NRS 428 Describe the effect of health care reform on the U.S. health care system and its respective stakeholders
NRS 428 Describe the effect of health care reform on the U.S. health care system and its respective stakeholders
A health care delivery system incorporates four functional components, financing, insurance, delivery, and payment, (the quad-function model). Health care delivery systems differ depending on the arrangement of these components. There are three main finance sources for health care in the United States: the government, private health insurers, and the individuals. Between Medicaid, Medicare and the other health care programs it runs, the federal government covers just about half of all medical spending (Havaei et al., 2019). The current US delivery system and financing structures are unsustainable. Inequitable distribution of resources continues, and an increasing number of American families do not have access to adequate care. The U.S. health care delivery system is complex and massive. I honestly feel unqualified to judge the effectiveness accurately, but while my gut instinct wants to say “no” the data supports that it is functioning better than any other system worldwide of its size. The vast array of institutions includes 5,700 hospitals, 15,900 nursing homes, almost 2,900 inpatient mental health facilities, and 11,000 home health agencies and hospices (Cleveland et al., 2019). Despite spending far more on healthcare than other high-income nations, the US scores poorly on many key health measures, including life expectancy, preventable hospital admissions, suicide, and maternal mortality. And for all that expense, satisfaction with the current healthcare system is low. By making health coverage more affordable and accessible and thus increasing the number of Americans with coverage, by funding community-based public health and prevention programs, and by supporting research and tracking on key health measures, the ACA can help begin to reduce disparities, improve access to preventive care, improve health outcomes and reduce the nation’s health spending.
Havaei, F., Dahinten, V. S., & MacPhee, M. (2019). Effect of Nursing Care Delivery Models on Registered Nurse Outcomes. SAGE Open Nursing. https://doi.org/10.1177/2377960819869088
Cleveland, K.A., Motter, T., Smith, Y., (2019) “Affordable Care: Harnessing the Power of Nurses” OJIN: The Online Journal of Issues in Nursing Vol. 24, No. 2, Manuscript 2.
the health care delivery system was described as a “cottage industry.” The main characteristic of a cottage industry is that it comprises many units operating independently, each focused on its own performance. Each unit has considerable freedom to set standards of performance and measure itself against metrics of its own choosing. In addition, cottage industries do not generally attempt to standardize or coordinate the processes or performance of Unit A with those of Units B, C, and so on.
Indeed, this is an apt characterization of the current health care delivery system. Even in many hospitals, individual departments operate more or less autonomously, creating so-called “silos.” Many physicians practice independently or in small groups, and ambulatory clinics, pharmacies, laboratories, rehabilitation clinics, and other organizations—although part of the delivery system—often act as independent entities. We often call this arrangement a “health care system,” even though it was not created as a system and has never performed as a system.
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Moving from the current conglomeration of independent entities toward a “system” will require that every participating unit recognize its dependence and influence on all other units. Each unit must not only achieve high performance but must also recognize the imperative of joining with other units to optimize the performance of the system as a whole. Moreover, each individual care provider must recognize his or her dependence and influence on other care team members (e.g., specialists in different fields, pharmacists, nurses, social workers, psychologists, physical therapists, etc.) (IOM,2003). These are the underlying attitudes that support a systems approach to solving problems.
Changing attitudes to embrace teamwork and systems “thinking” can be extremely difficult and may encounter resistance. Nevertheless, a concerted, visible commitment by management will be necessary to achieve this new way of thinking as a giant step toward the improvements identified in Crossing the Quality Chasm.
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The health care system is a combination of organizations such as private donors, out-of-pocket pay, and government insurance that serve society’s demands for health and illness-related services. Although the healthcare sector in the United States is expanding at a rapid rate, there are fewer doctors, hospital beds, and doctor visits are taking longer thus people make fewer visits and more hospitalizations here than in most other industrialized nations. The USA spends most of the healthcare per capita and GDP of any other country, but it still faces problems such as unstainable insurance premiums and socioeconomic disparities The national quality plan acts as a motivator and compass for a focus on quality improvement initiatives and a method of monitoring quality across the country. Research centers have specialized in the field of health research to enhance patient safety, effective outcomes and care, clinical practice, and technology evaluation and delivery. Further outcome measurement has historically placed more emphasis on functional status than clinical status when it comes to long-term care and excellent interpersonal care. The United States has implemented health care reforms that place an emphasis on prevention rather than treatment, pay attention to health disparities, improve delivery, and include important components like health insurance. Clients/patients, the government, and healthcare professionals were all involved in the reforms.
Authors Roosa Tikkanen, Authors, Tikkanen, R., Osborn, R., Mossialos, E., Djordjevic, A., & Wharton, G. A. (2020, June 5). United States. Home. Retrieved January 11, 2023, from https://www.commonwealthfund.org/international-health-policy-center/countries/united-states
Ridic, G., Gleason, S., & Ridic, O. (2012). Comparisons of health care systems in the United States, Germany and Canada. Materia socio-medica. Retrieved January 11, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3633404/
Every American should have access to affordable health care. However, health care spending continues to grow at an unsustainable rate. Whereas spending growth initially slowed after implementation of the ACA, it has accelerated once again. The consequences of this acceleration are well established and include a growing national debt; strained federal, state, and local budgets; stagnant wages; and increased financial insecurity for Americans. Even for those with insurance coverage, health care is increasingly unaffordable: Roughly half of US adults have delayed or avoided care because of cost. In the developed world, the issue of health system sustainability received unprecedented attention during the economic crisis. However, the discussion has mainly focused on “traditional” concerns like cost-effectiveness, quality of care, and, more recently, patient involvement. The question of who pays and, more importantly, the sustainability of financing have not yet received sufficient attention. This fundamental idea in health policy economics needs to be carefully rethought. Wage income is becoming increasingly inadequate to cover the rising cost of care in a globalized economy as the proportion of labor to capital decreases. At the same time, the economy’s competitiveness is put in jeopardy as medical costs drive up the cost of Social Health Insurance through employer contributions. These explanations explain why comprehensive National Health Insurance, which is funded by progressive taxation of income from all sources rather than employer-employee contributions, protects health system objectives and ensures health system sustainability by spreading health care costs to all production factors. The moral fabric and value system of a society determine who is responsible for paying for health care and how. Social involvement, personal responsibility, and freedom of choice are all facets of this deeply ideological and political issue. In conclusion, universal coverage, service quality, and rising life expectancy are incompatible with employment contributions as a source of health financing. Through increased competitiveness, a shift toward general taxation to pay for health care can also achieve important non-health goals like equity, financial protection, quality, and responsiveness even during economic downturns. As a system objective, the sustainability of the health system must turn to financing through progressive taxation of all income. Despite how unsettling this may appear, this is a fact that should not be overlooked.
National Library of Medicine. (2015). Health care financing and the sustainability of health systems. https://www.ncbi.nlm.nih.gov
World Health Organization (WHO) The World health report. Health systems: improving performance. Geneva: WHO;
Canadian Health Services Research Foundation (CHSRF). Myth: Canada’s system of healthcare financing is unsustainable. Mythbusters. 2017. http://www.cfhi-fcass.ca/sf-docs/
In the United States, 27.5 million people (8.5% of the US population) do not have health insurance Among the 91.5% who do have health insurance, 67.3% have private insurance while 34.4% have government-provided coverage through programs such as Medicaid or Medicare.
Employer-based health insurance is the most common type of coverage, applying to 55.1% of the US population. The United States is the only nation among the 37 OECD (Organization for Economic Co-operation and Development) nations that does not have universal health care either in practice or by constitutional right.
Proponents of the right to health care say that no one in one of the richest nations on earth should go without health care. They argue that a right to health care would stop medical bankruptcies, improve public health, reduce overall health care spending, help small businesses, and that health care should be an essential government service.
Opponents argue that a right to health care amounts to socialism and that it should be an individual’s responsibility, not the government’s role, to secure health care. They say that government provision of health care would decrease the quality and availability of health care, and would lead to larger government debt and deficits.
ProCon.org. (2020, May 4). History of the Right to Health Care. ProCon.org. https://healthcare.procon.org/history-of-the-right-to-health-care
[Editor’s Note: The APA citation style requires double spacing within entries.]