Major Health Care Problems in the US Problem statement: High and continuously rising cost of health care has been and still is one of the biggest challenges affecting the Health Care system in United States. Methods of Examining the Problem Both qualitative and quantitative research methods should be used to fully understand the issue of high cost of care in the US. Quantitative methods like surveys and experimentations will aid in estimating the prevalence, magnitude and frequency of the problem in different regions. On the other hand, qualitative methods like case studies and observation will help describe the extent and complexity of the issue. The two approaches need to work in complementation to obtain a clear understanding of this menace. Surveys, as a quantitative research method, is one of the most effective in the social research and present a more viable method of examining the cost of health in the country. They involve asking of questions in the form of questionnaires and interviews. Questionnaires are written questions to which the response can be open ended or multiple-choice format. This would be used to gain information about cost within determinants that are of disagree/neutral/agree nature. An example is if patients are contented with the cost of services they get or they deem the cost of cover worthy. Interviews, the researcher discussing issues with the respondents, are to be used to gain more details on already known aspects of the system. This may include gathering information to inform policies, administration and use of technology to minimize the cost of care. Since health cost in the US is not a new challenge and there have been studies about it, qualitative methods like case studies would help in interrogate the multifaceted nature of the MAJOR HEALTH CARE PROBLEMS IN THE U.S. 3 problem. This method would unearth and differentiate between perceptions and real-life situations about the subject as they are carried out over a period of time. The method involves a comprehensive study of the issues with the objective of finding the influencing factors and their relationship. Background Information According to the Organization for Economic Cooperation and Development (OECD), the United States, compared to all the other countries, spends the most on healthcare. In the year 2002, as per Anderson, Hussey, Frogner and Waters, the US used up $5,267 per person in health care which is $1,821 more than Switzerland which was the second highest spender on health (2005). Research has shown that hospital stays, physician visits, and pharmaceuticals attract the highest prices in the United States than any other country. Although the country boasts of significant technological advancements in the treatment of various diseases, these services are only available to those with big insurance plans. This has resulted to hospitals shifting costs by charging those with small insurance plans more to compensate for those uninsured and lower charges for the ones with large covers. A large number of physicians per individual have not helped as they are unevenly distributed in both specialty and geographically. Low-income areas especially those habited by the African Americans have seen a continuous and consistent decrease in the number of primary care office- based physicians. Incentives in the form of finance have encouraged high-cost diagnosis, specialization, and treatment. The ripple effect of this has been reduced primary health care (Cooper & Taylor, 1994). Care plans have also restricted the rights of a patient to choose their physicians and MAJOR HEALTH CARE PROBLEMS IN THE U.S. 4 doctors to choose specialties, and the location and how to practice. This has resulted in incentives, which encourage the development of new expensive drugs and high-tech methods of treatment. A high administrative overhead of 19 to 24 percent of all the other health costs is a contributing factor to the high health care cost. As per the account of Cooper and Taylor, marketing jobs and administrative jobs rose to 71 and 20 percent respectively between 1983 and 1989 while the clinical human capital rose negligibly (1994). This cost is attributable to the need by the insurers and service providers to market themselves and staff to handle the huge paperwork. Rising cost of care has been fueled by the use of technologies like Electronic Health Record (EHR) and Health Information Exchange (HIE). As much as these innovations have bettered the quality of health care, they have also increased cost through their management in the sense of data security and updating systems. Use of robotic surgical equipment has been adopted rapidly in the country. Robotic technology has increased cost in that it is much more expensive than manual surgical procedures. The high cost of premiums and pre-existing conditions have seen many denied insurance policies. The cost of premiums in the country rose by 5% in the year 2008. This can be attributed to the great consolidation of the pharmaceutical and insurance industry. Sweeney says that in one out of seven of the more than 300 U.S. markets within the metropolitan areas a single insurance company (2012) covers 70% of the patients. This introduces partial monopoly, which affects the prices of products and services negatively. Even though lifestyle disease like high blood pressure and diabetes have been linked to the largest number of deaths in the country per year, health care MAJOR HEALTH CARE PROBLEMS IN THE U.S. 5 delivery is more focused on medicine rather than dietary and lifestyle interventions (Sweeney, 2012). He adds that more than a third of illnesses in the country are due to smoking, poor lifestyle practices and poor diet. This approach of medicinal care is more expensive compared to preventive care. Controversies of the Problem As evident as the challenges of health care in the country are, controversies and conflicting interests by parties have stood in the way of solving the problem. On one hand, there are those who need care; they crave for more while on the other hand, there is the healthy taxpayer who agitates for containment of the rising care cost. All the medics, leaders, and professionals agree on the need for not only quantity, but also the quality of the care and high remunerations. However, they cannot seem to agree on the best way to accomplish this. Care provider employers and regulating bodies are also geared to slowing the rising cost, increase accessibility and quality, but still diverge on the best approach to these issues. The insurance and pharmaceutical companies are also fighting to increase their profit margins by selling more (Kovner, Knickman & Jonas, 2011). Impact of Affordable Care Act of 2010 The Affordable Care Act 2010 has gone a long way in improving quality, affordability and access to health care. The insurance marketplace has seen a strong enrollment with more the 10 million American having an active cover. According to Health and Human Services (HHS) department, 16.4 million of previously uninsured Americans have acquired plans through the Medicaid growth, youths staying under parents' plans up to 26 years old and the marketplace. MAJOR HEALTH CARE PROBLEMS IN THE U.S. 6 This coverage has also been noticed in all the groupings with a 9.2 percent and 12.3 percent decline in the rates of uninsured among the African Americans and Latinos respectively. More than 10.2 million consumers had their premiums paid which is an indication of affordable coverage. More insurers have joined the marketplace providing an increased number of plans, and this competition and options are associated with premiums that are more modest. Patient harms have reduced by 17 percent, which the HHS estimates, to savings of up to $12 (Affairs, 2015). Establishment of Accountable Care Organizations (ACOs) has established that one out of every fourteen Americans receive better care by creating better outcomes. Solutions Simplifying the health sector may go a long way in ensuring that the system is responsive to the current problems and future challenges. For example, the government pays to care for the uninsured through systems like Medicare, the Military, the Veterans Administration, Medicaid, and others. All these plans have different criterions for eligibility, reimbursement, and benefits making the system quite complicated (Sweeney, 2012). Instead of working to achieve the best health care in the world, the professionals and leaders should refocus their attention to examining and investigating the underlying aspects of training and system performance. The performance indicators should be geared towards improving accessibility, quality, and quantity of care. Portability of the coverage will also be vital in ensuring that citizens maintain their benefits wherever they move. This calls for the examination of the employment-based insurance plans, which are persistent in the country vis-a-vis the single payer system. A universal system, which provides similar benefits to all citizens, may help solve the high and rising cost of health in the US. Medicare plan is majorly designed for the elderly while MAJOR HEALTH CARE PROBLEMS IN THE U.S. 7 Medicaid is focused on the children of the low-income earners. This disparity in programs creates high overhead cost concerning administration and advertisement. Recommendations To understand the problem better more research needs to be carried out. We should focus more on the management of chronic disease, which apparently accounts for more than two thirds of all the health care cost in the country. The dictation of medics and nurses to treat clients as per their insurance policies should be shifted to doctor’s best judgment. This will go a long way in improving the quality and cost of care MAJOR HEALTH CARE PROBLEMS IN THE U.S. 8 References Anderson, G. F., Hussey, P. S., Frogner, B. K., & Waters, H. R. (2005). Health Spending In The United States And The Rest Of The Industrialized World. Health Affairs , 24 (4), , doi: 10.1377/hlthaff.24.4.903. Assistant Secretary for Public Affairs (2015, June 24). The Affordable Care Act is Working. Retrieved October 2, 2013, from Health Care. U.S. Department of Health & Human Services: working/index.html Cooper, E., & Taylor, L. (1994). Comparing Health Care Systems. God Medicine , 39, 35. Kovner, A. R., Knickman, J. R., & Jonas, S. (2011). Jonas and Kovner's Health Care Delivery in the United States (10th ed.). New York: Springer Publishing Company. Sweeney, S. (2012, May 29). 8 Major Problems of the U.S. Healthcare System. Retrieved October 2, 2016, from Benefit Babble: problems-healthcare-system/
