Leaderships Role in Providing Efficient, Effective, and Equitable Care - Assignment Example

Running Head: Leadership’s Role in Providing Efficient, Effective, and Equitable Care Student’s Name: Instructor’s Name: Course Code and Name: Institution: Date Submitted: Leadership’s Role in Providing Efficient, Effective, and Equitable Care Section A: Analyze the Federal Government’s Health Care Role (1000 Words) I am convinced that the US federal government has in the past played a central role in funding, management and development a progressive policy framework for the health care industry. Robert Wood Johnson Foundation, (Jaffe, 2009), concurs that in the known industrialized nations, the US federal government plays the single largest role “in the financing, organizing, overseeing—and in some instances—even delivery of health care” (pp. 1). For the last two decades, the US federal government has focused on making health care accessible to citizens who wouldn’t otherwise access it. This includes health programs for the poor, the elderly, children and the disabled (Hogan, 2001). According to Robert Wood Johnson Foundation, new health reforms are now targeting those Americans and American residents who cannot afford health insurance or who are usually turned away by the insurance companies for having higher risk levels (Jaffe, 2009). Since the 1960’s, the US federal government has supported numerous social welfare health programs aimed at increasing the accessibility of health care to poor minorities with an example being the Children’s Health Insurance Program (CHIP) initiated in 1997 (Kaiser Family Founda­tion, 2009; Jaffe, 2009). Another central role that the federal government has played in health and health care provision so far, has been also fostering new medical discoveries by supporting and financing research in health care. The US National Institute of Health is today the world’s largest and well funded biomedical research institute. The federal government pumps over $30 billion annually to various projects of discovering, testing and advancing science in such areas as prevention, care, treatment and cure of diseases. Numerous grants are given out by the federal government each year to individuals and institutions conducting research in any significant area of health and health care. Other similar projects include the U.S. Center for Disease Control and Prevention. Further, the US government has in the past been instrumental in regulating the private-market of the health industry to ensure that the practices are genuine, safe, unexploitative and complementary to the health agenda. A good example of such regulation is the U.S. Food and Drug Ad­ministration which supervises and regulates safety of vaccines, foods, blood products, drugs, dietary supplements, biological medical products and devices etc. Robert Wood Johnson Foundation says that the best way to examine federal government’s role in health and health care is to compare the share of the total US national health spending that is borne by the assorted government structures (Jaffe, 2009). In 2008 for instance, the US national health spending stood at $2.4 trillion (Jaffe, 2009). In this, the federal, state and local governments carried over $1.108 trillion to the public coffers, amounting to over 46%. The federal government was responsible for a whopping 33.7% of the national health spending standing at $810.6 billion (Jaffe, 2009). The major spending areas for the federal government were in Medicare, Medicaid (Hogan, 2001) and numerous other welfare programs such as the Children’s Health Insurance Program (CHIP) (Kaiser Family Founda­tion, 2009). This alone is indicative of the role the US federal government has played in funding health care in the country. The US federal government also offers tax subsidies to many entities involved in provision of health care and health coverage as a way of encouraging private participation (Warner & Hutton, 1980). The amount of tax subsidies offered in 2008 if added to the federal government spending on health in the same year, according to the Robert Wood Johnson Foundation, would bring the public burden to over to three-fifths of the entire U.S. health spending amount (Jaffe, 2009). The role of insurance in providing medical coverage to citizens in private arrangements has also not escaped the federal government. Currently, the US federal government runs several publicly financed health insurance programs in which, although not delivering health care to the public directly, plays the pivotal role of a financial conduit to collecting taxpayer’s money and funnel it productively to increase the private sector health care provider ability to delivering health care (Warner & Hutton, 1980). It should also be included that the federal government is currently the largest health and healthcare employer in the US today, with over 9 million federal workers in 2009 being covered, both they and their de­pendents, under the Federal Employees Health Benefits (FEHB) program. It is also the federal government that funds and provides all health care needs to all employees, past and present, of the federal government. The Defense Department also runs government funded pro­grams for those in active-duty and all retired military per­sonnel (including their families) in care facilities run, staffed and owned by the federal government. For instance, over 7.8 million veterans are currently receiving health care di­rectly under the Veterans Health Administration (Henderson, 2002). The Department of Health and Human Ser­vices also runs health care programs pro­viding care directly to over 1.9 million American Natives in about 35 states (Kaiser Family Founda­tion, 2009). This is just an exemplification of how far-reaching the role of the federal government in health care provision is. According to Hogan (2001) and Henderson (2002), the ranking federal health expenditure is the Medicare programs currently covering over 45 million people (about 38 million being over the age of 65 and over 7 million being disabled) (Gruber, 2000). The second ranking expenditure is Medicaid covering over 61 million low-income earners (Henderson, 2002). If this amount is compared to the GDP as Robert Wood Johnson Foundation recommends, it emerges that the US federal government spends over 4% of the GDP on these two health programs (Medicare and Medicaid) and the rate is projected to rise to over 6% by 2019 and 12% by 2050 (Gruber, 2000). In addition to this, the Children’s Health Insurance Program is currently covering over 7 million low-middle income children since 1997 (Kaiser Family Founda­tion, 2009). Given the above monumental burden of government funding in numerous disjunct programs that serve particular groups (Henderson, 2002), I am of the opinion that the US government would better adopt a universal healthcare program that is funded by the federal, state and local government as a singular approach to health care (Herbert, 1996). Additionally, based on a 2008 survey conducted by Society for Human Resource Management, the following five are recommendations that the US federal government must assume as their role, mandate and responsibility, with the strength of each given in brackets. First the government should strive to increase access to quality health for the uninsured population (37%), then foster a continued prosperity of the private-public health care systems (19%), then ensure the sustainability of heath care for cover beneficiaries (16%), then Create a single provider of health care coverage, maintained and managed by the federal government (10%) and finally, ensure affordable healthcare for all (5%) (SHRM, 2008). A congregation of these recommendations lies in a singular universal health program such as of Canada and other nations (Warner & Hutton, 1980). It would not just be more structurally efficient and cheaper than the current dozens of health care programs in the country given the amount the federal government in already spending, but also beneficial to equity, cost saving and welfare objectives in the long run (Warner & Hutton, 1980). The rising costs of medical care have made it necessary for the federal government to play an ever increasing role of market regulation, policy enactment and leadership (Faulkner, 1960). Without leadership of the federal government, the low income earners are going to be swallowed in healthcare despair (Herbert, 1996). But this must go far than funding separatist programs without a national administration (Marmor, 2000). Section B: Health Care Leadership Matrix Collaboration (1000 Words) Introduction The following matrix helps compare the US health care system with that of Germany. The first column describes the type of healthcare system in each country, the second column lists all the similarities between the two and the third one lists the existing differences of the two government run systems. For each of the listed similarity or variance, the matrix also includes a variety of reasons ranging from different political systems, philosophy, or such other determining factors. Type of healthcare System Similarities Differences Reasons United States Medicaid: a federal-state partnership healthcare plan helping those in need of medical care and not able to afford it Medicare: a federally funded health insurance for people age 65 or older or people under the age 65 with certain disabilities. a) a) Coverage for the employed involves a contribution from the employer and the employee (Kronenfeld, 2002). b) b) US has a highly decentralized health system with responsibilities mostly shared between the states and federal government (Glied, 2008). c) c) The system features both state regulated and public regulated insurance plans but with optional membership for the population (not compulsory) a) a) The healthcare system targets particular members of the society such as the elderly, the disabled, children etc b) b) The Medicare and Medicaid programs are fashioned out as a welfare program to assist those who cannot fund their own medical cover. c) d) c) Funded by the federal government and the state government (Medicaid) (Glied, 2008). e) f) d) The US system does not operate in regards to the Universal Declaration of Human Rights (article 25) which the US refused to ratify (WHO, 2004). g) h) e) Spends about 13.7% of the GDP (Glied, 2008’ Ernst & Young, 2006). i) j) f) US health care system is based on market forces where competitions and coverage operates on basis of market-based prices for those who can afford particular covers (Kronenfeld, 2002). k) l) g) Private insurance providers usually refuse to offer cover to some illnesses based on their risk factors m) Requires patients to attend to particular MOH doctors and not any doctor. n) o) h) US was ranked by WHO in 2003 to be the 37th among 191 countries of the world based on cost effectiveness of the health care system (WHO, 2004). The US health care system works based on a capitalistic approach of free market. Individuals are left out to fetch for their own health cover from the most competitive of the private providers (Glied, 2008). The providers on the other hand are allowed to operate based on market forces and to be regulated much by the market competition (Giaimo, 2002). It is therefore not rare to find some providers refuse to cover certain individuals whose pre-existing conditions are overly risky and unprofitable (Glied, 2008). The US legislative houses have continuously refused to enact control of the health care industry preferring to let the market forces determine how the industry works and then providing welfare programs such as Medicare and Medicaid to cater for the marginalized members of the society who cannot afford the competitively priced covers in the market (Giaimo, 2002; Kronenfeld, 2002). Germany Germany has a universal health care system operating under the principle of universal coverage to all society members through a combination of mechanisms for health financing and service provision arrangements. a) a) Also started as a segmental coverage of some members of the society such as the Health Insurance Bill of 1883 (for the poor), the Accident Insurance Bill of 1884 (for accident victims) and the Old Age and Disability Insurance Bill of 1889 (for the elderly). b) b) Germany has a highly decentralized health system with responsibilities mostly shared between the states and federal government (Kirkman-Liff, 1990). c) c) The system also features state controlled and privately controlled insurance plans. Membership to these plans is however mandatory in Germany before retirement or reaching the age of 65 (Kirkman-Liff, 1990). a) a) Coverage to all society members without distinctions (Kirkman-Liff, 1990). b) c) d) b) Funded fully by the central government (Kirkman-Liff, 1990). e) c) Based on Universal Declaration of Human Rights (article 25) as signed in 1948 to guarantee universal health to all people (WHO, 2004). f) Spends 10.7% of the GDP (Glied, 2008; Ernst & Young, 2006) g) h) d) Germany’s health care system is based on social welfare where all members of the society have equal access to the same cover unless one opts out willingly (Kronenfeld, 2002). i) e) All forms of illness are covered irrespective of the health risk (Kirkman-Liff, 1990). j) f) Patients have the freedom to choose their doctor and the place they want to be treated (Kronenfeld, 2002). p) Germany was ranked by WHO in 2003 as the 25th among 191 countries of the world based on the cost effectiveness of their health system (WHO, 2004). Germany’s health care system is actually regarded as the oldest universal health care system in the world, dating as far back as the social legislation of Otto von Bismarck in the 1880’s. The principle of the system is based on government regulation of the health care market where even the population is discouraged and sometimes completely prevented from having private health insurance plans (Kirkman-Liff, 1990). Germany health covers extend to all people including the employed and the unemployed, the elderly and the young (WHO, 2004). The market though decentralized is highly uncompetitive and operates much as a public utility frontier (Ernst & Young, 2006). Section C: Discussion Questions (900 Words) Question One Which is most important to the health care leaders: structure, processes, or outcomes? Rubin, Pronovost and Diette (2001) posts that, health care can be measured by studying the processes, structure and outcomes of healthcare programs and organisations. The most important of the three – structure, process and outcomes – in health care quality management is and should be the outcomes. A good structure that does not achieve the objectives of a healthcare institution or program is worthless and much more of a waste of public resources. Similarly, effective bureaucratic processes that still do not help patients in their needs, are as worthless (Gilmer, 2005). According to Rosenthal, Hammar and Way (1998), when patients get quality outcomes from medical care, the objective of the health care institution or program is attained. The best way to look at this scenario is from the perspective of health managers and leaders. Their performance is only judged from the outcome of their administration since very few patients will want to know how things run (processes) or who is senior or answerable to whom, in a hospital (structure). Ideally, both processes and structures are measures adopted to improve the outcomes. How good the processes are and how good the structures are can and should only be evaluated based on the outcomes. Rubin, Pronovost and Diette (2001) argue that the public agents and the taxpayers place their ultimate concern on “the provider’s impact on patient outcomes” (pp. 469). Agreeably, the US Institute of Medicine (IOM) as quoted in Rubin, Pronovost and Diette (2001) defines healthcare quality as, “Degree to which health services for individuals ... increase desired health outcomes ...” (pp. 469). Essentially therefore, measures of process and of structure should strive to improve outcomes. Rosenthal, Hammar and Way (1998) conclude on this discussion by posting that, heath care leaders should in most cases, initiate, adjust, improve and constantly review the structures and processes as a means of amplifying the patient outcomes. Question Two Is it possible to provide efficient care ineffectively? Is it possible to provide effective care inefficiently? It is indeed possible to provide efficient care ineffectively. A good illustration is a not-for-profit hospital with limited number of staff and operating in a poor community without another hospital nearby. The few highly qualified medical personnel believe in giving quality care to their patients. Yet, while they may provide effective care to a few patients, they will be unable to cater for the high demand for medical care services in the area. In this regard, they will be offering efficient care ineffectively. The fact that health care is evaluated based on what it achieves and now how it achieves it makes efficiency by itself unsatisfactory (Galbraith, 2001). On the other hand, it is impossible to provide effective care inefficiently. Drucker (1993) emphatically posts that that modern healthcare institutions are overly complex and perhaps the single most complicated forms of human organization requiring management in the history of civilization. According to Drucker (1993), that complexity arises from the fact that heath care organisations are a confluence of professions ranging from physicians to nurses, from pharmacists to administrators as well as having a host of stakeholders ranging from patients to payers, from government to public agents. Each of these parties comes with seemingly incompatible perspectives, interests and time requirements. In the end analysis, lack of efficient management means that nothing gets done or done well (Change Foundation, 1997). The exacerbation of challenges accrue for many healthcare leaders in trying to find how the highly specialized professions and the stakeholders are streamlined towards satisfying the ‘insatiable demand for healthcare without an unlimited financial support” as Golden (2000, pp. 12) puts it. As such, it is impossible to provide effective care inefficiently since if the systems and the practitioners are inefficient, the healthcare provided cannot be effective (Gilmer, 2005; Galbraith, 2001). Patient records will be lost, departments will not collaborate to help patients in their respective fields, there will be no sense of responsibility or accountability, duplicate and inconsistent efforts will mean much effort is put in producing little results etc. All these are symptoms of inefficiency and which will mean that the patients will not be given efficient care (Galbraith, 2001). Question Three Of the three E"s—efficiency, effectiveness, and equity—which is the most important for leaders to address? Why? All the three – efficiency, effectiveness and equity – are of great importance to health care leaders. An ideal health care scenario would accommodate each of the three to a relatively equal degree. Nonetheless, if one among the three is to be upheld than the others, be it due to financial and or manpower limitations, then it should be effectiveness. Health care providers have a unique mandate of serving communities. How effective their care is determines the quality of life that individuals in that community have (Golden & Martin, 2004). Effective care will mean that the patients who come to the hospital are treated and cured successfully (Emanuel & Fuchs, 2005). Efficient while ensuring the accountability of the clinicians and well-ordered management structures of health care institutions, cannot help the patients if the care given is not adequately effective (Galbraith, 2001). Ideally, efficiency is only a measure geared towards establishing effective patient care (Golden, 2000). The same goes with equity, where although a desired trait in health care provision, will help none of the patients if the care given is ineffective (Emanuel and Fuchs, 2005). If anyone irrespective of social class, race, gender, age and such distinctions can access health care and still be plagued with their conditions since the care is ineffective, then none of them would benefit (Emanuel and Fuchs, 2005). The case would be different if for those who can access health care, the care is effective, as the health care systems addresses the needs to integrate equity (Emanuel & Fuchs, 2005). There three requirements of equity, effectiveness and efficient are ideally essential ingredients of proper health care (Golden, 2000). But as institutions, programs and nations strive towards integrating all the three, the primary emphasis must remain first on the effectiveness of the care provided (Change Foundation, 1997; Golden & Martin, 2004). References Change Foundation (1997). Leading the Management of Change. Toronto, ON: The Change Foundation. Drucker, P. (1993). The New Realities. New York: Harper & Row. Emanuel, E. & Fuchs, V. (2005). 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Retrieved July 20, 2010, from http://www.rwjf.org/files/research/82409healthaffairs7.pdf Kaiser Family Founda­tion (2009). Medicaid: A Primer—Key Information on the Nation’s Health Program for Low-Income People, Kaiser Commission on Medicaid and the Uninsured, January 2009. Kirkman-Liff, B. (1990). Physician Payment and Cost-Containment Strategies in West Germany: Suggestions for Medicare Reform. Journal of Health Care Politics, Policy and Law (Duke University), Vol. 15 (1). pp. 69–99. Kronenfeld, J. (2002). Health care policy: issues and trends. Volume 759. Westport, CT: Praeger Publishers. Marmor, T. (2000). The Politics of Medicare, second edition. New York: Aldine de Gruyter. Rosenthal, G., Hammar, P. & Way, L. (1998). Using hospital performance data in quality management: The Cleveland health quality choice experience. Journal of Quality Improvement. Vol. 24 (3). pp. 347 – 360. Rubin, H., Pronovost, P. & Diette, G. (2001). The advantages and disadvantages of process- based measures of health care quality. International Journal for Quality in Health. Vol. 13 (6). pp. 4669 – 474. Shortell, S. (2006). Health Care Management. Albany: Delmar Thompson Learning. SHRM (2008). What should be the federal government's role in health care system. Survey Poll Results. Society for Human Resource Management. Retrieved July 20, 2010, from http://www.shrm.org/Research/SurveyFindings/Documents/w082608_-_Elections_Healthcare.ppt Warner, K. and Hutton, R. (1980). Cost-Benefit and Cost-Effectiveness Analysis in Health Care: Growth and Composition of the Literature. Medical Care, Vol. 18 (11). pp. 1069-1084. WHO (2004). Snapshots of Health Systems: The state of affairs in 16 countries in summer 2004. Retrieved July 20, 2010. From http://www.euro.who.int/document/e85400.pdf Read More