The health care deliverance is through distinctive organizations to the people in the U.S. The operation and ownership of healthcare facilities widely contribute to the private healthcare operators businesses (Henslin, 1991). Such programs as Medicaid, Medicare and children’s insurances health programs and veterans’ health administration provide 60 percent spending on the healthcare.
The employed family members and the government in America contribute to the insuring citizens. Some Americans buy the health insurance cover while the other remainder remains un-insured. The city governments and counties, state federal, and other private hands claim or even own healthcare facilities in the U.S.
Further, the non-profit hospitals are sharing a bigger hospital capacity, and they have remained stable for years (Boorstin, 1992). Additionally, the ownership of hospitals is private and profit valued more as compared to the government hospitals owned by the government in some locations by cities and counties with healthcare services.
Moreover, there is a strong relationship witnessed between the health insurance coverage and medical services insurance. The health insurance determines the difference of whether the people access necessary medical care and when they receive their care.
According to Henslin (1991), the current political and economic climate in the U.S helps in changing the approach of America’s healthcare. Merely, the government pumps more funds on existing model and it does not improve the public health sector in general. Instead, James believes that the healthcare reforms must centre on the multi-pronged approach (Henslin, 1991).
Additionally, sociological choices and conditions need to be advised or modified. He argues that shifting emphasize on the medical system to prevent it from remedies. This will also involve a bigger number of the primary-care physicians and more valuable it requires alteration of the societies view on the importance of doctors. Moreover, the American government and citizens should bridge healthcare disparities received by the ones on higher and lower socio-economic brackets (Boorstin, 1992).
Further, the differences in socioeconomic standings are playing a vital part in overall healthcare and the longevity as put forth in Whitehall study. Also, the phenomenon explained by higher degrees of social stress present in areas with higher income inequality, but also having confounding variables that exist as underlying income causes and inequality with lifestyle choices.
As a sociologist, I would prefer researching on the basic issues in the American healthcare system. In the research, the issues on social problems looked at in every part by the use of either micro or macro paradigms. Particularly, I will ensure that the funds generate a solution to the research conducted on the impacts and effects of healthcare on American citizens.
As a researcher, I will use thorough qualitative research method that will develop worth measures of growth, distribution and designing of reports with relative reports with efforts in excellence enhancement. Moreover, healthcare deliverance is naturalistic in settings and a wider range of the professional organizational with community contexts.
Healthcare has experienced rapid change; the areas with rapid change mostly include measurement of quality and dissemination in comparative quality information and the efforts to promote quality (Pexman, 1999).
The areas work benefited from increased qualitative and the mixed methods in researching and stands to do so even more in the near future. Thus, it is extremely beneficial to extend the qualitative techniques and usage especially structuring the observations to record the details and service delivery designed to boost quality so as to boost efficiency and implement difficult procedure measured carefully and compared to the results.
References
Boorstin, D. (1992). American healthcare system. New York: Random House
Henslin, J. (1991). Sociology a down to earth approach (11th edition). Illinois: University Southern Illinois press
Pexman, P. M. (1999). American Healthcare and social economic. Washington, DC: American sociological Association
In the long run, it behooves a country’s administration to be responsible for the progressive performance of its healthcare system. Thus, the state of health care is a reflection of the stewardship provided by an administration towards health care development.
Health care is as old as regimes of human civilization. The health care is a reliable indicator on social inconsistencies. Gutiérrez, Mizota and Rakue (937) demonstrate that there exist inter-regional inequalities in China’s healthcare system, while, in the US, these occur across different races and social groups.
Furthermore, it is emerging that the extent of the GDP growth and the size of the budget and subsequent allocations have become debatable indicators of the public health. It is becoming evident that the future of better public health will be demonstrated through the influence of robust policies that cross-cut health and other social security sectors. The US is in the spotlight for the prolonged absence of reforms towards a public medical security system that universally cushions every citizen.
In the absence of a comprehensive healthcare scheme, there are palpable health care differences across races, origins and income brackets. And now that the Obama Healthcare Bill has recently been passed, its consequences are of pertinent concern with regard to public financing, access to medical care and health insurance packages, thereof.
The demand for healthcare insurance and the cost of health care services are projected to rise. Contrastingly, China operates on public health system for all. There are scheduled major adjustments focusing on enhancing training and practitioner fraternity. China remains the only country that advances the use of conventional and traditional medicines. Its medical insurance system is packaged in three programs targeting workers, public employees and village populace.
China’s economic policy reforms have tended to advance the health care interest of the village populace through fiscal decentralization and financial responsibility systems. The National Health Services is vested with managing the healthcare scheme in the UK. The Issues on healthcare in the UK replicate those of the US, though approaches differ.
Research lacuna exists on whether most national healthcare regimes consider solutions such as an equal-chance approach to use of processed and natural medicines. Moreover, the political class has dismally demonstrated their will to bridge inequalities and injustices within the social and health systems. Thus, health services are disproportionately distributed.
Squires (1) argues that fiscal spending on health care is high in the US; emerging discrepancies and disproportionate outcomes result from exorbitant prices, obese population and readily disposable technology. Wagstaff, Doorslaer and Paci (91) recommend that the government administration to rethink their goals based on the resource redistribution and equity concepts. Squires (1) exonerates higher income, aging population and increased supply and use of physicians and medical facilities as likely negative causal factors.
While out-of-pocket spending in the US is at US$ 976, in the UK, it is approximately three-times less; yet the budgetary allocation in the US has been higher than the UK’s both in per-capita and percent GDP (Squires 3). Out-of-pocket spending in China is 56% of the total health care spending.
The Figure 1 below shows health care spending in China. Exworthy et al. (78) view that the initial difference in addressing healthcare begins with the policymakers approach. In the US, the focus is on disparities; while, in the UK, it is about inequalities.
Figure 1: The Trend on National Spending on Healthcare in China
Source: EUSME Centre (4)
In the last 5 years, the US has focused on finding solutions on access and providing insurance cover scheme; resolving racial differences and settling any political ends. The UK has concentrated on harmonizing the socioeconomic status. China has focused on industrial growth of healthcare through meeting the demands of the urban populace and improving the social welfare of the rural folks by upgrading medical facilities. China ‘s approach is market socialism that embraces organizational arrangement, philosophy and financing.
In a cross-country assessment, Wagstaff, Doorslaer and Paci (90) note that the ultimate goal of achieving a robust system lies with settling the imbalances of inequality through harmonized policies. Exworthy et al. (75) share similar views particularly on disparities and inequalities.
Pertinent challenges to the ultimate milestone include bridging differences in perceptions among lawmakers. The US is among the industrialized states that have worrying disproportion on practicing physician per-capita (at 2.43) well below the recommended 3.00. Nevertheless, the UK is just above the US at 2.62.
There are no automatic or inexpensive exit strategies for the healthcare concerns across nations; however, the most preferred systems will have to best demonstrate quality service to all; adequately meet expectations and cushions against costs of ill health.
The immediate divergent paths taken on healthcare solutions by China, the UK and the US amidst inequality concerns were the driving-force for this scholarly inquest. While the US is on the verge of a complete overhaul, the UK has overtime revised hers and China is on a socialist drive for its health care. These different transitions provide vital lessons about the past for charting solutions into the future, considering health care has multi-sector crosscutting baseline.
Works Cited
EUSME Centre. 2012. The Healthcare Sector in China. PDF file. 13 Jan. 2013. .
Exworthy, Mark, Andrew Bindman, Huw Davies, and Eugene Washington. “Evidence into Policy and Practice? Measuring the Progress of U.S. and U.K. Policies to Tackle Disparities and Inequalities in U.S. and U.K. Health and Health care.” The Milbank Quarterly, 84.1 (2006):75–109. Mighealth. Web.
Gutiérrez, Susana, Tsutomu Mizota and Yasuyuki Rakue. “Comparison Of Four Health Systems: Cuba, China, Japan and the USA, an approach to reality.” Southeast Asian J Trop Med Public Health. 34.4 (2003):937-946. Mahidol. Web.
Squires, David. “The U.S. Health System in Perspective: A Comparison of Twelve Industrialized Nations.” Commonwealth Fund pub. 16 (2011):1-13. CommonwealthFund. Web.
Wagstaff, Adam, Eddy Van Doorslaer and Pierella Paci. “Equity in the Finance and Delivery of Health care: Some Tentative Cross-Country Comparisons.” Oxford Review Of Economic Policy. 5.1 (n.d.):89-112. Oxford University Press. Web.
In the modern world, statistics indicates that the United States of America is the leading spender on healthcare. In addition, the costs of healthcare continue to increase every year. According to government statistics, the nation spent some 1.9 trillion dollars in 2004 alone, which represents an approximate 16% of the nation’s total GDP (Holtz 103).
In fact, America spends more than 5,000 dollars per person per year, while other countries like Japan and Switzerland spends a mere $2,000 and $3,500 per person respectively. Despite this, a large number of people remain uninsured, while others cannot access good healthcare services (Holtz 102).
So, what are the causes of these problems? The purpose of this discussion is to review the root problems affecting the healthcare system in the United States of America. The paper argues that malpractices within the healthcare system, business nature of the insurance companies and policies and minimal government involvement are the primary causes of the problem.
Malpractices in healthcare system as a cause of America’s high cost of healthcare
Currently, the American healthcare system is ridden with a number of malpractices that tend to affect the provision of services. For instance, Americans have to pay implausible amounts of money for insurance services, yet most of these resources are required to cover for malpractice insurance.
The use of expensive and new technologies in an effort to achieve faster and effective diagnoses and treatments of diseases increases the amounts of money needed to cover the healthcare (Congressional Budget Office 9). Although opponents argue that Americans get better and effective services, data from more than 30 countries indicate that the US has less physicians and hospital beds per patient compared to some European nations such as Italy, Austria and France (Holtz 107).
Secondly, American doctors and other healthcare professionals are more involved in malpractice than in any other country. For example, the American insurance law does not provide a limit on the amount of money a doctor can be sued for, which means that the amounts needed to meet the cost of these malpractices are passed on to the patients. This is an automatic and obvious cause of high cost of healthcare in the US (Congressional Budget Office 9).
Moreover, doctors and other healthcare professionals tend to fear being sued for getting high salary for doing too little. To overcome this fear, they tend to do too much. For instance, doctors are faced with costly lawsuits in their work if they are sued for doing too little (Holtz 111).
Therefore, they normally recommend their patients to undergo extra or extremely high tests or prescribe extra drugs, which in most cases are seemingly unnecessary. In this case, the doctors are safe from expensive lawsuits, but the patients end up paying for high cost but unnecessary services.
It is surprising to note that a good number of surgeries carried out in American hospitals are costly yet unnecessary as per the prevailing conditions. For instance, doctors in America are paid more for performing surgeries and less for using drugs in managing certain diseases and conditions.
To get the extra money, doctors end up performing surgeries, even in cases where generic drugs would have worked equally better. According to Holtz (117), patients who had undergone heart surgeries fared almost the same as those who obtained therapeutic interventions with generic drugs. This is an indication that Americans normally pay much for services they actually do not require.
Business Nature of Insurance as a cause of high cost of insurance services
In the US, healthcare insurers are merely business organizations interested in making profits than in providing the best possible healthcare services to the people. For instance, American insurers tend to spend more on administrative costs than on healthcare services offered to clients. Insurers have high number of employees, and executives. Normally, these individuals receive high salaries, especially for a nation where GDP and cost of living is high. Unfortunately, patients have to meet all these expenses.
Just like American doctors, healthcare insurers enjoy dealing with expensive services, most of which are unnecessary. For example, insurers tend to pay for treatments than for disease prevention and mitigation (Sullivan 108). They enjoy paying for serious and complex treatment services such as surgeries, while the amounts of money they pay for prevention services are less significant. After all, they are interested in making money.
Minimal government involvement as a cause of the problem
Being a capitalistic nation, the US government is minimally involved in healthcare provision; despite the large economy it controls (Sullivan 107). American healthcare facilities and services are more or less run by business minded people and institutions, whose main purpose is to make good profits. The government has collaborated with the private sector in insurance and healthcare provision. Evidently, the government is interested in the tax it gains from these institutions than the quality and cost of services its people gain.
Conclusion
From a review of American healthcare system, it is evident that the high cost of healthcare services is actually a product of its inherent nature. The system allows malpractices within the healthcare provision. Secondly, the insurance providers are business minded, while the government is minimally involved in the control and provision of healthcare services.
Works Cited
Congressional Budget Office. Rising healthcare costs: causes, implications, and strategies. New York, NY: Congressional Budget Office, 2001. Print.
Holtz, Carol. Global healthcare: Issues and polices. New York, NY: Jones & Bartlett Publishers, 2012. Print
Sullivan, Kip. The Healthcare Mess: How We Got Into It and How Well Get Out of It. Washington, DC: AuthorHouse, 2006. Print
The book provides the deeper understanding of the connection between the occupations of nurses and ideological and political concepts. Being aware of the philosophical and political themes, the nurses will be able to develop better work strategies and perspectives. The authors note the role of the political philosophy and ideology in the issues concerning gender and race.
The authors highlight the question of individuals and states and present the major ideas described by Thomas Hobbes, John Lock, and Jeremy Bentham. Hobbes focused his attention on the significance of the role of the government in the life of the society. As the matter of fact, the philosopher claims that the community would live in chaos without the governance.
The theory can also be applied to the nursing practice, as the government should intervene in the health care system to prevent unlicensed practices that harm the clients (Mason, Leavitt, & Chaffee, 2012, p. 53). In contrast, Lock is sure that the individual rights should receive the priority, and the community requires little governance from the state (Mason, Leavitt, & Chaffee, 2012, p.54). Bentham notes that sometimes right of the individuals contradict, and that is, the government should interfere.
For example, people have the right to smoke, whereas other ones have the right to fresh air. Then the authors focus on the different types of the political ideologies, namely liberalism, conservatism, and socialism. The accent is made on discovering of the major representatives of the philosophers and pivotal objectives that describe each type of the political ideology (Mason, Leavitt, & Chaffee, 2012, p. 55)
The Policy Process
The conceptual models of the presented policymaking provide the better involvement of the nurses into the changing of the system. First and foremost, it should be stated that the “health policy encompasses the political, economic, social, cultural, and social determinants of individuals and populations and attempts to address the broader issues in health care” (Mason, Leavitt, & Chaffee, 2012, p. 61).
The authors provide a bright example that shows how the theory should work in practice. In case that the medical setting lacks nurses and patients have to wait long for receiving the care, the nurses should react to the issue appropriately, namely to work more hours in order to improve the condition. The authors move on to the peculiarities of the policymaking in the United States. It should be stressed that the sphere of the health care faces challenges.
The system of the financial side is complicated as it is decentralized (Mason, Leavitt, & Chaffee, 2012, p. 63). The problems in the state and federal cooperation influence the health care delivery. It was informative to get the better understanding of two models of the policy process, namely the Longest’s Policy Cycle Model and Kingdon’s Policy Streams Model (Mason, Leavitt, & Chaffee, 2012, p. 66).
The major aim of nurses is to improve the health care system, and that is, they should take an active part in changing the policies and influence the reformation process.
Care Transition and the Role of the Research
It is significant to understand the question regarding the care transition better. The authors provide the in-depth analysis of the modern system of the care transition and highlights that the inadequate managing can cost an impressive amount of money (Mason, Leavitt, & Chaffee, 2012, p. 73). However, one should keep in mind that such difficulties can be eliminated using the research as the major tool in shaping political and policy decisions (Mason, Leavitt, & Chaffee, 2012, p. 101).
Policymaking and the Children Health Care
One of the biggest accents is laid upon the problem connected to the policymaking and research for the improvement of the children’s health care. The policymakers who deal with children notice that underperforming and the cost issues became the significant problems in the medicine.
According to the recent researches, a number of fundamental elements influence the development of the brain; among them are poverty, discrimination, or adverse events. The stated problem will affect the child’s development and will have an impressive influence on the future performing (Mason, Leavitt, & Chaffee, 2012, p. 115).
Numerous researches and findings discovered the fact that almost 20% of children have mental problems across the United States (Mason, Leavitt, & Chaffee, 2012, p. 117). It influences their school success and relationship with the community. One of the possible solution described in the book is to increase the awareness of the public regarding the mental disorders, to monitor the risk factors, and to develop the new treatment programs that will contribute to the best outcome.
The researchers highlighted the need to change the policy of the children health care system. However, there are not enough possibilities to check whether all children live in good conditions, do not suffer from the racial discrimination, and have access to the high-quality medicine. The amount of money spend on the development of the children programs is considerably low in comparison to adults and disable (Mason, Leavitt, & Chaffee, 2012, p. 118).
However, it should be noted that nurses are responsible for the professional service delivery and have a significant impact on the public opinion. The nurses should provide the necessary information regarding the mental problems in children, join the groups, and change the policy.
References
Mason, D. J., Leavitt, J. K., & Chaffee, M. W. (2012). Policy & politics in nursing and health care. St. Louis, MO: Elsevier/Saunders.
Revenue management in any organization involves four basic elements, which are very vital. These include policy planning, assessment, evaluation and corrective measures. For any organization to run successfully it must have a planning method for its revenues that is concise and meets the organizational needs. In fact, technical expertise is needed in carrying out the plan for implementation.
After the planning process, the organizations need to set achievable goals and objectives within the scope of its work. The goals and objectives should be measurable and specific to maintain focus of the workforce. The stakeholders need to come up with an action plan that they follow to meet their set limits.
The action plan set must denote time and give clear responsibilities to the entire stakeholder. Evaluation and control measures are the final part in policy management that gauge the achievements against the goals set. Corrective measures also need to be followed when deviations are detected.
A study in Florida revenue structure reveals several issues of concern, especially in the health care sector. The revenue collected by the local government and redistributors among the population majorly runs the public health care system. This calls for a proper revenue management by local government to reduce losses and revenue mismanagement. The revenue alone cannot help in solving the health care needs in Florida health.
Therefore, other sources of financing enable them carry out their activities. However, the local government faces several economic challenges in meeting the health care demands.
Introduction
The need to satisfy healthcare demand using the scarce local government resources has led to cost maximization and proper utilization of these scarce resources. This led to the study of how local government revenue can be effectively and efficiently collected and utilized. The study also involves assessment of various factors affecting the local government revenues and the implication of policy system in revenue management.
Government Revenue Assessment
Florida has a well-structured health system. This includes the Government and the public sector. Funding policies have undergone several re-adjustments to create equity, affordability and accessibility of health care to all people.
The rates of revenue historically show drastic changes due dynamic nature of health care investment. The changes in government revenue pattern and rates are majorly attributed to economic patterns, which affect the stability and financial power of the government and the changes in health care system as well as its provision (Cropf, 2008).
These factors include the disease patterns, which have led to more expensive health lifestyle problems. As a result, the government revenue polices are always run to meet these demands. Several government revenue systems are identified in this local government acting at various levels include, taxes, fees, grants, fines, gambling revenue, and aids (Starling, 2010).
Taxes
Taxation is as the major revenue contributor to many local governments. Taxes collected by government are of different types namely; income tax, property taxes, sales tax, payroll tax and property tax.
Government needs include raising revenue for the local authorities operation in different sectors, redistribution of national wealth and price adjustment on externalities such as alcohol and tobacco, which are some of the signs of citizen representation to the government.
Income tax is levied by the government from individual person’s earning, either in business, employment or cooperation sector. In the personal investment, the tax levied is based on profits and net gains. The tax computation is based on national tax law principles.
The income tax can be regressive or progressive in nature depending on the government tax polices and laws. For instance, Pay as You Earn (P.A.Y.E) mode is mostly applied by many jurisdictions on personal taxes. Capital gain tax on capital assets is another revenue source under the government income tax (Lee & Wayne, 1998).
Social security fund revenue is usually found in the health sector of the government. It is a compulsory fund on health, often based on an individual income. Some governments use earning rates to determine the amount paid by an individual while in some cases it is a constant rate according to an individual’s health needs. In some government systems there are upper and lower limits of payments made by an individual (Starling, 2010).
There are also value added taxes and sales taxes. Value added tax (VAT) is imposed on the manufactured goods and services.
The manufacturers sell their products and services at higher prices to the retailers since they need to settle the value added tax paid to the government. On the other hand, Sale tax is levied on consumers when they purchase any product. It is among the major contributors to the government’s revenue collections (Lee & Wayne, 1998).
Moreover, the government gets a lot of revenue from tariffs, excise duty, ad valorem tax, occupation tax from licenses and inheritance taxes. Public facilities such as sports and recreation centres also contribute immensely to the government revenue.
Some of the major sources of revenue to the local government include fees, permits, and licenses. Besides, there are revenues from transport, health care and education sector. Various government businesses and foreign transactions also greatly contribute to its revenues (Usa, 2011).
The Chart below shows the United States Total Revenue
This shows the general Federal States revenue, as a major contributor to the local Government Health Care Program. The USA total revenue is also an indicator of the local government capacity in revenue collection. In turn, they receive the federal government aids.
Health Care Funding in Florida
Health care sector needs a lot of financing since it is wide and very dynamic. To come up with a proper solution to the funding, policies have been drawn in the local government. The policy systems also ensure equitable and quality health distribution that is accessible to all the social classes.
Although efficient and effective financing system is hard to achieve in health care, many health programs implementation in Oregon have been met through the financing systems (Wallace, 2010).
The federal government funding towards health care is a great contributor in the country’s health care system. This has been undertaken through direct injection of funds or indirectly through the acquisition of facility aid and health personnel from the federal government.
Government funds are state’s risk pool revenues arrangement aimed at all the population extensive health care provision. In addition to government funding, the government offers support to this health care through the social health policy (Wallace, 2010).
Social insurance source of financing is mainly from the employers’ contribution and salaried employees. It also provides a cover to the unemployed in this government through the social funds. The program is associated with benefit package to the health care contributors.
Notably, this is a non-profit program. In Florida, social funds have created minimal dependence on negations of budget other than on the state funded health care system and it is the most strongly supported health funding system by the citizens (Lee & Wayne, 1998).
The local government of Florida authorities have also injected indirectly in community-based health insurance. This health insurance seeks assistance of the government policy makers to help those that are unable to purchase healthcare insurance from the formal sector. It achieved a better health care access to the people in many parts of this local authority (Usa, 2011).
The Chart Below shows Florida local Government Financial Contribution toward Health
Care in the Local Authority
From the chart, it can be noted that the user fees and out of pocket take the largest share of the health payment system. The lowest contributor to healthcare is the insurance that ranks lowest as a result of high charges they offer. The government contributes 22 percent of the finances in health care (Lee & Wayne, 1998).
The governments also provide Medicaid services to enable the low-income groups to access health care. Medicaid is aimed at all the population despite the ages of the people who cannot afford personal insurance. In Florida, Medicare takes the basic health needs burden from the low-income group. Medicaid services are also available for the elderly and disabled group.
To supplement their out-pocket medical use, the local government has promoted the provision medigap method by private insurers. This mostly aimed at the poor who are unable to purchase their health insurance security (Wallace, 2010).
Some of national budgeting data for the government are tabulated. The data were taken from some of the priorities set by the government in health care provision and amount in dollar used.
The table shows the major government priorities in health care budget across the years, including medical services to seniors, venders’ medical users and public health service provision. It is noticed that health cost is constantly rising across the years. This has been attributed to rise in health care diseases among the population (Lee & Wayne, 1998).
The below shows Health Care Financial Budget by the Local Authority from the Year 2005-20010 (m.s) is the medical service rendered to the seniors.
Financial Year 2005 2006 2007 2008 2009 2010
Health Care Cost 882.0 866.1 920.0 1,042.2 1,129.9 1,233.0
Restrictions in Government Revenues on health Budgeting
Government spending in health care is determined by the economic status of the state and the federal government. During hard economic times, the government spending on health is reduced drastically to compensate for other sectors of the economy.
This comes up with several challenges to the users who are insured under the government like in Medicaid and Medicare provision. At times the cost of health is so high that proper provision needs extra funds, which the local government cannot easily allocate successfully. Therefore, the local government is restricted to the most basic primary health care (Federal Reserve Bank, 1997).
Operation of many local authorities gets a lot of influence from the state government. The local authority finds itself at a cross road at times when undertaking its programs due to regulatory measures by the government providers on the revenue use and application.
The local authority’s policies and health care priorities sometimes do not run with the government priorities, and are often forced to abandon their priorities to meet the financiers’ needs. Due to these, the government restricts the local authorities budgeting (Wallace, 2010).
Dynamics nature of health care and span make its budgeting policies very complex to amend every budgeting period to meet the new challenges. The increase on life style diseases has made it difficult for the health care planners to carry out adequate budgeting.
This can be depicted from financial short falls which normally occur in many planning periods. Budgeting for health generally has become very unpredictable, including the insurance coverage needs (Wallace, 2010).
Effect of Public Decision Policy on Revenue
Policies decisions are vital in revenue collection and creation of a harmonized environment to the revenue users and collectors. Policies enable people to appreciate the need and usefulness of collecting taxes. Every government has a distinct and proper policy set up for collection and use of its revenues.
The decision is vital in various ways for the local government, especially in safeguarding government resources. The decisions taken into consideration include revenue recognition in line with the general accounting principles and management of the receivable accounts by the government. Finally, the decisions are important in creating a negotiation on matters related to the revenue systems (Starling, 2010).
The policy structure describes the local government revenue is in the different parts. There are policies on collection and utilization of the government fees from the local health institutions. Grants and aids have systematic methods of handling them as well.
Medical services income and investment income are also handled according to specific policies to make sure there is a proper and transparent health care delivery. In addition, the government has laid regulations and policies on management of contributions and other forms of sources, which are normally channeled to specific programs (Cropf, 2008).
The management and formulation of the policies are under specific management bodies, each charged with different responsibility. The work of the teams is to monitor and start the implementation under their jurisdiction.
This is done according to the need and demand priorities in health care provision to the people. Managers in charge of the policies also ensure accountability, billing and collection of revenue in accordance with decisions on the ground. At times, the revenue management circle follows a given benchmarks to produce targeted goals (Starling, 2010).
When wrong decision on revenue management is made, the collection processes might be impaired from the first instance. This comes as a result of the people’s failure to understand the revenue system. Pressure groups might go against the policies makers as well.
In many places, poor accountability and transparency have led to loss of revenue, thus it becomes necessary that proper handling polices are drawn to ensure efficient collection and use of the resources (Wallace, 2010).
Choosing programs to run the health care requires the managers who have proper understanding of health care structure. The government must come up with proper recruitment policies which ensure that the health system is properly managed by responsible managers and planners.
Revenue collection from other sources such as aids needs proper negotiators who can draw and clearly come up with the requirements of the negotiators. Generally, the decisions made in these stages mark the success or failure of revenue management (Cropf, 2008).
Economic Conditions that Affect Revenue Projections
Revenue projection by the government depends on several economical factors, and any changes in these either positively or negatively affect the revenue. When the consumption pattern changes due to economic cycles, the health care revenue pattern also changes.
This results from economic factors such as inflation, decline in asset values, geopolitical factors, cost of credit and its nature, solvency and the stability of financial institutions, the financial market, and internal and external business pattern. Projecting revenue in any sector also becomes hard as a result of economic uncertainty that affects the financial market (Wallace, 2010).
The demand for health services and the availability of its revenue on the government overlie on the capacity of its purchase. When employment issues arise, the national insurance fund gets affected proportionately. When unemployment looms the contributors to health reduces while the consumers increase in number. This poses a great challenge to the government (Federal Reserve Bank, 1997).
At the same time economical problems like recessions normally result in poor trade pattern, the government might end up making losses in businesses as well as expecting limited revenue from the business sector. Consumers of healthcare at this time find it hard to purchase health products and opt to basic primary health strategy.
Fees charged on the health premises reduce drastically, forming part of the affected revenue system. Many people normally opt for promotion health pattern that do not require much financial investment to reduce their spending (Wallace, 2010).
Taxation patterns change with economic system when economical cycle is low; many people reduce their investment in the capital market. Consequently, manufacturing firms reduce their purchases since the consumption rate becomes low.
This directly affects the VAT and other trade related taxes. The government revenue also falls despite the need for the government to cushion most of its people from the economic challenges. Tariffs and customs also normally get affected by these changes making the revenue projection difficult (Wallace, 2010).
Pension deficits are also major hindrance to revenue projection. Many people under pension who fail to receive their pension become a challenge in projection of revenue since the groups are normally included in the revenue calculation. On the other hand, the government uses a lot of money every year to cover these pensions that in turn cut back into the projection estimates.
Calculation of pension to derive clear projection of revenue is also very difficult due to changes in pattern of employment and unemployment rates. Clear projections of revenues become rather hard or inaccurate for the planners at the national and local level (Federal Reserve Bank, 1997).
Public Debt always forms another challenge facing the revenue projection, both domestic and foreign. The accruing debts come with the expenses, which normally are being carried from one generation to another. The debt repayments normally affect the revenue sectors significantly.
This is because the projected revenues are utilized in non-profit generating programs. Thus, the planning becomes significantly challenging because of the debts. In turn, several public sectors including health get hugely affected due low net revenue (Usa, 2011).
Furthermore, there are economical losses in natural disasters, hurricanes and earthquakes affecting Florida. In as much as they are not anticipated. A lot of investments get destroyed when these disasters occur. At the same time, the government invests a lot to restore these structures in place. A lot of expected revenue is these areas are not met while more is used to restore the situation on the ground.
This has made projection of revenue in Florida generally hard and always results in the failures. It is beyond the control of the government since some of these points mark lucrative investment zones by the local government the tourism industry. Health investment meets these challenges as its funds are utilized in mitigation measures (Federal Reserve Bank, 1997).
Major revenue challenge in projection comes from the management of social security fund and retirement. This comes with failure to many people in Florid to take their own saving measures. Many people reach retirement age with little or no saving for both livelihood and health care.
The government hence spends a lot in social security funds and other revenue sources to cater for the basic needs of these groups, mostly in Medicare and Medicaid insurances. Projection of the revenue is a challenge since it is never accurate in calculation of the amounts invested in health (Usa, 2011).
In the technological advancement, the states spend a lot in to cope with technology in various fields like in business, security and science.
Projection of yearly spending on these sectors is very hard since each year comes with a new challenge, often at a higher cost. The state hence is unable to accurately determine the revenue amount it spends in these sectors. These make revenue projection generally hard and most unachievable (Usa, 2011).
Revenue Policy
For an effectively management of health care system in Florida, there is a need for concrete management and control of the revenue system. This calls for a properly diagnosed health revenue procedure and policies. In Florida, the local government came with a revenue control and management policies in all it sectors to ensure accountability, transparency and efficiency in running the program (Cropf, 2008).
The policy system runs as shown:
Internal Control Measures
In order to manage revenue effectively, a proper organization of input, process and out put resources are put into place. Proper coordination in communication and technological application is enhanced. A chain of hierarchy is drawn from managers to lower level work force (Wallace, 2010). The aspects of internal control are;
Work organization and delegation of duties
Process of payment recording from various accounts
Efficient fund deposits to respective areas
Reconciliation of major accounting books
Creation of security measures
Application of automated systems for accurate processing and harmonization
Creation of control and fraud detection procedures with efficient reporting process
Checking on compliance and non compliance measures by internal audit
Accounting
Records from different health department need to be kept according the standards accounting procedures. At the accounting stage;
Proper general ledger must be used in recording
Fiscal accounting period must be given consideration
Billing
There must be a properly established account of receivable for the advanced health care services (Wallace, 2010). The bills need;
To be properly dated except when stated by resolution or ordinance
On going account is necessary for service taken prior to payments
The bills need to be handled from central account then transferred to central ledger.
Fund Deposits
Proper depositing criteria need to be followed any time funds are to be deposited. In the health care deposits are;
Numerically controlled tied to official document from that department
Mode of payment should be indicated
Receivers identity need to be noted
Transfer of receipts to the accounting books
Posting the changes to the supervisor
Remote site
These are areas away from the treasury. These collection points need to;
Have a cash threshold that they deposit early the following day
All collections need no surpass five working days before deposit
Non deposited funds securely locked in safes
Keeping of shortage account for differences
No application of change drawer for personal work
Escrow Funds
When funds are sent to the system before the recognition of the revenue to remitted back they should be deposited in Escrow liability account that earns interest.
Interested will only remitted in Escrow under agreement
When they have gone proper identification they are hence transferred as revenue
Can only be returned under compliance payee on transferring for non-compliance
Collection
Collection will be done under each department with procedural and within specified period.
Receivable accounts needs to be recorded to permit analysis by the entity
Notice must be given to past due accounts and restrictions provided as possible
Returns
It the duty of each department to monitor and control returned cheques. They shall;
Unless specified, be handled by treasury
Fees charged on these cheques
Bad Debt
For these be dealt with, it need to be considered under receivable account. The computation should be annually based on write offs and aging of the receivables.
Budgetary Review
The monitoring of the accounts shall be within a specified time by the supervisors. Considerations shall be on;
Oversight from the departments
Revenue budget presented with documented evidence
Monitoring shall be carried out across the year
The policy system is aligned a specific checklist that evaluates the performance standard at each level (Wallace, 2010).
Conclusion
Despite challenges faced in Florida health care system, the government has high potential of helping the population as long as better measures of revenue collection and utilization are in place.
This calls for identification of challenges in revenue management and development of mitigation measures, which are supportive. After the identification process, the revenue structure should be assessment and re-drawn to meet the local government demands. This way, health and other sectors in Florida stand high chances of success.
References
Cropf, R. (2008). American Public Administration: Public Service Administration for the 21st Century. New York, NY: Pearson Longman.
Federal Reserve Bank of Cleveland. (1997). Economic Review (Vols. 33-34). New York, NY: New York Press.
Lee, R, D., & Wayne, R. J. (1998). Public Budgeting System. Canada: Jones and Bartlett Publishers.
Starling, G. (2010). Managing Public Sector. Boston: Wordsworth Publishers.
Usa, I. (2011). Samoa, American Country Study Guide: Strategic Information and Developments. Washington, DC: International Business Publishers.
Wallace, S. (2010). State and Local Fiscal Policy: Thinking outside the Box. Massachusetts: Edward Elga Publishers.
U.S. has unique healthcare system – largely privatized;
Rising costs create barriers to access;
Universal coverage – redistributive policy type;
Universal healthcare prevalent topic in politics and administration;
“Cannot be achieved without recognition of its dependence on, and consequences for, both governance and politics” (Greer & Méndez, 2015).
Most developed and developing countries in the world maintain a healthcare system which is universal or at least partially public, providing access to fundamental medical services and medications to its residents. In the United States, the government only serves as a regulator or subsidiary. There have been increased calls for universal healthcare, but the issue is strongly political and complex. Such healthcare uses the redistributive type of policy by building upon public goods for the benefit of society, benefiting less advantaged groups the most ((Denhardt, Denhardt, & Blanc, 2014). Such policy is financed from the national budget through taxation.
Impact of Organizational Resources
National healthcare is mostly created and regulated through the Department of Health and Human Resources (HHS);
Multiple sub-agencies engage in collaboration to drive national health initiatives;
Sophisticated strategic planning required to coordinate in the implementation of healthcare policy;
Organizational resources are available for implementation of universal healthcare;
However, significantly greater funding and personnel would be required to develop and implement a national level oversight that would be required.
The HHS is a vital agency and organization in the implementation of national healthcare policy. It consists of multiple collaborating subagencies within that strategically plan large-scale healthcare initiatives. The organization has significant resources at its disposal but relies on cooperation with other federal and state agencies as well as private entities to achieve its objectives which may be potentially challenging to such enormous changes as universal care.
Impact of Human and Budget Resources
Human resources drive implementation of healthcare policy;
Dedicated HR department at HHS agency with systemic approach to management;
Offices focused on program management, resource management, and operations vital to support the national healthcare system;
Budget for HHS approved annually by Congress;
Each department and sub-agency with HHS must submit proposals and justification;
Concern that universal healthcare will bankrupt the system unjustified;
Costs will increase but competent transparent budgeting can ensure achieving public health objectives.
Human and budget resources are key for the function of any organization, and in the HHS these are aspects that are highly systematic and regulated tediously. Human operations are a complex system which guides various aspects of functionalities and program development at HHS. Therefore, in the creation of a universal system of care, the HHS has the available professionals to develop its components but will need to expand. Meanwhile, the budgeting will have to be approved by Congress based on detailed justifications for each expenditure or program.
Politics and Policy Impact
Governance of political institutions impacts redistributive policy;
The U.S. bicameral and partisan political system has numerous veto points to essentially block healthcare policy;
Zero sum approach held by many on universal healthcare;
Policy must be not only passed but funded in future years;
Political ideology has significant opinions on universal healthcare influencing a stagnation of policy in U.S. federal and state representations;
There is increased political disagreement on how to proceed forward with healthcare in the U.S.;
Despite universal agreement that change is needed, the policy comes down to partisan and special interest influence;
This approach creates barriers to management and implementation of good public policy;
The HHS is reliant on funding from Congress, and not only budgetary constraints are concerning, but political slashing of funding for programs;
Policy and legislation being political results in leadership having navigate the complex politics when leading the agency and developing new initiatives.
Healthcare is defined by politics, particularly the concept of universal healthcare and the redistributive type of policy it entails. Any legislative and policy system has chokeholds, known as veto points, where a policy may become stagnated or fail, such as court rulings, referendums, or multiple chambers of legislature. In the U.S. the administrative political system has one of the highest numbers of veto points, which combined with ideology makes healthcare policy exceptionally slow to develop and pass. Furthermore, the politics promotes inegalitarianism on the privatized health system making it easy to stop implementation of universal care.
As was evident with Obamacare, major overhauls to national health policy are problematic. A decade after passage it still faces appeal, legal challenges, and funding cuts. Similar aspects would apply to universal healthcare, at an even greater intensity. The policy aspect of healthcare is so dependent on politics that neither legislature nor the HHS agency itself can proceed forward without constant barriers.
Ethical Concerns
First concern is fiscal responsibility when working with public resources and funding.
Management of funds must be transparent and avoid supporting private gain as commonly occurs with numerous private contractors and insurers in healthcare.
Competent management of funds to achieve access and coverage amid budge constraints (Tran, Zimmerman, & Fielding, 2017).
Second concern is equitable distribution of resources.
Healthcare is inherently disparate in terms of access.
Socioeconomic and racial factors play a role in availability of public health.
Equitable access and funding must be provided to all populations in need (DeSalvo et al., 2017).
Universal healthcare as a public service require competent management by public administration which provides the public good at a high ethical standard. Ethical concerns include fiscal responsibility and equitable distribution of resources when it comes to public healthcare. This includes ensuring transparency in spending and not inappropriately funding private entities present in the sector. Furthermore, the disparities should be eliminated to the best of the possibilities by public administration by providing equitable funding and quality of care to lower-class socioeconomic neighborhoods.
Constitutional Law
Constitution does not explicitly guarantee right to healthcare;
Provides Congress the ability to establish statutory rights for individuals;
Using this, Medicare and Medicaid have been created;
Congress has power to enact laws for public welfare as well as fund them;
Legislative powers used to regulate economic aspects of healthcare (Sunkara & Rosenbaum, 2016).
According to the Constitution healthcare is a not a guaranteed right. Instead the document provides legal tools for Congress to enact statures and laws which can create statures and legislation that regulate healthcare. This includes major policies and statures such as Medicare and Medicaid. Furthermore, Congress has the power to levy taxes, regulate commerce, create economic mandates, and fund mandates which are parts of the national healthcare system. This allows broad possibilities to expand access to healthcare to greater populations given proper policies and funding are in place.
Recommendations
Expanding the existing Medicare system to cover all Americans:
Refrain from a single-payer system but develop one that combines government and private coverage similar to Australia and many European countries;
Find political compromise that allows to corroboration of the public and private sectors.
Develop a realistic and practical funding system to cover universal public health:
Build upon existing infrastructure and systems (such as Medicare) to save costs;
Remove restrictions of government agencies to negotiate drug prices, cap premiums, and other aspects which may save costs in the long-term.
The only way forward to adopting some level of universal healthcare is to find compromises, primarily politically. This can be done by avoiding ideological slogans of medical “communism” but focus on developing a proposal of a healthy collaboration with the private sector since the majority of Americans support this approach rather than single payer system. In order to deal with funding issues, it is proposed to use existing systems, and provide greater bargaining power for the government in reducing its bulk purchases and investments into the healthcare system.
References
Denhardt, R. B., Denhardt, J. V., & Blanc, T. A. (2014). Public administration: An action orientation (7th ed.). Belmont, CA: Thompson – Wadsworth – Cengage Learning.
DeSalvo, K. B., Wang, Y. C., Harris, A., Auerbach, J., Koo, D., & O’Carroll, P. (2017). Public health 3.0: A call to action for public health to meet the challenges of the 21st century. Preventing chronic disease, 14, E78. Web.
Greer, S. L., & Méndez, C. A. (2015). Universal health coverage: A political struggle and governance challenge. American Journal of Public Health, 105 (Suppl 5), S637–S639. Web.
Sunkara, V., & Rosenbaum, S. (2016). The Constitution and the public’s health: The consequences of the US Supreme Court’s Medicaid decision in NFIB v Sebelius. Public Health Reports, 131(6), 844–846. Web.
Tran, L. D., Zimmerman, F. J., & Fielding, J. E. (2017). Public health and the economy could be served by reallocating medical expenditures to social programs. SSM – Population Health, 3, 185-191. Web.
A causal claim about the relation between governments’ policies and the livelihood of people
It is not a secret that appropriate healthcare offered in time is one of the most credible chances to extend a human life. This is why the governments try to develop the most important implications on the citizens’ livelihood. The leaders truly believe that their policies may considerably improve the lives of people they represent and rule. Still, it is very important to understand that lengthy and sometimes conflicting negations considering the interests of different politically powerful medical subcultures should take place in order to introduce the required portion of healthcare (Arbuckle 2012).
The role of government in the life of each citizen is crucial indeed, and the way of how healthcare is presented to people may influence the quality of life. However, it is hard to define the nature of a causal relationship between healthcare spending and life expectancy in different countries due to the presence of such factors like social inequality (Navarro, Muntaner, Borrell, Benach, & Quiroga 2006), pharmaceutical issues (Shaw, Horrace, & Vogel 2005), or the necessity to meet the other demands of society. Each country has its own peculiarities, social norms, and citizens’ expectations.
On the Figure 1, the data about some countries and their life expectancy and healthcare spending indicators from 1968 to 2013 is given. At a glimpse, it is evident that the Americans are the nation that is in need of certain healthcare reforms. Nevertheless, the other representatives help to create a more or less certain causal claim that, as a rule, higher level of OECD governments’ healthcare spending (x-axis) causes a higher level life expectancy (y-axis), still, some expectations should be taken into consideration. Of course, there are a number of hurdles that define the quality of such claim, and their evaluation is a good chance to comprehend the essence of the relations better (Kellstedt & Whitten 2008).
Hurdles in establishing a relation between healthcare spending and life expectancy
According to Kellstedt and Whitten (2008), there are four main hurdles that should be taken into consideration while evaluating the chosen causal claim. Our claim is that higher level of OECD governments’ healthcare spending leads to a higher level life expectancy. So, it is high time to answer the following questions: is it possible to prove life expectancy’s dependency on healthcare spending? Yes, it is.
There are many developed countries that find it necessary to spend much money on health care in order to improve population health (Funtleyder 2008). However, each year, financial needs necessary for health care increase considerably, and the governments want to know whether it is still beneficial to support the chosen spending.
Figure 1, as well as the investigations introduced by Anderson and Fronger (2008), Goldsmith (2010), or Williams (2010), proves that the United States spent about $6000 per capita on health care in 2005 and demonstrated one of the lowest results in life expectancy. The other countries demonstrated the opposite results and proved that healthcare spending influence life expectancy; still, it is difficult to demonstrate a casual influence of healthcare spending on life expectancy.
The reverse causal mechanism shows that it is possible to reject an idea that life expectancy defines healthcare spending because health care spending is defined by the period after birth and the time to death, and life expectancy cannot directly increase healthcare demands as the majority of such demands are usually postponed in such situations. In other words, it is wrong to believe that life expectancy can directly influence healthcare spending.
At the same time, the rejection of correlation between the two variables under consideration is absurd. The connection between healthcare spending and life expectancy is evident and cannot be neglected as in case people get an appropriate financial support and spend it to improve their health; they have a chance to live a longer life.
However, life expectancy may be determined by many other factors (confounders) like the style of life, personal habits (smoking, alcohol, etc.), environment (air or water pollution), or living conditions. The level of GDP is another important confounder that should be mentioned (World Health Organisation 2010). At the same time, Japan with the indicator of GDP lower than the one of the USA (Japan – 7.9% and USA – 15%) demonstrates a higher life expectancy level due to the above-mentioned factors (Wise & Yashiro 2007).
Other forms of evidence to test a claim
The connection between different determinants of healthcare spending and life expectancy has been proved above. Still, it is necessary to admit the existence of some other forms of evidence that could be used to test the chosen causal claim. For example, health care reforms may have an impact on life expectancy in its own particular way. Health systems differ between countries as they usually combine various forms of provisions and financing. This is why the way of how the reforms are introduced and implemented in society indirectly still effectively influence the quality of life.
Reference List
Anderson, GF & Frogner, BK 2008, ‘Health spending in OECD countries: Obtaining value per dollar’, Health Affairs, vol. 27, no. 6, pp. 1718-1727.
Arbuckle, G 2012, Humanising healthcare reforms, Jessica Kingsley Publishers, London.
Freedman, DA 2009, Statistical models and causal inference: A dialogue with the social sciences, Cambridge University Press, Cambridge.
Funtleyder, L 2008, Healthcare investing, chapter 4 – anatomy of the health-care system, McGraw Hill Professional, New York.
Goldsmith, S 2010, Principles of health care management: Foundations for changing health care system, Jones & Bartlett Learning, Sudbury.
Kellstedt, PM & Whitten, GD 2008, The fundamentals of political science research, Cambridge University Press, New York.
King, G, Keohane, R & Verba, S 1994, Designing social inquiry: Scientific inference in qualitative research, Princeton University Press, Princeton.
Laan, MJ & Rose, S 2011, Targeted learning: Causal inference for observational and experimental data, Springer Science & Business Media, New York.
Morgan, SL & Winship, C 2007, Counterfactuals and causal inference, Cambridge University Press, Cambridge.
Navarro, V, Muntaner, C, Borrell, C, Benach, J, & Quiroga, A 2006, ‘Politics and health outcomes’, Lancet, vol. 368, pp. 1033-1037.
Pearl, J 2009, ‘Causal inference in statistics: An overview’, Statistics Surveys, vol. 3, pp. 96-146.
Rothman, KJ & Greenland, S 2005, ‘Causation and causal inference in epidemiology’, American Journal of Public Health, vol. 95, no. S1, pp. 144-150.
Shaw, JW, Horrace, WC, & Vogel, RJ 2005, ‘The determinants of life expectancy: An analysis of the OECD health data’, Southern Economic Journal, vol. 71, no. 4, pp. 768-783.
Singapore is an Asian country that has a population of approximately five million people. The country has one of the most efficient healthcare systems in the world. Since its independence in 1965, the country has taken several steps that have led to significant improvements in its healthcare system. In 1983, the government developed the National Healthcare Plan.
The aim of the plan was to provide a roadmap for the development of the healthcare system for the next 20 years (Meng-Kin 17). During this period, the government introduced several programs that targeted various groups of people. In 2002, the government introduced the ElderShield plan. The aim of this program was to improve the healthcare of the elderly and disabled. On the other hand, the US healthcare industry is more than two centuries old.
The US government spends vast sums of money on healthcare provision. Medicaid and Medicare account for the lion’s share of government expenditure on healthcare provision. This necessitates the US government to formulate strategies that would help in reducing the cost of healthcare provision.
Increase in the proportion of the elderly to the total population necessitates the US government to take urgent steps to prevent further escalation of the healthcare budget. The US government should formulate a strategy that would help in replicating the strengths of the healthcare system of Singapore in the US healthcare system.
Healthcare Regulation
Singapore’s healthcare system has three pillars. The healthcare system strives to improve the general health of the population through various preventive healthcare programs. In addition, the healthcare system puts great emphasis on the personal responsibility of individuals towards their healthcare. The government strives to reduce the cost of healthcare services by subsidising healthcare in public health institutions.
The Ministry of Health (MOH), Monetary Authority of Singapore (MAS) and the Central Provident Fund (CPF) are the main health regulators. CPF is a social security savings plan that enables Singapore nationals to support themselves in their old age (Ho 95).
On the other hand, the US has one of the most complex healthcare regulations in the world. Numerous agencies help in regulation of healthcare. Healthcare agencies may regulate healthcare at the state or federal level. In addition, the regulators may be private or public.
The United States Department of Health and Human Services and the National Institutes of Health (NIH) are the major bodies that cater for the healthcare needs of all American citizens. The American Medical Association (AMA) is one of the vital private organisations that help in the oversight of healthcare industry (Field 608). In the US, different states may have different agencies that help in regulation of healthcare.
Healthcare Delivery
Singapore’s healthcare system helps in the delivery of various types of healthcare to the population. Approximately 2000 private hospitals provide 80% of the primary healthcare needs of the population. This shows that the government’s efforts to provide primary healthcare services to the population have been unsuccessful. However, the government provides the bulk of hospital care services.
Government healthcare facilities provide approximately 80% of hospital care services. In 2010, there were 8,881 hospital beds in government healthcare facilities (Ministry of Health Singapore para 1). Public health facilities had slightly less than thirteen thousand nurses and approximately 1800 nurses. On the other hand, private healthcare facilities had 2,268 hospital beds.
The number of doctors and nurses in the private healthcare facilities was approximately 3,300 and 5,100 respectively (Ministry of Health Singapore para 2). These statistics show that the government is the dominant player in the provision of hospital care. However, a close analysis of the number of doctors and nurses shows that there are less hospital beds for every healthcare practitioner.
The number of hospital beds per healthcare practitioner has a significant effect on the quality of healthcare. This may imply that the quality of healthcare services in private healthcare facilities is higher than in government healthcare facilities.
Community hospitals play a key role in healthcare delivery in the US. Community hospitals may be state-owned or investor-owned. Community hospitals are the major healthcare facilities that provide primary and intermediate healthcare services. Most community hospitals tailor their services to meet the healthcare needs of the community (Purves 88).
This improves the efficiency of healthcare services of community hospitals. There are 4,973 community hospitals. The total capacity of these community hospitals is 797,403 beds. On the other hand, there are slightly more than 200 federal government hospitals.
The total capacity of these hospitals is slightly more 100,000 beds. Therefore, community hospitals are vital in designing various preventive health programs. Most community hospitals have adequate staffing levels that enable them to meet the healthcare needs of the community.
Funding
Medisave, MediShield, Medifund, and ElderShield are the main medical schemes that help in financing public health in Singapore. Medisave is a social scheme that helps people to save for future healthcare expenses. Medisave caters for hospitalisation expenses and certain outpatient treatments of individuals and their immediate family members.
In addition, Medisave may help in paying the premiums of MediShield and Private Medical Insurance Scheme (PMIS). On the other hand, MediShield is primarily a medical insurance scheme that caters for severe health conditions. It caters for partial expenses of prolonged hospitalisation and outpatient treatment of various serious illnesses.
ElderShield is a health insurance scheme that caters for people who need long-term care. ElderShield mainly covers the elderly. Medifund is a government endowment fund that acts as a last resort source of funds if Medisave and MediShield are unable to cater for medical expenses.
The government replenishes the funds when there is a budget surplus. However, the government is not the only major player in the healthcare insurance industry. Several private health insurance companies provide health insurance to individuals and groups (Meng-Kin 19).
In the US, it is the duty of employers to ensure that their employees have medical cover. Medicare and Medicaid are the major medical schemes that help in financing public health. Medicare is a healthcare plan that covers the elderly and disabled. On the other hand, Medicaid covers people who have low incomes. Federal funds help in supporting Medicare while state and federal funds support Medicaid.
Patient Protection and Affordable Care Act (PPACA) is a healthcare regulation that ensures that all Americans have access to healthcare insurance. Access to healthcare insurance enables people to save huge sums of money that they would have used to cater for medical expenses (Pipes 107). People who would like to receive extended healthcare services may enrol in various private healthcare plans.
Healthcare Expenditure
Healthcare expenditure as a percentage of GDP is one of methods that help in determining the government’s commitment to improving the health status of the nation. In 2009, Singapore’s ratio of healthcare expenditure as a percentage of GDP was 3.9% (Ho 95). There is a gradual increase in the ratio of direct government expenditure on health through Medifund.
On the other, there is a gradual decrease in the social security expenditure on healthcare. In the private sector, out-of-pocket expenditure accounts for a sizeable percentage of healthcare payments (Ho 95). This necessitates the government and the private sector to formulate strategies that would improve access to healthcare insurance.
In 2008, the US had the highest healthcare expenditure as a percentage of GDP. The expenditure of the US on healthcare was 16% of its GDP. Medicare and Medicaid accounted for a sizeable percentage of the government spending on healthcare. In addition, out-of-pocket healthcare expenditure of the US was very high (Squires 2).
Conclusion
The US has one of the most efficient economic systems in the world. Very few economic systems can rival the US economic system. However, the healthcare system of the US has many flaws. Exponential increase in healthcare costs is one of the major problems that the healthcare system faces. On the hand, Singapore has been able to replicate the efficiency of its economic system to the healthcare system.
Despite having significantly lower expenditure on healthcare, Singaporeans are some of the healthiest people on the planet. Copying the healthcare structure of Singapore would enable America save huge sums of money. It would free up money for other activities that would lead to economic development. However, the healthcare systems of the countries face several problems that are unique to each country.
Works Cited
Field, Robert I. “Why is health care regulation so complex?” Pharmacy and Therapeutics. 33.10. (2008): 607–608. Print.
Ho, Lok-sang. Health policy and the public interest. Burlington, MA: Routledge, 2012. Print.
Meng-Kin, Lim. “Health care systems in transition ll. Singapore, part I.” Journal of Public Health Medicine. 20.1. (1998): 16-22. Print.
Ministry of Health Singapore. “Healthcare institution statistics.” Statistics. n.d. Web.
Pipes, Sally C. The truth about Obamacare. Washington DC: Regnery Gateway, 2010. Print.
Purves, Geoffrey. Primary care centres. Burlington, MA: Routledge, 2012. Print.
Squires, David A. “The U.S. health system in perspective: A comparison of twelve industrialized nations.” The Commonwealth Fund. 16.1. (2011): 1-13. Print.
The ruling by Illinois Supreme court in the case of York v Rush-Presbyterian-St. Luke’s Medical Center is a classic example of the vicarious liability of a hospital for the wrongful act of an independent contractor under the doctrine of apparent agency.
The case involves Dr. James York, a retired orthopedic surgeon who was admitted in Rush-Presbyterian-St. Luke’s Medical Center (“Rush-Presbyterian”) for three knee surgeries. During the third surgery, the attending anesthesiologist erroneously pierced the spinal cord of Dr. York permanently damaging some of the nerves. He sued Rush-Presbyterian for damages.
The Supreme Court reviewed the rulings of the lower court, which were adverse to the hospital. The center focus was on the application of doctrine of apparent agency in the context of a medical malpractice action. Supreme Court noted that the following three conditions must be proved by the plaintiff in order to hold the hospital vicariously liable.
“The hospital or its agent The hospital, or its agent, must have acted in a manner that would lead a reasonable person to conclude that the individual alleged to be negligent was an employee or agent of the hospital
Where the acts of the agent create the appearance of authority, the plaintiff must show that the hospital had knowledge of and acquiesced in the acts and
The plaintiff must have acted in reasonable reliance upon the conduct of the hospital or its agent” (Basberry.com)
The court mainly relied on the third condition in establishing the vicarious liability on the hospital. The court was of the opinion if the plaintiff relied upon the hospital for undergoing the treatment instead of on his faith on a particular physician then the third condition can be said to have been satisfied.
The court was clear in stating that when a patient enters a hospital he expects to receive the required care from the hospital except to that part of the treatment to be provided by the physician chosen by the patient. In case if the patient has not opted for any specific physician then it can reasonably be assumed that, he relied on the hospital to provide the complete medical care. This complete medical care can be taken to include the provision of support services like radiology, pathology and anesthesiology. These services are expected to be provided to the patients through the hospital staff.
Even though, reliance was placed on the third condition, the Court also took into account the first condition by stating that the first condition will be deemed as satisfied in cases, where the hospital holds itself out to the patient as a complete service provider. In this case, the hospital should have used such support services without informing the patient that it relies on an independent contractor for the provision of any service. The Court further observed that the plaintiff would not be entitled to presume the existence of an apparent agency if the patient knows or should have known that some of the services are being provided by independent contractors and the plaintiff has the knowledge of the independent medical status of such contractor.
The Court further observed that Dr. York chose the hospital for his medical care based on the reputation of the hospital in providing quality medical service. The hospital also failed to keep Dr. York informed of the fact that the anesthesiologist was an independent contractor and not an employee of the hospital (Basberry.com).
Work Cited
Basberry.com. Illionois Case Holds Hospital Liable for Independent contractor Anesthesiologist. 2009. Web.
When healthcare organizations use related technology in maintaining electronic health records (EHR) alongside information technology, it is referred to as the Meaningful Use. Payments can also be received from the federal government when Meaningful Use status is attained. Such payments are received under two main mechanisms that have been put in place namely the Medicaid EHR Incentive and the Medicare HER programs.
The HITECH Act that was adopted in 2009 has several remarkable provisions that outline the benchmark operations of the Meaningful Use. For example, incentive payments will be advanced to organizations on condition that they have attained meaningful use within a specified time. The year 2014 is the set deadline for healthcare organizations that will qualify for the Medicare HER incentive program. On the other hand, a penalty may be charged against healthcare organizations that will not have attained the set standards by 2015.
The first stage of meaningful use of the Electronic Health Records should be achieved by hospitals and individual physicians so that maximum reimbursement can be received. This provision was supposed to take place during the 2011- 2012 financial year and also within a period of 90 days. It was then expected to resume the rest of the year after the expiry of 90 days.
Incentive payments can be received by individuals who qualify for Medicaid program only if meaningful use is realized before the close of 2016. In addition, it is imperative to mention that the incentive program under the confines of the meaningful use established regulations for the first stage through the cooperation of two major bodies. These were the Department of Health and Human Services (DHHS) and the Centers for Medicare Medicaid Services (CMS).
The second and third stages of the meaningful use will also be established by the working group. The stage 2 criteria have already been suggested and will be put into consideration in 2014. However, the criteria for stage 3 will be dealt with at a later date.
Requirements
In terms of summary of the requirements of MU, there are three key requirements of the meaningful use that have already been adopted in stage one. To begin with, healthcare organizations and physicians are supposed to make use of the Electronic Health Records certified technology in an appropriate manner.
In other words, they should utilize the latter meaningfully. E-prescribing should also be included in this usage. Second, users ought to prove that they have the ability to make use of electronic health information in a collaborative manner through exchange programs so as to boost the quality of healthcare provision. Finally, they are expected to remit data on clinical quality measures.
Effects of meeting/not meeting the requirements
The effects of meeting or not meeting the MU requirements on healthcare organizations have also been documented in the provisions of the new law. Penalties are advanced towards healthcare organizations that fail to meet the meaningful use requirements. Since MU is an ongoing annual event, users are supposed to comply with all the provisions of the Act.
For instance, if meaningful use requirements are not met by healthcare organizations, medical reimbursements will be reduced accordingly within a given period. In spite of the fact that annual penalties will be implemented from 2015, the penalties will largely depend on the performance of the healthcare organization during the previous two calendar years.
However, the 2015 annual penalty can be avoided by a healthcare organization if the 2013 payment year is successfully addressed. In addition, healthcare organizations can avoid the 2016 penalties if they attain meaningful use in 2014.
Issues facing healthcare organizations and solutions
There are quite a number of issues facing healthcare organizations that demand immediate redress. First, poor quality healthcare delivery is a major challenge facing such organizations. It is imperative to note that healthcare industry is a highly dynamic field that requires constant checks and balances.
In order to deliver better value to healthcare recipients, value-based payment structures and the best innovative practices will have to be adopted by healthcare organizations in order to boost performance. In addition, premiums and administrative costs should be reduced significantly by insurers so that patients can afford to access high quality care.
Second, it is highly likely that usage will be hampered by the accompanying payments and increased deductions. In other terms, the rising cost of healthcare provision is grossly affecting the performance of healthcare organizations because consumers are deferring care. As a result, there is a resultant decline in income for healthcare organizations.
This reduction in revenue will have to be countered by the healthcare organizations. Besides, the effects of care deferral should be keenly monitored by both employers and insurers in order to assess the net loss especially in regards to the overall productivity and health of employees.
There is a sharp rise in demand for some medicinal products coupled with discontinued drugs and slow production process of vital medicines. These have negatively impacted the performance of healthcare organizations. Worse still, generic drugs have raised several issues regarding quality. As a consequence, drug shortage is a regular challenge to consumers.
Therefore, healthcare organizations can redeem their performance if FDA is given a heightened focus. Pharmaceutical companies and hospital units should also be keen on controlling quality, real-time inventory exercises and supply chain management.
Ramp up in the health informatics investments is also a growing issue of concern for healthcare organizations. As it stands now, huge investments have been made on health informatics by these organizations. This implies that additional expenditure on health informatics is an added financial burden for healthcare organizations.
There is a growing need for healthcare organizations to share vital data with like-minded organizations. In order to effectively manage the well-being of vulnerable populations, expedite the time taken by a product to reach the desired market, identify population health trends, coordinate patient care and improve the overall health outcomes, surplus investment in healthcare informatics will be the only viable option for healthcare organizations.
Privacy and security concerns in the operations of healthcare organizations are yet another challenge. Most healthcare consumers are hardly willing to share their personal information unless it will expedite the process of healthcare delivery. Some consumers argue that their choice of hospitals is largely determined by privacy and security issues. As a remedy to this challenge, healthcare organizations should guarantee consumers that their personal data will not be shared with other parties without their authorization.
Why some organizations do not meet the requirements
There are some organizations that are choosing not to meet the requirements and just bear the resultant penalties. As much as the various functionalities of the Meaningful Use are beneficial, some healthcare organizations have opted not to meet its requirements. They have identified potential demerits associated with the Act.
These include reduced privacy and security of health records, declined productivity, changes in the workflow, financial concerns, and other several unanticipated consequences. For instance, there are costs to be incurred in the adoption and implementation process of this technology. In addition, maintaining the technology demands additional expenditure. While executing the latter, loss of productivity leads to reduced earnings.
This eventually acts as a disincentive for healthcare institutions and employees. Training end-users, adoption of electronic charts, hardware and software installation as well as purchasing equipment are some of the direct costs incurred when adopting the electronic health records system.
In-patient and out-patient settings require these inputs in order to fully implement information technology in healthcare organizations. The associated cost of purchasing, installing and maintaining electronic health records system is a real scare for some healthcare organizations. As a matter of fact, the proposed penalties are far less than the cost of adopting the technology.
Health information technology and the Meaningful Use provisions have also been known to cause serious disruption of work in systems that have been fully established. Providers and medical staff can hardly concentrate on their work platforms due to the associated interruption occasioned by electronic health records.
This leads to short term drop in productivity. The main cause of this drop is the end user learning process because some personnel have to be trained before using the electronic health records systems. There are providers who perceive this limitation as a gross production setback because it takes both time and financial resources before an organization can resume its original position.
The penalties proposed by the new piece of legislation are minimal compared to the potential losses that a healthcare organization can undergo after implementing the requirements of the Act. Over-reliance in technology, power structure changes, negative emotions and increased medical errors are some of the unexpected negative impacts that may be caused by the adoption of electronic health records.