Category: Healthcare

Introduction

The State of Georgia (GA) is the ninth most populous American state and the third most populous southern state in the US. However, the health coverage in Georgia remains rather weak, particularly due to the state’s government refusing to proceed with the 2014 Medicaid expansion act, as well as due to the exit of several big insurance competitors from the market.

Current Health Care Delivery Structure

Georgia uses a federally-run health insurance exchange (Norris, 2017, para. 1). There are currently five carriers on the Georgian healthcare marketplace offering plans: Blue Cross Blue Shield of Georgia, Human, Kaiser Permanente, Ambetter from Peach State Health Plan, and Alliant. The only carrier that has a full coverage of the state, however, is the Blue Cross Blue Shield of Georgia, whereas the only area where all five choices are present in the Atlanta metro area (Norris, 2017, para. 15). During 2016, the number of people enrolled in private plans through the Georgia exchange was 587,845, which made Georgia fourth in the ranking of states with the highest enrollment among the Healthcare.gov users (Norris, 2017). The majority of registered people (almost 90%) in 2016 received premium subsidies – on average, about $290 per month, out of the effectuated enrollment cost of $478 (Norris, 2017).

However, given that there were nine carriers on the market in 2016, in 2017, there will be a noticeable reduction in health plans available, and their cost since less competition will allow the companies to raise their pricing. This might further affect the overall availability of health insurance to the population of Georgia, making health plans less affordable to the majority of people. The state’s health care accessibility rankings are already quite low: “The state ranked in the bottom 20 percent on 12 of 44 measures, faring worst in terms of uninsured adults (46th) and adults who went without care in the past year because of cost (50th)” (Dorsey, 2016, para. 5); however, given the state’s refusal to proceed with the expansion of Medicaid, which would make more people eligible to get free care, the decrease in the number of insurance providers could reduce the overall healthcare availability in the region even further.

Determinants of Market Power

The determinants of market power are different for insurance firms and healthcare providers. For instance, in the case with insurance providers, most employers embrace health insurance products with broad provider networks (Ginsburg, 2011, p. 1), so having a broad range of providers available in the insurance plan is one of the primary sources of market power for insurance firms. On the contrary, the main determinants of market power among healthcare providers in the plan generosity (Baker, Bundorf, & Kessler, 2015a) and the range of services provided – for instance, hospital ownership of physicians’ practices (Baker, Bundorf, & Kessler, 2015b). This can be justified by the fact that the two types of structures target different types of customers: for example, insurance firms mainly provide plans for corporate buyers who often value the accessibility of healthcare over its cost. In contrast, hospitals service individuals, who are more interested in the quality and range of service.

Competitive Forces in the Healthcare Industry

As shown above, the main competitive force in place in the healthcare industry is a competitive rivalry. The higher amount of competitors affects the pricing strategy of insurance providers, causing them to decrease the prices, while at the same time pressuring them into increasing the quality of customer care and the range of providers included. However, the sudden reduction in the number of providers at the end of 2016 also created a decrease in supply. Given that the demand remained the same, there will be less pressure on the insurance providers to keep their prices low and to enhance the quality of care. Another significant competitive force is the pressure of substitutes. The main substitutes for private insurance are government health plans, such as Medicare and Medicaid. However, given the state government’s decision to not expand its Medicaid provision, it is unlikely that this force will have a significant influence on private insurers in the next year.

Pros and Cons of HMO-Managed Care

Both from the provider’s and the patient’s point of view, HMO-managed care has its advantages and disadvantages. For example, the cost of such care for the patient is significantly lower than the cost of private insurance, which makes healthcare more affordable to a wide range of people. When the provider is governed by an HMO, it also means that the quality of care the patient receives will be higher than in other types of low-cost medical care. It is also not necessary to wait for the service to be authorized by an insurance company, which allows receiving care more quickly in case of an urgent need. On the other hand, though, managed care restricts its users to a single primary care provider, who is generally not authorized to provide specialized care. If the patient requires specialized care, it will be necessary to obtain a referral from the primary care provider before that type of care is arranged. Moreover, HMO-managed care does not cover medical treatment received outside of the pre-arranged network, except for emergency cases.

In the case with care providers, there are two main benefits of HMO-managed care: the reduction in competition and a stable flow of patients, both resulting from the fact that patients are tied to the provider, and in the case of health problems they will have no choice other than to go to that particular provider. The main disadvantages of this practice, though, are the increased control from HMO and the need to go through a complex credentialing procedure. The latter process is time-consuming and difficult for larger providers, whereas the control by an HMO is on-going and can be challenging for some workers and managers.

Incentives to Healthcare Providers

Two major types of incentives are available to medical care providers in Georgia. First, the Medicaid EHR Incentive Program provides incentive payments for the meaningful use of certified electronic health record technology by eligible providers (GDCH, 2012, p. 1). The aim of the program is to promote the correct use of electronic health record technologies to improve the efficiency of health care provision. Electronic health records allow quick access to the patient’s medical history, lab results, and other medical information through electronic technology. As a result, both patients and care providers can spend less time and effort on accessing the past information, which allows them to increase the efficiency of the medical institution’s operations, as well as to potentially transfer the data between the institutions to reduce the need for repeated tests and examinations. The incentive program is available to all kinds of providers, including physicians, nurse practitioners, certified nurse-midwives, and dentists (GDCH, 2012, p. 1). Incentives for eligible professionals are $ 21,250 in the first year and $8500 in every subsequent year, with a total of over $63,000 during the six years of the program.

This incentive program is quite useful, considering both the benefits of the EHR use and the financial incentives available to the participants. The payment amount will attract both large and small providers, introducing them to technology in the first year. The reduction of the payment amount in the subsequent years will not decrease the effectiveness of the program, as by this time the providers would have already discovered the non-financial benefits of using the EHR.

Another incentive program available to health providers relates to workforce development. This is one of the problem areas in the Georgia health system, as access to medical care in the countryside remains very limited. The program of Georgia’s Board for Physician Workforce aims to use incentive programs to motivate graduate medical specialists to work in the areas with lower healthcare access by helping them to pay their student loans (Sweeney, 2016, p. 8). The loan repayment program is available to 30 physicians a year, who can receive up to $100,000 during the four-year period (Sweeney, 2016, p. 8). However, this program is not nearly as effective as the EHR Incentive Program for several reasons. First, the payments only cover less than half of the total cost of medical school tuition. Given the fact that medical specialists working in the countryside are likely to be paid less than those working in large cities, covering half of the tuition costs is not enough to motivate them to stay working in the rural areas. Furthermore, the selected number of practitioners is not sufficient to promote a significant development of healthcare in rural areas. With 9 million of people scattered around Georgia’s 159 counties, 30 professionals will not have a significant influence on the availability of healthcare in the rural areas: once their student loan is paid, the participants might seek employment in regions with higher pay, and thus a permanent increase in the number of rural health practitioners will not be achieved.

Capitation Risks

Another method of improving the providers’ efficiency is the use of a capitation payment system. However, there are many financial risks associated with this system. For instance, if the volume of patients decreases, so will the provider’s pay. It is hard for the providers to estimate and evaluate all the risk factors that could influence the outcome in the same way that insurers do, which is why the financial risks should be addressed by the consumer-driven health plan itself – for instance, by providing fair compensation in case the patient number decreases due to reasons not related to service quality.

Conclusion

Overall, the health system of Georgia has some significant gaps that have to be addressed to improve the accessibility of healthcare and its coverage of the area. One of the crucial steps in achieving this would be accepting the Medicaid expansion, thus allowing access to affordable healthcare to a wider population. Addressing the issues in healthcare would help to increase the overall health of the people in the region and, consequently, their quality of life.

References

Baker, L. C., Bundorf, M. K., & Kessler, D. P. (2015). Does health plan generosity enhance hospital market power?NBER Working Paper No. 21513. Web.

Baker, L. C., Bundorf, M. K., & Kessler, D. P. (2015). The effect of hospital/physician integration on hospital choice?NBER Working Paper No. 21497. Web.

Dorsey, J. (2016). Georgia health insurance. Web.

Georgia Department of Community Health (GDCH) (2012). An overview of the Medicaid EHR incentive program. Web.

Ginsburg, P. B. (2011). Health care provider market power. Web.

Norris, L. (2017). Georgia marketplace history and news. Web.

Sweeney, T. (2016). Prescribing remedies for Georgia’s medical provider shortage. Georgia Budget & Policy Institute Report. Web.

Arranging competitive benefits in a health care organization is a crucial constituent of the organization’s success. Competitive advantage makes a facility establish unique features that the rivals cannot easily copy (Ginter, Duncan, & Swayne, 2013). Determining these distinctive elements presupposes a switch of the center of attention to reflective analysis and the internal environment. The best approach to assessing the ways in which facilities create value is the “organizational value chain” (Ginter et al., 2013).

Value-Based Care in a Health Care Facility

Value is interpreted as the degree of satisfaction obtained by patients in relation to the amount of money they spent on some health care service (Ginter et al., 2013). Thus, the value does not price alone. Rather, it is the connection between price and satisfaction. A value chain for a health care organization incorporates service delivery activities and support activities (Ginter et al., 2013). Service delivery measures are divided into pre-service, point-of-service, and after-service procedures. Support activities include organizational culture, structure, and strategic resources. The most important elements of service delivery activities are market research, determining the health care customers, suggested services, and pricing (Ginter et al., 2013). Although organizational culture and structure belong to support activities, they are crucial for sustaining a supportive atmosphere for the customers. Establishing a value chain makes a health care organization more competitive and provides it with a better place in the market.

Suggestions for Adding Value in Primary Care

To add value in primary care (PC) practice, it is necessary to come up with an integrated strategy for the complete range of PC operations (Porter, Pabo, & Lee, 2013). Porter et al. (2013) suggest a framework for adding value in PC which consists of five constituents:

1. PC needs to be arranged around groups of patients who have common needs;
2. Team-based duties should be performed for every patient group throughout its complete care period;
3. Effects and costs for every patient need to be estimated by groups as a conventional component of care;
4. Payment needs to be customized to accumulate reimbursement for every group and compensate for the advancement of value;
5. Teams working with PC patient groups need to be consolidated with the appropriate specialty providers (Porter et al., 2013).

For the successful implementation of this framework, it is necessary to outline the precise aims of it. In our case, the purpose is to enhance value for the customers (Porter et al., 2013). Value assessment is required to show the influence of modernizations and validate supplementary investments.

Another way of adding value to PC is the enhancement of electronic health records (EHRs) (Sinsky, Beasley, Simmons, & Baron, 2014). Currently, EHRs mostly serve as the doctors’ facilitators. Improvement of EHR will add value to the patients rather than merely concentrate on visits and payments (Sinsky et al., 2014). Ideally, EHRs should serve as communication tools for physicians and patients in PC settings.

Conclusion

Competitive advantage brings more opportunities for health care facilities’ success. One of the core elements of creating competitiveness is organizing value-based care in organizations. Adding value aims at improving the services performed by the health care workers and increases the probability of customers’ preference when choosing a facility. To add value in primary care, it is necessary to enhance the electronic health records and arrange care in groups of patients with similar needs.

References

Ginter, P. M., Duncan, W. J., & Swayne, L. E. (2013). Strategic management of health care organizations (7th ed.). San Francisco, CA: Jossey-Bass.

Porter, M. E., Pabo., E. A., & Lee, T. H. (2013). Redesigning primary care: a strategic vision to improve value by organizing around patients’ needs. Health Affairs, 32(3), 516-525.

Sinsky, C. A., Beasley, J. W., Simmons, G. E., & Baron, R. J. (2014). Electronic health records: design, implementation, and policy for higher-value primary care. Annals of Internal Medicine, 160(10), 727-728.

Introduction

Technological development is the greatest trigger of the changes that are being witnessed in the healthcare industry today. Advancement in technology has influenced the manufacture, distribution, and even administration of healthcare equipment and medicine. Professional and academic requirements for healthcare practitioners are also dependent on the current technology.

The medical world is now full of machines and bioengineered equipment that require a certain degree of technological proficiency to operate. Moreover, technology has also empowered customers to seek and access their healthcare rights and information. Customers can now use current technology to assess the credentials of medical practitioners.

Negligence and errors in medical treatment that were witnessed before the inception of modern technology have reduced. With this hint in mind, there is a need research more on the impact that technological advancement has had on healthcare. Besides, there is a call for further research on how such technological changes have altered healthcare education and labor requirements in the health sector.

The paper therefore provides a framework/plan for a case study final paper on this subject with four chapters each providing a detailed scrutiny of the issue under study. Primary sources such as statistical findings on the subject will be used in the research. Archival documents such as reports, government publications, responses, and reflections on the subject from different stakeholders will also be used.

Technology and the Cost of Healthcare

The first chapter will involve a literature search on the impact of technological changes on the cost of health care. The cost of healthcare has also risen in the past few years owing to the adoption of technological methods of treatment. In this chapter, the impact of technology on the healthcare financing will be evaluated using relevant literature detailing the same. Chaudhry et al. (2006) are some of the authors with significant work in this area whose work will be reviewed.

Medical technology is expensive and hence the high cost of medicine and medical services today. Modern technology has also been credited with the current increased level of accuracy in medical treatment. Cannon in his literary work provides details of the various ways that technology has aided in the compliance to medication for mental health patients (2000). This work will also be reviewed. Medical technology is however expensive.

According to Braun et al., this case has not complemented the shortage of medical staff (2013, 1). In fact, one would expect the healthcare sector to increase staff to seal the gap of the few medical tools (because of its high cost) in a bid to attend to a recommendable number of patients. Nagykaldi and Mold evaluated the role of health information technology on the translation of research into practice and managed to capture some of the limitations, with cost being a major factor (2007).

Teich et al. also duplicated the findings, with their study showing that cost limits the adoption of basic medical technologies (2000). The materials used to make medical equipment are costly. Medical equipment is made with materials that do not react with certain chemicals such as glass. Medical equipment and tools also call for high level of care when handling them.

Some modern machines such as the X-ray machines, physiotherapy machines, and life support machines require a high level of maintenance. Housing them also requires specialized facilities and continuous maintenance that is often expensive (Haddad, 2012, p. 149). Despite the costs, however, the technology has proven to be useful in medicine. According to Galas and Hood, medical schools and other health institutions also find it expensive to adapt to new technologies (2009, 4).

Megan McArdle suggests that “Healthcare costs are driven by technology, not Presidents” (McArdle, 2013). The author claims that the new act named ‘Obamacare’ has helped in reducing the expenses on health-care. The program has not been fully operative but by the reports that have come in so far the results are encouraging. The providers of health care started preparing for the actual launch of the program.

Figures 1 and 2 depict the expenses being incurred on health care. Figure 1 shows the top 10 items in terms of expenditure and the change in these expenses as compared to the previous year.

Among the top 10 supply items, IVD End Plate (increase of 0.8%), Cochlear implants (increase of 2%), and Spinal Cord Stimulator – Analgesic (increase of 4.5%) have registered an increase in their respective expenses.

Implantable pacemaker (decrease of 1.3%), CRT – P (decrease of 1.5%), Biological heart valve (decrease of 0.1%), Hip implant – Acetabular shell (decrease of 2.3%), Knee implant – Femoral (decrease of 9.3%), Shoulder implant – Humeral (decrease of2.6%), and Drug-eluting stents (decrease of 4.9%) have registered a decrease in their respective expenses as compared to the previous year (“Technology price index” 2013).

Figure 2 shows the change in the expenses in capital items since the previous year. Among the most expensive capital items used in health care are Angio, Cardiac Cath lab, CT Radiotherapy Simulation System, CT scanner, Digital Mammo, Digital X-Ray, Linac, MRI, PET/CT, and Radiosurgery.

Among the top ten capital items, only the following three have registered an increase in their expenses: CT Radiotherapy Simulation System (increase of 3.2%), Digital Mammo (increase of 14%), and Linac (increase of 18.7%). The rest of the capital items have shown a decrease in their expenses as compared to previous year (“Technology Price Index” 2013).

Growth and Development in the Healthcare Sector

This chapter will highlight some of the important milestones in the health sector in relation to health technology. Cannon and Allen state its usefulness in the medication compliance (2000). However, with the increased medical technology development, the government has also resulted to higher spending in the health sector (Bardhan & Thouin, 2012, 443). The benefits of the spending will be weighed against the efficacy of the technology in this chapter.

Chaudhry et al. evaluated the benefits over a ten-year period, with benefits being weighed against the costs of technology in healthcare (2006, 743). The growth in the industry will be evaluated in terms of mechanization and in the solid facilities housing the machines. According to Haddad, these have also seen significant developments (2012).

Most of the major technological developments in the health industry have been in the health information system, and this is commensurate with the global advances in information technology. The study by Nagykaldi and Mold will be important in this chapter to highlight these developments (2007). More people are in health insurance schemes, which make it easy for them to access modern health care.

This may be one way of making technology affordable to them. Some researchers have defines the medical costs in the industry (Teich et al., 2000). This work will also be evaluated here. The use of modern aircraft and medical ambulance boats has enabled faster rescue missions in case of a disaster.

Reproductive health has also benefitted from the emergency response (Somigliana et al., 2011, 1152). Such equipment is fitted with modern communication gadgets that enable quick medical response in case of an emergency. This has resulted in the expansive growth in the sector.

Due to the incessant developments in technologies, there have been numerous developments in all walks of life and health care is no exception. The healthcare services in the United States are probably the largest throughout the world. Russ Britt claims that “Health care due for big changes in 2014, not all from Obamacare: Study” (Britt, 2013).

It is reported that the insurance companies will have to bear the brunt of the new program, Obamacare. The ‘Affordable Care Act’ will bring about enormous changes in the healthcare industry. Britt further adds that “There are elements of the act that are spurring change, such as paying more for value than volume, and getting more coverage to people” (Britt, 2013).

The health care industry is moving forward to embrace cost saving, a phenomenon that has not been achieved till now. During the past couple of years, the medical inflation has been in double figures. It is encouraging to note that in the coming year, this rate is predicted at 4.5% (Britt, 2013). Everyone is now waiting with crossed fingers to see the results of the efforts of the Obama government.

Impacts of the Current Technology on Health Education and Labor Requirements

This chapter will deal with the relevance of technological advances in the health sector to the labor requirements and in health education. Modern technology and medical informatics are quickly taking over some of the traditional roles that were played by medical practitioners (Korzep, 2010, 354).

Teich et al. state that the availability of medical information on the internet means more patients are seeking treatment at an earlier stage of diseases. This case has propelled costs downwards (2000). Some of the other researchers’ work that also upholds this view will be evaluated such as Chaudhry et al. (2006). Procedures of treatment diseases are all over the internet pages. Therefore, in case of an error in treatment, medical practitioners quickly find themselves in court and eventually in jail for negligence and incompetence.

Despite the developments in the health technology, the medical practitioners remain the primary healthcare providers. Machines will not replace them any time soon. However, mechanization has led to the reduction in the number of personnel required to perform certain procedures as evidenced in some of the literary works to be reviewed (Nagykaldi & Mold, 2007; Haddad, 2012).

This will be discussed in this chapter in relation to the labor laws. Well-documented health records on computers are quickly replacing the period of bad handwriting of doctors (Dhillon, 2011, 397). Health database can now be retrieved from medical health data banks in most of the modern hospitals.

Although the presence of more informed patients will affect labor requirements in medical field, some of the roles will remain. Regardless of the point of prescription or diagnostics, the patients for surgery will still have to see a surgeon. However, the role of the medical doctor and the medical health practitioner are far from being downsized or replaced. Medical technology will result in the development of new jobs.

Training of medical practitioners will also become easier with technology. Technology comes with speedy changes. Therefore, practitioners will be forced to concessionary go back to college for more training and refresher courses.

For example, with the coming of personal genomics treatments, computerized systems will be used to select specific medicines for particular patients by their DNA. Such a move will necessitate the acquisition of particular computerized technology by health practitioners. Cannon and Allen detail some of the changes in the industry especially in the dispensing of drugs (2000).

The increase in cost on healthcare service depends mainly on the technology being used. Innovative technologies cost more and as such the health care service cost also increases. It is not necessary that all innovative technologies are effective for example, the innovations in the treatment of cancer have not yielded encouraging results but the cost has kept on increasing. Astonishingly, in comparison to the year 2010, the number of patients is expected to be doubled by the year 2014 (McArdle, 2013).

Sustainability of Health Technology

In this chapter, an evaluation of the sustainability of the existing health technology will be evaluated. Over time, smaller, better, and more sophisticated machines have always replaced most of the technological innovations in different fields. The health industry is no exception. Researchers are always looking for better interventions (Chaudhry et al., 2006).

In this section, a review of the likely changes will be done. Some of these are available in the recommendations of the research that will be reviewed (Cannon and Allen, 2000; Haddad, 2012). In their research, Nagykaldi and Mold state that technology is dynamic and will change in line with the prevailing innovations (2007). The sustainability of such changes and the existing technological milestones will therefore be reviewed in this section.

Reference List

Bardhan, Indranil, and Mark Thouin.”Health information technology and its impact on the quality and cost of healthcare delivery.” Decision Support Systems 55, no. 2 (May 2013): 438-449.

Braun, Rebecca, Caricia Catalani, Julian Wimbush, and Dennis Israelski. “Community Health Workers and Mobile Technology: A Systematic Review of the Literature.” Plos ONE 8, no. 6 (May 2013): 1-6.

Britt, Russ. 2013. “Health care due for big changes in 2014, not all from Obamacare: Study.” Web.

Cannon, Dale, and Allen Steveb. “Comparison of the effects of computer and manual reminders on compliance with a mental health clinical practice guideline.” Journal of the American Medical Informatics Association 7, no. 2 (May 2000):196-203.

Chaudhry, Basit, Wang Jerome, Wu Shinyi, Maglione Margaret, Mojica Walter, Roth Elizabeth, Morton Sally, and Shekelle Paul. “Systematic review: impact of health information technology on quality, efficiency, and cost of medical care.” Annals of Internal Medicine 12, no.144 (June 2006): 742-753.

Dhillon, Sigh. “Medical Equipment Reliability: a review, analysis methods, and improvement strategies.” International Journal of Reliability, Quality & Safety Engineering 18, no. 4 (June 2011): 391-403.

Galas, David, and Leroy Hood. “Systems Biology and Emerging Technologies Will Catalyze the Transition from Reactive Medicine to Predictive, Personalized, Preventive and Participatory (P4) Medicine.” Interdisciplinary Bio Central 1, no. 1 (March 2009): 1-4.

Haddad, Tamer. “The Applicability of Total Productive Maintenance for Healthcare Facilities: an Implementation Methodology.” International Journal of Business, Humanities and Technology 2, no. 2 (March 2012): 148.

Korzep, Karen. “The future of technology and the effect it may have on replacing human jobs.” Technology & Health Care 18, no. 4/5 (August 2010): 353-358.

McArdle, Megan. 2013. “Healthcare costs are driven by technology, not Presidents.” Web.

Nagykaldi, Zsolt, and Mold James. “The role of health information technology in the translation of research into practice: An Oklahoma Physicians Resource/Research Network (OKPRN) study.” Journal of the American Board of Family Medicine 2, no. 2 (June 2007): 188-195.

Somigliana, Edgardo, Alice Sabino, Richard Nkurunziza, Emmy Okello, Gianluca Quaglio, Peter Lochoro, Giovanni Putoto, and Fabio Manenti. “Ambulance service within a comprehensive intervention for reproductive health in remote settings: a cost-effective intervention.” Tropical Medicine & International Health 16, no. 9 (January 2011): 1151-1158.

“Technology price index.” Modernhealthcare.com. Last modified October 2013. Web.

Teich, Jonathan, Merchia Pankaj, Schmiz Jennifer, Kuperman Gilad, Spurr Cynthia, and Bates, David. “Effect of computerized physician order entry on prescribing practices.” Archives of Internal Medicine 1, no. 160 (June 2000): 2741-2747.

Introduction

Most consumers approach the purchase of the services rendered by certain healthcare in a manner similar to retail shopping. Therefore, most healthcare adapts to such retail-oriented pricing strategies in order to be a step ahead of their competitors. They have realized that consumers not only choose a health care service based on the price of the service but also the quality and level of such care. The purchasing decisions made by consumers are affected by the kinds of services healthcare offers. My pricing strategies will hence take into consideration the healthcare’s ability to command a significant market niche for our services (prices that will enormously attract customers). Besides, pricing is the most crucial profit determinant in the market (Feldman, 2002).

Features of Pricing Element

To start, price is the only revenue-producing element. Any other element in the market will only but represent incurred costs. Therefore, all healthcare should appropriately fix their price on the products they are offering.

Besides, price signifies the value and quantity of currency an organization charges for its product. In general, it represents the summation of values that customers exchange for using a product.

Price is considered as the most flexible factor among the set of elements in the market mix. This is to say that the prices of products are bound to change any time due to changes in discounts and allowances given to employees (Jones, 2003).

Errors Incorporated in the Pricing Strategies

Most healthcare organizations make mistakes when formulating and implementing pricing strategies. Such mistakes include cost-oriented pricing strategy, seldom revision of the formulated strategies in accordance to the market changes, unvaried prices based on the products as well as purchase occasions, and prices that partially encompass the whole marketing mix (Pesse, Erat, & Erat, 2006).

Pricing Strategies and the Costs Considerations

Taking a position in the market

The following are some of the pricing strategies that my healthcare will absorb during its pricing stage:

The low-price approach

We will focus on advancing low prices but cautiously sustaining margins on the average standards. To effect this, we will establish an advanced technology to dispense our services while being extra careful to maintain the optimal standards where enough capital will still be available to invest in other differentiating items (Pesse, Erat, & Erat, 2006).

The product-value approach

On the other hand, this strategy will be employed so as to increase as well as diversify the benefits our services will be generating. The strategy will target to meet the lifestyle expectations of most (if not all) consumers within their price brackets. My healthcare will leverage all of its service packagings to an affordable cost position.

The elite-value approach

Healthcare will avail products that are not readily found in the marketplace. This will be after we have identified products that are on high demand in the market and their corresponding profit margins. The target places include academic centers and urban settlements.

Once I identify my market position, I will come up with expectations that healthcare will work towards their achievement.

Product pricing

The strategy I will take in pricing my product will be aligned to delivering the identified market positions. My healthcare will adopt both tiered and basic product pricing strategies.

Tiered pricing

The level of the services we offer will determine the prices the consumers will pay. We will demonstrate the high level and quality services and ensure our customers perceive them as such. We will ensure we meet all standards necessary to be accredited and receive recognition as the best healthcare provider in the region. We will achieve this by valuing our customers highly, offering angel solutions and finally, being market neutral (Pesse, Erat, & Erat, 2006).

We will price our products with respect to the neutrality of the market so as to stand out as healthcare which provides services at a competitive coinsurance rate compared to other healthcare. To achieve this, we will offer services that are thought to be associated with minimal clinical risks.

We will deliver higher personal value so as to convince our customers why they should pay more. To achieve this, we will employ certified medical staff and go ahead to allocate personal physicians to our in-patients. We will also set higher customer satisfaction targets and ensure we work round the clock to implement them. We will then carry out research via questionnaires to find out how such scores are perceived (Titus, 2007).

For the angel solutions, we respond effectively to any arising severe diagnosis without being price-oriented.

Basic services pricing

We will apply different prices in different cases. As an expert, I know that an increase in the out-of-pocket deductibles will result in a shift of consumers to our competitors. We will always ensure we have a conversation strategy for customers diagnosed at risk so as to retain them, however the price of our services (Pesse, Erat, & Erat, 2006).

Conclusion

Therefore, we will employ certified medical staff and go ahead to allocate personal physicians to our in-patients.

References

Feldman, D. (2002). The Pricing Puzzle. Marketing Research, 14(4), 14-19.

Jones, J.D. (2003). Developing an effective generic prescription drug program. Benefits Quarterly, 19(1), 14-18.

Pesse, M., Erat, P., & Erat, A. (2006). The Network is the Customer: Setting the Stage for Fundamental Change in Pharmaceutical Sales and Marketing. Journal of Medical Marketing, 6, 165 – 171.

Titus, F. (2007). Price transparency’s role in healthcare purchasing reform. Frontiers of Health Services Management, 23(3), 29-31.

Executive Summary

Indian reservations are designated areas for the Native Americans (Indian American and Alaska Natives). The areas were designated through an executive order after the natives surrendered their lands and this entitled them to free health care service under the Indian Health Care system.

The Indian Healthcare System has been facing a major challenge and that is chronic underfunding. This health care system has been underfunded for a long time that even if the government was to increase the budget it cannot adequately address the healthcare needs of the Indian Americans. The chronic underfunding has not only made health care service under this system inaccessible but also inadequate to the natives living on reservations.

This is a complete contrast to the federal health care system. Therefore, the U.S government must consider changing the mechanism of funding Indian Health Care System from a discretionary program to mandatory appropriation whose budget is reviewed annually.

Introduction

Overview

American Indian reservations are designated land areas that are under the Native Americans (Castle and Robert 2). There are approximately Indian reservations in the U.S according to the U.S Department of Internal Affairs. This means that not all the 500 plus recognized tribes are under the reservation or share reservations (Frantz, 5).

Indian reservations were established in the early 1850s after the passing of the appropriation bill and the executive order which allowed for the creation of reservations for the Native Americans. The reservations were fronted as solutions to the brewing conflict between the natives and the settlers. The former were increasingly encroaching into the native’s territory (Castle and Robert 3).

The Indian reservation policy became contentious just from the beginning. These reservations were set up through an executive order which forced white settlers to surrender their lands and the natives forced into the reservation areas. The white settlers strongly opposed this policy (Frantz, 7).

On the other hand, numerous reports submitted to the U.S federal government revealed massive corruption among those who were in charge of resettling the Native Indians into the reservation areas. In addition, the relocated tribes were living in poor and deplorable conditions compared to the white settlers (Castle and Robert 3).

The reservations led to the increased alienation of Native Americans by the white settlers and other non-natives. The controversies surrounding India reservations have continued up to date and they encompass various aspects including socio-economic, cultural and environmental dimensions (Frantz, 8).

The quality of life within a number of these reservations is similar to developing economies. The infant mortality rate is high, life expectancy is low compared to the rest of the country, nutrition is poor, and the level of poverty is alarming. Some of the Indian reservations, for instance, South Dakota and Shannon County are among the poorest in the U.S (Frantz, 9).

Report Purpose

According to many studies in the U.S, the highest numbers of the poor are found in the urban slums dominated by African-Americans (also known as ghettos). The second highest numbers are found in the reservation areas predominantly occupied by the Indian Americans or the Native Americans. The infrastructure and social amenities in both the ghetto and reservation areas are arguably poor.

In addition, the mortality rate (especially infant mortality) is relatively high coupled with low life expectancy. These are mainly attributed to the healthcare system in these areas. The purpose of this study is to explore the health care system on Indian reservations and compare it with the healthcare system of white Americans.

General Status of the Native Americans

The Native Americans here are the Indian Americans and Alaska Natives. About 1.5 percent of the total U.S population identifies themselves as having Native American heritage. Currently, most of these people live in urban, suburban or non-reservation countryside areas. Only a third lives in the reservation areas.

In the last three decades, most of the American Indians and Alaska Natives have migrated to metropolitan areas. The federal government recognizes about 564 American Indian and Alaska Native tribes. The native tribes have incredible cultural diversity and speak over 200 languages. (Graham 12).

Majority of the Indian Americans and Alaska Natives live in poverty. According to the statistics, more than twice as many American Indians and Alaska Natives live in poverty compared to the rest of the American population. In other words, the general level of poverty in the U.S is estimated to be about 12 percent.

On the other hand, the poor American Indians and Alaska Natives are approximately 26 percent of the total number of Native Americans (Graham 14). The life expectancy of Native Americans is also low. The life expectancy of the American Indian and Alaska Natives are 6 years lower than the average American. The mortality rate among infants is also high compared to the rest of the American population (Singer 5).

Indian Health Care System

The two main links between the federal government and the Native Indians are the Department of Indian Affairs and the Indian Health Service. The Indian healthcare system is a wide organizational structure that encompasses services that are offered directly by the federal IHS, tribal programs, and metropolitan Indian clinics.

The Indian Health Care System is normally considered as prepaid because of the land surrendered by the tribes in 800 consented agreements and government executive orders. Therefore, Indians living in reservation areas are not supposed to be charged health care services (Graham 15).

The provision of healthcare for Native Americans falls under the federal trust responsibility of the U.S supreme law. The U.S constitution recognizes the government’s obligation to the Indian tribal governments or Indian Americans living on reservations.

Given the constitutional recognition of the state obligation to the tribal government, there has been mutual respect between the two governments and they are working together on a culturally sound health care system. However, the major deficiency of this system is the persistent underfunding of the state (Institute of Medicine 4).

Unlike other federal health care systems, the Indian Health Care System depends on discretional appropriations from the government budget. The funds are insufficient and can only meet 60 percent of the need. Approximately a quarter of the Indian Health Care System (IHS) clinical service budget originates from the Medicaid, whereas less than one percent of the Medicaid expenditure goes to the IHS (Graham 15).

Any individual who is an offspring of a Native American qualifies under this system. Slightly over 1.9 million Native Americans meet these requirements and about 1.65 million are regular users of the Indian Health Care System (US Census 3).

The Indian healthcare system is comprised of 50 hospitals, approximately 250 healthcare center, 5 referral hospitals, 300 health stations, and 34 metropolitan clinics, in addition to satellite clinics and community health center (US Census 3). Access to crucial, specialized, and emergency services and long term care are restricted by geographical factors and persistent underfunding.

Additional budget cuts may result in further rationing of the healthcare services in these hospitals. Given the fact that Indian Health Care Programs are comparatively ambiguous and are small in size, the consequences of the budget cuts have often gone unnoticed or ignored by the policymakers (Institute of Medicine 9).

Even though the federal government has always supported the Indian Healthcare System since the early 1850s, the health status of the Native Americans has continued to worsen compared to Average Americans.

This is attributed to chronic underfunding from the federal government, high level of poverty among the Native Americans, high illiteracy level, poor housing, and poor transport system. The most common ailments among the natives are obesity and diabetes. This is shocking since these diseases can be prevented or cured (Graham 17).

Indian Health Care System versus the White Health Care System

Most of the Non-native whites in the U.S have health insurance cover compared to the Indian Americans and Alaska Natives. According to the U.S. National Institute of Medicine, the uninsured Americans including the Native Americans can only access half of the medical care available to the insured whites.

The Indian Health Service is discretional and has a low budget. This means that it is inadequate (rationed) and inaccessible to the majority of Native Americans. On the other hand, the enormous budget is allocated to the white healthcare system because of their contribution.

The white healthcare system has adequate facilities and infrastructure. In addition, given the fact that most white non-native Americans are medically insured they have full access to health services in these facilities (Institute of Medicine 13).

Civil rights activists view the low budgetary allocation and rationed health care services for the Native Americans as blatant discrimination (Institute of Medicine 13). The Civil Rights Commission’s 2004 report compared Indian Health Care System and Health Cares Systems including the Medicare, Medicaid, federal prisoners, and veteran healthcare service among others.

The report established the health care system for the Native Americans was far way below the federal medical programs. One of the shocking revelations on that report was the fact that the Indian Healthcare Service per capita appropriation in 2003 was half the amount of the federal per capita allocation of the federal prisoners (Institute of Medicine 6).

Another shocking revelation was the fact U.S government had spent billions of dollars to build more health facilities and to provide health care services in Iraq at the expense of doing the same for the Native Americans. Singer compares the healthcare facilities for American Natives living on reservations to those of third world countries (Singer 3).

He adds that the disparity of the Indian Healthcare System and the federal health care system reached a crisis level and the consequences to the American Natives are gross. The shocking disparity is evident in the health of the Native Americans and the White non-natives.

The American Indians are 720 percent of succumbing to alcohol-related causes than white Americans. They are also 650 percent and 420 percent more likely to succumb to tuberculosis and diabetes respectively than whites (Singer 9).

The Indian American population has a higher probability of contracting dental carries due to inaccessible dental care. In addition, the number of Indian Americans with Dental Caries is three times higher than the whites.

This statistic reveals the growing disparity between the White Healthcare system and India Health care system which is basically broken. Therefore, the U.S government faces major and intricate challenges in ensuring a world-class health care system for all (Singer 10).

Reasons for the Disparity

U.S economists and medical experts argue that the solution to the disparity between the two medical systems goes beyond the budgetary allocation. They stress that there is no quick remedy for this problem since the factors that have caused the disparity are complex and interrelated.

Due to poverty, Indian Americans are less probable to have health insurance or a personal doctor, making regular visits less probable. Many of the individuals who don’t have health insurance in the U.S have no choice or power over the kind of medical service they receive. In addition, the poor living conditions facing most Indian Americans do expose them to many health hazards.

The current financial crisis facing the U.S and the rest of the world has limited the ability of the federal government to increase to improve its health care system. In addition, the growing population and increased cost of health care is also contributing to a huge gap between the required health care service and the available healthcare service (Devi 11).

However, the healthcare budget for the Indian Healthcare System has been growing at a slower rate than other federal healthcare budgets. Even with the Amendment of the Indian Health Care law in 1979, health care service for Indian Americans and Alaska Natives still remains substandard three decades later. Congress has failed to tremendously in enforcing the amendments (Institute of Medicine 12).

Human rights activists state that the disparity existing between the Indian Health Care system and the federal healthcare system violates the very American principle of justice and equity. Many Native Americans have lost their lives as a result of the broken health care system that keeps getting worse with time (Graham 17).

The U.S Congress has become so used to the chronic underfunding of the Indian Healthcare System to an extent that they are failing to recognize the consequences or the tragedy facing the Native Americans as a result of their actions. Some argue that the tragedy caused by these persistent budget cuts has grown so big that they are afraid of tackling them. Nonetheless, the U.S government can afford to renege on its responsibility (Devi 7).

Conclusion

The Indian Healthcare System was established in the early 1850s to cater for the Native Americans. Most of the Natives Americans live in poor conditions which are comparable to those that exist in developing economies. The Indian Health Care System is free of charge and is as a result of a treaty signed between the Natives and the federal government for surrendering their tribal land.

However, the problem with this system is that it has persistently been underfunded by the federal government. The chronic underfunding has led to inaccessible and inadequate health care services to the Natives. On the other hand, the Healthcare System for White Americans is the opposite of the Indian Health Care system.

They enjoy huge budgetary allocations and provide adequate medical care to all the patients. The disparity between the two systems is evident in the general health status of the Indian Americans and the Alaska Natives compared to the whites. The latter has a low life expectancy and a high mortality rate.

Works Cited

Castle, George P., and Robert L. Bee. State and Reservation: New Perspectives on Federal Indian Policy. Ed., Tucson: University of Arizona Press, 1992. Print.

Devi, Sridhar. Inequality in the United States Healthcare System, Oxford; UNDP, 2005. Print.

Frantz, Klaus. Indian Reservations in the United States, Chicago: University of Chicago Press, 1999. Print.

Graham, Katherine. A National Roundtable on the Indian Health System and Medicaid Reforms, Washington, DC: Urban Institute, 2005. Print.

Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, Washington, DC: National Academies Press, 2002. Print.

Singer, Michelle J. Health Care Disparities and the Native American Community, Washington, DC: U.S. Department of Health and Human Services, 2005. Print.

US Census. American Indian, Alaska Native Tables from the Statistical Abstract of the United States: 2004‐2005. PDF file. 02 Dec. 2012. www.census.gov/statab/www/sa04aian.pdf >.

Despite the fact that cholera is no longer the plague of the humankind, it still remains a tangible threat, no matter how hard one might wish to believe that the disease was fatal only in the 19^th century. True, a range of methods for preventing cholera epidemics have been developed since then, including a range of vaccines, development of basic hygiene principles, etc.

The disease itself, however, did not vanish without a trace – the instances of cholera still occur, and, to prevent lethal cases triggered by the disease, a range of guidelines have been designed for healthcare organizations to protect people from contracting a virus of cholera (Schlipköter & Flahault, 2010).

When it comes to mentioning major organizations, which provide detailed recommendations on preventing outbreaks of cholera, one must mention the World health Organization as the leader in securing people from cholera. Indeed, according to the official statement of the WHO, a range of steps used to address the early stages of the cholera epidemics outbreak have been designed for the subordinate organizations to comply with.

The WHO demands that notifications should be sent by the health authorities that have spotted the symptoms of cholera: “Under the terms of the International Health Regulations of 1969, cholera is one of three diseases for which it is mandatory to notify the World Health Organization” (WHO, n. d., p. 11).

Other organizations, though following the WHO standards for the most part, have been provided with a specific set of actions to be undertaken apart from sending notifications to the WHO. Moreover, numerous organizations have defined their own pattern of addressing the problem based on the requirements listed by the WHO.

For example, the Pan American Health Organization mentions the necessity for the control of the water sanitation process to be carried out by the corresponding services so that the threat of cholera epidemics could be driven to nil (CSIS, 2013, p. 6).

In addition to the regulations designed by the WHO, the members of the UNICEF Organization have also provided their rules and guidelines on the course of actions for an organization to follow in case of an outbreak of cholera epidemics.

Unlike the WHO, which provides rather brief guidelines for organizations to act in case of epidemics of cholera, UNICEF focuses much more on providing citizens with the safety that they need and instructing them on what must be done if an outbreak of cholera occurs.

More importantly, the UNICEF Organization specifies the precaution measures that must be taken in order to void cholera epidemics; these measures include specific guidelines concerning personal hygiene and sanitation.

In addition, the UNICEF Organization explains how the isolation of the people that have contracted cholera must be carried out (UNICEF, 2012, p. 26). Finally and most importantly, the UNICEF Organization outlines the course of actions for community engagement, which is bound to reduce the possibility of cholera epidemics.

Comparing the regulations defined by two major health organizations, one must give UNICEF credit for offering an incredibly detailed set of recommendations and rules. The members of the UNICEF have taken every minor detail into account and have provided all the rules required, including the burial procedure.

In addition, the information provided by UNICEF includes the information on the possible causes of the epidemics, such as water contamination (UNICEF, 2012, p. 24). Therefore, out of the three major sets of recommendations, the ones provided by UNICEF are clearly superior in clarity and efficiency and can be used as the basic guidelines in case of a cholera outbreak.

Reference List

CSIS (2013). Water and sanitation in the time of cholera. Web.

Schlipköter, U. & Flahault, A. (2010). Communicable diseases: achievements and challenges for public health. Public Health Reviews, 32(1), 90-119.

UNICEF (2012). Cholera outbreak guidelines. Web.

WHO (n. d.). Guidelines for cholera control. Web.

Is Universal Healthcare right for America?

Even with the introduction of Medicare program in the United States, the debate for and against universal and comprehensive healthcare still rages on in the country. Against the backdrop of the many discussions in the globe, the right to access medical care regardless of one’s socio-economic status in the society became one of the most important issues. Many governments are charged with the facilitation of access to all citizens.

However, for a long time, many healthcare systems have been run on a capitalistic arrangement where an individual in need pays for the services provided according to market rates. This system has, however, been accused of locking out millions of households from middle and low income earning categories, who are not able to afford proper medical care for some medical procedures.

For governments, a healthy nation directly relates to a healthy economy where there is enough human resources and reduced expenditure on health infrastructure. In many cases, the rich have been able to access modern healthcare facilities while poor families continue to lose their loved ones because of affordability and accessibility issues.

As a result, the reactions for many governments have resorted to the formulation of policies and guidelines to facilitate fast, affordable and easy access for all (Pozgar, 2012). A universal healthcare framework is one such model that has been adopted globally.

However, for effective implementation, there have been challenges for healthcare organisations, professionals, administrators and for patients. This paper looks at the impacts of universal healthcare on the different stakeholders in the sector and provides recommendations for future improvement.

Universal Healthcare

Universal healthcare basically refers to the facilitation of basic healthcare services to residents of a particular region or country. Generally, this arrangement involves the provision of healthcare insurance and payment of healthcare costs by the government and other private institutions within an arrangement where the patients do not have to pay directly from their pockets.

Within a national establishment, universal healthcare may therefore involve the taxation of all citizens, combined with health insurance coverage that eventually caters for the costs of medical care when required. The government is also charged with the facilitation of universal care through policy formulation, regulation and providing mandate to all care providers.

In some forms of arrangement, popularly referred to as ‘single payer health insurance’, the government is only involved in financing of healthcare, while healthcare institutions are charged with service delivery.

Under the Affordable Care Act of 2010, the United States’ government has adopted the concept of universal healthcare that came into force in 2014 (Murray & Frenk, 2010). It is notable that by the time of adoption, the US was the only developed nation that did not have this kind of arrangement for its citizens.

However, the program did not come into the societal limelight recently as the legislation process may suggest. Calls for universal health coverage began in the early 1900’s, but legislation and adoption has seemingly dragged on, because the adoption of universal healthcare has its own challenges across the board that has led to intense debates.

Effective implementation of universal healthcare has numerous impacts on health professionals and organisations as outlined in the following section.

Impacts on Healthcare Professionals and Healthcare Organisations

The impact of universal healthcare on professionals and organisations in the sector are numerous. However, major impacts will be felt in the areas of financing, facility capacity building, personnel workload and regulatory requirements. First, funding is important for the success of any healthcare institution, be it for profit or not for profit.

Within the universal healthcare framework, there might be cash flow problems for hospitals that have to provide care and seek compensation from the insurance companies or the government depending on the arrangement. In most cases, the process of cost reimbursement may take some time.

Without proper management of finances within healthcare institutions, therefore, there might be many risks attached to insufficient supplies and late payment of health workers.

Secondly, capacity development plans for many healthcare organisations will remain highly effected. Universal healthcare improves access for the previously ‘locked out’ populations. As a result, there is a likelihood of increased numbers for the out and in-patient hospital sections. To be able to take care of this boom, hospitals will have to increase their capacity without compromising on the quality of care.

This may present a bigger challenge if financial management in the hospitals is not effectively enhanced. However, there are also opportunities for hospitals if the numbers are going to translate into improved financial performance hence increased expansion. The healthcare professionals like nurses may also expect improved pay structures.

On the other hand, increased number of patients is likely to result in issues of personnel workload. When the already overburdened healthcare professionals receive large number of patients in the wards and clinics, there is a need for increased personnel. Just like in the expansion of space and facilities, this is another area that is likely to negatively impact healthcare professionals and organisations if not effectively planned.

Lastly, regulatory requirements of the new healthcare act have new professions for access to quality care that may require change within healthcare organisations. The healthcare professionals will also need to acquaint themselves with the new requirements. For instance, every organisation must understand the procedures for claims and reimbursements for the different medical insurance plans.

Impacts on Patients and Families

Even though universal healthcare holds a big promise to patients and their families, the impact on the new system for this category must be noted. Generally, issues of access, quality, taxation and technical knowledge are most critical for this group of stakeholders. On a positive note, the impact of universal healthcare on access can be tremendous provided organisations effectively align to the required changes.

Patients from all forms of social and economic backgrounds will be provided with easy access to modern care facilities that they could not previously afford. This is a good step in the right direction for the US, since all citizens and particularly from the poor families will be assured of their right to live a healthy life.

For many families who have had to spend the little money they have on seeking treatment for chronic illnesses like heart disease, diabetes and cancer, this provides a lifeline for economic and social empowerment.

However, increased access raises an issue of quality of care within the participating healthcare organisations. In the event that poor management in such organisation results in overstretched capacity, the quality of care might be compromised at the expense of patients and their families. Any slight negative impact on quality of care may be against the main aim of universal healthcare in the country that many families have yearned for.

Another issue raised by the opponents of this program is that of taxation. The impact of facilitating this program on national economy may be damaging if not properly managed. Generally, when the government chooses to increase taxation to help in the funding of this program, families already living in tough economic times may be adversely affected.

Lastly, the issue of technical knowledge required for decision making is very important for the patients and the families. Many poor families may not have the literacy levels required to select the suitable medical plans for their households. Given that private and profit making institutions are involved in the program, the impact on choice of medical cover may be negative if proper guidance is not provided for families.

However, the mentioned impacts may not necessarily mean that universal healthcare may not be viable for the United States. There are numerous case examples that may be used to indicate the benefits of this program and how the many challenges associated to it may be overcome.

Critical Analysis

As stated earlier, many governments have strived to provide universal healthcare access to their citizens globally. The Netherlands, Germany and Singapore are examples of developed nations that have successful universal healthcare programs for their citizens (Hooe, Considine & Sethi, 2013).

The Asian nation can however be a better case for highlighting the importance of universal care programs. With a fast growing population, the economic powerhouse in the Asian continent still recorded higher rates of infant mortality and other deaths associated with venerable diseases like malaria. The rural populace in the country, mostly low-income earners, were the most affected.

However, the adoption of a single pay health insurance system for its population, the country has made enormous gains in the healthcare sector that may be a model for many countries.

As a result of the comprehensive medical care implemented by the government in collaboration with healthcare organisations and professionals, the life expectancy rates in the country have significantly improved similarly to the declining infant mortality rates. From this case, it is easy to connect the healthy population with the country’s booming economy.

Significance to the Practice of Healthcare Administration

Universal healthcare can only be achieved with proper management as already pointed out in the discussions. The implementation of universal healthcare programs provides challenges as well as opportunities for healthcare administrators. Universal healthcare has great implications for healthcare administration practice.

First, there is need for effective change management that should begin from administrative levels (Shi & Singh, 2012). For all departments and personnel to effectively implement universal care and take advantages of growth opportunities presented by it, administrators must be ready to initiate change.

Secondly, risk management is an essential part of health organisations’ success in the new universal care system. For administrators, the challenge for effective risk management is of great significance to performance, because the financial inflexibility that may be brought within the transitional period has far reaching implications for growth.

Third, quality assurance has been identified as another area of challenge for the universal healthcare program implementation. Administrators are also required to effectively co-ordinate departments and cross functional activities to ensure that success for all mentioned areas is attained. The benefits of universal healthcare present huge opportunities for administrators in the sector.

Most importantly, administrators are presented with the opportunity to attain the goal of providing healthcare to all individuals regardless of their cultural, social or economic backgrounds. In addition, administrators also have an opportunity to collaborate with their counterparts in other organisations to ensure that they comply with the requirements of the new system.

Recommendations

Having examined the benefits of universal healthcare, it is easy to conclude that the US needs the system. Given the success story noted from the selected case, the challenges identified may be eliminated in many ways. First, there is need for training of all administrators and personnel on the legal, economic and social implications of the newly implemented system.

Training will also help professionals provide guidance and advice to the illiterate individuals who may not be able to choose suitable healthcare plans for their families.

Secondly, the government and other sector stakeholders should engage in frequent policy restructuring to ensure smooth implementation, because universal healthcare relies on particular regional and institutional factors like geographical and demographic dynamics (Savedoff, de Ferranti, Smith & Fan, 2012).

The mode and nature of care for different individuals should also be clearly defined to avoid cases of congestion in hospitals. Next, it is important that healthcare organisations plan for financial risk protection through access to other sources of financing while reimbursements are forthcoming.

In this way, operations are likely to run without hitches pegged on capacity and resource availability. Lastly, community sensitisation programs should continue to be carried out to ensure that all citizens are aware of their rights of access and the available avenues for doing so.

References

Hooe, B. S., Considine, P. T., & Sethi, M. K. (2013). National healthcare systems: A worldview. New York: Springer.

Murray, C. J., & Frenk, J. (2010). Ranking 37th—measuring the performance of the US health care system. New England Journal of Medicine, 362(2), 98-99.

Pozgar, G. (2012). Legal aspects of health care administration. Sudbury, MA: Jones & Bartlett Publishers.

Savedoff, W. D., de Ferranti, D., Smith, A. L., & Fan, V. (2012). Political and economic aspects of the transition to universal health coverage. The Lancet, 380(9845), 924-932.

Shi, L., & Singh, D. A. (2012). Essentials of the US health care system. Sudbury, MA: Jones & Bartlett Publishers.

Project Summary

Currently, New York Methodist Hospital is in the process of merging with Columbia University Medical Center (Columbia Presbyterian Hospital). The complex change project also includes the step of developing a preceptorship preparation class in order to train those nurses who want to become preceptors. The purpose of this paper is to summarize the project and discuss its contribution to the nursing profession.

Synthesis

The problem that has been identified as important with the focus on the nursing practice in New York Methodist Hospital is the lack of preceptorship skills in those professionals who are selected as preceptors and mentors among the most experienced nurses in the organization. It has been found that being selected because of their experience, these nurses have no adequate training as preceptors, and they experience problems with organizing their work and communication with novice nurses. The solution to this problem and the proposed intervention is the development of a preceptorship preparation class (Donley et al., 2014). In January of 2017, the group of specialists working at New York Methodist Hospital and Columbia University Medical Center will continue to develop the curriculum for the class. It is expected that preceptors will be selected with reference to their degree (Bachelor of Science in Nursing) and willingness to become a preceptor (Duteau, 2012; Watson, Raffin-Bouchal, Melnick, & Whyte, 2012). The work of the preceptorship class and participation of nurses in this program will be sponsored by the organization.

It has been found that the theory that is most appropriate to implement the intervention is Kurt Lewin’s theory of change. As a result, during the unfreezing stage, the representatives of a project team are expected to recognize the need for change (Shirey, 2013). This stage has been completed recently. The second stage is moving, and it is based on developing a detailed plan of action and the curriculum for the program. This stage is planned to be completed in January of 2017. At the stage of refreezing, the work of the preceptorship preparation class will be analyzed and reflected in the organization’s policies. At the final step of the moving stage, it is also important to conduct the evaluation of the project results with the help of questionnaires and protocols developed for administrators, instructors, trained preceptors, and preceptees.

Contribution to the Nursing Profession

The contribution of the project to the nursing profession is in accentuating the necessity of developing preceptorship programs in healthcare organizations in order to guarantee the continuous education of nurses and the improvement of their practical skills (Price, 2014). As a result, there are benefits for nursing education and administration of preceptors’ work, as well as for their cooperation with preceptees. The project emphasizes the need for uniting theoretical and practical elements in preceptor education with the focus on explaining the role of a preceptor in the context of her or his professional tasks. The organization of preceptorship classes in healthcare facilities guarantees that preceptors will improve their skills in training novice nurses and this approach will contribute to organizing the work of experienced nurses, as well as improving their time management (Shinners, Mallory, & Franqueiro, 2013). Furthermore, it is possible to expect positive changes in the communication between preceptors and preceptees, increased levels of retention among novice nurses, and improved patient safety and quality of care.

Conclusion

The paper has presented the summary of the project and analysis of its contribution to nursing education and practice. The proposed intervention is the development of a preceptorship preparation class in the selected healthcare facility. The final stages of the project are planned to be completed in January and February of 2017.

References

Donley, R., Flaherty, M., Sarsfield, E., Burkhard, A., O’Brien, S., & Anderson, K. (2014). Graduate clinical nurse preceptors: Implications for improved intra-professional collaboration. The Online Journal of Issues in Nursing, 19(3), 34-38. Web.

Duteau, J. (2012). Making a difference: The value of preceptorship programs in nursing education. The Journal of Continuing Education in Nursing, 43(1), 37-43. Web.

Price, B. (2014). Preceptorship of nurses in the community. Primary Health Care, 24(4), 36-41. Web.

Shinners, J., Mallory, C., & Franqueiro, T. (2013). Preceptorship today: Moving toward excellence. The Journal of Continuing Education in Nursing, 44(11), 482-483. Web.

Shirey, M. R. (2013). Lewin’s theory of planned change as a strategic resource. Journal of Nursing Administration, 43(2), 69-72. Web.

Watson, L. C., Raffin-Bouchal, S., Melnick, A., & Whyte, D. (2012). Designing and implementing an ambulatory oncology nursing peer preceptorship program: Using grounded theory research to guide program development. Nursing Research and Practice, 2012(1), 1-15. Web.

Private sector

According to Dr. Wilson, the private sector, which consists of insurance companies, health plans, pharmaceutical and device manufacturers, has a critical responsibility in the healthcare system reforms. These stakeholders offer products and services that have direct impacts on lives and health of patients.

Wilson recognizes that these stakeholders have responsibilities beyond business in the healthcare system reform. Hence, they must engage in transparent practices and develop products and services that focus on patient needs rather than market and profit driven.

Government

Elected leaders have curtailed possible reforms in the healthcare sector because of constant bickering. Consequently, it is difficult for any meaningful policy decision or suggestions to be debated.

Wilson notes that elected leaders should have legislation and regulation frameworks to serve the public effectively. Hence, they must overcome partisan tendencies, accommodate and understand diverse views across political divides. It is necessary for public officials to remember that they represent the interests of the public and must act as required by public duty.

Business

Wilson acknowledges that businesses should invest in health of their employees for long-term benefits. Such investments should go beyond providing insurance to encourage healthier lifestyles among employees.

It is therefore imperative for both large and small employers to take keen interests in health of their workforce. Employers should promote healthier habits and practical solutions such as helping employees to quit smoking, offering gym membership and providing healthier diet options.

Potential outcomes will offer both physical and financial rewards. Healthier employees reduce cases of absenteeism related to health issues, obesity, diabetes, cancer and related costly medical bills for managing chronic conditions.

This prescription is effective for external stakeholders to support the ongoing healthcare system reform. It clearly defines how different stakeholders can play their parts to enhance healthcare system reforms in the US. The prescription not only identifies stakeholders, but also highlights specific areas of concerns that require their inputs. Various studies and reports have recognized contributions of different external stakeholders in healthcare system delivery and reforms, and Wilson highlights these issues well.

Patients

Healthcare system reform is all about patients. Wilson argues that patients must educate and empower themselves. Patients must take personal responsibilities to understand the type of healthcare they get.

Patients should make vital health decisions. For instance, families should have insurance, personal physicians and writing preferred end-of-life care. Patients have responsibilities to protect themselves from several preventable diseases. They need to adopt healthier behaviors. Patients must understand that individual health and well-being are critical personal assets and they should not be wasted.

Medical students

Although medical students have just begun their careers, they have to understand what the practice entails. While the healthcare system requires massive reforms, its tradition has been always defined by excellence and it is as strong as ever. American physicians have revolutionized healthcare delivery, medical knowledge and care provision.

Medical students must understand that the profession is incredibly fulfilling. They heal, comfort and relieve patients’ suffering. Hence, it is a great trust and privilege bestowed upon physicians. Medical students will derive such sense of gratification throughout their practice. The ultimate goal is to help patients.

Wilson wants medical students to listen to their patients because patients understand their problems and could offer possible diagnoses too.

Medical students should join medical associations, including AMA. They need to get involved with “organized medicine and take part in leadership in order to influence healthcare reform policies that affect education and future the profession”.

Physicians

Wilson also offers prescription for fellow physicians. He urges physicians to view healthcare system reform as a challenge and a source of tremendous opportunity for all. Wilson urges physicians to support different medical associations because they are the only means through which physicians can address their challenges and provide the required efforts to support provision of effective care to patients.

Wilson looks forward to undivided physicians’ body. There is a need for collaboration among physicians to limit the current differences and support each other. Wilson, as the president of AMA, promises to do what it takes to ensure unity among physicians.

Wilson’s prescription is essential for the ongoing healthcare system reform. It includes all internal stakeholders and defines their roles. It clearly shows that reforms in the healthcare sector require a collaborative approach. These stakeholders must play their roles just as Institute of Medicine has demonstrated.

The required reforms are the responsibility of everyone, including patients, business community, policymakers and medical students among others. Wilson shows how all stakeholders can transform healthcare system in America if they play their parts effectively. Remarkably, these solutions do not require massive resources to implement and monitor.

For instance, the role of nurse leadership remains critical in healthcare reform as other studies have shown, and nurses can only overcome their present challenges through unity. Most importantly, this prescription must change with transformation in the healthcare system.

References

Hain, D., & Fleck, L. M. (2014). Barriers to Nurse Practitioner Practice that Impact Healthcare Redesign. OJIN: The Online Journal of Issues in Nursing, 19(2), Manuscript 2. DOI: 10.3912/OJIN.Vol19No02Man02.

Institute of Medicine. (2011). The Future of Nursing: Leading Change, Advancing Health. Washington, D.C.: The National Academies Press.

Wilson, C. B. (2010, June 15). A Prescription for America’s Health Care System: Inaugural Address. American Medical Association. Retrieved from https://www.ama-assn.org/

Introduction

According to a recent study, the number of mobile devices worldwide has increased by almost 8 percent since 2013 (Statista, 2016). The research findings also reveal that around 61 percent of the world’s population used mobile phones in 2015 (Statista, 2016). It is estimated that this number will increase by 6 percent in 2019 (Statista, 2016). The figures for the United States were even higher. Around 74 percent of the American population owned a smartphone in 2015 (Statista, 2016). The growth of mobile usage and IT consumerization has led many industries to adopt Bring Your Own Device (BYOD) policies that would encourage their employees to use private mobile phones in the workplace (Marshall, 2014).

This paper will examine the use of personal electronic devices for work-related purposes in the clinical setting.

Hypotheses: Research and Null

The study hypothesis is that the use of personal mobile devices by registered nurses increases their ability to make clinical decisions regarding patient care. The null hypothesis is that the use of personal mobile devices by registered nurses does not impact their ability to make clinical decisions regarding patient care. Experimental confirmation of the study hypothesis will determine the success of the application of the scientific method to the problem-solving.

Outcomes

The expected outcome of the study is to gather qualitative data that will confirm the potential of BYOD policy to positively impact patient care.

Theoretical Framework

The basis of the theoretical assumption of this research is the results of the study conducted by Phillippi and Wyatt (2011). According to the researchers, the easy access to educational materials and professional guidelines in clinical settings can be facilitated by the use of smartphones (Phillippi and Wyatt, 2011). Another study shows that the use of mobile phones can increase the efficiency of interprofessional communication between clinicians (Wu et al., 2011). It also suggests that personal electronic devices can help nurses and other health care professionals in the clinical decision-making process through the aid of clinical decision support tools. Moreover, research conducted by Chatterley and Chojecki (2010) reveals that medical students prefer the use of personal smartphones over other handheld devices for access to professional data.

Method

The study requires a group of clinical nurses that will participate in the study. Simple random sampling will be used to obtain a required sample. The randomization method will allow us to rule out some of the possible extraneous variables, such as the extensive previous experience of working in the nursing field. The research will be designed as a primary study and will require first-hand data from the participants (Saunders, Lewis, & Thornhill, 2009).

Setting

Considering the limited amount of resources available to the researcher, it will be impossible to conduct this study in more than one health care facility. Therefore, only one clinic will be chosen for the research based on geographic proximity to the investigator.

Data Collection

In order to increase response and participation rates, online questionnaires will be used for the purpose of data collection (ESRC, 2007). They will help to gather qualitative data that will show how health care professionals perceive the efficacy of the use of clinical decision support tools on their personal mobile devices (ESRC, 2007). The participants of the study will be required to fill in online-based questionnaires that have numerous advantages over e-mail or paper-based data collection tools. For example, they are cost-effective and can be used even by those respondents who do not have personal e-mail accounts. The questionnaires for the study will be created with special software and designed in an intuitive way (ESRC, 2007).

Test-Retest Reliability

In order to examine the stability of the study instrument over time, the test-retest reliability method will be used. It is conducted by administering the initial questionnaire to the same group of research participants (Vaz, Falkmer, Passmore, Parsons, & Andreou, 2013). Better reproducibility of the study results suggests a high level of the precision of developed or existing instruments. There are two possible outcomes of the test-retest reliability approach. The first is that the results of the second test do not differ from the results of the first one (Vaz et al., 2013). The second outcome is that there is a significant variation between the two tests. In order to obtain those measures, two approaches could be taken (Vaz et al., 2013). One tactic requires the researcher to invite the group of registered nurses participating in the study to take a retest one week after the research. Another approach includes an e-mail survey in which health care professionals that took part in the study will be asked to fill in the initial questionnaires one more time (Vaz et al., 2013).

Evaluation of the Results

If the data from the online-based questionnaires does not support the hypothesis, the study’s premise of the potentially beneficial effects of personal mobile devices on the health care outcomes might seem sufficiently doubtful. In such a case, a re-evaluation of the original hypothesis might be required.

References

Chatterley, T., & Chojecki, D. (2010). Personal digital assistant usage among undergraduate medical students: Exploring trends, barriers, and the advent of smartphones. Journal of Medical Library Association, 98(4), 157-160.

ESRC. (2007). Methods of Data Collection in Social Surveys. Web.

Marshall, S. (2014). IT Consumerization: A Case Study of BYOD in a Healthcare Setting. Technology Innovation Management Review, 4(3), 14-18.

Phillippi, J., & Wyatt, T. (2011). Smartphones in Nursing Education. CIN: Computers, Informatics, Nursing, 29(8), 449-454.

Saunders, M., Lewis, P., & Thornhill, A. (2009). Research Methods for Business Students. New Jersey, NJ: Prentice Hall.

Statista. (2016). Mobile phone user penetration as percentage of the population worldwide from 2013 to 2019. Web.

Vaz, S., Falkmer, T., Passmore, A., Parsons, R., & Andreou, P. (2013). The Case for Using the Repeatability Coefficient When Calculating Test–Retest Reliability. Plos ONE, 8(9), 109-117.

Wu, R., Rossos, P., Quan, S., Reeves, S., Lo, V., Wong, B.,… Morra, D. (2011). An Evaluation of the Use of Smartphones to Communicate Between Clinicians: A Mixed-Methods Study. Journal of Medical Internet Research, 13(3), 59-64.