Health Care in the U.S.: A System or Not, Research Paper Example

Abstract

The paper discusses the meaning of the concept “health care system” and its relevance in present day care environments in the U.S. The definition of “health care system” is discussed and compared to health care realities in America. The paper shows the promotion of physical and mental well-being, as well as accessibility, affordability, and quality as the basic criteria of a well-functioning system. Based on the literature review findings, the paper confirms the lack of any systemic contributions to the U.S. health care and reveals the need for a profound transformation, which will turn health care in the U.S. into a well-integrated and well-coordinated system.

Introduction

The last decade of the 20^th century was marked with the growing controversy over the efficiency and reliability of the current health care system in the U.S. Unjustified costs, inconsistent accessibility patterns and deteriorating quality have become the topics of the hot national debate. On the one hand, the health care system in the U.S. is well-known for its costs, which are higher compared to other developed countries. On the other hand, these costs are not always associated with the higher quality of medical care in the country, which makes prevention and health promotion rather problematic. Unfortunately, the word combination “health care system” is usually taken for granted and implies the presence of health care services and institutions in the United States. In reality, however, and based on the definition of “health care system” and the word “system” itself, what the U.S. currently possesses and operates is nothing else but a range of dispersed medical institutions and services, which are poorly coordinated, inefficient, hardly accessible, and simply unaffordable for the majority of the American population.

Health Care System: Definition and Evaluation

The meaning of “health care system” in different countries is mostly the same: it is “a country’s system of delivering services for the prevention and treatment of disease and for the promotion of physical and mental well-being” (Budrys, 2005). The presence of a well-developed health care system in any country implies that the authorities and medical professionals have a clear vision of how medical care is to be organized, financed, and delivered (Budrys, 2005). In other words, as well-developed and well-organized health care system implies that authorities, medical professionals, and care recipients know who provides care, who finances care, and how this care is delivered (Budrys, 2005). Based on this definition, consumers and citizens often arrive to an erroneous conclusion: at first glance, what the U.S. currently has about health care meets the three basic criteria – people seem to know who cares, how cares, and who pays. However, looking deeper into the meaning of health care in the U.S. (and here I intentionally avoid using the word ‘system’), it is far from being systematic and is not even close to the meaning of a well-developed and a well-coordinated “system”. Apart from the fact that neither consumers nor caregivers have a clear vision of who pays and who cares, the current state of health care in the U.S. does not meet the three other criteria which make the definition of “health care system” consistent and full: these include high quality, universal accessibility, and affordable cost (Budrys, 2005). In light of these inconsistencies, health care in the U.S. is not a system, but is just a set of poorly coordinated care facilities and instruments. As a result, health care in the U.S. does not fulfill the basic functions of a system: it neither treats diseases effectively nor is capable of promoting physical and mental well-being among different population groups.

Health Care in the U.S. Is Not A System: Literature Review

A wealth of literature has been written about the most problematic aspects of health care in the U.S., but no one has ever tried to evaluate these inconsistencies against the basic and the simplest definition of ‘system’. However, where the meaning of “health care system” implies the need for medical facilities to work in a concerted fashion for the purpose of promoting physical and mental well-being in individuals and groups (Budrys, 2005), and where a good “health care system” is to be high-quality, accessible, and affordable, the current state of literature makes it possible to identify and evaluate the gaps in the U.S. health care and to confirm the lack of systematic approaches to health care delivery in the country. Needless to say, that the discussion of these inconsistencies should begin with quality as the determining factor in promoting wellness, health, and treating diseases in the American population. In their recent research, Lutfiyya et al (2007) provide an evaluation and comparison of the medical care quality between urban and rural health care facilities in the U.S. The authors state that “two recent Institute of Medicine reports highlight that the quality of healthcare in the US is less than what should be expected from the world’s most extensive and expensive healthcare system” (Lutfiyya et al, 2007). Although Lutfiyya et al (2007) refer to U.S. health care as a “system”, what they discuss in their paper actually goes against this definition.

To begin with, the authors use the data from Medicare and Medicaid services to assess the quality of medical care in rural and urban hospital settings according to a set of quality indicators; these include aspirin at discharge, beta-blocker at arrival, beta-blocker at discharge, left ventricular function assessment, discharge instructions, adult smoking cessation counseling, pneumococcal vaccination, oxygenation assessment, and blood culture performed before first antibiotic received (Lutfiyya et al, 2007). Here, Lutfiyya et al (2007) conclude that urban hospitals perform much better than those in rural areas, especially when it comes to heart failure and left ventricular function assessments. Furthermore, the authors of the article are particularly concerned about the lack of care elements which are usually within the scope of medical services provided by rural hospitals – even aspirin at discharge and beta-blockers are often a problem for them (Lutfiyya et al, 2007). These findings may suggest that health care in the U.S. (a) is characterized by ineffective distribution of medical and pharmaceutical resources and (b) health care facilities in the U.S. fail to achieve high quality even in the basic medical services. This information obviously confirms the lack of a systemic vision in U.S. health care. Even that there the quality of care differs between rural and urban medical facilities reveals an increasingly problematic nature of health care in the country and denies the presence of a “system” element.

Unfortunately, while the quality of health care in the U.S. deteriorates, the costs continue to be rising. Lutfiyya et al (2007) write that health care in the U.S. is the most extensive and the most expensive in the world, and their ideas are further supported by Jha et al (2009), who write about the relationship between the cost and the quality of health care in the U.S. According to Jha et al (2009), savings in health care could have reached $25 billion, if hospitals had avoided adverse events and if duplication of tests had been eliminated. Naturally, the growing costs and even the duplication of tests could have been justified by the growing quality and effectiveness of care, but as Lutfiyya et al (2007) and Jha et al (2009) assert that U.S. was not able to link the growing costs of health care to its quality. That means that what the country currently has about health care is not a system at all, but is a kind of shapeless mass of medical institutions at the infancy stage of their organizational development. The duplication of tests and adverse effects confirm the lack of coordination between institutions, and the lack of information about the quality of care in medical institutions (Jha et al, 2009) implies that medical care facilities in the country are not even close to being the participants of a well-established health care system. These findings go in line with what Shi and Singh (2009) say about the U.S. health care: 13% of the gross domestic product spent on health care and more than 40 million of uninsured in the U.S. disrupt the vision of system in American healthcare. Problems with accessibility of health care add to the range of systemic controversies and reveal a complex of problems, which the country was not yet able to solve.

That millions of the U.S. residents fail to access even the basic health care services is no longer a surprise. A whole range of factors contribute to the poor accessibility of medical care in the country, including race, ethnicity, immigration status, social class, disability status, and even psycho-social elements (Vamos, Novak & Musci, 2009). Although Vamos, Novak and Musci (2009) limit their research to the problems with accessing renal transplantation, they also imply that their findings can further extend to cover other related aspects of health care. Vamos, Novak and Musci (2009) conclude that health-care-related barriers include genetic predisposition, one’s ability to pay for care, health risk behaviors, cultural differences and communication problems, and these are only some out of dozens and hundreds of problems, which prevent individuals from either entering health care or utilizing the full range of medical care services that fit their health conditions.

Health Care – A System or Not? The Summary of Findings

What other authors were able to find out about the topic is briefly and perfectly well summarized by Shi and Singh (2009): in their book about essentials of the U.S. Health Care the authors call health care in the U.S. as “high on cost, unequal in access, and average in outcome.” As such, health care in the United States does not meet the basic criteria of a system, which imply accessibility, affordability, and quality. The problems with accessibility, affordability and quality also mean that the country and care recipients do not know who cares, how cares, and who pays for this care. These problems make it impossible for health care in the U.S. to promote physical and mental well-being among different individuals and population groups in the U.S., and at this point, U.S. health care ceases to be a system and turns into an array of poorly-coordinated health institutions without a single, integrated, and effective organizational vision.

Sometimes, this lack of coordination and centralization in health care in the U.S. is considered as one of its beneficial features – Shi and Singh (2009) suggest that a variety of payment and insurance mechanisms provides health care customers with the right to choose and turns medical facilities into free market players. However, even in its basic form, free market is designed to promote competition, to increase the quality, to reduce the costs, and to provide better access to the products and services. The situation in health care is quite different, if not the opposite. For health care in the United States to be called a system, it should be coordinated to the extent, which turns it into the driver of physical and mental wellness across different population groups in the U.S. For health care in the U.S. to be called a system, it should be based on universal accessibility, affordable costs, and satisfactory quality outcomes, which will further lead to the development of a more consistent organizational health care vision.

Conclusion

The definition of “health care system” implies that health care works to promote physical and mental well-being among individuals and population groups. To be a system in health care means to know who cares, how cares, and who pays for this care. For health care to be considered a system, it should meet the criteria of affordability, accessibility, and high quality. In its current state, health care in the U.S. is not a system but resembles an array of poorly coordinated medical institutions, which neither provide quality care nor guarantee universal access to at least the basic medical services. I believe that without accessibility, affordability, and high quality, health care in the country does not fulfill its basic functions and can hardly be called a system. Without these elements, the U.S. will not be able to develop a new coherent and systemic vision of health care for future generations.

References

Budrys, G. (2005). Our unsystematic health care system. Rowman & Littlefield.

Jha, A.K., Chan, D.C., Ridgway, A.B., Franz, C. & Bates, D.W. (2009). Improving safety and eliminating redundant tests: Cutting costs in the U.S. hospitals. Health Affairs, 28 (5), 1475-1484.

Lutfiyya, M.N., Bhat, D.K., Gandhi, S.R., Nguyen, C., Weidenbacher-Hoper, V.L. & Lipsky, M.S. (2009). A comparison of quality of care indicators in urban acute care hospitals and rural critical access hospitals in the United States. International Journal for Quality in Health Care, 19 (3), 141-149.

Shi, L. & Singh, D.A. (2009). Essentials of the U.S. health care system. Jones & Bartlett Publishers.

Vamos, E.P., Novak, M. & Mucsi, I. (2009). Non-medical factors influencing access to renal transplantation. Int Urol Nephrol, 41, 607-616.