U.S has one of the largest and costliest health care system in the world. Healthcare is the second largest industry in the country. In spite of this achievement, the health status of the people in U.S, does not match the cost and infrastructure put into it (HealthCare.gov, 2016). Both communicable and non-communicable diseases still continue to harm a large sector of the population, when compared to other developed countries. Unlike other developed countries, people in U.S were expected to obtain individual health coverages and pay individually for health services. The right to health was not treated as a basic human right. This prevented people who could not afford the cost, from assessing health services. To address this issue, the government decided to pay for people who could not afford to pay for themselves. In 1965, the government introduced Medicare and Medicaid health insurance to cover for the health care cost of elderly (>65 years’ age) and the poor, respectively (Economic Intelligence Unit, 2009). However, this had a number of limitations like: it did not cover the complete cost, there were restrictions to the services that could be used and many hospitals were not willing to accept patients who were covered through this system. There are private insurance services for individuals who are not covered by federal insurance. In some cases, employers may contribute a share in their employee’s insurance. In spite of this, more than 17% of the U.S population remained uninsured in 2009 (HealthCare.gov, 2016). A majority of the uninsured were from racial and ethnical minorities. They belonged to low economic background or were from rural regions or young adults.
In spite of having more than 6 million physicians, there is a shortage of physician who are available for treating the poor and those dwelling in rural areas. This is because, physicians prefer to migrate to regions that pay more. Since a majority of the physician opts for higher education and specialization, those available to treat general conditions are low in number. The result of this scenario, is the increase in the incidence of serious disabilities and diseases among the economically backwards and the people in rural dwelling. There is insufficient follow up on the case and also difficulty in gaining access to health care staff, as a result of overcrowding. In addition, high insurance rates and hospital budget, also adds to the problem. In the past (before 1960s), the goal of health care was to serve the needs and today health services work with the aim of making more profit. This has resulted in rising health care cost and expenditure. The healthcare sector has become more of a commercial enterprise than a service enterprise. While this competition may have contributed to the improvement of quality and value of care, the decisions in health care services were driven by money. To tackle the issue of increasing health care cost and enhance affordability of health services to all individuals in the country; the federal government introduced reforms and recommended for restructuring the health care system. As a part of this effort, all individuals in the country will be covered by a national health insurance policy, in the future. This will ensure universal access to basic and routine health care needs. This national insurance will be managed and run by the government.
According to the latest statistics, 187.4 million American own private health care insurance (Shi, Singh & Shi, 2010). While 35.2 million and another 31.5 million American, benefit from the government owned, Medicare and Medicaid insurance facilities (Shi, Singh & Shi, 2010). In order to improve efficiency of care and end health disparity in the population, the health care was restructured into the health care delivery system. There are four domains under this new system: managed care, military, vulnerable population and integrated delivery. Managed health care is a system in which many components are integrated to enable easy coordination of resources, and clinical care is provided at the point of service delivery. This will help control cost, improve quality, undertake preventive measure and enhance the overall health of the population. The integrated system is made of a network that connects the central Health Maintenance Organization (HMO) with the peripheral Preferred Provider Organization (PPO) and Point of Services (POS). The main aim of managed care is to provide a patient centered system of care. Managed health care is the most dominant system of care in U.S and serves a majority of the Americans. The main financier in this system is the employers and the federal financiers.
Challenges facing the health care system: Though diseases and infection pattern has changed with time, the basic principle for treating patients in the 21st century is largely dependent on the previously established models. There is a need for new models to handle the challenges in the current healthcare. A hundred years ago, the average life span of the population was less than 60 years (Cdc.gov, 2016). Advancement in science, technology and medical practices have helped to reduce infectious diseases and mortality in the population. Today, life expectancy in the population has increased to an average of 80 years (Cdc.gov, 2016). By 2020, more than 35% of the American population are expected to be above 50% (Cdc.gov, 2016). The aging population needs a more sophisticated and comprehensive care. There is a serious demand for physicians, nurses and health care workers who are qualified to treat this population.
The second challenge to healthcare is the rising incidence of obesity in the population. More than 30% of the Americans are obese. Obesity is a predisposing factor for a number of costly chronic diseases. The cooperation of all health care workers and the community members is necessary to combat this problem. Heart disease, cancer, chronic pulmonary diseases and diabetes are the cause of 2/3 of mortality in U.S, and this can be significantly reduced by promoting wellness and fitness. Maintaining a healthy body weight can reduce risk for these diseases.
The third major challenge, is the high cost of availing health care services. Very often the cost of availing health service has been higher than average income of the person or takes a significant part of a person’s income. For many who lack support from government and employers, the health expenses accounts for approximately 50% of their income. One way of reducing the healthcare cost is to prevent diseases and by effective management of health care resources.
In order to meet these three challenges of health care, we need leaders who can contribute to the strategies and communicate with others about the need to address these challenges. In a management set up, not all individuals are given equal authority. Strategies are made by individuals in the top or senior positions. If these strategies are not made considering the workers at all levels in an organization, it may hamper collaborative efforts that are needed to achieve the goal. Therefore, it is necessary to implement changes at an individual level and also at a team level in an organization. The first step in the leadership process, is to provide healthcare staff with a sense of purpose. Their role in tackling these challenges is extremely important. The second leadership role will be to ensure that every participant acts in alignment with this purpose, and then finally, the leader engages people who are committed to achieve this purpose. This collaborative leadership model, will help the management to bring about the necessary transformation in healthcare and meet challenges. Doctors, nurses and caregivers are part of this leadership model and their skills and competencies will determine the overall success in addressing the challenges. Provided below are strategies and leadership roles that the U.S health care can adopt to face the three challenges: healthcare of an aging population, obesity and high health care cost.
Strategies and leadership role to provide care to aging population: Fall in fertility and increase in longevity, are reasons for a greater proportion of elderly in the population. Adults aged above 65 years of age, spend more money on health care, when compared to other age groups. The incidence of severe disability associated with a fall, severe chronic conditions and other less severe disabilities are common in this population. The cost spent on the health care of an aging population has increased by 0.2%, between 1970 to 2002 (Economic Intelligence Unit, 2009). The first step in tackling the challenge associated with the geriatric population, is to make geriatric medicine an important part of medical and nursing education. There is also a need for geriatric specialists. Policy makers and education providers, can motivate students to go for higher studies in geriatrics by offering them scholarships. Secondly, promoting home based care can help reduce the cost of care. The cost of hospital admission, cost per bed and other management cost is significantly higher than home based care. Thirdly, geriatric patients have a slower metabolism than young adults, and thus, there is a need for pharmacological drugs that are better suited for use in the geriatric population. Fourth, the medical community can create awareness in the population about the seriousness associated with falls and depression in elderly. It can also organize workshop and program to find creative solutions for the problem. Fifth, technology can be an important aid in geriatric medicine. In Japan, “robot nurses”, are employed for cleaning and assisting patients. Telemedicine and remote monitoring system will also be useful in assisting home based care. Nevertheless, technology can never replace humane aspect of care that is essential for healing. There is also a need for social understanding about the issues related to the elderly. Though aging may cause certain inefficiencies and inabilities, it does not necessarily mean that the elderly cannot continue to contribute to the job, society and the family. Engaging them in part time activities will motivate them to maintain mental and physical health. Elderly adults who tend to lead a sedentary lifestyle are at risk of adopting unhealthy lifestyles and developing chronic diseases. Community healthcare services can encourage good eating habits and lifestyle among the elderly. Finally, regular surveillance for diseases among the elderly, will help in early identification of diseases and prevents complication.
Leadership strategies to tackle obesity: Obesity is a complex and multifactorial disease. All health care professional should have a commitment to promoting health outcomes in people. Obesity is characterized by excessive weight gain and in most cases it is due to high calorie intake and less calorie expenditure. Children whose parents have obesity are more likely to end up being obese, and thus obesity control in the society must include families. Healthcare professionals can provide leadership roles to address obesity. Creating awareness about the ill effects of excessive weight gain and the benefits of maintaining normal weight, can be immensely useful. Easy availability of unhealthy food that is rich in calories and poor in nutrients is an important reason for obesity. Eating high calorie food during pregnancy, inadequate prenatal care, lack of proper nutrition for infant and children, can increase risk for obesity in children. Mothers who have obesity, tend to have children who are obese. Parents act as role models for children and influence their lifestyle. The health care physicians and nurses can assist in decision and policy making. It is also necessary to plan town and living spaces that provide space for physical activity. At-least one-hour physical activity should be advocated for school children. Schools and communities can plan programs to promote physical activity and good diet practices in its children. Eating local fruits and vegetable as snacks and avoiding processed food will help in reducing incidence of obesity. Reducing obesity will prevent risk for many diseases and also help save money spend on these diseases.
Healthcare leadership role in reducing health care cost: Healthcare providers can help reduce health care cost by improving efficiency and by preventing wastage of resources (Partners.org, 2016). There is also a need to come up with creative ways to cut down cost. Patients with chronic diseases require coordinated care. Cost can be reduced by improving coordination between managed care and insurance schemes. Managed care will enable the physicians to attend more patients in a given time, when compared to unorganized care. It will also benefit the patient by relieving them of the stress of managing their care by themselves, and also helps in faster healing. Managed care is provided by a team that is made of nurses, physician, social workers and psychiatrists and other healthcare workers, who unite to deliver care and enable faster recovery. There is also a need for improving the quality of care and this cannot be compromised in the effort to reduce costs. An integrated healthcare system can help implement changes on a larger scale. It will also help reduce unnecessary use of emergency care and also enable faster delivery from the hospital. Planning managed care will be useful for heart attack patient, for whom regular monitoring is required and regular follow-up can prevent the incidence of readmission. Reducing harm done in hospital and ensuring patient and staff safety will help prevent infection that is acquired from hospitals. Likewise, effective use of drugs and correct dosage calculation will help in proper healing. Indiscriminate use of antibiotics will lead to resistances. Safety measures can also cut down incidences of injuries and infection.
Conclusion: Unlike the past, patient’s today, demand more accountability and quality from healthcare service providers. A system wide transformation is necessary to meet the current challenges. Hospitals can have provision for patient feedback, as it is an important source of information, based on which improvement can be planned. An organization that is committed to continuous learning and improvement, will be effective in delivering care that is in line with current evidences. Correct staff organization and proper infrastructure design, will enable resource utilization and optimum utilization of personnel and physical space.
References:
Cdc.gov,. (2016). Public Health and Aging: Trends in Aging --- United States and Worldwide. Retrieved 9 February 2016, from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5206a2.htm
Economic Intelligence Unit,. (2009). Healthcare strategies for an ageing society. London: The Economist.
HealthCare.gov,. (2016). Get 2016 health coverage. Health Insurance Marketplace. Retrieved 9 February 2016, from https://www.healthcare.gov/
Partners.org,. (2016). Process Improvement | Healthcare Efficiency | Cost Control In Healthcare | Innovation and Leadership | Partners HealthCare. Retrieved 8 February 2016, from http://www.partners.org/Innovation-And-Leadership/Improving-Efficiency-Controlling-Costs/Process-Management.aspx
Shi, L., Singh, D., & Shi, L. (2010). Essentials of the US health care system. Sudbury, Mass.: Jones and Bartlett.
