Quality Issues on the Medicine in the United States

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Table of Contents

Defining quality in Health Services
Quality assurance in Health Services
Quality issues, policy and systems
Meeting Diverse Needs and Expectations
Quality Improvements
Conclusion
References

Defining quality in Health Services

Defining quality implies the development of well-standardized quality according to the demands of the customers. These standards are categorized as clinical or administrative by developing inputs, processes and productivity. Standards can apply to the individualistic or entire healthcare system. The standards of quality can be comparable based on scientific approaches of multiple dimensions of quality. The basic demands and expectations of stakeholders (clients & community) are accurately measuring tools of quality standards. Pre-planned or definite standards of quality are the best tools for the evaluation of quality. If there are no standards, these should be developed by the authoritative management of health care. The standards of quality, universally acknowledged standards are very assistive to formulate the local standards. Sometimes, there is a need of refining such standards which already exist so that they may be workable by health care employees.

Quality assurance in Health Services

Standards are designed according to the expected quality of the health care system and workers. These standards include varied forms of procedures, clinical practice guidelines, algorithms, critical paths, standard operating procedures, treatment protocols and statements of estimated healthcare outcomes. Standards are communicative for both health care workers and clients in order to improve the performance of the health care system with desirable outcomes. It is the keystone of quality assurance to work according to the given standards of the healthcare system, including health facilities, evaluative tools of performance and improvement of performance.

Britain has a system of providing health care from cradle to grave. The National Health Service, which was launched on 5^th July, 1948, is now a multi billion pound operation. Since its initiation, it was accepted by all the governments that general taxation will be used as the source of funding for the NHS which will then be available free when used (Young, 2005). New therapies like chemotherapy, transplant surgery and others are included in this program as well as forthcoming treatments are also including in the program. We will discuss this program in the next paragraphs.

Quality issues, policy and systems

Policies

Due to the rise in healthcare reformation in many states, there has lately been an increased need of policies and strategies to develop health-related plans equally and unanimously in each state. Because the number of patients and healthcare providers has increased, the need to compare and contrast the existing systems and future healthcare strategies is essential between states, so that they can each follow a certain set pattern in medical practices.

Over the past few years, a lot of attention has been given to improvement in the quality of healthcare provision. The main elements responsible for the initiation of improvement strategies are the government, the media, healthcare professionals, and the public. In most countries, the government plays a pivotal role in chalking out the policy plans for the improvement of any segment, including the healthcare sector. The key aspects of the formation of government policies to improve healthcare matters include legal requirements, policy content, and policy priorities.

Legal Requirements – the legal requirements that have been devised since the last few years have shown some sort of improvement in the development of healthcare quality. These legal requirements are what many countries possess, which are followed by healthcare providers.
The Matter in the Policy – this contains the content of the policy devised, which may consist of setting goals or aims, according to certain standards. It also contains some guidelines for healthcare individuals to follow.
Priorities of the Policy – most of the documents that are present in the governmental programs contain the following points as most essential:

Improvement of patient safety.
Greater involvement of patients.
Development of quality systems and structures.
Evaluation and assessment of quality systems present in the healthcare institutes.

The policies that are being made for healthcare have been found beneficial for patients, as well as the quality of the care that is rendered. The clinical guidelines and the feedback obtained from patients are the most important aspects that have affected services. Good results may be obtained if training regarding quality improvement and leadership is given. A proper system or program that has key factors like keeping basic records of the performance of the staff and organization, efficient data collection systems, well-maintained equipment, and a high-quality plan with devoted resources, is crucial for the execution of any health policy in the country.

“If you don’t have health insurance, the system is an insane nightmare” (U.S. House of Representatives, 2005), remarked by Molly Ivins on the current system of healthcare. It is a reality that even health insurance is a pain but the system works. On the other hand, employers are decreasing health insurance, hiring temporary workers or have their workout sources. This situation is leading to more and more people without health insurance. On the other hand, it is worried by people that when a Universal healthcare system will be started in America it will made insurance companies out of the medical insurance business. Others think that it is more or like socialism and therefore they call this taking away of private health care is un-American (Mance, 2003). The administrative costs are supposed to be decreased dramatically because only a centralized system will be used decreasing lots of departments to be involved. The Massachusetts Medical Society and AMA of Massachusetts reported a study which concluded that Massachusetts could save 1.7 to 2.7 billion dollars annually through public health insurance plans for Massachusetts⁶. The current status of the United States in the industrialized world for the health conditions is not a good one. Its position is 16^th in the infant mortality, in longevity it is 18^th, and in immunizations, its position is 67^th among the other industrialized countries. These positions show that lot of American citizen does not have access to the health care resources due to their financial position or lack of money. Like in Britain, before 1954 it was a real worry for some of the families when they think for medical care because that was not affordable. But, a key strand of the Atlee government’s post-war reconstruction in 1945 was the National Health Services a state-funded organization to provide health services to everyone (Young, 2005).

In the same manner, if the American government take initiative and provide healthcare to every individual then the situation will not be as worse as it is today. A little increase in taxes will not affect people who are already paying for the health insurance but it will dramatically reduce the cost of managing all the havoc when it will come under one administration. Now, as rich have easy access to healthcare insurance and all the facilities and poor are losing their battle to live a healthy live it became un-democratic and this practice should be avoided. Every person in a democratic society should have equal rights. The right to choose who will run the government is in democratic society which in turn requires that rulers should be serving people. This is where people think that a democratic society should have a system of serving everyone equally. As education is free in the America then why not medicines? Rich and poor has their own rights but the right to live, educate and be medicated must be same to everyone regarding of their income level or race. That is why the discussion on Universal Healthcare is going on and on in the American society.

Although there could be some problems may arise initially like Britain’s NHS where people “expect more from our health care system than ever” (Young, 2005) but these can be solved gradually, also like the Britain.

The first concept is tax credit. In this regard government will provide tax credit to individuals who then purchase insurance private health insurance by this credit. It enables uninsured people to but full or partial insurance premiums. Tax credit is very simple plan and easy to implement because there will be no need of heavy structural changes in the healthcare market. This system matches with the ideals of such Americans who do not believe in Universal Healthcare as American. It also empowers patients to have more control and choice over their health insurance. On the other hand, it does not guarantee medical coverage to every citizen of the States. It may not be realistic for some as it will not be paying the full cost of medication. The expenditure in healthcare will be remaining intact as the current system will not be going to change. The worst effect is that patients will be bound in choosing their physicians and doctors will continue having the same problems in treatments that they encounter now a day.

The second alternative is Medical Savings Accounts (MSA). In this manner individuals could have access to money in a tax-exempt saving account for the use of healthcare only. In this plan minor healthcare is paid by the individual and the big or emergency healthcare will be paid by the MSA. This will help encourage people to decrease unnecessary medical spending like visiting doctors because of headache and so on. When people will also pay from their pocket they will have more choice of providers. Therefore people will get high-quality care in spending less. In contrast, this system will not change the facilities of the low-income people. It may increase healthcare costs as patients need to pay for their routine visits to the doctor. Also, discouraging people to visit doctor at an early stage of any ailment will increase the risk of terminal diseases which will in turn be more costly than the current system (U.S. House of Representatives, 2005).

Issues / Restraining factors in Health services

When health institutes are aimed at providing maximum top-quality services to clientele, some restraints or obstacles come in the way, which hinder the smooth implementation of any plans that may have been devised. All health setups make their strategies for improvement of services or healthcare provision, but the restraining factors prevalent in the nation keep the institutes from acquiring the goals that they set for themselves. The entire public health system depicts a gruesome picture, and the legislation needs to pay attention to it, as early as it possibly can.

The legislative bodies are at stake, to reset their policies and reinvent ways to get rid of the hurdles being faced by the states at present. The masses, on the other hand, also suffer, because of these factors, and are unable to get proper health care with the little amounts they have, to run households and cater to family needs. However, in times of need, they do consult healthcare providers, and alongside face the following problems:

Rising Healthcare Costs – the costs of medicines and healthcare services is on the rise at present. The services that employees render have risen in cost; this makes it difficult for the low-income masses to turn to healthcare services. This in turn affects the business, which indefinitely affects the economy at large. The healthcare costs will continue to rise, because of the economic turmoil faced by the entire globe currently, and which is expected to stay on for a few more months. Till then, costs will keep rising, and affordability for the public will be an extremely thought-provoking process.
Uninsured Patients – the majority of the masses are uninsured. They either do not have the facility provided to them by their employers or cannot afford to get themselves insured for health. This is a big hindrance in healthcare provision, as many patients are left untreated, or are seeking medical aid without having the affordability to do so.
Shortage of Workforce – there is a lack of hospital or medical center personnel, due to the rise of the economic crisis. Jobs are rendered at a very slow pace, and much selected amounts of people are employed, which causes a shortage in these institutes. The ratio of the amounts of patients to the hospital personnel attending them is a fraction of what it should be.
Budget Shortfalls – the world has been going through an economic crunch lately, which has affected the national budgets of every country. People are worried about how to feed themselves, let alone seek medical advice for health problems. The budgets of nations have been doomed, and need to be completely revised, with setting of new goals and aims with the revenues collected, in order to prevail in a normal function. These shortfalls have affected the healthcare provided to the populace, due to the tight budgeting which has caused slow progress in the facilitation of basic health care and services. After the budget is revised and settled, the systems of healthcare provision cal also see some improvement.

In order to solve the problems that are prevalent in the existing system, some points need to be kept in mind, about how to handle these factors.

Meeting Diverse Needs and Expectations

The needs of the population are ever-growing, especially in the area of health and safety. The greater the population, the more their needs increase to, and the health problems keep increasing. There is a diversity of needs present, which need to be paid attention equally. The way to meet those individual needs have to be planned by the administrative bodies. People, in general, expect to get what they pay for, and also hope to get basic health care from the government. Most of all, the public wants to get ‘more, for less’. They wish to gain maximum benefits from the least amount of expenditure from their side.

Dealing with Conflicting Priorities

Every individual thinks whatever is on his mind must be of priority. This creates distress at workplaces. For the legislation to attain good command over control of plan implementation, goal-setting should be executed on priority basis. These priorities may be opted for by analyzing past records and looking into those factors that had not produced benefits, and those that did. Another issue in attaining healthcare goals is that of the goals set in relation to the budget. If long-term goals are set, an inadequacy is still faced midway, because of the great amount that is given to Medicaid. The Medicaid expenditure has been seen to affect other budget priorities due to Medicaid cost overruns.

The pressure on Medicaid and other publicly funded health programs have been seen to grow due to the rise of uninsured people. The number of uninsured people is also seen to be rising with passing years, and this increases strain on the budget.

The current public health services benefits only the very poor, pregnant women and children. This is a start for any health care system, but it is a place where the government has stagnated with regard to providing health care for all citizens. The people most in need are getting the minimal level of care but it is limited by income, age and health status. The government’s next step toward general health care is to revise the income requirements so that middle-level income people can benefit from programs with minimal co-pay rather than having to fund their entire insurance bill. At the same time, this change would remove the age limit and give care to all age groups and a broader income level.

Once the benefits are available to all age groups and a broader, if not all, income level the government can implement steps toward regulating the system’s management. Regulations for medical treatment, transfers, referrals, etc. have to be in place so that there are no areas that will suffer from a lack of professionals and no practitioners are abusing the laws or under-treating their patients.

Existing health programs are working well in the industrialized world and are being encouraged in countries that are industrializing as well as those just making the transition to people run governments. It is important to realize that these types of changes cannot happen overnight but that they are possible if the people in a country are willing to work for and work with the government officials in the interest of personal and public health. Our current health services are not a free ride for poor people, they are a necessity for all. Test experiments should be run beginning in small localities and extended to states to determine which way is the best to approach such a sweeping change. Health care quality is a right of all people for the good of the nation, not a privilege for those who can afford it. It’s time we care for all people rather than just those with money.

Quality Improvements

In every organization or setup, there are some standards that are kept in mind, which are made and meant to be maintained. These standards are maintained by the quality of work that is put in, and the improvement in the quality can be made by bridging the gap between the present quality status and the expected quality, that is to be achieved.

There are some tools of management that can be used for addressing the system deficiencies, enhance strong points, and improve the processes of healthcare. They include the four-step approach to quality improvement, the spectrum of quality improvement approaches, performance improvement and benchmarking.

Approaches to Quality improvements

Countries that do not have broad-based governmentally funded health care systems often have health insurance programs that are available to those who can afford the rates, but also have a large population of uninsured citizens which puts the health of the general population at risk of infectious disease. Having a large population of people who are uninsured also increases the insurance premiums which makes insurance even more difficult to afford. One country with this very difficult problem is the United States.

Quality healthcare is of the utmost importance when discussing the issue of workplace productivity. Productivity is increased when employees are healthy and able to work the vast majority of the fiscal year. For this reason, many employers offer health insurance but employees are at risk of losing it during times of economic hardship. People who have been laid off or fired wind up in the public health system and find it difficult to navigate a new system or that they are ineligible to receive benefits due to their previous income or assets. If this type of system replaced were by a universal or single-payer system there would be no change in health care for people who have lost their income. Losing health care insurance can be a huge issue for people who have small children in need of immunizations and regular doctor visits, who are older in need of geriatric care, or who have chronic health problems.

There are a great many advantages to implementing a healthcare system. Some of those advantages include the lack of co-payments and deductibles; all of the health-related needs are financially covered; people who are unemployed or laid off have health coverage; immigrants have necessary health coverage to ensure that foreign contagions are not spread to the general population (Young, 2005).

Economically the healthcare system is more cost-effective than the private insurance/HMO system. “In a single-payer system, administrative costs are centralized and drastically reduced. It’s cheaper to finance a public health care system through taxes than it is to administer it privately.” (Batista, 2005) Without the administrative costs of stockholders in large companies and the salaries needed for executives and staff, much more of the cost of healthcare can go to the patients.

The disadvantages of universal healthcare are nonexistent for the recipients of the care. Such issues would be as simple as an increased waiting period for regular appointments or as far-reaching as an increase in taxpayer contribution by way of sales and income taxes (Young, 2005).

The greater disadvantages are those that would affect the health care providers. It is almost certain that the salaries for health care workers would decrease but a universal system would remove the private business aspect from health care, placing it under the care of the government, and reduce the income from health services and products (Young, 2005). This may reduce the incentive for some to become health care professionals, but in doing so the people who will continue to pursue such careers would do so with the knowledge that they are doing so for the benefit of the patients rather than themselves. This should result in better health care for the patients provided by people who genuinely want to help patients rather than simply profit from their care.

The healthcare of people in countries with quality healthcare services tends to be better than in those countries without such a system. An obvious reason for such a tendency is because people are able to see physicians when a problem begins rather than when it becomes acute and needs emergency treatment. “Countries that have universal healthcare systems in place have a lower infant mortality rate and higher life expectancy than industrialized countries without such systems and non-industrialized countries. For example, Canada has a mean life expectancy of 79.8 years, which is the second-highest life expectancy in the industrialized world. Japan, which has had universal healthcare the longest, has the highest life expectancy at 80.9 years (Mance, 2003).

“A new study by researchers at Harvard Medical School and Public Citizen estimates that national health insurance could save at least $286 billion annually on paperwork, enough to cover all of the uninsured and to provide full prescription drug coverage for everyone in the United States.” (Kucinich, 2005) With the insurance premiums that are already going to insurance companies, there is already enough money to fund a universal system. Eliminating business bureaucracy makes a broad system more cost-effective so long as there is a well-trained government-based staff that oversees the creation and maintenance of the universal system. It has become abundantly clear that with the amount spent on insurance per year the funding could be done with tax dollars for a universal plan.

Conclusion

The crisis in the United States healthcare system is not a health issue, but the fact that people who have health problems cannot afford to have them taken care of medically. A growing population of seniors are unable to afford health insurance at all and are dependent upon an antiquated and underfunded system which results in their having to pay for a large portion of their prescription medications and to keep a handle on their increasing health problems as they age. It has been stated that the United States social security system’s funds are being depleted and maybe completely empty within the very near future. Without these regular payments, some seniors will be forced to continue working well past their retirement years. The continued work can result in further health complications and a further deterioration of their health.

In addition to seniors who are facing the health care crisis, are middle-class families who have too great an income to qualify for public health assistance and too little income to finance health insurance and health problems. Many of these families have small children or parents who are beginning to age and need an increased amount of medical support. With a universal system none of these people would be at risk medically and could concentrate their funds on more pressing financial issues like mortgages and bills.

One of the greatest issues with universal healthcare is the financial burden on the government and the taxpayers. In non-universalized healthcare systems, a large amount of money goes to administrative costs which include executive salaries, stockholders, and commissions which means that fewer of the dollars paid to insurance companies actually go to the healthcare of the individual (Healthcare for All, 2005). With less of the healthcare funds going to the cost of care, the problem of substandard health care crops up.

References

American Medical Students Association. Introduction. 2005.
Young, Rosalind. Universal Healthcare: An Internet Guide. 2005.
Batista, John R., McCave Justine. Make Healthcare a Right! It’s Cheaper. Conneticut Coalition. 2005.
Sage, Bobbie. What is Universal Health Care? 2005. Web.
Mance, Saadiq. 2003. Universal Health Care for All Citizens. Emerging Minds.
Healthcare for All – California. Healthcare in Crisis. 2005.
U.S. House of Representatives. Bush Administration Ignores 44 Million Uninsured in U.S as it Awards Contract for Universal Health Care in Iraq. 2005.
Kucinich, Dennis. Universal Healthcare. 2005.

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