The US Health Care Delivery System continues to be a debacle among federal and state legislators. Since the first attempts to change and overhaul the system in the early 1990s, nothing much has changed. What is new and what has evolved so far from the efforts of both legislators, health service providers and other stakeholders are the sprouting of other “sub-systems” in an effort to move away from the ineffectiveness of the current rigid systems that had left millions of Americans without health insurance coverage and without access to an effective health care system delivery.
The current health care delivery systems in place consist primarily of the health maintenance organizations or the HMOs and the preferred provider organizations or the PPOs. Recent years saw the sprouting of other forms of partnerships between health care service providers and other stakeholders in the health industry. As a result, we now have the managed care organizations or the MCOs, and doctor lead point of service or POS products in an effort to provide a wider range of choice to health care access and delivery by the consumers or the American public.
Others still continue to evolve like the provider sponsored organizations or PSO, integrated service networks or the ISNs, integrated care service networks or ISNs, and community care networks or CCNs. Whatever form of delivery is chosen by the individual patient though, the goal of the continuing evolution of health care provision and delivery should be to provide better access and quality of care to the American Public. In-Patient Care as a component of US Health Care Delivery System.
Let us now focus on the various components of the health care delivery system, namely, long term care, home care, in-patient care, out-patient care, mental health care, occupational health, school health, and others. Each component has its own pertinent needs and contribution for health care delivery to be effective and timely. Ideally, each component should also be able to provide ample mechanisms for the patient in their transition from one level of care to another.
This discussion paper will discuss and focus on the current contribution of the in-patient care component and how it contributes (or lack of) in the overall management of health care resources. In-patient care is one of the more vital component of the US Health Care delivery system. According to a US Census study based on year 2000 figures, the US population is getting older and the baby boomer generation will soon need more medical attention in the next two decades or so. From this, we can expect an influx or surge in in-patient care demand within the same period of time.
The nagging question is, are we ready for it? Do we have the systems in place? How effective are these systems and have we met the basic indicators for supplying the health care professionals, facilities, finances and other vital resources to meet these challenges ahead? In trying to respond to these questions, let us consider zeroing in on the various facets of providing in-patient care. In-patient care requires a physical hospital structure, its administration, clinicians and varied health professionals and support staff to administer the health care required by patients.
More recently, studies have shown that these are not the only requirements to make in-patient care effective. Issues and factors that affect in-patient care delivery such as understanding and communicating with patient’s families, ensuring the viability of the hospital’s finances and putting in place error-free mechanisms while continuing to participate in the training of would be medical practitioners and continued good relations with the immediate and surrounding communities and socio-political entities could overwhelm the most seasoned hospital administrator (E.
Siegler, et. al. ). Currently, we face a shortage of health professionals (B. Brush et. al, 2004). The most felt shortage of which is the nursing shortage in hospitals intended for in-patient care (J. Hiebert-White, May 2007). Thus, the delivery of basic nursing care for in-patients and its effectivity is threatened. The US, as a policy in general, has gone as far as relaxing barriers to “importing” registered and experience-rich nurses (E. Siegler, et. al) from other parts of the globe.
This policy, however, “exports” the problem of nursing shortage to third world countries whose health professionals rush to the US because of higher pay and higher standard of living for their families and themselves (E. Siegler, et. al). Furthermore, recent studies that raises the bar for a more quality in-patient care in hospitals led to legislation that would limit the number of hours that nurses can work – from previous 12 ? hour work day to 8 ? hour workdays to minimize errors in health care delivery (J.
Hiebert-White, May 2007). Although legislations like this would improve the quality of in-patient care in the long run, it presents a bigger headache for hospital administrators and has caused closures of hospitals that cannot comply with federal and other state requirements. A glaring example of this is the increasing number of hospital closures brought about by factors beyond the realm of hospital management (J. Leighty, 1999). Foremost in hospital closure since the early 1990’s is the state of California (J. Leighty, 1999).
Due to numerous factors such as healthcare professionals’ shortages, rising un-reimbursed in-patient care expenses, new retrofitting laws for hospital structures and many other concerns. To quote: “Experts say there’s one big factor that is bound to accelerate the closure rate—the law requiring seismic retrofitting of all hospitals by 2008. ”We think there will be a dramatic closure of hospitals over the next 10 years because of this mandate, which will cost a projected $20 billion,” said Nathan Nayman, regional vice president of the Hospital Council of Northern and Central California” ((J. Leighty, 1999).
Hence, going back to the original concern of whether or not the US health care in-patient delivery system component contribute or not to the overall management of health care resources, the answer is a glaring no. Neither is the system ready to provide the necessary requirements or patient demands for transitional level of care from in-patient to either home-care or long term managed facility care. It is ironic that for a first world democracy like the US, and having the highest per capita income in the world, only 20% of the US population have immediate access to in-patient health care services (Singh, D.
& Leigh, S. , Chapter 1, p. 25, 2003). The bottoms 20% have no access at all and the rest of the American public have their health concerns put at the bottom of their spending priorities (Singh, D. & Leigh, S. , Chapter 1, p. 25, 2003). Unless something structural is done to overhaul the current US Health Care Delivery system, the continuing regression of health care services delivery will continue.
References:
Douglas A. S. , & Shi, L. (2003). Delivering Health Care in America: A Systems Approach. Jones and Bartlett Publishers. (pp. 20-35).Maryland. Brush, B. L. , Sochalski, J. and Berger, A. M. (2004). Imported Care: Recruiting Foreign Nurses To U. S. Health Care Facilities. Health Affairs, 23, no. 3 (2004): 78-87 doi: 10. 1377/hlthaff. 23. 3. 78. Retrieved on May 11, 2007 from: http://content. healthaffairs. org/cgi/content/abstract/23/3/78 Jane Hiebert-White. (2007). Nursing: Legislation on Working Hours; New Nurse Shortage Study. Health Affairs. Retrieved on May 11, 2007 from: http://healthaffairs. org/blog/2007/05/08/nursing-legislation-on-working-hours-new-nurse-shortage-study/?
source=promo Leighty, John. (1999). Closing Time: California leads nation in hospital closures. Retrieved from: http://www. nurseweek. com/features/99-5/hospital. html Siegler, E. , Mirafzali, S. , & Foust, J. (2003). An Introduction to Hospitals and Inpatient Care. Springer Publishing Co. (pp. 112-139). New York. Workshop Transcript : Understanding the Alphabet Soup of Managed Care Integrated Delivery Systems. Retrieved May 12, 2007 from: http://www. ahrq. gov/news/ulp/ulpmcids. htm