Introduction
The government reluctance is the greatest contribution to the problems facing the United States in terms of the Health Care System. The U.S. is the only significant industrialized nation without universal health insurance. The consequences are increasingly well known â inequities in terms of care, mortality (avoidable) and substandard care, burdens of finance on those not insured, and poor productivity. The US spends two times as much, as an average industrialized nation, but does not systematically achieve the best care. As many people do, I think the healthcare system in America has serious problems, and if care is not taken, these problems will form part of American life. The problems lie with the government, healthcare providers, and to a lesser extent, the general public i.e., the recipients of healthcare. Doctors are being discouraged from effectively doing their jobs due to the mounting number of lawsuits being filed against them day by day. A doctor will workday and night to rescue a patientâs life, but a small blunder in the line of duty may make the family of the patient sue for damages. It is so unfortunate that they do not see the effort that the doctor made but rather, cling to the fact that the doctor was not able to cure their loved one. These among others are the main factors discouraging doctors from working to their capacity.
There are solutions to these problems that I have suggested below. It is not to say that the suggested solutions are 100% effective, but once considered, they could be in the right direction towards improving healthcare in the United States.
The millions of uninsured Americans
Some Americans are ineligible to apply for government-provided insurance. More often than not, this same group is unemployed and thus cannot benefit from the insurance offered by the employer. These people, therefore, are left to cater for themselves medically and usually go without medical insurance â resulting in tragic consequences should a medical catastrophe strike. (Sultz & Young, 2010).
Figures vary. It is estimated that between 15% and 29% of Americans are without insurance (American Census Bureau). Figures by the Census Bureau in the U.S illustrate that of the uninsured (estimated to be around 46 million) 36 million are American citizens while the other 10 million are non-citizens. The global financial crisis of 2008 saw more than 2 million Americans lose their health insurance policies and had to apply for Medicaid. Uninsured Americans do not get their healthcare for free. In 2008, they had to pay $30 billion to cater for medical expenses (health care) as noted by Jack Hadley and colleagues of George Mason College in the August 25 issue of âHealth Affairsâ. Moreover, Hadley and colleagues calculate that the U.S government will have set aside $56 billion to cover for those uncompensated in terms of health cover.
In one of the U.S censuses, there were significant disparities that were revealed about insurance cover (U.S Census Bureau, 2009). Such disparities include;
- 10.4% of non-Hispanic whites were uninsured.
- 19.5% of non-Hispanic blacks were uninsured.
- 32.1 % of Hispanics were uninsured.
- 16.8% of Asians were uninsured.
- 32.1% of American Indian/ Alaskan natives were uninsured.
- 20.5% of Native Hawaiians/ Pacific Islanders were uninsured.
The disparity is also clearly visible when analyzed from a household income point of view.
Insurance coverage drops with the decrease in household incomes.
- The Uninsurance rate for people in households that make less than $25,000 is 24.5%
- For people making between $25,001 – $49,000 is 21.1%
- For people making between $50,000 – $74,999 is 14.5%
- For people making $75,000 or more is 7.8%
In summary, the following facts and figures show the grim reality of health care in the United States.
- Over a third (36%) of the family that is below the poverty line is not insured.
Black Americans (34%) who are not insured are almost two times the number of uninsured whites (16%). This is supported by the Human Development report i.e. UNDP (2005).
- Over 9 million children in the United State do not have health insurance (The Great Divide: When Kids Get Sick, Insurance Matters, Families USA Publication No. 07-102, February 2007)
- Almost 8000 people die every year because they are not insured.
- The UN Human Development Report (2005) demonstrate in its article that, those people who are not insured are more unlikely to have regular inpatient care; hence, they are likely to receive fewer services, thus, have a high chance of death as a result of lacking proper medical care, in contrast to those people who have insurance in medical care. A large number of those not insured (over 40%), go to regular places when they fall ill, and some of them report that they or somebody in their family went without care (including drugs and treatments) in the previous year because of high-health costs.
Half of all bankruptcies are caused by medical bills. Three-quarters of those filings are people with health insurance. This is supported in the article by Himmelstein on âHealth Affairsâ.
A suggested solution to uninsurance
Political wrangles continue to overshadow the plight of the uninsured. Attempting to jump-start he revamps on matters of medical care, President Obama said that the United States is the only democracy that lets its people suffer from health hardships. However, he outlined that his plan would not cover all the uninsured, and neither will it cover illegal immigrants. On the other hand, Republicans such as minority house leader John Boehner from Ohio argue that it is hard for the government to spend up to $1 trillion on healthcare.
This problem is worsened by the fact that those who do not have insurance are politically unorganized and form an exceedingly weak voting bloc.
Creating an insurance pool for small businesses and the self-employed
April 2006, a plan was enacted by Massachusetts to make insurance coverage for all residents. The plan adopted the financial responsibility system, making it compulsory for everyone to purchase health insurance. Employers were also required to provide health benefits to employees or pay them $295 a year to help in finance cover. Funds from the state are used in subsidizing care for those people who are poor; Medicaid was extended to cover children from families with lesser income i.e. three times the federal poverty threshold. An insurance pool was also created for small businesses and individuals as a result of this plan. Former California governor, Arnold Schwarzenegger, followed the Massachusetts example and proposed universal cover. This also included that every person obtains cover and subsidies (premium) given by the state for anyone who is on low income. Also, he proposed a requirement that the employer provides insurance or pay a fee equal to 4% of what the employee earns.
The federal government should also allow small enterprises, and those not insured to purchase coverage through programs such as the âFederal Employees Health Benefits programâ. The federal government should also dedicate tax of at least 1% of income, towards financing cover and make use of subsidies for low-income charity to facilitate finance expansion.
High administrative costs
The U.S expenses are much more than what its G.D.P per capita can predict. This then leads to the question â what are the extra benefits that the Americans receive in return for this enormous spending?
One of the things that are bundled up in the extra spending is the overhead load which is large by all standards. It is estimated that spending on health administration and insurance added up to 21% of the estimated total excess spending on administration (Kronenfeld, 2002). This amounted to almost $120 billion in the year 2006 and $150 billion in the year 2008.
The McKinley Global Institute estimated that about 85 % of the administrative overhead is as a result of the highly complex health care insurance in the U.S. Others such as underwriting and product design account for two-thirds of the total. The 15% remaining is attributed to the public payer. However, these are not saddled with design (product), marketing, and medical underwriting. As a result, they spend a smaller fraction of all the spending on administration.
A suggested solution to the high administrative costs
It had been felt that managed care was the answer to rising healthcare costs, but this has not turned out to be the case. Some believe that the greater use of technology like the electronic medical record can help reduce costs. This allows for efficient transfer of medical information thus, reducing administrative costs.
There are some initiatives in place to make healthcare a higher quality item and to make it more efficient for everyone. This involves standardizing healthcare and reducing unnecessary healthcare costs due to unnecessary procedures and testing. Some geographical areas have healthcare spending that is much higher than others. Some say that up to 30% of healthcare is entirely unnecessary, and with standardization, this can be eliminated.
Provider compensation needs to be looked at. This means that doctorsâ fees remain the same regardless of any given geographical location. There can be the possibility that physicians are rewarded for efficiency and value outcomes rather than the volume of care they take.
Prevention of diseases should be the focus rather than treatment of diseases already present. It has been shown that prevention is cheaper than treatment. This can mean cheaper costs for people who are at risk of chronic diseases like diabetes, heart diseases, and mental health diseases. There should be financial incentives to workers who engage in preventive medicine projects and who engage in things like physical activity. However, paradoxically if an individual lives because of appropriate health practices, he/she lives longer and therefore, uses healthcare longer!
Hospital staff shortages
The quality of medical care in the United State is affected by a workforce shortage (survey by American Hospital Association). Other than focusing on shortages in the future, AHA proposed that health centers need to deal with immediate problems. Vacant jobs for nurses who are registered that are available are 126000. Approximately 1 in 15 pharmacist jobs are vacant, 18% of radiological jobs are unfilled, and 12% of lab technologist jobs remain vacant. The effect of workforce shortage is felt by hospitals in rural areas, but urban health centers also experience this shortage.
The tremendous population growth, decrease in the number of those applying to nursing school, a workforce that is aging, and generation of the baby boom that will require concentrated medical care in the future are all contributing to this condition.
As new opportunities have developed for the young ladies and women, and with even more emphasis made to the profession, the majority of the women have opted to take careers other than those that are medically related such as nursing. Many people are weighing their options with any choice of a career that will compensate them, improve their life as well as enhance the quality of their life. Women nowadays are pursuing careers that are more competitive and even lucrative. A good number of them are entering law school and the corporate world in droves. Research now reveals that 30% or fewer of the women would go for nursing as their career of choice.
The shortage of nursing educators has also affected enrollments in nursing schools. In 2005, applicants who were qualified were not recruited to nursing colleges and other training institutions due to deficiency in educators. This number of applicants is estimated to be 32,617. Faculty age keeps climbing; more compensation can be found in different sectors, luring educators (and potential) away from teaching.
Great changes in the way the sick are cared for in the care environment are what is compounding this shortage. The need for trained and experienced nurses and other medical professionals is not met due to the reduction of the duration of stays in health centers and more care. Expertise level is what lacks in the health centers even though there could be indications of sufficient nurses and other medical personnel.
The declining number of nurses can also be attributed to the nurses themselves. Children are not encouraged by their parents (who in this case are nurses) to take nursing as their career if at all they have other considerations. In any given society, nurses may undermine their capability or underestimate their contribution, instead of shading light on their expertise and what they are capable of doing. (Andersen, Rice & Kominski, 2007).
Solutions to the nursing shortage
Since this shortage is seen to worsen in the coming years, strategies of recruiting students are required so that the students can work in this field for long periods or even permanently. Great efforts have been made to recruit students from high school. In San Diego, six hospitals have contributed $1.3 million to support a program known by the name “Nurses Now”. This program will aid in adding faculty and student slot at San Diego University. AHA News reports that in Laredo, the CEO of a certain hospital in Texas worked with Texas University to come up with a four-year bachelor’s program and provide $425,000 for local student scholarship in the next five years. The Dallas, a Fourth worth hospital council, raised $600,000 to expand local enrollment at local schools.
One strategy that Ruth Kleinpell suggested in the âNursing Spectrumâ, the Metro edition included the new tales by Cherry Ames which reflected the contemporary society. This was seen to inspire both men and women in society. Although this suggestion might have a lot of skepticism, think of how much impact stories have on children and the impact that Cherry Ames had on the majority. Books exist about nursing leaders and nursing, meant for anyone who is a reader (especially lovers of stories). These books act as resources. Nurses from any organization (health Care) could easily give away these books as gifts.
Recruiting can be carried out with the aid of students who are taking a nursing course. Credit courses offered by Allentownâs Cedar College require that students make a presentation in their local schools and upgrade their library with reference materials on nursing and books of other related fields.
Retention of nurses
Nursesâ retention highly depends on how an organization will or will not value its employees. Executives must change how they view employees. Employers should start viewing their employees as an asset to the organization. This in turn will bring about different results in the place of work. Medical care executives including those in charge of nurses must adopt new means for valuing the staff. Nurses in collaboration with the other heads in the place of work can facilitate discussion in which both the employers of the organization and the employees (nurses) can come to an understanding in case of a dispute. This process would make the nurses see that at least they are not taken for granted and that their effort and role in these very organizations do not go unnoticed.
Conclusion
The government reluctance is the main contribution to the problems facing the United State in terms of the Health Care System. However, those stated above are only a few of the problems facing healthcare in the United States. Many problems abound including neglect and/or delayed care for veterans. Some people also accuse the U.S legal system of contributing to part of the healthcare problem.
However, we cannot entirely blame this on the government. The health care system in the U.S has become a profit-making entity hence as much as the doctors would love to help people, they would also want to make a substantial amount of money. If someone requires heart surgery to survive, the doctors might charge him/her anything since they know that he/she needs to survive. In some countries such as Cuba and areas of Europe, health is regarded as a job of all individuals. In Canada or England, if anyone requires an operation e.g. heart surgery, or suffers a serious accident, the doctors recommend proper treatment without any crushing debt (Shi & Singh, 2008). The same case applies to Norway and Cuba.
I cannot boldly say that the solutions I have suggested will be the right way to solve the problem. Politics will play a vital role, and although it is disheartening to see congress deeply divided along party lines on the issue of healthcare, we should have hope that the government has put the healthcare agenda among the most crucial issues to discuss and solve.
References
Andersen, R., Rice, T. & Kominski, G. (2007). Changing the U.S. health care system: key issues in health services policy and management. London: John Wiley and Sons.
Kronenfeld, J. (2002). Health care policy: issues and trends. New York: Greenwood Publishing Group.
Shi, L. & Singh D.(2008). Delivering health care in America: a systems approach. New York: Jones & Bartlett Learning.
Sultz, H. & Young, K. (2010). Health Care USA. New York: Jones & Bartlett Learning.
U.S Census Bureau, (2009). U.S Census. Web.