This paper discusses the notion of quality in regards to the concept of healthcare (particularly, American healthcare). The main idea that is being promoted throughout the course of this paper’s entirety can be defined as follows: in order for the functioning of the American health care system to be able to regain its former effectiveness, a number of pragmatic aspects of how clinicians address their professional duties should be revised. The foremost key to accomplishing this is lessening the extent of American healthcare’s commercialization.
Nowadays, more and more Americans are beginning to realize that there are a number of inexcusable drawbacks to the functioning of the American health care system. The reason for this is quite apparent – there is simply not much quality to the medical services provided by this system to citizens. As it was noted by Kumar, Ghildayal and Shah (2011), “The US healthcare system is characterized as the world’s most expensive yet least effective compared with other nations” (p. 366). Therefore, it will only be logical, on our part, to assume that, in order for us to be able to define approaches towards ensuring a high quality of health care services in the U.S., we will have to analyze what accounts for the deficiencies of the American healthcare system’s functioning at the present time. In this paper, I will aim to do just that, while utilizing the obtained analytical insights, within the context of how I will elaborate on what should be considered the discursive manifestations of a high quality healthcare, in general.
As of today, the U.S. remains the only Western country that does not provide its citizens with the benefits of a universal health-coverage. In its turn, this results in the creation of a situation when the majority of Americans rely on their employers and on private insurers, as the mean of being qualified to receive healthcare services, in the first place. Such a state of affairs, however, cannot be considered thoroughly appropriate. This is because the absence of an all-inclusive healthcare system in the U.S. puts 16% of unemployed and socially underprivileged Americans (47 million) in a position when they simply cannot afford undergoing prolonged medicinal treatment. There is even more to that – the fact the majority of citizens have no choice but to resort to private insurers, when striving to assure their eligibility to receive healthcare services, naturally results in the drastic increase of the associated administrative costs. Cm becoming ‘medical tourists’, while seeking to receive healthcare services abroad.
After all, as compared to what happened to be the cost of receiving a particular medicinal treatment in America, the cost of receiving the same treatment in foreign countries appears thoroughly affordable. According to Sengupta (2011), “Hip replacement surgery, which normally costs around $25,000 in the United States, can be performed for $5,000 in India. Heart valve replacement surgery, which costs around $200,000 in the United States, costs $10,000 in India” (p. 312). The earlier observation provides us with the clue as to how American policy-makers may go about making sure that there is indeed a high quality to the functioning of the American healthcare system. Apparently, they should consider nationalizing this system, just as it is being the case in Canada, U.K. and Sweden. This will result in the elimination of the factor of a corporate greed out of the conceptual framework of providing healthcare services to Americans – hence, increasing the rate of patients’ satisfaction with the received medicinal services.
The validity of this suggestion can also be explored in regards to the fact that, due to the commercialized nature of healthcare services in America, many clinicians are being often tempted to prescribe patients with heavy doses of drugs – even when circumstances do not really call for it. This is because clinicians’ financial well-being directly depends on their willingness to impose treatment-related extra costs on patients. This results in the creation of a situation when many physicians end up believing that it is specifically the generation of a monetary profit, which constitutes their foremost professional priority. As it was pointed out by Chassin (1998), “Studies show that physicians with X-ray diagnostic facilities in their own offices or ownership interests in physical therapy or radiation therapy facilities use more services than their counterparts who do not have such arrangements” (p. 570). In its turn, this explains why a considerable bulk of medical errors, made by physicians, relates to the healthcare professionals’ tendency to ‘overdose’ patients with drugs. What makes the situation even worse, is the fact that the extent of clinicians’ professional adequacy is being usually looked upon as such that reflects the strength of their enthusiasm in prescribing drugs. This is because those healthcare professionals that do not exhibit an observable ease in doing that are assumed to have experienced problems, while diagnosing a particular patient.
Nevertheless, in the field of healthcare, the notion of professional enthusiasm and the notion of professional excellence do not always correlate. Quite on the contrary – by becoming passion-driven advocates of a particular treatment, physicians cease being reliable caregivers. What it means is that the functioning of the American healthcare system will never be associated with the notion of high quality, for as long as there are remain objective preconditions for physicians to be primarily concerned with making money, while providing services to patients. This once again points out to the fact that the very principles, upon which the functioning of the American healthcare system is being currently based, should be revised. Apparently, this system’s continual reliance on the fee-for-service (FFS) principle of providing healthcare professionals with performance-enhancing incentives can no longer be considered appropriate.
What also undermines the quality of American healthcare is the fact that the majority of healthcare professionals in this country deploy an essentially ‘industrial’ approach, while treating patients. After all, it does not represent much of a secret that, as of today, in order for physicians to identify a particular patient’s diagnosis and to prescribe him of her with the appropriate medicinal treatment/therapy, they do not necessarily need to meet this patient face-to-face. All that physicians need to do, in this respect, is to simply analyze the concerned patient’s blood or stool samples. This, of course, cannot result in anything else but in increasing the rate of American patients being misdiagnosed. Therefore, in order for the quality of American healthcare to be substantially improved, the delivery of healthcare services in this country should adopt a ‘human-centered’ approach. That is, instead of being solely concerned with reducing the acuteness of patients’ illness-related symptoms, clinicians should pay a particularly close attention to the whole scope of different factors, which may have caused the deterioration of patients’ health, in the first place. This, of course, would require healthcare professionals to establish a close and personal relationship with people they treat.
Therefore, we can only subscribe to Searl, Borgi and Chemali’s (2010) suggestion that, “An understanding of human thought processes, emotions, and behaviors needs to guide the design of healthcare delivery systems” (p. 6). It is understood, of course, that the incorporation of a ‘human-centered’ medicinal paradigm into the conceptual premise of how healthcare professionals go about addressing their professional duties, will prove rather challengeable. Nevertheless, the vector of an ongoing progress in the field of healthcare makes such an eventual development dialectically predetermined. This is because there can be no much quality to the functioning of a particular healthcare system, for as long as clinicians remain emotionally detached from their patients.
When it comes to discussing the possible ways of how the quality of American healthcare may be enhanced, it is very important to understand that, as time goes on, the very concept of healthcare undergoes a qualitative transformation. In its turn, this process reflects the fact that the healthcare’s procedural methodologies never cease being affected by an ongoing progress in the fields of biology, genetics and IT, on the one hand, and by the process of American society becoming increasingly secularized, on the other. This state of affairs is thoroughly objective. After all, the very emergence of healthcare, as a social concept, was deemed possible by the fact that, in the early 19th century, the pace of scientific progress in Western countries had assumed exponential subtleties. In its turn, this implies that the quality of healthcare cannot be discussed outside of how the effectiveness of healthcare treatments is being continually improved by the mean of new scientific breakthroughs becoming incorporated into the healthcare’s procedural paradigm.
Therefore, it will only be logical, on our part, to suggest that one of the reasons why it often proves impossible for American healthcare professionals to improve the quality of services they provide, is that America’s Christian lobby continues to create obstacles on the way of American healthcare becoming ever more efficient. The validity of this statement can be well illustrated in regards to how American bible-thumpers succeeded in ‘outlawing’ a stem-cell research, “In 2006, President Bush… vetoed the Stem Cell Research Enhancement Act on July 19. In domestic politics, the Christian Right and the pro-life movement greeted his decision with enthusiasm” (Smith, 2010, p. 624). Yet, no continuous improvement of the actual quality of American healthcare can be ensured without biologists being allowed to conduct experiments, concerned with stem-cell research, because the foremost purpose of this research is to increase the rate of transplant surgeries’ successfulness. Thus, there can be no good reasons to expect a steady improvement to the quality of healthcare services in a society where religiously minded individuals are able to influence the passing of healthcare-related legislations.
What has been said earlier, also relates to another contributing factor to the reassurance of a high quality healthcare – specifically, physicians’ willingness to treat terminally ill patients in a thoroughly compassionate manner, which in turn presupposes their readiness to part away with a number of moralistic prejudices. After all, there are a number of objective reasons for the healthcare-related practices in America to be increasingly concerned with the concept of palliative care. As it was noted by Creer (2009), “Americans 65 years and older now represent about an eighth of the population and devour about a third of all health spending. By 2030, this group will comprise about a fifth of the population and account for nearly half of health spending” (p. 136). Unfortunately, many American healthcare professionals do not quite understand that; whereas, the purpose of a curative care is to restore patients’ health, the purpose of a palliative care is to lessen the acuteness of terminally ill patients’ suffering – often by the mean of assisting them, during the course of euthanasia procedures (Varelius, 2006). This is exactly the reason why in America, the incidents of terminally ill patients being subjected to a number of painful but essentially pointless therapies (due to their relatives’ insistence), are not utterly uncommon. Nevertheless, there can be very little quality in trying to ‘cure’ terminally ill patients. Therefore, in order for the functioning of American healthcare system to be consistent with the realities of a post-industrial living, which in turn would increase the objective quality of associated treatments/therapies, physicians should cease referring to one’s illness in terms of an ‘abnormality’, while trying to eliminate this ‘abnormality’ at any cost.
It has always been a commonplace assumption among healthcare professionals that, along with providing people with curative services, they should also strive to encourage them to lead healthy lifestyles. This is because the chances of a particular individual developing a disease are being geometrically proportional to the strength his or her tendency to indulge in various health-destroying behaviours. Unfortunately, the promotion of a general healthiness rarely constitutes an integral part of how American healthcare professionals address their duties. As Ungos and Thomas (2008) noted, “American physicians spend little time in screening and prevention activities, such as health counseling” (p. 279). Partially, this can be explained by the fact that, in today’s America, the very concept of physical and mental health is being often regarded as such that contradicts the fundamental tenets of political-correctness. This is reason why many American overly ‘progressive’ politicians suggest that schoolchildren should not be required to attend physical culture classes. This also explains why, as of 1998, America featured the world’s highest rate of obesity among both: adolescents and adults (Jeffery & French, 1998).
However, as practice indicates, one of the necessary preconditions for the functioning of a national healthcare system to be considered truly effective is the state-sponsored promotion of physically active lifestyles, when physicians are being required to adjust their professional activities to serve the goal of increasing the overall extent of nation’s healthiness. The validity of this statement can be illustrated in regards to the most distinctive feature of China’s healthcare system – the fact that Chinese healthcare professionals take an active part in various health-awareness campaigns, sponsored by the government (Diep, 2008). This, of course, cannot be said about their American counterparts, who often apply a conscious effort into making people believe that just about every health issue, on their part, can be successfully dealt with by the mean of taking a pill or two. Therefore, along with what has been implied earlier, one of the main keys to increasing the quality of American healthcare is requiring physicians to act in a socially responsible manner. The discussion of how this could be done, however, is beyond this paper’s discursive boundaries.
The earlier provided suggestions, as to what can be considered discursively appropriate approaches to ensuring that American healthcare may continue being associated with the notion of high quality, can be summarized as follows:
- Decommercialization – American healthcare professionals should cease referring to their patients’ health problems solely in terms of a money-making opportunity. Partially, this can be accomplished by the mean of passing legislations that reduce the influence of American pharmacological lobby on the process of patients being provided with circumstantially appropriate therapies/treatments.
- Methodological shift – the current practice of physicians prescribing their patients with heavy doses of medication can no longer be considered appropriate.
- Intellectualization – the process of designing healthcare policies in America should cease being affected by the representatives of this country’s religious lobbies. This development will be fully consistent with the foremost provisions of the American Constitution.
- Liberalization – in order for American healthcare system to continue featuring a high quality of provided services, individuals in charge of designing healthcare policies should consider the legitimization of a number of currently illegitimate practices, such as euthanasia.
- Promotion of healthy lifestyles – one of the main prerequisites of clinicians’ professional adequacy should be considered their willingness to encourage patients to lead physically healthy lifestyles.
As it was illustrated earlier, the adoption of these approaches by American physicians is potentially capable of increasing the extent of patients’ satisfaction with the received healthcare services. In its turn, this will naturally result in the overall quality of American healthcare being substantially improved. I believe that this conclusion correlates with the paper’s initial thesis.
References:
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