Essentials of Health care in the United States
- What are 6 basic characteristics that differentiate the U.S. health care delivery system from that of other countries?
The US healthcare system has ten main characteristics that make it unique. Firstly, in the US system, no central governing agency exists to integrate and coordinate health. Secondly, the US delivery system is a technology driven delivery system that focuses on provision of acute care. The US system, is very costly and unequal in access, yet the outcomes are at best average. In line with the cost aspect is that access is selectively based on insurance coverage. Fifthly, with the US system, the government acts as a subsidiary to the private sector, unlike in most other countries where government is the central health provider. Lastly, the US healthcare system is influenced by a fusion of market and social justices.
2. Most Western European countries have national health care programs that provide universal access. How does the National Health Insurance system, such as the one adopted by the country of Canada differ from the National Health system, such as the one structured in Great Britain?
Both health care programs are funded through taxes. The difference is that with the National Health Insurance, government guarantees a basic health package to all citizens, which is delivered through private physicians of choice. With the National Health System, on the other hand, the entire system is government controlled, with patients having no discretion as to the facilities or health care providers.
3. List the 4 health determinant categories and provide an example of how the government is improving help in each determinant.
The four main determinants of health care are environment, heredity, behavior and lifestyle, and medical care. The government is improving help in these categories through a number of interventions. Policy interventions such as product safety regulations improves environment. Heredity is improved through community-level or individual-level interventions, as are behavior and lifestyle. Finally, access to medical care is improved through health care interventions, whose aim is to reduce the cost of healthcare.
4. Explain how the U.S. has both market & social justice aspects of healthcare.
Market justice in the U.S. healthcare system is seen through individualized responsibility for healthcare, with benefits accruing based on an individual’s buying power. Many times, individuals are covered by insurance from their private employers. The system is, however, not purely a market justice one. Instead, social justice is exhibited through Medicare and Medicaid, which deliver collective health benefits.
5. Describe what healthcare providers and institutions were like before the Industrial Revolution.
Before the industrial revolution, healthcare was largely disorganized and in disarray. There was no standardized or scientific medical education. Anyone could practice medicine, with the procedures used being primitive. The existing hospitals were few with poor sanitation and unskilled staff, being located only in big cities.
6. Discuss some of the advancements that changed healthcare and the switch from a “traditions” approach to a scientific approach because of these groundbreaking medical discoveries.
The healthcare situation improved due to advances in a number of key areas. The main drivers were scientific discoveries and reforms in education. Urbanization was also an important driving force. Scientific breakthroughs led to among other effects, the development of science-based systems and an imbalance between specialists and generalists. The field of medicine became organized, with hospitals as a center of medical care.
7. Describe the differences between an allopathic physician (MD) and a holistic physician (OD).
The mainly differences between allopathic physicians and holistic physicians is in the philosophy and approach to treatment. ODs emphasize on holistic care, and focus on preventive care such as diet and environmental factors. MDs, on the other hand, focus on the diagnosis and treatment of disease. The underpinning of osteopathic medicine is that the body is one system where all parts work together and influence one another.
8. In the U.S. we have an imbalance of specialty care and primary care. What are the major medical care distinctions between these two majors? Explain the negative consequences of specialty maldistribution.
Specialty care usually comes after primary care, and requires referral from primary care. Primary care is very methodic and longitudinal, following a sequence whereas specialty care is episodic. Following up on this regard, specialty care is confined to a specific organ or instance of an illness, while primary care is concerned about the person as a whole. There are generally more specialists than generalists and this has several negative effects. First is the rise in healthcare costs due to an increase in procedures that are intensive, expensive and invasive. Having more specialists also contributes to a demand for initial contact with specialists. Moreover, the concomitant decrease in the number of primary care givers affects underserved populations, who are the largest recipients of medical care from primary care givers.
9. Describe the training of and discuss the important role that advance practice nurses and physician’s assistants (Non-Physician Practitioners) play in providing high quality, cost effective medical care.
Advance practice nurses are nurses who have educated beyond that of a registered nurse. They may specialize in one of four areas, namely clinical nurse specialists (CNSs), certified registered nurse anesthetists (CRNAs), nurse practitioners (NPs) and certified nurse-midwives (CNMs). Non-Physician practitioners practice in many areas that practitioners do, but lack an MD or DO degree. They include physician Assistants (PAs), NPs and CNMs. Training for NPs can be a certificate program or a master’s degree program. Clinical training in direct patient care is also imperative. CNMs receive additional training in maternal and fetal procedures, maternal and child nursing and patient assessment.
ANPs and NPPs play an important role in improving access to primary care, particularly in rural areas. Since they exhibit a greater personal interest in patients, they can provide high-quality care cost-effectively. Other advantages include better communication and interviewing skills. They can serve in rural and underserved areas, thus curing geographical maldistribution.
10. What impact does the growth of technology have on healthcare costs? How has technology impacted access to medical care and why aren’t new treatments, medications, modalities and machines available to everyone?
There are different categories of medical technology, which service different aspects of healthcare. Technology has led to a general increase in healthcare costs, though there have been declines in terms of specifics. Through technology, it is possible to improve geographical access to health care. This is through the mobilization of equipment and subsequent deployment to rural areas for example. However, new technologies are not available to everyone, and this is chiefly due to prohibitive costs. While excessive costs can be taken care of through insurance, not everyone has insurance.
11. What is HIPPA and what role does it play in protecting patient privacy when it comes to electronic medical records?
HIPAA refers to the Health Insurance Portability and Accountability Act. The act makes it illegal for anyone to gain access to personal medical information unless it was for the sake of health care delivery, operations or reimbursements. The act also empowers patients to request for copies of their health records, request for corrections and restrict access, thereby safeguarding patient privacy.
12. Discuss some of the examples of new, cutting-edge medical technology and its impact and implications for society, politics and religion.
Some examples of health technologies include electronic health records, which enable management of patient data through collection and storage, immediate/on-demand access, provision of knowledge and decision support and support of efficient processes. Another technology is telemedicine, which enables diagnosis and patient care where the patient and service provider are geographically separated. Telemedicine makes use of telecommunications technology.
Medical technology has many implications not only within health, but also within the social domains. Medical technologies have improved the quality of life. However, there are political and religious implications stemming from bioethics. This concerns particularly pertain to genetic research where the use of embryos in research remains controversial.
13. Explain how public and private financing of health care affects the demand for healthcare services and products.
Healthcare financing increases the demand for healthcare services and products. The increased demand arises from the nature of the US healthcare system being partly influenced by market justice factors. Healthcare insurance obscures the cost of health care for both providers and consumers, thus desensitizing them from these costs. Consumers feel obliged to overindulge since costs are already catered for by the insurance company. Moreover, services whose reimbursements are not constrained experience greater uptake while for those whose cost is constrained, uptake is curtailed. The overall effect is an increase in the cost of healthcare services.
14. Explain the significance of Gatekeeping in regards to primary care and keeping healthcare costs down.
Gatekeeping is a process that restricts patients access to specialists or hospital admission to the event that such care is recommended by their primary care provider. It is important in protecting patients from unnecessary procedures which are more intensive with specialist care providers. Moreover, it also keeps costs down since as has been noted, increased demand for specialized care increases the cost of healthcare.
15. Discuss the four principles of insurance and the nature and purpose of cost sharing in private health insurance
Insurance is a mechanism through which individuals are protected against risk, which refers to a potential financial loss. There are four fundamental principles belying insurance, the first of which is unpredictability of risk for the insured individual. Secondly, there should be a capability to predict the risk within a reasonable degree of accuracy. Through a pooling of resources, insurance provides a mechanism through which the risk is transferred from the individual to the group. Finally, the actual losses arising are shared through some equitable basis amongst members of the group. Cost sharing provides a mechanism through which an individual assumes some part of the risk. Its aim is to reduce the misuse of insurance benefits.
16. Discuss Medicare; when and how it was developed (parts A and B) and, how it has changed since its inception, i.e., Part C and D, managed care and the Affordable Care Act
Medicare developed in 1965, and has continuously evolved through the addition of features. Hospital insurance is financed through payroll taxes for all working individuals. There is also a supplementary medical insurance which is voluntary. Part C, Medicare advantage, mainly manages Medicare benefits for members. Finally, part D, prescription drug coverage, was added in 2003 and fully implemented in 2006. It is voluntary, requiring a monthly premium payment.
17. What are Diagnostic-Related groups (DRG’s), Ambulatory Payment Classification (APC), Outpatient Prospective Payment System (OPPS), Resource Utilization Groups (RUG), and Home Health Resources Groups (HHRG) and how are “codes” like this utilized to try to control cost?
DRG is a reimbursement method used to cater for hospital in-patient services. APC is a prospective payment method and caters for hospital outpatient care. RUGs is a system which serves as the basis upon which SNFs are paid. Finally, HHRG is a system used to pay for home health care. These codes are useful in controlling costs since the amount of reimbursement is predetermined and not based on the length of care.
18. Based on the information in your text, how were the National Health Expenditures were spent and what impact did this have on the Gross Domestic Product (GDP) and the Consumer Price Index (CPI)?
National health expenditures for 2006 amounted to $2.105 trillion. Of this, 84% of expenditure was on personal health services and products. These include items such hospital care, dental care and home health care. For the other 16%, expenditure was mainly on research administrative costs for government programs and administrative costs of private insurance companies among others.
19. Describe the types of Outpatient Care, and discuss why it has grown so quickly the impact this has had on society.
Outpatient care refers to provision of healthcare services that do not require the patient to stay in the hospital overnight. Outpatient care may occur in a variety of settings, including the patient’s home. Apart from primary care services such as physical exams and minor treatments, outpatient services today also include outpatient surgery. Outpatient care has increased due to a number of factors including the cheaper cost of outpatient care and technological factors. Moreover, payers are discouraging inpatient stays in favor of outpatient care. Finally, social factors such as a preference amongst patients of receiving care at home. Outpatient care has increased access to healthcare.
20. Distinguish between primary, secondary, and tertiary care.
Primary care is short-term care that is provided by a
generalist, and is of low intensity. Secondary care is also short-term, but
more intensive than primary care. It is done by specialist, and involves the
provision of expert opinions and advanced interventions. Tertiary care is at
the highest level, and addresses uncommon conditions. It is carried out at the
institutional level and is highly specialized. It also tends to be long-term in
certain instances.
Reference
Shi, L., & Singh, D. A. (2010). Essentials of the U.S. health care system. Sudbury, Mass.: Jones and Bartlett.