Introduction
The healthcare sector is one of the areas that have come under sharp focus in recent periods both in the United States and around the world. Issues that have raised concern include the ability of the respective system to handle a changing demographic outlook; and the ability of the financiers to pay for all the essential services required by the population. The demand for healthcare services has been increased by various factors; such include an increase in the population, an enlargement of the proportion of elderly people; and increased cultural, racial and ethnic diversity.
The immense pressure placed on the system has eventually resulted in some sections of the population receiving less than satisfactory healthcare services; resulting in disparities in health among racial and ethnic minorities; people from poor socioeconomic backgrounds; and uninsured and/or underinsured people in the United States. Additionally, there have been clear shortcomings in the management of chronic diseases such as heart disease, diabetes and obesity; particularly in regards to the development and management of co-morbidities. This can largely be blamed on the fragmented nature of the healthcare system; which was originally designed for acute health care and which has not adapted quickly enough to the current challenges to the general health of the population.
Various stakeholders have awaked to the fact that healthcare delivery is arguably the biggest challenge that the United States and indeed the Western civilization will face in the near future. This was clearly evident in the central role which the issue took in the run-up and during the 2008 American presidential election. Additionally, the issue continues to emit debate and discussion regarding the problems and possible solutions to alleviate the current deficits and prevent future disasters.
In this paper, I am going to explore various facets of the healthcare sector vis-à-vis the challenges they are facing and the possible solutions to ensure safe, effective, patient-centered, timely, efficient, and equitable delivery of healthcare services.
Cultural Competence and Patient Focus
The challenges of being culturally competent and providing patient-centered care are among the newer hurdles that healthcare providers have had to surmount in the recent past. This has largely been fuelled by an increase in the cultural and ethnic diversity of the American population; this has rendered the standard “one-size-fits-all” services ineffective in addressing both the unique need of minority populations and the barriers that stand in the way of effective delivery of healthcare services to this section of the population. Such barriers include language barriers; personal and institutional racism; racial and ethnic stereotypes and misconceptions; mistrust; socioeconomic status; and access to health insurance (Woloshin, 1995; Rowland & Shartzer, 2008; Gornick, 2000). These barriers have contributed to the development of disparities in health between the white majority and the ethnic minorities in the United States; seen as lowered life expectancy and poorer clinical outcomes. This disparity has been shown even between people with a similar socioeconomic status but of different racial extracts. The need to surmount these barriers has given rise to the concepts of cultural competence and patient-centered care.
Patient-centered care
This can be summarized as viewing each patient as a unique human being; and thus formatting all interventions to cater to the unique health need of such an individual (Balint, 1969; Saha et al, 2008). Such would result in the development of a trustworthy relationship between the patient and the provider and would be seen as better clinical outcomes as a result of a better understanding of the patient’s symptoms; accurate treatment of the condition due to accurate diagnoses; and better adherence to the clinical regiments as a result of the trust created between the physician and the patient. Patient-centered care, therefore, seeks to understand not only the disease but also the patient.
Such would also mean making the patient a partner in the process of care and recovery; rather than the traditional role whereby the patient was a net recipient of all diagnostic and treatment processes. Indeed, during this process, the agenda of the physician is to attain full recovery of the patient in the quickest and safest way possible; and more recently, at the lowest cost possible. It is also however important also to recognize that the patient also has an agenda; and whose scope is wider than the simple recovery from disease. For example, the patient would like to go through a process that would not only ensure effective recovery, but that would also ensure dignity, keeping of taboos and adherence to cultural beliefs and practice. Any issue which the patient perceives to be violating any of these factors would be passionately opposed and/or avoided; and would firmly stand in the way of speedy and complete recovery (Flores & Vega, 1998).
Traditionally, the medical fraternity majored in the analysis of the clinical outcomes of the diagnostic and therapeutic outcomes. The need to provide patient-centered services has resulted in the development of new measurements of the effectiveness of these processes, the patient-centered outcomes. These are measurements of variables that the patient might have interest in, but that would be of no use to the physician (at least not in the immediate clinical care of the patient). Such measurements include the quality of life, functional status and patient satisfaction. The improvement of these measurements has a direct correlation to better clinical outcomes in a contemporary healthcare setup (Saha et al, 2008).
Cultural competence
The other concept that has arisen concurrently to that of patient-centered approach is that of cultural competence; the main drive of this concept is also to address the varied healthcare needs of a multicultural society as that of the United States. However, the concept has been aided greatly by the need to have a visible effort to reduce the mentioned disparities in health so as to quench public opinion calling for equity in health services provision (Saha et al, 2008). This has resulted in the development of numerous programs for healthcare professionals and workers; with the aim of training them on issues of cultural sensitivity. Additionally, there have been efforts to introduce cultural sensitivity aspects into the curriculum of a medical professional so as to produce candidates that are fully equipped to handle patients from a wide range of cultural backgrounds. Additionally, there have been efforts to provide culturally friendly environments in healthcare facilities; such as the availability of interpreters to break the language barriers; and the provision of patient-education material in the native language of a minority patient; among other things.
Considering the current and increasing diversity of the population, these efforts have had mixed results. The key to achieving complete cultural competency is to be able to respond quickly and effectively to the day-to-day challenges posed by cultural diversity. Indeed, it may not be financially feasible to have permanent measures in place in a hospital. For example, rather than having an interpreter permanently stationed in the hospital, it may be more practical to have one available on short notice for languages that are less common in the area.
Financing Healthcare Services
Healthcare has become among the most expensive commodities in the market today, and issues surrounding its financing have become points of contention both in the public and private domains. Among the most urgent of the issues surrounding financing is the widespread lack of health insurance among Americans.
Lack of health insurance has been associated with poor health outcomes ranging from elevated morbidity and mortality; lack of primary prevention services and subsequent increased incidence of preventable diseases; lack of access to essential healthcare services by sections of the population; thus leading to deferment of seeking proper care until the disease has developed into an irreversible or serious state. This results in the stretching of hospital facilities which are forced to admit more patients who would have been treated as simple outpatient cases if the necessary care had been sought earlier.
Healthcare delivery in the United States is achieved through a complex system of overlapping roles shared between the private and the public sector; this has developed over a long period into a mechanism that is able to adequately handle the large, growing and diverse population. However, there still remain gaps in the system through which a significant proportion of the population slips through and lack basic medical cover (Rowland & Shartzer, 2008).
All the people under the age of 65 are ideally supposed to be covered through job benefits offered by employers as part of the employment package. On the other hand, Medicare covers all people who are 65 years and above in age; and people who are below this age but have severe or permanent conditions that do not allow them to work. Two crucial segments of the population have however been underserved by this seemingly adequate arrangement; these are people below the age of 65 but that do not have access to employer-sponsored insurance either due to a state of unemployment; and minors. To furnish these segments, two programs Medicaid and the State Children’s Health Insurance Programs (SCHIP) were instituted; access to these services is however regulated by eligibility as determined by the perceived socioeconomic status of the candidate. This effectively locks out a large number of people who on one hand cannot afford out-of-pocket healthcare expenses, and on the other hand, are deemed ineligible since they do not meet the obligatory criteria for income deficits.
In 2006, about 47 million people were uninsured in the United States (Silverman, 2008; Rowland & Shartzer, 2008); this constitutes about 18 percent of Americans below 65 years of age. However, this is an increase of over 7 million since 2001. It is prudent to mention that arbitrary figures may not be accurate representations of the situation in the field. This is due to the fact that the gain or loss in health insurance by the individual and population is determined by the state of the economy, demographic changes; and occurrences in the labor market. As such, a one-time sample of the population will not capture the individuals who lose their cover during periods outside the scope of the study. This is of particular significance to the non-elderly people; who have been shown to experience about 30% lack of cover for a period of at least one month of the year (Rowland & Shartzer, 2008).
Health services in the US are largely financed by employer-sponsored coverage; this has been rendered inadequate by the dual-attack by elevated costs of healthcare forcing employers to pay higher contributions for their respective employees; and an economic meltdown that has adversely affected the job market with many industries hiring less and making staff cutbacks in attempts to reduce their costs of operations. On the other hand, the ability of the federal government to fund public coverage both as an attempt to cover the deficit left by the private sector; and to play its traditional role as the financier of services for senior citizens has been put into question especially considering federal deficits and a rapidly aging population. It is also prudent to recognize the impact of lack of insurance on the country’s economy; the cost of poor health and shorter lifespan in uninsured and underinsured is estimated to be between $65 and $130 billion for every year of lack of cover (Silverman, 2008).
In order to overcome this challenge, various stakeholders will have to invest significant financial resources. Additionally, they have to make political and philosophical compromises (Silverman, 2008). Indeed, some states such as Massachusetts and Vermont independently instituted measures to mitigate the current situation; with legislations aiming to ensure universal coverage. However, to effectively tackle the situation, a national approach is necessary.
Healthcare Safety
Medical error and its effects on the patient are a major cause of injury and mortality in the US (Kohn et al, 2000; Health Grades Inc.; 2004; Kizer and Blum, 2005). This is in spite of measures put in place to ensure that the safety of the patient is put at the forefront. To cater to the safety needs in healthcare practice, the National Quality Forum (NQF), a public benefit corporation was set up in May 1999 and was fully functional by February 2000. This forum was set up under the recommendation by the President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry (National Quality Forum; 2003). The mandate of the NQF was to come up with standards of measurement for patient safety, and that is based on consensus among stakeholders, and that are aimed at an overall improvement of the healthcare system in the US.
The NQF has gone ahead to endorse safe practices which cover a wide range of possible scenarios in a healthcare setup. For example, the forum endorses the referral of a patient to facilities that have demonstrated superior outcomes for high-risk or elective surgery; or medical care. The NQF also recommends that patients in intensive care units should be managed by medical professionals who are specifically trained for and critical care certified. These are only two of many other recommendations made in the report titled Safe Practices for Better Health Care: A Consensus Report (National Quality Forum; 2003).
Full implementation of the (30) Safe Practices would ensure the medical procedures and care become safer; and a reduction of adverse outcomes of disease and medical errors. Additionally, the fact that the practices were derived from a consensus process makes them even more relevant, achievable and widely acceptable. However, there also is a need to have regular evaluation and updating so as to cater for possible scenarios that may arise with the passage of time.
Conclusion
The above-discussed issues are by far not the only ones challenging the effective delivery of healthcare services in the US; however, they are the ones that have affected the sector more severely; and have the potential of crippling the industry altogether. It is therefore incumbent on the stakeholders to take drastic and concerted action to make sure that the issues are resolved and within a short period.
References
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