The U.S. Health Care System: Long-term Care
Your portfolio assignment focuses on a specific sector of healthcare and its relation to the current U.S. healthcare system. Choose one of the healthcare sectors listed below for your portfolio assignment:
- Long-term Care
- Mental and Behavioral Health
- Ambulatory Care
- For-Profit/Public Health Care.
Write a ten to twelve page paper where you address the following:
- Describe of the sector’s historical development and current role in healthcare delivery.
- Explain how the political influence in the U.S. healthcare system impacts how this sector provides healthcare to specific communities.
- Evaluate how quality, safety, and competition within this healthcare sector impact patient care.
- Examine what major challenges exist for this sector for the system over the next decade from healthcare reform and other factors. Discuss a minimum of three challenges and offer your recommendations on how healthcare leaders and administrators can manage them.
- Provide a conclusion summary of your findings and of the project experience.
The U.S. Health Care System: Long-term Care
Among the advanced industrialized countries, healthcare system of the U.S.A is unique, for its healthcare system is not uniform and the government does not offer a universal health care insurance coverage for her citizens. It is only till recent that legislation mandating coverage of healthcare services for everyone was enacted. Unlike the other developed countries that have a universal health insurance coverage for their citizens, America is different with no such insurance coverage. The United State embraces a Long-Term Care System which encompasses the social services and the medical continuum which deals with the disabled or those suffering from chronic illness. Long-Term provisions include housing, social services, and the traditional medical services with the sole role of preventing recipient’s health deterioration and improving their adjustment. In a Long-Term care system, the expectations of a patient getting better are not necessarily taken into consideration, unlike the rehabilitation care. These services can be provided in assisted living facilities, nursing homes which are an example of residential living facilities as well as a person’s home. As a result of it being a concept, it makes it quite difficult to quantify the numbers of service providers and the recipients. (American Health Care Association, 1978)
Historical Development of the America’s Healthcare system
For any healthcare consumer, it is of significant importance to have a comprehensive and clear information on the U.S. health care delivery system that is the healthcare operations, all the ethical and legal considerations, and the kind of participants of the system not forgetting the problems involved. (Understanding the U.S. Health Care System, 2017) Establishment of hospitals in the U.S. kicked off in the mid-1700s with the establishment of the first medical school at the University of Pennsylvania, hitherto, there was no any hospital in the United States. Medical training was done through internship without any formal tuition and mandatory testing. In 1847, to protect the interests of the people/providers, the American Medical Association was developed. Council on Medical Education was created in 1904 by the AMA to establish standards for medical education. Medical education underwent some changes by 1928 with respect to the Flexner Report that led to standardized admissions. (Albrecht, & Stevens, 1973)
There were changes in the healthcare sector between 1940s-1960s for it is the period when the federal government grants aimed at aiding the medical school’s operation and the teaching hospitals. To take care of the representation of the healthcare consumer in the hospital care, a Patient Bill was issued in 1970 to 1980. Since then, the healthcare sector has undergone several changes up to date. (Howard, 2012)
The Role plays in the Healthcare System
Long-Term care services play a momentous role in the United States healthcare system. The facilities under the long-term care are; Alzheimer’s facilities, Services like Home health care, Adult homes and assisted living facilities as well as Domiciliary care, Retirement Housing, Nursing homes, Supportive care and much more that play a significant role in the healthcare of the recipients.
In 1995 and 1999, nursing homes with special care units for patient’s cognitive impairments or the Alzheimer’s disease increased by 35%.There is a variation of 10,000 to more than 40,000 people who are assisted in living residences. Sub-acute and post-acute services have been on drastic increasing supply over the past decade as a result of technological advancements the help in the prevention of the post-acute patient’s health status deterioration. In the military, long-term care is provided through the Veterans Administration facilities to retired military personnel suffering from certain psychological and other health problems. The Veterans Administration care system focuses on hospital care, long-term care, and the mental health services to its members. The Military Medical system has 153 hospitals, 732 ambulatory services and community-based clinics, 209 counseling centers, 73 home health care programs, 47 domiciliary and 135 nursing homes. Evidence shows that the Veteran Administration system budget is over $30 billion and employs a staff of 263,350 (National Center for Veterans Analysis and Statistics, 2007).
The significant role of the long-term care system is much effective with the vulnerable populations. The uninsured, those living in geographically and economically disadvantaged communities, the minority, the elderly and the disabled. This vulnerable population receives their health care from the safety net providers that include health centers, hospital outpatients, emergency departments and physicians’ offices. They are offered with well-defined services and medication to meet this vulnerable populations needs which include supporting them socially, monitoring their nutrition and providing them with education on health, handling their case management as well as providing them with child care services. (King, 1984)
Community-based health centers that provide long-term services for the migrants, seasonal workers, homeless persons and school-aged children are provided with a federal support by the Department of Health and Human Services. The uninsured and the Medicaid populations’ health outcomes have been significantly improved as a result of health centers contributions and reduced the disparities in health care and health status. The government’s health insurance programs like the State Children’s Health Insurance Program, the Medicare, and Medicaid enhances healthcare access by the vulnerable population. (Eckelman, & Sherman, 2016)
Medicare being the largest health insurance in the U.S.A serves the elderly suffering from certain disabilities and those diagnosed with the end-stage renal disease. The model of Medicare is of three parts, A. B, and D. Part A covers health cares in nursing facilities, hospice care, hospitals, and some home health care, while part B covers doctors’ services and other outpatient care. Part D is a program whose role is to protect those in Medicare burdened with very high drug costs. (Anderson, 1984)
Medicaid supported the people who are old and low-income women and people with disabilities. This program plays a pivotal role by offering the vulnerable population like the elderly and the people who have disabilities as well as the people who do not have health insurance with a long-term care plan. As a result of the growing uninsured population in the country, the government took the initiative by giving insurance and support to the children who belonged to the uninsured families. It also helped cover the children who did not qualify for Medicaid like who had a modest income. With this insurance, the children could afford any emergency room visits, physician visits, hospitalizations, and immunizations. (Conklin, 2017)
Political Influence on Healthcare Service Delivery
The political climate in any country plays a pivotal role in healthcare service delivery. Depending on the political climate in the country, the influence on the healthcare service delivery can either be positive or negative with is the same case with the United States political influence on the healthcare service delivery.
The political climate determines enactment of any healthcare bill. In the U.S., unlike other developed countries, the national government has left the healthcare sector to be dominated by the private sector. It only plays the role of taking care none beneficial gaps left by the private sector such handling environmental issues, funding research, training and covering those that cannot afford insurance cover provided by the private sector. Through the government healthcare insurance such as the Medicare and the Medicaid, the vulnerable population can access health services thus significantly improving their healthcare status. (Message et al., 2017)
In the March of 2010, President Obama signed off a contract names Affordable Care Act according to which there would be an expansion of the health care coverage, prevention, and wellness. It would increase consumer protection, would improve administrative effectiveness and endorse evidence-based treatment. With a sole role of curbing the health care costs. The enactment of the ACA into law brought about significant changes in all healthcare sectors. The creation of health insurance marketplace exchanges is the major provision of the ACA where individuals despite their present insurance status can still shop for health insurance. This act though beneficial, it has received opposition from those with self-interests to the extent of them going to court to stop its enactment, the court ruled in their favor in some areas though the act is in effect and it is being felt. (Conklin, 2017)
In the years 2014-2015 there was an increase in the health insurance coverage in the markets which was found by the Commonwealth Fund. It was all with a desire to deliver choice transparency and promote competitions among the health care insurance providers to consumers.
Though healthcare improved under the ACA, still there are some challenges to till with if there would need to make health care better. With the enactment of ACA, still 10.4% Americans were still uninsured in 2014 and those with insurance cover still facing higher deductibles and premium costs.
The ACA law banned lifetime monetary caps on insurance coverage for all new plans and prohibited the plans from excluding children and most adults with preexisting conditions thus improving the healthcare access and affordability. Canceling of insurance coverage plans was prohibited unless in the case of fraud.
Furthermore, Prevention and Public Health Fund was established under the ACA to allocate $7billion to facilitate prevention care such as screening of diseases, providing the prenatal care of the pregnant women and the coverage of immunizations. The Independent Payment Advisory Board that was mandated to provide endorsements to Congress and the President for controlling Medicare costs if the costs exceed a targeted growth rate was one of the actions taken to control in the healthcare, thus, helping to curb rising medical costs. The ad hoc administrative process of transferring funds, and determining eligibility have been simplified under the ACA bill by allowing doctors to charge of the billing. Medicare Advantage program was also modified to provide incentives to the private plans to increase its quality and efficiency as well as provide bonuses to high graded plans. Along with the supplies of the ACA the hospitals who had a high admission rate saw a decline in Medicare payments. Along with this, there was a new expenditure reduction program introduced within the canters of Medicaid Services. (“What Is the Government’s Role in US Health Care?”, 2017)
The Quality, Safety, And Competitiveness of American Healthcare
Among the world’s best specialists, the United States specialist stands out as the best worldwide. Regardless of America having the best medical equipment and specialties, the treatment plan in the USA is overpriced and over specialized. Also, it neglects preventive and primary care making it difficult for many people to have quality and safe care. As such, it results in poorer health care as a whole as compared to other developed nations which are way more advanced than America health wise. Evidence by the Commonwealth Fund Commission (2014), ranked U.S.A the last in comparison to Canada, Australia, Germany, the Netherlands, Norway, the U.K, Sweden, France, New Zealand, and Switzerland. The evidence also showed that regarding quality care in comparison to other developed countries America was ranked fifth but came in the last position regarding the efficiency of the care, equitability, and the healthiness of the citizens’ lives. The American Healthcare system dysfunction is underscored on an international context.
In the year 2013, the practicing physicians in America were only 2.6 per 1000 people which is below the OECD average of 3.3 physicians per 1000 people and America has a relatively high health expenditure level in comparison to other OECD countries. (Albrecht, & Stevens, 1973)
With the expanded access to insurance under the Obama Affordable Care Act, more people can seek out treatment with the provision in the legislation to increase the number of primary care physicians in the country. Projections indicate that America will need 52,000 more primary care physicians in addition to the current by the year 2025 to meet the growing demand as a result of population growth and the increased aging that makes up the population.
Infant mortality rate in the U.S.A is an implication of poor quality healthcare services in comparison to other OECD countries. In the year 2013, infant mortality rate in the U.S.A was at 5.96 per 1,000 live births, and the OECD mortality rate median was 3.8 which is quite a big margin difference that raises the alarm. The obesity rate among the adults in the U.S was at 35.3% in 2013 which was the highest rate compared to all other OECD countries. The average obesity rate for the OECD countries by 2013 was at 19.0%
Unlike the other developed countries in the OECD, the United States has not universalized its healthcare service delivery system; rather the health care sector is highly dominated by the private sector as the insurance providers render the vulnerable population inaccessibility effective health care service.
In matters regarding technology in health care sector, United States has been a blueprint as a result of continuous research and innovation. Creation of demand for new services despite the shrinking resources to finance sophisticated care comes as a result of the growth in science and technology. Advancements in technology in the US have ushered in a new generation of successful interventions in the health care system even though the problems of high cost for technological interventions cannot be ignored. In the US, a significant population of the uninsured meaning they are not sheltered by any insurance program, public nor private making it close to impossible for such people to access medication which leaves them at a health risk. As a result of all this, the American health care system is rated, poor, unsafe and less competitive in comparison to other developed countries under the OECD making it necessary for a reformation in the American Healthcare system as the Affordable Care Act alone cannot be sufficient to resolve all these issues. (Conklin, 2017)
America’s Healthcare System Future Challenges and Issues
The American Dream entails having a high quality, efficiency and effectiveness in her health system to be able to meet the health demands of her citizens, however, issues of high costs, declining and stagnant quality and incomplete insurance coverage are not to be ignored since they still linked to the America’s health care system. Regardless of such issues, some reforms are being implemented in the health care system with the view of improving the health care system implementations such as the Patient Protection and Affordable Care Act. Technological, international conditions of health care and the ethical challenges are some of the things deemed to shape the future of health care in the United States. Such issues that affect the success or failure of the health care system.There are more challenging problems facing the American Healthcare system which have remained unaddressed leading to low effectiveness and quality in the provision of healthcare services in the United States. (Conklin, 2017)
The rising cost of health care remains the top challenge that has not yet been addressed adequately to date which poses a vital challenge to the health care system that needs an immediate response. The rising cost expenditure by the United States government is not a sign of higher quality health care. (“Long Term Care Facts. Washington, American Health Care Association”, 1978)
Projections show that there will be a need for 52,000 more primary care physicians in the United States to be in a position to meet the growing population by 2025. Lack of primary care physician competent enough that would replace the retiring doctors and nurses is one of the factors that lead to a shortage of primary care physicians. Nursing homes lack a standard number of physicians to meet the demands of the patients which remains unaddressed problem in the future and now. (Kessler, Heron, & Spilsbury, 2017)
Ethical issues remain a major challenge to the United States health care system. The United States remains at stake due to its failure to universalize health care services, the government’s health care insurance does not cover illegal immigrants who remain a threat to the country since when the immigrants fall sick, they may spread the disease to other Americans meaning the government will have to spend more on health care in treating them. Therefore, the United State government remains with the challenge of implementing a universal health care coverage to curb the rising health care costs. Confidentiality and privacy of patients are the ethical challenges faced by the government of the United States resulting from the use of technology in information sharing. There is need to implement reforms in the health care system to address these ethical challenges relating to the patient’s rights. (Conklin, 2017)
Recommendations and Conclusion
With respect to the U.S. healthcare analysis, it is quite clear that the government has to embrace the universal healthcare coverage if there is any desire to cut the rising costs within the healthcare sector, though technology has been seen as a vital tool in improving the healthcare service delivery, the government should implement it with some moderate caution of the increasing cost on technical interventions. In general, the United State healthcare system still has a long way to go in meeting the international standards of the other developed countries, as thus, there is a need for reformations in the sector.
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