Several countries across the world have problems with their end-of-life care systems and the United States is not an exception, as there are several issues affecting healthcare care in the U.S. This has never changed since then, and the situation is becoming worse, since many U.S. citizens are not getting the health insurance cover. These problems emanate from the stakeholders in the end-of-life care system. The current system is purely governmental, which is not acceptable. The public sector should be in partnership with the private sector to encourage healthy competition for the end-of-life care service delivery. If citizens are given a choice of both public and private mix, then it is obvious that this will be a preference to the pure government system.
Analysis of public policies that will be driving the U.S. health care system in 2030
High Cost of Health care and its proposed management strategy
Proposed U.S. medical cuts are initiatives, which the federal government has initiated to minimize the cost of treatment to the people, whose income level is relatively low. This plan targets lower income groups who depend on agriculture as the source of livelihood, thus might not be able to meet the high cost of hospitalization (Social Security Advisory Board, 2009). Reports have acknowledged that health care costs have drastically increased, and low economic growth has thrown many residents in the area, a situation that necessitates government involvement in the matter (Council of Economic Advisers, 2009). Although the proposed medical cuts have significant effects on the privately owned community hospitals in the state, the facility owners should not panic, because the anticipated legislations would not affect their operations completely. For example, there are some proposed cuts that are likely to be most relevant for the operation of the hospital. Therefore, the hospital owners need to focus on the reductions that will help them achieve a remarkable level of development and economic sustainability.
The proposed U.S. medical cuts will reduce the overall state’s expenditure and probably ease the level of taxation of the people. In return, the low income earners might have some money to seek medication at the community facility. The healthcare medical cuts would also result in a substantial reduction of medicare-aid program that the state government rolls to help the low income earners meet the cost of treatment. The reduction in the amount of money spent on the scheme means that there are people who might not get the security of the medicare-aid program and would use their own money to finance their medical cost (Medicare, 2000). In this regard, the community health facilities would remain relevant to the people and will continue to offer treatment to the local patients from the low income category.
Medicare is a health insurance plan funded by the commonwealth. Through this scheme, a subsidized or free health care is provided to a country’s population. Traced back in 1945, Harry Truman asked the Congress on the need to legislate the national health insurance establishment plan. The program changed from being a universal coverage plan to a social security system as developed by administrators of the government.
The plan provided health care for a special group of people, the seniors who were above 65 years of age and to the disables below 65 years. Medicare and Medicaid bills were then signed into law and ex-president Truman was the first to register for the program. The scheme is increasingly covering up to 45 million people by 2007. It costs the federal government lots of billions of dollars to give service claims.
The federal government administered the Medicare program under the established laws. The federal government provides financial support for the program. The program is then classified into part A, part B, part C, and part D categories. These categories offer different levels of coverage plan to the patients.
Part A of the program covers inpatient medical services including those hospitalized, and those in nursing homes in sub-cute status. This category of people had certified work requirement, and their contribution to the plan was through payment of Medicare tax deducted directly from the employer (Payment Reform, 2011). Part B covers outpatient treatments. They pay monthly premiums and gets government subsidy. Part C had an array of health insurance plan from through traditional to network insurance model. Part D was initiated in 2006 and covers outpatients. The benefit here is delivered through plans from the private sector. Enrollment in this part is free just as in part C.
The centers for Medicare & Medicaid services were established to control the administration and the smooth running of the healthcare program. The center was to carry out the nationwide framework to conduct effective background checks on perspective patients who were direct access employees. The employees were beneficiaries of long term care plan (LTC.). LTC services included perfect nursing facilities, provision of skilled nursing, home health agency, and providers of personal care services. The purpose of the program was to find effective, efficient and proper economical rules used in performing background checks. This was to end any bureaucracy and to avoid corruption cases.
CMA also has the role to oversee the implementation through distributing funds to the respective states. It gets federal funds, which are available to all states and U.S. territories to be spent on nationwide background check. In 1965, the early funding was partially done by the government. The government could give more financial support to the Medicare plan. There was also a personal contribution. In part B of the Medicare program, an individual was entitled to pay $ 3 per month for the scheme initially. From the 1960s, the nation has been striving to control health care cost. Much has not been realized hence raising the question of reduction of health cost by the existing American Government. There was an effort named as the “advent of managed care” by 1980s. This seemed to generate savings, but the healthcare has since exhausted the savings. The approach now is on the design of suitable policy measures to curd higher health care cost.
Helping the low income earners cope with the rising cost of employments, their involvement in the medical scheme would make sure that they obtain this essential service. On the other hand, the increased number of people losing their employment due to job cut that result of economic downturn indicates that the Medicareaid program will experience increased enrollment beyond its capacity. Since the U.S. government might not fund the increasing medical cost of the rising low income earners, it will reduce its contribution to the program. This will force a number of local people with low income to use their limited financial capability to seek medical attention from the community facilities.
The other proposed healthcare medical cuts that the government intends to implement that would be relevant to the operation of the hospital in reducing the provider’s payments. This is significant, because the amount of money that the medical facility owner will spend could reduce. As a result, he or she would spend more money on developing the facility and be able to provide the best treatment to the patients.
Third, the proposed healthcare medical cut that the government intends to implement that would be relevant to the operation of the hospital is promoting the program integrity. Here, the government intends to put efforts to improve the honesty with which the treatment services are provided to the people. Therefore, the patients who visit such facilities would get the best medical attention, thus will not shun the facilities. Therefore, most of the proposed healthcare medical cuts would be relevant to the operation of the hospital, and the owners should mainly focus on quality.
Stakeholders, regulations and accrediting health care agencies determine how to be efficient and exercise ethical standards in recruitment programs. As a result, the healthcare personnel encounter opportunities to get better pay, develop their careers and have a quality higher education with better use of current technologies. Besides, nurses and doctors experience equal treatment in their places of work. The health care policy making process can be centered on issues of migration of health practitioners in other parts of the world, in search of better paying jobs (Lambert, 2012). In this regard, accrediting healthcare agencies from different countries, which experienced the great migration of the health care practitioners, should be able to investigate why that happens, and then assess the impact on service provision in healthcare (Seboni, 2009).
It is pertinent that the current information base allows stakeholders, regulators and policy makers evaluate the virtual loss as a result of the migration of healthcare workers or other countries compared to the few migrations into the country (Roscow, 2011). This will provide information, like when physicians and nurse move from the private sector to the public services and vice-versa. Besides, it should offer information about practitioners leaving the professional totally to join other venture. The flow of professionals could be visible on the international scene yet it has a very minimal numerical impact, because of being replaced by employees from the private sector or from the colleges. Moreover, accrediting agencies should be aware that an uncontrolled or unmanaged movement of health workers outside a country could cause bad impact on the health system's efficiency, or even erode the existing and future potential functionality of the country’s workforce pool (Seboni, 2009).
Several countries have already set in place some policy reactions like developing programs that help the nurses to bond with their home county’s employment systems for a certain period of time after their graduation from the colleges to facilitate proper healthcare management. The processes of monitoring have not been able to help the government to track down the graduating students getting into the workforce. Some strategists suggest that the use of tactics involving the use of monetary incentives and regulatory barrier would be more efficient in terms of policy response to healthcare management. It is also evident from the following quotes from the text that:
“Encouraging development of new patient care models is a major objective of the new law. Within CMS, the Center for Medicare and Medicaid Innovation (CMI) came into being in 2011. (22) CMI’s mission is to develop and test new payment and service delivery models, intended to improve quality while reducing costs. Medical Homes are just one of the new models, designed to transition primary care practices away from fee-for-service reimbursement and toward capitated or bundled payments. Other models may involve direct contracting with provider groups, use of comprehensive care plans to coordinate care services, and management of chronic illness to minimize the need for high-cost services in acute care facilities” (Groszkruger, 2011 & Health Policy, 2001) .
These strategies also act as impediments to the free movement of people discriminated against the healthcare practitioners. However, some of the developing countries are striving to counter the push factors by addressing issues of poor pay for the health workers and increasing the courses in the higher learning institutions as well as developing more diverse care facilities so as to increase the career prospects in the field of healthcare (Seboni, 2009). Even though governments try to institute policies, laws and regulations to deal with poor working conditions and overworking the employees, job security issues and advancing as well as increasing the educational prospects are huge programs that pose a greater challenge to the healthcare management.
Healthcare Quality Association on Accreditation (HQAA) and the Accreditation Commission for Health Care (ACHC) ascertain whether healthcare management operates according to the established health standards and policies (Seboni, 2009). In this regard, health care management standards are strictly followed. In summary, these accrediting agencies can as well work towards reforming the health delivery system, thus improving the healthcare management.
The U.S. Population growth and the proposed health care management strategies
Since the U.S. population is mainly composed of old people, about 60 years, it is very important to embrace the end-of-life care policy to manage future health care problems. This policy can be regarded as non-feasible, thus making several patients die at home with the support of hospice and family, instead of spending a lot of money on ICU hospital bills and patient visits (Waldo, et al., 1991). Older adults’ health care systems are put in place, so that they can meet and satisfy the healthcare needs of people. They have the mandate to deliver health care services to the intended group or population and ensure fair contribution of finances. The set up of these systems vary from one country/state to another, though they seem to have similar goals, since they are geared towards promoting and maintaining the best quality end-of-life care service delivery to the citizens. The systems play a major role and should be maintained and supported if people are to achieve the desired standards, regarding the end of life care service delivery. This includes proper design and plan of the structures, which constitute the participation of the government, charities, trade unions, employers, religious groups, and all coordinated bodies to deliver the intended end-of-life care services to the intended populations.
More than 50% of deaths increase in the U.S. are from the aged population. The ageing population is one of the major forces driving the epidemic of chronic disease. The changes in many social and economic conditions will continue increasing the major chronic disease incidences in the U.S. The U.S has portrayed a major increase in economic growth from 26% in 1990 to 45% in 2010, and this is expected to increase to 60% by 2030. The environmental changes due to increase in urbanization are increasing the prevalence of the major risk factors for chronic disease. Tobacco use, inadequate exercise and unhealthy diet have led to lung cancer, diabetes and hypertension increment. The lung cancer death rates have doubled and are increasing at 2% -5% in urban and rural areas. The burden of chronic disease causes premature death, major adverse effects on the quality of life of the affected people and it also creates large adverse economic effects on families, communities and the whole society in general. The chronic deaths are mostly found in the rural areas, where it comprises of the low income earners and the middle class population.
The impact of chronic diseases in public healthinclude an increase in financial burden, which can push individuals into poverty. Most of the individuals with chronic diseases depend entirely on the whole family to survive. Direct costs in healthcare are a significant burden in U.S’s economy. Limitations in daily work, loss of productivity and non-consistent days of working are affecting the present U.S. economy. The U.S will forego millions of dollars in the notation income over five years as a result of lung cancer, heart diseases and diabetes.
This is a serious situation for both the society and the public health and also the economies affected, and this effect is expected to increase in future. Chronic disease is preventable, the public health puts effort on health promotion and disease prevention in order to achieve better health for people. Some of the prevention measures include reducing the amount of salt in processed foods, high taxation rates in tobacco products and improved meals in schools to avoid overweight. This is not only cost effective, but will also raise government’s revenues. The WHO and the ministry of health in U.S. has developed a high level national plan for chronic disease prevention and control. Behavioral changes, such as reducing and stopping smoking, increase in physical exercises and a healthy diet reduce the rate of chronic diseases in U.S. Improvement in treatment results in additional costs, but it significantly increases the lifespan of the population. Public health programs are also important in promoting adoption of good health and educating the population on the awareness of chronic diseases. The benefits of preventive programs and services have long term effects and are for the society as a whole not only on individuals.
There are restrictions where people have to take up insurance covers, based on their employers’ demand and not their own choice of health insurance cover. The implication is that people end up being locked into their jobs for fear of losing their health cover. Currently, patients are undergoing a lot of problems when trying to access the doctors, and this is another major challenge in the end-of-life care system. Moreover, the physicians often have problems in accessing the patients’ records. Lack of consistency in measuring the quality of care for older and using the findings in decision making is another problem.
Experts believe that much of the health care for older people being offered in the United States is a tax burden on the state budget expenditure. Everybody can agree that health issues are sensitive, and all the necessary measures have to be put in place to ensure quality. However, the misconception that in an attempt to be cost-effective would result in quality undermine is misleading and these are some of the reasons why the cost of care for older people in the U.S. has always been on the rise. This can be associated with unnecessary pride, where the rich and the most influential people, such the political elites and the most successful business people, fight to keep the access to health services unreasonably high in the name of quality, when the poor are languishing without coverage of health insurance and generally access to proper medical facilities. It is an irony that as the world struggles to attain cost effectiveness in its service delivery to the citizens; this does not apply to the health sector, and especially in the United States.
In conclusion, it is still possible to tame the rising costs of health care and provide the Americans with the best rates, especially in 2030. Everybody should be given adequate incentives and a better working environment in order to deliver the best to the patients in general. It is obvious that it is important to ensure that everyone has access to affordable health care. It is sad that even those who have health insurance are increasingly facing affordability problems in terms of paying for their health care.