that there is an ongoing debate regarding the ability of different delivery system reforms aimed at increasing value, there still exists clear attributes of various reform approaches, which compared to others, stand greater chance of slowing the cost growth and enhancing health. There have been strong indicators that the coordination of primary care, the management of chronic disease coupled with Health Information Technology (H.I.T) can greatly enhance outcomes in quality and health. Such programs or approaches also portray evidence of reducing the cost growth (Institute of Medicine et al., 2011). Despite the fact that the implementation of these reforms has been heterogeneous, enhancements in value and especially in cost reduction have never been automatic (Trouth et al., 2010). Despite evidence pointing out the fact that interventions in the delivery system can ultimately lead to the reduction of health care costs, there have been arguments that it is should be easy to attain a larger and more specific savings through having accountability incentives which are meaningful and risk adjusted. To make this a success, then such requirements and incentives should be attached towards specific steps of quality improvement (Levine, 2009). In order to improve the value of the US health care system over a long period of time, then Comparative Effectiveness Research or CER should be put into use. As opposed to other CER definitions which place emphasis on the dissemination and support of head to head trials for specific treatment of ailments, Comparative Effectiveness Research could have a more greater effect if it was broadly focused on the comparison of the benefits, risks and costs of different practices in health care and in the evaluation and revision of policies which influence practices and in the development of strategies aimed at practices towards specific types of patients. The broad conceiving of CER will play a big role in the support of continuing enhancements in the Healthcare delivery system and reduction of disparities in the US healthcare system based on geography, race and other factors (Budrys, 2011). Reforms in the delivery system of the US health care system are actually most effective when they are integrated and meant to ensure that there is real accountability from both the patients and providers in order to enhance results. In order to enhance care quality and bend the cost curve, evidence has portrayed that multiple strategies and approaches towards reforms in the delivery system may be required (Institute of Medicine et al., 2011). For instance, it is a fact that the effective management of any given disease management approach may actually become limited for those patients having multiple chronic ailments and diseases which need coordinated medical care from many medical specialists (Trouth et al., 2010). Efforts aimed at coordination of health care will be less successful if there is lack of a comprehensive decision support system and electronic medical records for both the providers and the patients (Andersen, et al, 2011). The provision of sophisticated Health Information technology will prove to be ineffective if the health providers lack payments and other relevant incentives aimed at promotion of coordination of medical care, which is systematic. In addition, health care providers will not be effective in their work over a long period of time if they lack access towards practical evidence which forms the basis of clinical practices required by patients in urgent interventions and in particular or specific cases. Promising results have been obtained from evaluation of past efforts, which are ultimately integrated in the delivery system reforms. In order to provide the incentives, tools and resources required to assure better outcomes in patients, then delivery system reform s in the US Healthcare system should be implemented alongside other reforms (Atlas, 2011). Interventions aimed at specific groups of patients and clinical areas have a greater effect on quality enhancement and other cost entertainment as opposed to broader approaches (Institute of Medicine et al., 2011). In medical sciences and specifically in the promotion of value and quality, interventions, which are specifically targeted at specific treatments to relevant patients, is utterly more crucial (Trouth et al., 2010). The utilization of predictors like for instance complexity of conditions, high utilization, personal and other clinical characteristics may enhance the returns, which arise from investments of the delivery system. Indeed, research conducted has indicated that certain groups of patients having chronic illnesses, minority and low-income groups and patients who are undergoing care transitions are actually more at risk and thus likely to obtain benefits arising from specific medical interventions in the US (Trouth et al., 2010). Furthermore, programs in the chronic care management can have a great effect on patients who are frail and those having multiple chronic ailments through family and patient satisfaction, enhanced health outcomes and a reduction in costs. Despite of this, these subgroups usually have the lowest access towards effective care management approaches. For future reforms in the US health care system to be successful, then better analytic and evidence based capabilities targeted at appropriate delivery system interventions should be developed (Harrington, et al, 2011). For the US Healthcare system to be more effective, then changes in system delivery and coverage expansions should actually be implemented together as one thing. The expansion of coverage and the reformation the health care system and payment in the United States are not only complementary to each other but each one of this aspect is critical towards the achievement of the other (Trouth et al., 2010). Coverage expansion on one hand, is crucial in order to fully deal with the under-using of appropriate or relevant health care; a common problem in people who are uninsured. On the other hand, the reform in the successful payments and delivery is required to increase health care value resulting in slower cost growth and quality care in the US health care systems. It is through such improvements that most American people will in induced to purchase health insurance schemes since it will have become more valuable and affordable (Davidson, 2010). In order to transition the US healthcare provider reimbursement away from both the intensity and volume of the services to value and quality, then reforms in the healthcare sector are highly needed (Trouth et al., 2010). The changing of the provider reimbursement will involve placing focus away on the intensity and volume of the provided services and moving towards accountability aimed at overall quality and cost which are crucial for the support of reforms in the integrated delivery systems. Various challenges face the US healthcare system like for instance, many of the valuable services in some of the health facilities in the country are underprovided due to the reason that most of these hospitals and the doctors therein do not have enough financial and other support mechanisms to provide such services (Pol, et al, 2012). The current US healthcare system establishes incentives aimed at providing more intensive care and treatments while giving little regard towards the effectiveness of such treatments based on more enhancing health while lowering the costs. A reformed US healthcare system should therefore reward the value before the volume and reward quality before quantity through organized deliveries as opposed to disorganized care (Dranove, 2009). Individual interventions or reforms in incremental delivery will be less likely of addressing the major gaps that exist in value and quality in the American healthcare system if there is lack of payment reforms (Trouth et al., 2010). The payment reforms aimed at presenting providers with the much-needed support to enable them to become increasingly accountable for delivering better health care at lower costs, which can easily be affordable. Benefit designs should also be changed through assuring consumers that cost can never be a barrier to healthcare in the United States (Tozzio, et al, 2009). When faced with the expenses from out-of pocket, most patients in the United States actually become more likely of ignoring necessary care just like they also forego unnecessary medical or health care. Cost-sharing coverage and requirements should therefore be designed with an aim of encouraging patients to efficiently use cost effective preventive and primary care services in order to either prevent or delay the onset or start of any conditions associated with chronic ailments (Rouse, 2010). In order to improve the US health care system, individual patients in the country should be encouraged to choose high quality health care at affordable costs and should be able to easily gain access towards reliable information regarding the total costs of their available treatments options and outcomes (Trouth et al., 2010). This is necessary since most current insurance plans or schemes make patients suffering from chronic ailments to incur huge costs on the treatment. This makes the patients to be unable to obtain any shares in the savings which could otherwise been achieved if they got access towards less costly healthcare that could suit their needs (Barr, 2011). There have been predictions from various sources that if reforms in the delivery system in the US health care system can aid in the achievement of an increase in the value, then millions of other American people could easily obtain health insurance schemes or covers by the year 2019 despite the absent expansions that may arise in coverage. It should however be noted that delivery system reforms on their own cannot be capable of ensuring universal coverage (Trouth et al., 2010). Rather major steps should be initiated and implemented in order to ensure that there is coverage for each American individual. In addition, it should be also noted that high progress should be focused towards the efficient delivery system in the US healthcare system in order to achieve the goals in respect towards the coverage that has been expanded (Shi, et al, 2009). The findings in the US healthcare systems have had numerous implications regarding policy actions by both the Obama administration and the Congress. Medicare should be started through implementation of a clear vision aimed at transitioning payments towards the promotion of higher accountability for enhancing the value of health care. It should be noted that efforts aimed at promotion of delivery reform, which do not actually entail Medicare, can never have a greater impact on the medical practice environment (Patel, et al, 2008). In order to have an efficient healthcare system in the United States, there should be an establishment and promotion of meaningful, consistent, valid and widely available sources of information (Trouth et al., 2010). Information regarding the cost and quality of healthcare in the nation especially through placing special emphasis on the overall costs and measurements of health outcomes at both levels of individual patients and at care episodes. This will also involve the use of Healthcare Information Technology (HIT) systems in order to simplify the collection of data, its reporting and building of better evidence through which delivery programs and approaches can work best (Barton, 2010). In order to achieve a better US healthcare system, then an integrated approach should be developed to delivery reforms through presenting the providers with a feasible pathway through which local delivery reforms can be organized based on the accountability principle (Trouth et al., 2010). The approaches should therefore work simultaneously in order to continually implement and improve the HIT quality and measurement of infrastructure. They should also provide better systems aimed at coordination and delivery of primary and preventive care and introduce new systems of payments aimed at supporting reductions in the cost growths and enhancement of quality in the US health care systems. Efforts at both regional and State levels should be encouraged in order to enable both the private payers and the public entailing both the Medicare and Medicaid to participate positively in the private/public initiatives. With a view of using outcome-focused better performance measures, in order to support benefit reforms and payments, which promote accountability to achieve greater value (Goldsteen, et al, 2012). References Andersen, R, et al. (2011). Changing the U.S Health Care System…New York: John Wiley & Sons. Atlas, S. (2011). In Excellent Health…New York: Hoover Press. Barr, D. (2011). Introduction to U.S Health Policy. New York: JHU Press. Barton, P. (2010). Understanding the U.S Health Services System. New York: Health Administration Press. Budrys, G. (2011). Our Unsystematic Healthcare System. New York: Rowman & Littlefield. Davidson, S. (2010). Still Broken: Understanding the U.S Health Care System. New York: Stanford University Press. Dranove, D. (2009). 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