Health Care in the United States is described as the “cottage industry” it has been fragmented at the national, state, community and practice levels. There is not one single entity or set of policies guiding the health care system; Furthermore, this fragile primary care system is on the verge of collapse according to the Commonwealth Fund Commission. (A.
Shih, 2008) The fragmentation of our delivery system is a fundamental contributor to the poor overall performance of the U. S. health care system.
In our fragmented system: * patients and families navigate unassisted across different providers and care settings, fostering frustrating and dangerous patient experiences; * poor communication and lack of clear accountability for a patient among multiple providers lead to medical errors, waste, and duplication; * the absence of peer accountability, quality improvement infrastructure, and clinical information systems foster poor overall quality of care; and * high-cost, intensive medical intervention is rewarded over higher-value primary care, including preventive medicine and the management of chronic illness.
No single policy will fix the fragmentation of our health care system. Rather, a comprehensive approach is required—one that might lead progressively to greater organization and better performance. The following strategies were recommended: (A. Shih, 2008) * Payment reform. Provider payment reform offers the opportunity to stimulate greater organization as well as higher performance. The predominant fee-for-service payment system fuels the fragmentation of our delivery system.
We recommend that payers move away from fee-for-service toward bundled payment systems that reward coordinated, high-value care. In addition, we recommend expanding pay-for-performance programs to reward high-quality, patient-centered care. The more organization in delivery systems, the more feasible these payment reforms become (Exhibit ES-1). These payment reforms also could spur organization, since they reward optimal care over the continuum of services. Specifically, we believe that: Patient incentives. Patients should be given incentives to choose to receive care from high-quality, high-value delivery systems. This requires performance measurement systems that adequately distinguish among delivery systems. * Regulatory changes. The regulatory environment should be modified to facilitate clinical integration among providers. * Accreditation. There should be accreditation programs that focus on the six attributes of an ideal delivery system we have identified.
Payers and consumers should be encouraged to base decisions on payment and provider networks on such information, in tandem with performance measurement data. * Provider training. Current training programs for physicians and other health professionals do not adequately prepare providers to practice in an organized delivery system or team-based environment. Provider training programs should be required to teach systems-based skills and competencies, including population health, and be encouraged to include clinical training in organized delivery systems. Government infrastructure support.
We recognize that in certain regions or for specific populations, formal organized delivery systems may not develop on their own. In such instances, we propose that the government play a greater role in facilitating or establishing the infrastructure for an organized delivery system, for example through assistance in establishing care coordination networks, care management services, after-hours coverage, health information technology, and performance improvement activities. Health information technology. Health information technology provides critical infrastructure for an organized delivery system. Providers should be required to implement and utilize certified electronic health records that meet functionality, interoperability, and security standards, and to participate in health information exchange across providers and care settings within five years
These do not necessarily mean it will fix the health care system as we know it, but could generate, a better understand on what is expected of the United States as a whole, when the Medicare and Medicaid system is done away with, those born in the late 60’s to 2000’s will probably not benefit from the Medicare or Social Security system, when they reach the age of 65, Why you might ask, because the way the economy is going these systems will be obsolete in the future, while the Government is trying to build a better ntity, they will probably in fact, not accomplish this, it is my understanding that they will be doing away with the Medicaid program by the year 2012, this will be a great burden to those who are currently on this, If the Government could make it easier for those who can’t afford insurance to acquire commercial insurance at a lesser cost, then the majority would be get these types of insurances, (ex Cigna, Humana, Aetna, BCBS, United Healthcare)
I work in the medical field, I see daily the abuse some of these patients are taking from the Government in regards to their medical care, one month they have the insurance, the next they are on what is called “Share of Cost”,(SOC) this is just like an HMO or PPO, you have a deductable to reach every month, the only problems is, these patients do not have any money to pay, so they have to go to the local Hospital, to get their SOC covered, the patient see’s is as a convenience while the Hospitals sees it as a nuisance. Our fragmented health care delivery system delivers poor-quality, high-cost care. We cannot achieve a higher-performing health system without reorganization at the practice, community, state, and national levels.
This report focuses on the community level, for which we have identified six attributes of an ideal delivery system. Our vision of health care delivery is not out of reach; some delivery systems have achieved these attributes, and they have done so in a variety of ways. We can no longer afford, nor should we tolerate, the outcomes of our fragmented health care system. We need to move away from a cottage industry in which providers have no relationship with, or accountability to, one another. Though we acknowledge that creating a more organized delivery system will be difficult, the recommendations put forth in this report offer a concrete approach to stimulate greater organization for higher performance. (A. Shih, 2008)
In India, Primary Health Centers (PHCs) are the cornerstone of rural healthcare; a first port of call for the sick and an effective referral system; in addition to being the main focus of social and economic development of the community. It forms the first level of contact and a link between individuals and the national health system; bringing healthcare delivery as close as possible to where people live and work. (Patel, 2005) Primary healthcare services substantially affects the general health of a population, however many factors undermine the quality and efficiency of primary healthcare services in developing countries. In India, although there are many reasons for poor PHC performance, almost all of them stem from weak stewardship of the sector, which produces a poor incentive framework.
The World Health Organization (WHO) specifically points out that to some extent, the deterioration in health status is attributed to inadequacies in PHC implementation, neglecting the wider factors that have been responsible for this deterioration such as lack of political commitment, inadequate allocation of financial resources to PHCs and stagnation of inter-sectoral strategies and community participation. The main ones being bureaucratic approach to healthcare provision, lack of accountability and responsiveness to the general public and incongruence between available funding and commitments. The current PHC structure is extremely rigid, making it unable to respond effectively to local realities and needs. For instance, the number of ANMs per PHC is the same throughout the country despite the fact that some states have twice the fertility level of others.
Moreover, political interference in the location of health facilities often results in an irrational distribution of PHCs and sub-centers. Government health departments are focused on implementing government norms, paying salaries, ensuring the minimum facilities are available rather than measuring health system performance or health outcomes. Further, the public health system is managed and overseen by District Health Officers. Although they are qualified doctors, they have barely any training in public health management; strengthening the capacity for public health management at the district and taluk level is crucial to improving public sector performance. Patel, 2005) Primary, secondary, generalist and specialist care, all have important and inclusive roles in the healthcare system and should be used to create a comprehensive and integrated model; one that combines universalism and economic realism with the objective of providing coverage for all. (Patel, 2005)| | The majority of these countries are trying to make it better for all to achieve the best health care entity possible; we are trying to make sure that everyone is covered by insurance.
REFERENCES A. Shih, K. Davis, S. Schoenbaum, A. Gauthier, R. Nuzum, and D. McCarthy, Organizing the U. S. Health Care Delivery System for High Performance, The Commonwealth Fund, August 2008 (A. Shih, 2008) Express Healthcare Mgmt. Business Publications Division, Indian Express Newspapers (Bombay) Ltd. , Express Towers, 1st floor, Nariman Point, Mumbai 400 021 (Patel, 2005)