The Future Challenges of Healthcare Delivery

Introduction

Nowadays, the US health care system meets considerable challenges. Experts, journalists, and policy-makers have brisk debates on the subject of potential transformations in the field of national health care system. Many researchers argue that the US health care is costly and technologically progressive in comparison to other countries worldwide. Specialists draw attention to the fact that multiple modifications would complicate the patients’ nursing. On the other hand, changes in the current system are urgent because of such factors as the aging population, unfavorable living conditions, scarcity of experts, and people’s viewpoints on the issue of meeting their end of life. Nowadays, the accent is replaced from curing chronic illnesses to the prevention of serious diseases. Therefore, the issue of the future challenges of healthcare delivery is topical, requiring predictions and finding proper ways of potential obstacles during reforming, improving, and adapting the US health care system to its citizens’ needs.

Managed Health Care Quality

The basic aim of the national health care is to provide high quality medical service. This issue can be solved by means of developing health care staff’s professionalism and striving for perfection. Competition among physicians is the secret of success. Rivalry contributes to the introduction of innovations and increases the quality of health care. Nevertheless, many physicians are prejudiced against any kind of competition and market-based initiatives, considering them dysfunctional and harmful.

According to Porter and Teisberg (2007), the failure of the current disfunctionality in health care field is in shifting priorities. This suggests reducing costs of medicine and boosting the productivity by means of shortening the time physicians dedicate to their patients. The success of the above-mentioned approach is doubtful, suggesting privileges at other participants’ expense. Physicians cut their contracts with hospitals and start their own business practices. Hospitals are united into groups to make more profit and they involve more physicians teams to provide  referals. Health plans shorten the number of suggested services and cut physicians’ salary. This way is misleading because each participant of the process wins at other players’ cost.

Researchers suggest another approach, claiming the high quality of provided services be the key goal. Being successfully implemented in different fields, this approach would work in medicine. This value-based method is based on three ideas. According to them, “the goal is value for patients, care delivery is organized around medical conditions and care cycles, and results are measured” (Porter & Teisberg, 2007, p. 1104). These innovations would lead to improving the range of suggested medical services, more successful assistance. They would decrease the rate of malpractice suits, initiate profitable health plans and government payers. Despite one payer model, the consumer-driven approach suggests a dramatic number of consumers. Nevertheless, the authors argue that health care must not have anyting in common with shopping.  Next, payment for performance means obtaining rewards by physicians when certain positive results are reached. Nevertheless, the main access should be made on high quality of health care service, but not on the payment. Finally, an integrated payer-provider system cannot be the perfect model. It initiates competition only among health plans, cutting contest on the delivery level (Porter & Teisberg, 2007, pp. 1108 - 1109).

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Health Insurance Coverage: Provider Contracting

In the United States, health insurance plans play the crucial role in both the domestic ecoomy and the households’ one. In fact, above 160 million US citizens possess employer-sponsored insurance plans. Approximately 17 million Americans buy insurance, becoming the participant of the private insurance market. Above 100 million individuals have government-sponsored insurance plans. According to the statistics, 49% of Americans have individual insurance programs, 16 % enjoy Medicaid, and 13% have Medicare. Nevertheless, 16% of the US citizens are uninsured  (Keckley & Copeland, 2013, p. 121). Nowadays, certain changes have place in the US health insurance industry. First, the role of employers in the domestic insurance market is transformed. To illustrate, a dramatic number of Americans enjoy insurance programs suggested by their employers. The following tendency can be observed. First, employee share business responsibility. Second, the circle of providers becomes narrow because employers make contracts with providers whose plans are financially profitable to them. Third, employees’ health is of prime importance. Preventive programs dealing with chronic deseases comprises about 75% of the program costs (Keckley & Copeland, 2013, pp. 122 -123). 

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Cost Containment

Strict cost containment methods are to be involved during health insurance reform. The majority of them are directed to decreasing costs of insurance. This step will contribute to improving the state of affairs in the US health care system. There are several reasons that lead to decreasing prices. First, the US families have troubles with purchasing higher premiums. Second, businessmen face the necessity to choose between dropping coverage and hiring their employees. Third, the USA would meet inevitable fiscal challenges in managing the US national and state budgets. According to the Congressional Budget Office (CBO), the reforms in the health care field will save $143 billion over the next 10 years and about $1.2 trillion in the following decade (Keckley & Copeland, 2013, p. 122).  

Reforming delivery system is the right step towards value-based payments. In fact, individuals will have the opportunity to get the proper nursing in the suitable hours and in the most convenient way. Since 2013, hospital payments depend on the dollar cost of the Medicare programs. The reform removes prodigal overpayments to Medicare Advantage programs (Kirk, 2010).

Effects on Medicare and Medicaid

Medicare and Medicaid are popular health insurance programs. Being widely used nowadays, Medicare and Medicaid were introduced in the 1960s as the government programs to pay for health care services for the aged and moneyless people. Medicare includes four modules. Part A deals with hospitalization payment. Part B concerns outpatient services, such as consulting physicians, medical procedures, and certain medical equipment. Part C comprises advantage plans. Part D provides drug support. Nowadays, approximately 45 million individuals enjoy the Medicare program. Approximately 50% of them belong to the poor layers of society. About 40% of respondents suffer from more than three chronic diseases. About 16% of Medicare owners are disabled. Five per cent of respondents have to stay at hospitals for a long term. According to expert forecasts, the US government will have to direct about 14% of the federal budget to the Medicare programs during the period between 2010 and 2030. The number of the US citizens enjoying Medicare will increase from 46 million to 78 million. Providing without taking any payment, Medicare is rather expensive program. The funds take 1.45% of income from the US workers and employers until they retire. According to surveys, many respondents are satisfied with the suggested Medicare services (Healey & Evans, 2014, pp. 131-155).

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The Medicaid program was initiated in 1965 by the US government. Initially the supporting program for children from poor families and their caregivers, now Medicaid contributes to health protection of approximately 62 million the US citizens. Approximately 60% of individuals, staying in nursing homes, own the Medicaid program. The US federal authorities direct 43% of the cost of Medicaid. The government spending on health care programs has been increasing. To illustrate, the US authorities directed $1 billion to cover the expenses in 1965. Nowadays, approximately $200 billion is sent to support the citizens. The Centers for Medicare and Medicaid Services make forecast that about 26 million of the US citizens will possess the Medicaid programs in 2020. This popularity can be explained by comparatively low costs of the medical services suggested by the programs (Healey & Evans, 2014, pp. 131-155).

In 2010, the adoption of the Affordable Care Act (ACA) contributed to the urgent necessity of further reforming healthcare delivery. According to the document, all the US citizens must possess their own health insurance program. Since 2014, individuals who employ more than 50 workers lacking health insurance coverage, have to pay the penalty of $2,000 per individual every year. This fact would lead to enhancing the number of purchasing insurance programs up to additional 27 million issues (Healey & Evans, 2014, pp. 131-155).

The Future Role of Government Regulations

More than 100 million Americans possess different health insurance plans, such as “Medicare, Medicaid, Federal Employee Health Plan, Children’s health Insurance Plan, State and Local Government Employee Health Plans, and Military Health Plans” (Keckley & Copeland, 2013, p. 123). The US government sponsors many health insurance programs. To illustrate, the authorities may buy insurance plans through private companies. For instance, the government bought approximately 13 million MedicareAdvantage Plans and 32 million of prescription Drug Discount Plans through private agencies.

Experts predict the dramatic increase of the health insurance coverage, both domestic and international ones. They focus on the consolidation, when few players with wider opportunities are represented on the arena. The insurance industry will be strictly managed. Third, the process of diversification will be observed. New products and services will originate in the healhcare delivery. Fourth, the reforms will contribute to achieving the balance of costs and care (Keckley & Copeland, 2013, pp. 124-132).  

Innovations in the Field of Health Delivery

Researchers predict that hospitals and clinics would implement ‘third platform technologies’ in the future decade. These innovative technologies would be founded on mobile instruments, social sites, information analysis, and the cloud technologies of storing information. The above-mentioned advancements would boost health care standards and broaden individuals’ access to medical services.

Implementing electronic medical records is the subject to brisk debates during the last decade. An electronic medical record can be referred to as a digital variant of the traditional paper-based medical histories for patients. Electronic medical records are used for patient diagnosis and treatment. Electronic medical records contain data about a certain individual such as his/her contact information, data about a patient’s height, weight, and a body mass index. Moreover, electronic medical records include information about previous and predicted medical treatment, medical orders, and prescriptions. Furthermore, electronic medical records comprise details about a patient’s medical improvement and surgical facts. Finally, electronic medical records involve billing details such as insurance, discharge summaries, and treatment plans.

Modern society is interested in initiating programs of boosting health care standards, safety, and efficiency by means of implementation of health information technologies, such as electronic health records and confidential and protected electronic health information interchange.

Nevertheless, experts draw public attention to several drawbacks of EMRs, such as privacy protection, medical records synchronization, considerable expense, and legal inconsistency, shortage of similar terminology, system design, and indexing. Initiating electronic medical records is expensive. Physicians and hospitals do not have financial return from investing their money into providing the electronic healthcare system. Moreover, installing, maintaining, and updating the above-mentioned system pose many difficulties. Finally, privacy, confidentiality, and security of patients’ health data cannot be guaranteed. In fact, providers keep digital Protected Health Information in various electronic systems. Nevertheless, the common threat for all the current data systems is their vulnerability to cyber-attacks (Auerbach, 2012, pp. 606-610).

Recommendations

Michael Porter and Elizabeth Teisberg (2007) note that deacreasing the high costs of medicine should not be the key purpose of the current reforms. They highlight that the basic aim of the national health care is to provide high quality medical service (Porter & Teisberg, 2007). This issue can be solved by means of developing health care staff’s  professionalism and striving for perfection

The authors warn against false steps, such as single payer, consumer-driven health care, pay for performance, and integrated payer-provider systems (Porter & Teisberg, 2007). The researchers do not agree with the idea of introducing a single payer system. The modern health care system faces two difficulties. First, it spends dramatic costs on the administrative module to decrease a single payer. Second, a significant number of American citizens are unisured. This fact restricts their access to health care. Single-payer system would aggravate the situation. As Porter and Teisberg (2007) state, “The single payer would have even more power to achieve its cost-reduction goals by setting arbitrary prices, dictating practice standards, shifting costs, and restricting services” (p. 1105).

Conclusions

To sum up, the US health care system meets considerable challenges in its various aspects. On the one hand, reforming the health care system is the urgent step because of numerous problems facing this field during last decades. On the other hand, many experts are not satisfied with the implemented approaches. The key goal of the national health care is providing high quality medical service. This issue can be solved by developing health care staff’s  professionalism and striving for perfection. On the other hand, the failure of the current disfunctionality in health care field is in shifting priorities. This suggests decreasing costs of medicine and boosting the productivity  by means of shortening the time physicians dedicate to their patients.

In the United States, health insurance plans play the crucial role in both domestic economy and households. Nowadays, certain changes have place in the US health insurance industry. In fact, the role of employers in the domestic insurance market is transformed. First, employers share business responsibility. Second, the circle of providers becomes narrow because employers make contracts with providers whose plans are financially profitable to them. Third, employees’ health is of prime importance.

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Strict cost containment methods are to be involved during health insurance reform. The major of them is directed to decreasing costs of insurance.

Medicare and Medicaid are popular health insurance programs. Being widely used nowadays, Medicare and Medicaid were introduced in the 1960s as the government programs to pay for health care services for the aged and moneyless people. The Medicaid program was initiated in 1965 by the US government. The Medicare program was originated as the supporting program for children from poor families and their caregivers. Nowadays, the above-mentioned coverage enjoys popularity. Experts predict the increase of their owners’ number during next decades.

In 2010, the adoption of the Affordable Care Act (ACA) contributed to the urgent necessity of further reforming healthcare delivery. Experts focus on the consolidation, when few players with wider opportunities are represented on the arena, strictly managed insurance industry, and originating new products and services.

Modern society faces the necessity of introducing modern technologies into healthcare field. Researchers predict that hospitals and clinics would implement ‘third platform technologies’ in the future decade. These innovative technologies would be founded on mobile instruments, social sites, information analysis, and the cloud technology of storing information. An electronic medical record can be referred to as a digital variant of the traditional paper-based medical histories for patients

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Implementing electronic medical records is the subject to brisk debates during the last decade. Despite numerous advantages, experts draw public attention to several drawbacks of electronic medical records, such as privacy protection, medical records synchronization, considerable expense, and legal inconsistency, shortage of similar terminology, system design, and indexing. Experts highlight that the common threat for all the current data systems is their vulnerability to cyber-attacks.

Taking into account  all the above-mentioned information, the following conclusion comes. Reforms in the healthcare field are urgent. Nevertheless, any transformations face obstacles and challenges. Despite several drawbacks of the health care reforms, this step is  urgent, striving for the wise balance of costs and care in providing high quality medical service.

 

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