Health care is an integral part of each community since healthy population is the base for healthy and prosperous society. The mission of health care system is to promote the health and well-being of people in each community.
However, in recent time there are many obstacles that prevent medicine from fulfilling its goals and following the values. Despite the strong influence of the opposition, health care system should make such reforms that allow to provide its clients with an appropriate help at reasonable price or for free at all.
During the last 20 years health care system faced many changes and reforms, though the main question to be discussed has always been how to make health care support as much affordible as it is possible for the majority of population.
Health-care reform was one of the major issues during each Presidential campaign. While no major reform bill was passed during Bill Clinton’s two terms in office, health-care reform has remained a major topic of congressional debate (Emanuel, E.J. Protecting Patient Welfare in Managed Care: Sex Safeguards).
The ultimate source of much of the health-care reform debate has been the rapid rise in the cost of medical services during the past 30-40 years. During most of this period, the rate of medical cost inflation substantially exceeded the overall inflation rate. While the increase in medical costs is partly the result of an improvement in the quality of medical services, it has substantially reduced the ability of non-insured low-income individuals to acquire medical services.
Traditional private insurance coverage in the United States consisted of a fee-for-service system. Under this system, insurance companies paid all or a given percentage of the costs of most medical services (Ginsburg, P., and J. Pickreign. Tracking Health Care Costs: An Update). Individuals selected their own physicians and the physicians decided what services were appropriate.
This system, unfortunately, results in a moral hazard problem that exists because individuals who do not face the full cost of medical services (as a result of their insurance coverage) tend to overconsume medical services. Physicians concerned about the rising cost of malpractice insurance might be expected to engage in excessive medical testing (particularly since they know that their insured patients do not have to pay for the tests).
In response to higher medical costs (and the consequent increase in the price of traditional health insurance programs), health maintenance organizations (HMOs) and other managed care arrangements have become a dominant feature in the health-care marketplace during the 1990s. Participants in such plans must first receive the approval of their primary care physician and the insurance company before receiving any specialized medical treatments. While some of the best health care in the world is available in the U.S., not all individuals have access to the same level of medical care.
The infant mortality rate in the U.S. is among the highest among developed economies. Unemployed individuals, low-income workers, homemakers, discouraged workers, and members of minority groups are substantially less likely to have insurance coverage. Several proposals for health-care reform involve a form of national health insurance.
A popular variation of this plan involves the replacement of the current system of private health insurance with a single payer system (as in the Canadian system). Other proposals rely on a market-based system of national health insurance in which all companies would be required to provide a standardized insurance plan to all applicants without regard to their health status. In several proposals, all employers would be required to provide health insurance for all of their employees.
Cost-effectiveness, efficiency, quality of life and right to health care should be considered while talking about health resource allocation. Cost-effectiveness analysis (CEA) is potentially an important aid to public health decision-making, but its use and impact at the level of individual countries is limited. Cost-effectiveness analysis has been used as a tool for addressing issues of efficiency in the allocation of scarce health resources.
Estimates of cost-effectiveness are imbued with an apprecible degree of uncertainty. It confirms that it is simply not possible to be sure that one is more effecient than the other. Efficiency is only one criterion out of many that influence public health decision-making. Thus, there is always a need to balance efficiency concerns with other criteria, including the impact of interventions on poverty, equity, implementation capacity and feasibility.
Some specific examples of public policy in devising an allocation system concentrate on the criteria of effeciency and cost-effectiveness. However, ethical criteria must also be considered: is it ethical to omit the rescue of a person from death because their rescue by bone marrow transplantation is less cost-effective than some preventive measures?
How is cost-effectiveness to be applied to persons with shorter natural life expectancy, such as the elderly? Though as Norman Daniels says, “each person may enjoy his or her fair share of the normal opportunity range for individuals in his or her society”.
Debates over this issue have been lengthy and serious. Many policy proposals have been considered: some implemented and others rejected. However, as systems of managed health care are created, the question of fair and just allocation of resources must be raised and the various proposals, theories and criteria must be reviewed for their applicability to the policies of managed care organizations.
Many health care reforms and acts were rejected or implemented incorrectly by the government due to different reasons. For example, the Health Security Act of 1993, often referred to as “ClintonCare” or National Health Care, became very important event in medicine and politics.
However, Congress did not pass the enabling legislation and have assumed the plan was given a proper burial. Despite all the government actions, two question remain: (1) Have the two most important issues of health insurance cost and health insurance access been resolved? and (2) Has health care been reformed or deformed?
Difficult allocation decisions include triage decisions, quality of life and right to health care. There are many reasons for the situation where intervention is in short supply while more persons are in need of this intervention. Such reasons might be the following: expensive equipment may be lacking in a particular region; few personnel might be trained for a certain technical procedure; insurance coverage is unavailable or of prohibitive cost and many others.
Triage decisions are required when many patients simultaneously need medical attention and medical personnel cannot attend to all at the same time. Certainly, the common sense rule is to serve patients whose condition requires immediate attention. Others, whose condition is not as serious and who are stable, may be deferred.
A second type of triage decisions is indicated in disasters, such as earthquakes, or in military action. The rules of military triage, developed centuries ago, direct the physician to attend first to those who can be quickly and successfully treated and returned to the battlefield. This sort of triage is applied to civilian disasters by treating persons, such as firefighters or public safety officers, who can quickly return to duty and help others.
Patient’s quality of life should be judged in allocation decisions as well. Physicians often rate the patient’s quality of life much lower than the patient himself does. Thus, if the patient is able to communicate, it is important to engage him/her into a discussion about his/her own assessment of his/her condition.
Quality of life judgements based on prejudices against age, ethnicity, mental status, socioeconomic status, or sexual orientation generally are not relevant to considerations of diagnosis and treatment. Furthermore, they should be used, explicitly or implicitly, as the basis for rationing medical services.
Recently all these things are not always considered while providing health care support to patients, especially those with unavailable insurance or without any opportunity to pay high costs for medical treatment. Usually it happens when staff members refuse to serve patients until they show the insurance coverage (Reason, John. Problems With Insurance Coverage). It seems horrible if to consider the importance of person’s life.
The person can die while insurance is being checked. However, usually patients demand much more other services from the hospital members except usual treatment. When those are not done, the medical employees are blamed in bad or unprofessional service.
When someone’s health or well-being is in distress, health care givers have to provide perfect remedy, although sometimes hospital might do not have appropriate equipment or medicine because of the limited budget provided by the government.
It shows once again that sometimes hospitals are tied hand and foot because they are not provided with appropriate equipment of high quality. Thus, it negatively influences on providing necessary medical treatment in time and urgent surgeries without asking for insurance coverage, etc.
The American health care system is urgently in need of a basic overhaul. This statement was raised by Bill Frist, physician and the majority leader of the Senate. He argued that old approaches in U.S. health care system failed because they led to high costs which are growing too fast and cannot address new challenges of the future years (Ginsburg, P., and J. Pickreign. Tracking Health Care Costs: An Update).
He mentioned that United States spends almost 15 percent of its income on health care, far more than other advanced countries. As it was found, almost 82 million people, one out of three below age 65, were uninsured at some point during 2002-03, most of them for at least nine months.
There are only few people who can afford to pay high costs of the medical services without great affect on their budget. Others can pay for the services, but in parts. However, for the majority of people medicine costs remain very high.