U.S. Healthcare and Benchmark Development Overview

U.S. Healthcare Overview

According to NHE Projections 2018-2027 Forecast Summary (2019), “Centers for Medicare & Medicaid Services projected that health care spending is expected to grow 4.8 % in 2019, up from 4.4 % in 2018, and will reach $3.8 trillion.” Per Marvasti and Stafford (2012), “The United States pays more for medical care,” yet problems continue to exist in the health care system. Young (2018) states, “Compared with its high-income peer nations, U.S. population health outcomes are poor with the lowest life expectancy and highest rate of infant mortality.” Marvasti and Stafford (2012) also stated that, “unsustainable costs, poor outcomes, frequent medical errors, poor patient satisfaction, and worsening health disparities all point to a need for transformative change.”

Medical care culture continues to encourage high technology solutions instead of focusing on the concept of preventive services. There is growing market pressure for health care systems to meet the “bottom line” and be financially solvent. Additionally, instituting a single-payer healthcare for the United States continues to be the subject of controversial debate. 

High technology solutions instead of prevention

Most of the dollars spent on health care goes toward the sickest people causing a rise in cost of health care for preventable chronic conditions as heart disease, stroke, and diabetes. Young (2018) states, “Unfortunately, priorities of health care have favored heroic medicine over the more mundane and far less costly preventive care that results in measurable human and economic benefits.” The more expensive technological approach remains a role in the current system, such as advanced surgical procedures, therapies, and treating with high price medications. These are deemed more lucrative than preventive solutions of health care, such as behavioral modifications or cognitive tasks. Another component of according to Marvasti and Stafford (2012) is “its use of a piecemeal, task-based system that reimburses for “sick visits” aimed at addressing acute conditions or acute exacerbations of chronic conditions.” According to Young (2018), “The treatment-oriented rather than prevention-oriented healthcare philosophy has been encouraged by an insurance system that, before managed care’s prevention orientation and efforts to curb unnecessary interventions, rarely paid for any disease prevention other than immunizations.” Strategies that can prevent diseases and promote health are underfunded. 

Focus needs to be directed toward preventive services. According to Frist and Rivlin (2015), “it turns out behaviors – shaped by physical and social environments – are the primary determinants of health and well being not high technology solutions.” A whole-person approach emphasizing “health rather than disease and diagnosis” (Marvasti & Stafford, 2012) are far more effective in health promotion. Health care providers need to embrace a multidisciplinary team approach. Per Frist and Rivlin (2015), “A prevention first approach can reduce the risk factors that lead to chronic diseases, slow their progression, improve overall health, and reduce health care spending.”

“Bottom line” focus for hospitals and other health care institutions

Due to growing market pressure, the need to be financially solvent has changed the way hospitals and health care systems operate in terms of bringing quality and delivering care. The implementation of ever changing regulatory and legislation influenced by insurance has also played a significant factor. 

Health care facilities need to focus on efficiency, expand the use of health information technology, and focus on the long term to remain competitive. Patients are becoming more educated consumers, cognizant, and willing to shop around for healthcare. They expect to receive the value for what they pay. It is up to health care administrators to strategize and address these issues while continuing to provide quality care for patients and promote the best possible health outcomes.   

Single Payer concept resistance in the United States

Christopher (2016) pointed out that “currently, the health care finance structure is made of a complicated network of multiple payers, involving both private and government health insurance options.” The U.S. is facing increasing cases of chronic diseases including obesity and the only developed country without a single-payer health care. 

Single-payer health care has always been a subject of debate in America. In a single-payer health care system, all the financing for health care for all citizens is the responsibility of one entity. It is referred to as a single-payer because it is only one agency- the government that pays the costs.  This system will take private health insurance companies out. Advocates for a single-payer system proposed that it will decrease overall expenses and wasteful spending. Benefits will further include giving everyone access to health care without the worry of cost and preventive services. 

While universal government health insurance is a good option, it will not solve the healthcare problem in the United States. The negatives would include significant tax hikes, longer wait times, and reduced government funding. It would mean higher taxes for Americans. It also means that the government will control the price placed on what providers and hospitals can do to keep costs down. According to Stark (2019), “this will lead to strict rationing of health care which can then result in unacceptable wait times, to denying access to specific procedures to certain populations, to inefficient systems” as seen in the Veterans Administration health system. According to Atlas (2019), “Single-payer countries with decades of experience now turn toward private health care insurance to solve their failures.”

Reducing the price of health care by competition, not by over regulation by the government will lower insurance premiums and broaden access to quality care. Consumers are allowed to freely make their own choices for what are the best health care decisions for their needs with their health care money. It would give the best chance for Americans to use their right to access health care, become smart and savvy consumers, thus leading to a healthier population.

Conclusion

The time has come to innovate and develop a strategy to improve the quality, care, and access of health care. The U.S. Chamber of Commerce (2014) stated: “Improving quality of care and shifting to a culture of promoting wellness rather than just trying to treat diseases and their complications is the best way to get a high-value health care system.” Multiple strategies need to be implemented to remain competitive. A single-payer might not be the best solution. An ideal solution would be a plan that combines both the private sector and government, expands coverage to deliver preventive and chronic care, and policies that foster, safer, and healthier environment and behaviors. The overall focus should be on the patient for them to become healthier, to make their own decisions, and become productive members of the population. 

References

• Atlas, S. W. (2019). The fraud of single-payer health care. Washington Times. Retrieved from https://www.washingtontimes.com/news/2019/jul/24/fraud-single-payer-healthcare/
• Christopher, A. S. (2016). Single payer healthcare: Pluses, minuses, and what it means for you. Harvard Health Publishing. Retrieved from https://health.harvard.edu/blog/single-payer-healthcare-pluses-minuses-means- 201606279835/
• Frist, B. & Rivlin, A. (2015). The Power of Prevention. U.S. News. Retrieved from https://www.usnews.com/opinion/blogs/policy-dose/2015/05/28/focus-on-prevention-to-cut-us-health-care-costs/
• Marvasti, F. F. & Stafford, R. (2012). From “Sick Care” to Health Care:  Reengineering Prevention into the US System. N Engl J Med. 2012 Sep 6; 367 (10): 889-891. doi: 10.1056/NEJMp1206230.
• NHE Projections 2018-2027 – Forecast Summary (2019). CMS.gov. Retrieved from https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsProjected.html
• U.S. Chamber of Commerce (2014). Health Care Solutions: High Value, Low Cost Strategies. Retrieved from https://uschamber.com/above-the-fold/health-care-solutions-high-value-low-cost-strategies/
• Young, K. M. (2019).  Sultz & Young’s Health Care USA. [VitalSource Bookshelf]. Retrieved from https://bookshelf.vitalsource.com/#/books/9781284142099/