Introduction
Medicine is not all, or even mostly, about money. Science, caring, professionalism, and even religious concerns regarding birth and death can be more important than dollars.
Healthcare is among the world’s largest industries, accounting for 10 percent of gross world product, but only a tiny fraction of world trade. Around the world, healthcare institutions are encountering growing pressures from governments, investors and the general public. Healthcare is indeed a more complex economic problem than bridge-building.
Like some other professions but unlike many other goods and even services, it is difficult for the consumer (the patient) to evaluate the quality of services received. Much depends on the self-control and reliability of the individual practitioner, the supplying group, and the medical profession as a whole, in ways that the ordinary patient cannot readily check whenever he/she needs to.
These institutions must simultaneously improve the health and well being of the public, cut costs and remain competitive. To achieve these goals, many healthcare institutions have implemented total quality management (TQM). Evidence from hospital-based studies, however, suggests that the success of TQM is constrained by inadequate information systems and poor application of information technology.
Change appears to be a driving force in society today and the American healthcare system is no exception. In addition to the need for change in today's society, the importance of creativity in bringing about needed change must also be considered. An organization will quickly lose strategic advantages that it has worked hard to gain unless it invests in innovation and creativity, and consequently, change.
According to some experts, the American Healthcare system is on the brink of failure. To support this assertion, experts point out signs of failure in the healthcare system. For one, Americans spend more than twice as much as Canadians on healthcare. And, there is a similar disparity between American and British spending. The Americans certainly don't get their money's worth, according to some experts. The US has roughly 43 million people with no insurance whatsoever, and among the rest, many are underinsured. That is, they have shrinking packages. This might be covered, but that won't be covered. What's more, experts argued that Americans are unhealthy. The life expectancy is shorter and infant mortality is higher. Childhood immunization rate is lower.
The United States is considered to have the highest healthcare costs per capita in the world. The healthcare industry faces a lot of challenges at present and which can be reflective of what lies ahead. These includes health care costs, the growing diversity of health populations and their expectations, government support for healthcare, the increasing use of technology and yet its poor application, the decreasing quality of healthcare education and the growing shortage of healthcare professionals especially the nurses among many others. There is also a challenge on the kind of leadership and management that is present in the healthcare profession.
Hospitals will be forced to shell out more on bioterrorism preparedness. Insurers will face rising demand for costly behavioral healthcare services. Vendors will have to scramble to supply new antibiotics. And physicians' pleas for better Medicare payments may fall on deaf ears as Congress remains focused on homeland security.
Add to that the economic slowdown-which is leaving more Americans without health insurance and compelling states to squeeze their Medicaid budgets-and citizens have a perilous outlook for the coming year.
The distribution of health is unequal and has a profound impact on economic well-being. Some people work productively for years and die contentedly with wealth and happiness in old age, while others struggle for a few months or decades in agony as they are relentlessly drawn down into premature mortality.
In the situation depicted in the previous paragraph, the question is not whether the distribution of health is fair, or whether it determines or is determined by income, but whether it is amenable to change.
The unequal distribution of healthcare is only one of the many challenges that the healthcare industry is facing and will continue to face in the next years. The question whether this could be change is answered by Yes. It is possible, provided the right measures and support are done.
Many health problems are usually concentrated in specific, underserved populations, usually ethnic minorities or areas of extreme poverty. Although tremendous resources are available for advanced experimental treatment, electronic scanning for diagnosis, and long-term rehabilitation, there is still a lack of primary care resources ensuring that every child is immunized, that all pregnant women receive adequate prenatal care and nutrition, and that every person has a primary physician to contact when in need of advice or care.
In many ways, the American healthcare system faces the same problems of maldistribution and misallocation in the delivery of healthcare as other high-income and low-income countries.
The American healthcare system is facing reform, which demands collaboration instead of competition, employment of a more diverse work force, and service to a larger number of uninsured individuals.
Purpose of the study
This paper aims to look into the American healthcare system and the challenges that lie ahead by using the qualitative method of research. By looking into the various challenges that the American healthcare system now faces and will be facing in the future, individuals will be more aware and vigilant regarding their health and healthcare.
This paper also aims to provide recommended actions that can be taken in order to properly face and overcome these challenges.
Importance of the study
Healthcare is an indispensable part of people’s lives. Given the strong relationship between mortality and income, questions have arisen regarding the importance of healthcare, especially in increasing life expectancy of individuals. As a whole, the importance of healthcare is connected to increasing life expectancy of individuals.
One complication though is that more and better healthcare is usually associated with higher incomes. Along with that are the other various challenges that the American healthcare system is facing now.
Cows can get just as many diseases as humans do and we could put all the resources to saving cows, but we don’t. We are the ones paying the bills and therefore we put the resources for our own health.
What can be said of the future of health and healthcare over the next fifty years? It is relatively certain that clinical challenges will still be present. There will also be continued increases in longetivity, greater technological capacity to treat diseases, and continuous increases in expenditure among others.
By being aware of these healthcare challenges that the Americans are facing now and being aware of solutions and ways to solve them, there would be a higher chance of overcoming these challenges and provide a better quality of care for all the Americans.
Aside from awareness, Americans have to understand how various healthcare factors interact and affect the healthcare system. Like for instance, Americans might be wondering why healthcare costs so much. It is because health is so precious that its value exceeds that of the things that people possess.
Scope of the study
This study focuses on the various factors that interact in the provision of healthcare. We are all aware that the provision of healthcare is not without challenges. These factors in fact themselves provide a challenge for the American healthcare system.
This study regarding the clinical challenges that the American healthcare system faces and is going to face in the future was undertaken to provide information about these various situations, and also to address specific recommendations on these problems that we face.
This study summarizes some of the descriptive information, as well as information from the historical record, in an attempt to describe the challenges present within the American healthcare and their impact on whole quality of care for the Americans.
Data will be collected from various healthcare professionals within the country. These are practicing professionals from any field of healthcare. Their opinions and ideas will be collected and used to further verify what has been observed by ordinary citizens and authors.
Rationale of the study
One of the main issues in the rationale for this study was the opportunity to study the interaction of healthcare factors and the challenges it brings to the American healthcare system.
As stated, the United States has one of the most expensive healthcare systems in the world. Moreover, the quality of care provided is more or less the same as that of other countries even with the higher healthcare cost. Thus, many Americans are still not being provided with adequate healthcare.
These are just some challenges that somehow make the American healthcare system less than perfect. Something has to be done so that there would be a proper provision and allocation of healthcare goods and services to all Americans.
This study can help support the consistency of what ordinary American citizens and various writers have already found about the challenges that the American healthcare system face. Added to that, this can also help healthcare organizations come up with solutions on how to face these challenges.
Definition of the terms
Balanced Scorecard - a performance metric used in strategic management to identify and improve various internal functions and their resulting external outcomes. The balanced scorecard attempts to measure and provide feedback to organizations in order to assist in implementing strategies and objectives.
Bioterrorism - the use of biological agents, such as pathogenic organisms or agricultural pests, for terrorist purposes.
Charges – the amount appearing on the patient’s bill.
Clinical Pathways – a protocol, or defined standard set of tests and procedures which are to be used in the diagnosis or treatment of a particular symptom or disease.
Coinsurance – the amount of the bill not paid by insurance, but by the patient. A plan with 15% coinsurance means that the insurance company pays 85% and the person pays 15%.
Consumer - one that consumes, especially one that acquires goods or services for direct use or ownership rather than for resale or use in production and manufacturing.
Continuing Professional Development (CPD) - is the means by which members of professional associations maintain, improve and broaden their knowledge and skills and develop the personal qualities required in their professional lives.
Disabled – a clear preference in referring to people having either physical or mental impairments, with the impairments themselves preferably termed disabilities.
Efficacy – the ability to actually cure a disease; how well a treatment works in practice.
Enrollee – a person covered by a health benefits plan.
Entitlements – social insurance payments to which beneficiaries are entitled by law with little regard to actual contributions or premiums, or income qualifications (e.g. Medicare, Social Security).
Generic Drugs – drugs that are identical in chemical composition to a brand name pharmaceutical preparation, but produced by competitors after the firm’s patent expires.
Grandfathering – approving those who are already in practice to continue even if they do not meet the new standards.
Healthcare - the prevention, treatment, and management of illness and the preservation of mental and physical well-being through the services offered by the medical and allied health professions.
Homeopathy – an alternative form of health practice emphasizing natural remedies used in extreme dilute solutions.
Infant Mortality - the death rate during the first year of life.
Information System – is a technologically implemented medium for recording, storing, and disseminating linguistic expressions, as well as for drawing conclusions from such expressions. It is a business application of the computer. It is made up of the database, application programs and manual and machine procedures. It also encompasses the computer systems that do the processing.
Information Technology – the development, installation, and implementation of computer systems and applications.
Inpatient – services or goods which are provided within a hospital or within a nursing home.
Licensure – the establishment of legal restrictions specifying which individuals or firms have the rights to provide services or goods.
Life Expectancy - the number of years that an individual is expected to live as determined by statistics.
Long-Term Care – Nursing homes, visiting homes, home I.V. and other services provided to chronically ill or disabled persons.
Malpractice – the legal framework for failure to meet the required professional standards.
Managed Care – the use of a manager to control utilization of medical services and control costs.
Management – (a) the act, manner, or practice of managing; handling, supervision, or control: management of a crisis; management of factory workers; (b) the person or persons who control or direct a business or other enterprise; (c) skill in managing; executive ability.
Mandated Benefits – specific services (e.g. pregnancy, alcoholism detoxification) for which a state requires all health plans to provide coverage.
Medicaid - a program in the United States, jointly funded by the states and the federal government, that reimburses hospitals and physicians for providing care to qualifying people who cannot finance their own medical expenses.
Medicare - a program under the U.S. Social Security Administration that reimburses hospitals and physicians for medical care provided to qualifying people over 65 years old.
Medigap – a policy designed to pay coinsurance, deductibles, drugs, and other expenses not fully covered by Medicare.
Morbidity – illness or disability, especially when expressed as a rate.
Mortality – death, usually expressed as a rate per one hundred, thousand, or hundred-thousand.
Open Book Management – a management technique wherein the method is to give employees all relevant financial information about the company so they can make better decisions as workers. This information includes, but is not limited to, revenue, profit, cost of goods, cash flow and expenses.
Outpatient – services provided in a physicians’ office, clinic, or other ambulatory setting.
Outsourcing - the procuring of services or products, such as the parts used in manufacturing a motor vehicle, from an outside supplier or manufacturer in order to cut costs.
Out-of-Pocket – payments made by individuals or their family, rather than an insurance company, government, or other third party, for healthcare services.
Over-the-Counter – a drug that consumers can purchase without a prescription from a physician.
Primary Care – the basic medical attention provided by a physician to a patient seeking care, as distinct from referral services obtained from specialists, or tertiary care provided in technologically sophisticated hospitals.
Quality Adjusted Life Years (QALY) – a way of measuring the value of a medical intervention by the increase in life expectancy, adjusted for difference in disability and timing.
Strategic Partnerships - an alliance between two parties (frequently one corporation that provides engineering, manufacturing or product development services, and one smaller, entrepreneurial firm or inventor) to create a specialized new product.
Supply Chain Management (SCM) – the planning, scheduling and control of the supply chain, which is the sequence of organizations and functions that mine, make or assemble materials and products from manufacturer to wholesaler to retailer to consumer. The driving force behind supply chain management is to reduce inventory.
Tertiary Care – medical care delivered in technologically sophisticated and university hospitals.
Third-Party Transaction – an exchange which is indirect and often pools the funds of many individuals with money collected and disbursed by a third party such as an insurance company, voluntary non-profit organization, or government agency.
Total Quality Management (TQM) - an organizational undertaking to improve the quality of manufacturing and service. It focuses on obtaining continuous feedback for making improvements and refining existing processes over the long term.
Transformational Leadership – offer a purpose that transcends short-term goals and focuses on higher order intrinsic needs. The four dimensions of transformational leadership are: Charisma or idealized influence, Inspirational motivation, Intellectual stimulation, and Individualized consideration.
Universal Health Insurance – a national plan providing health insurance or services to all citizens, or to all residents.
Overview of the study
A number of external and internal forces cause health care systems to consider the need for change. The process in changing governance and management had three critical elements: establishment of a vision and guiding principles for the change, development of support, and implementation of change in governance and management.
The healthcare professions all involve life and death situations. In these situations, quality is crucial and quantity is irrelevant. Clinical governance provides a framework for a coherent, local program of quality improvement and an opportunity to share best practice. For the healthcare professionals, clinical governance will be about building upon and linking together many of the activities that they are already involved in, which help to promote and improve standards of patient care.
The various challenges that the American healthcare system faces includes the high cost of medical care, challenges faced in health insurance, the advantages and disadvantages of technological advancements, the problems encountered in dealing with diverse populations (as the United States has citizens of many different cultures), the role of the government, what the consumers (patients) expect, the problem of deteriorating healthcare work environments, the need for further education and training of healthcare professionals, and the need for a better management.
Local government is a large portion of the overall health care safety net in the United States, providing direct-care services and funding such items as public hospitals, transportation, educational outreach, and housing subsidies. Whatever the government decides and implements can affect the whole healthcare system and the ordinary American citizens.
Healthcare costs are skyrocketing. Most people are frustrated and angry about the state of affairs, and they want something done to rectify the problem. The assortment of components of health care cost increases are not independent but interact.
Health insurance coverage is currently the primary means for access to medical services when unexpected medical crises arise and for everyday health concerns. The high costs of health insurance and medical services has led to reliance on (1) employer-provided health insurance coverage, and (2) federal- and state-funded Medicare and Medicaid programs.
Rapid advancements in science and technology, along with investor dollars, have created major advances in medical care. These emerging technologies in medicine, which were increasingly housed in hospitals and physicians' offices, not only laid the groundwork for the coming shift in the way health care was delivered, but also increased healthcare costs as well as new problems in their implementation and management.
The diverse American population also presents a challenge in clinical healthcare. Of particular importance are the elderly population who requires other special services and the non-English speaking patients who need translators in order to ensure that the right medical care is given.
Consumer expectations are fueling demand for health information that they can understand and services that they want. Consumers would want to know what their care options are and what health plans are available to them. By offering consumers a choice of healthcare services and plans, various healthcare organizations encourage the development of price competition among competitors.
The deterioration of healthcare work environments is a major problem of concern to the healthcare leaders or managers. It presents a challenge to the American healthcare system. A healthy work environment is necessary to bring about quality healthcare service to the population. An unhealthy work environment would create a devastating impact not only to the healthcare professionals and the clients but most importantly on the effectiveness of the entire healthcare system.
There is also a growing acknowledgement of the importance of continuing professional development (CPD) in order that the individual can continue to refine skills and keep up to date with current evidence for practice. CPD must encompass, among many other things, technical skills and attitudes towards patients, staff and the general population.
For this proposal, the authors will employ a combination of qualitative methods. The qualitative methodology that was employed in this research is appropriate since it seeks to interpret or illuminate the actions and/or subjective experiences of the healthcare professionals regarding their experiences in the American healthcare system. This kind of research can utilize the qualitative method.
For the particular study, the participants will be various healthcare professionals from different parts of the country. Basically, how the participants will be selected is only a matter of random.
Before the study will be conducted, an approval to perform the study will be obtained from the ethics committee. The researchers will employ an interview method of data collection in two forms: (1) a questionnaire which will be sent by mail or email (2) a narrative interview through the telephone.
Every participant in the study will be interviewed in the same manner and the data will all be collected in the same way. The timing of when the interviews will take place will also be within one timeframe – e.g. within a span of two weeks. The reason for this is because discrepancies in time could significantly affect the data collected.
Data analysis employed in the study will be carried out in steps. Every data form (audiotape-recorded or written and transcribed) will be carefully read in order to have an idea of the whole results concept. The text will then be read again and divided into meaningful units as the researchers see fit. Data will be condensed and formed into four syntheses which will be integrated to form the structure of the challenges of the American healthcare system.
The data gathered from the study will show the many challenges that clinical healthcare faces and will continue to face in the future. These are all ideas which healthcare professionals think of in the current situation that is being faced at the moment.
From these generalizations, various recommendations are put forth. These recommendations are focused on management, performance measurements, and improving skills and performance among others.
Most early leaders in healthcare management had a vision that stressed the primacy of patient care. The aim of management is to put the interest of the patient first, regardless of race, creed, or ability to pay, and to seek complete health rather than just to cure the ailment at hand. This is a critical moral commitment to the same core value as the caring professions. Any philosophy that puts management values contrary to the caring professions will be corrosively destructive.
Managers for their part regarding information technology and information systems, should plan, coordinate and implement information technologies that can improve quality and efficiency in all processes. For example, an organization should provide on-line medical records and other clinical information at multiple sites, such as laboratory results and imaging.
Improving performance of employees in the healthcare setting is also recommended. There are three main routes to improve performance in the health care setting: (1) prevention, (2) appropriateness of services, and (3) coordination of services. Formal organization and trained management will be essential to all three.
Leadership style that should be employed in healthcare settings is the effective leadership style and shared leadership. Effective leadership style is an integral part of creating an environment that nurtures the development of an empowered healthcare staff.
The professional accountabilities of the empowered healthcare professional includes having a sense of value about their work and willingness to provide the full scope of practice as well as ability to work as equal members of a comprehensive interdisciplinary team. In order to move into a fully empowered position, healthcare professionals need mentoring, education, awareness of political activism opportunities, and networking skills.
Shared leadership is a collaborative team process in which team members share key leadership roles. Shared leadership is empowering employees to act autonomously, be decisive at the point-of-service, and create a shared vision aligned with organizational goals.
Shared leadership development and autonomously practicing nurses appear to be the equation for success in delivering quality patient outcomes in today's organized health care delivery systems. Employees must develop or refine new behaviors and skills in empowerment, facilitation, negotiation, systems thinking, and accountability on behalf of patients.
It is increasingly recognized that formal preparation is necessary for healthcare staff so as to ensure true teamwork. We are moving away from the traditional, didactic teaching methods (e.g. lectures) to more student-centered enquiry or problem-based learning methods. These alternative approaches not only develop problem-solving skills and enhance critical thinking, but they may also provide a forum for the frank discussion of issues relating to deviance, difference and dilemmas in healthcare.
In an increasingly technological healthcare world, it is therefore apparent that in order to respond to the ever-changing and increasing diversity of skills required to participate effectively in a highly technological healthcare system, mechanisms for continuing skills acquisition are a necessity. Yet it is not solely technical skills that are required.
It is becoming increasingly important for healthcare staff to provide more holistic care which requires staff from differing professions to work effectively within a multidisciplinary team. These teams may be ward, acute care or primary care based, and may also require working across areas and with other voluntary and statutory organizations.
In this fast changing world, the American healthcare system is no exception the challenges that are present. The key to overcoming these challenges lies in the strategies that are used by healthcare organizations. But not only that, the government, private organizations and individual Americans all share the responsibility of overcoming these challenges.
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