Analysis of the US Public Healthcare System

The US public healthcare system entails many components, which members of the public need to understand. It is essential for healthcare consumers to understand the history of the healthcare delivery system, how it functions currently, and the stakeholders involved in the system, the legal, political and ethical issues that arise because of the system, as well as the challenges that continue to affect the system. Everyone in the US is a consumer of the healthcare system, yet in many occasions, people are usually ignorant of what they are purchasing. Healthcare consumer awareness protects individuals in both the personal and professional aspects of their lives. Students can pursue careers in the healthcare sector as either providers or administrators. People can also resolve to establish a business where they have the responsibility to provide health care for their employees. In addition, even if people are not interested in the two aspects above, it is vital for people to know from a consumer’s perspective so that they can make informed decisions concerning their health. 

The increased life expectancy in the US means that there is a rise in the aging population. More specifically is the so-called baby-boomers, a significant part of the population that comprises of people who were born between 1940 and 1964. Statistics indicate that this group makes approximately 20 percent of the total population (Catlin & Cowan, 2015). Health experts predict that with the increased population of the baby-boomers, the US is likely to be confronted with increased cases of chronic ailments. Nonetheless, this is just an overview of the challenges that will be discussed in more detail later in this article. 

It is also vital to mention that the US healthcare system is one of the most expensive healthcare systems in the world. According to statistics, the US spends over $2.6 trillion on healthcare, which translates to approximately 17.6 percent of its gross domestic product. However, experts predict that there is a likelihood of the healthcare spending to hit a record of $4.6 trillion by 2010, which means that approximately 20 percent of the gross domestic product will be spent on healthcare. 

Historical development and current role. 

Scholars assert that the long-term success of any organization is linked inextricably to the strategies it pursues over time. The public healthcare sector in the US has evolved and is projected to undergo various changes even in the future. The early practice of medicine did not need a lot of studies, board exams, training, or licensing, as it is needed currently. During the ancient times, anybody who had the will to set up a healthcare center had the liberty to do so. Interestingly, even people who had little knowledge in medicine such as clergymen, tradesmen, and barbers were also medical providers (Catlin & Cowan, 2015). It is even alleged that the barbers used the same blades they used to cut people’s hair to perform surgeries. In most instances, physicians did not have any technical expertise and instead relied on common sense to perform diagnoses. The competition was also intense during that time because there were no restrictions. 

Perhaps it is important to note that during the past one hundred years, two factors have defined contemporary health system; one is the development of scientific knowledge causes and ways of curbing disease; second, is the growth of public acceptance of disease control as both a public responsibility as well as possibility. In the past, when there was little information about the source of particular diseases, the society seemed to view the disorders with some level of resignation, and little action was taken (Howell, 2016). When various stakeholders, as well as the public, started to understand the sources of certain diseases and disorders, better interventions against the illnesses were put in place. Public organizations, as well as agencies, were created to apply the new measures against diseases. When people’s scientific knowledge advanced, relevant public authorities developed and assumed new roles such as regulation, immunization, health education, sanitation, and personal care. 

Before the eighteenth century 

During this period, people in the US like many others in different parts of the world used primitive measures to cure diseases or take care of the sick. Most of the severe diseases that people suffered from included, cholera, the plaque, and small pox. Such diseases were considered by the public as poor moral and spiritual condition hence people employed measures such as prayer and meditation to get rid of the diseases (Parks, 2012). However, the authorities used isolation and quarantine measures to prevent the spread of the aforementioned diseases. 

The eighteenth century 

Since better measures of treating the seemingly mysterious diseases had not yet been discovered, isolation and quarantine remained the most popular methods of preventing the spread of infectious diseases. It meant that people who had already contracted the diseases were left to die because there was little to do. It is even reported that most American port cities came up with rules for trade quarantine and separation of the sick (Irvine et al., 2013). For instance, in 1701, the city of Massachusetts implemented laws for the separation of patients infected from smallpox and for ship quarantine as required. More cities such as Philadelphia, Boston, Baltimore, and New York also enforced quarantine and isolation measures by the end of the eighteenth century (Rivers & Glover, 2013). The initiatives put in place in the eighteenth century demonstrated that people began to see the diseases as natural effects, which could be controlled through public action. Additionally, cities started to build voluntary general hospitals for physically ill individuals as well as public institutions to care for those who suffered from mental disorders. Consequently, the mentally ill, as well as the physically ill, started to be cared for by their neighbors in the local communities. The practice had started in the UK, and since the US was under the British rule at this time, the practice was introduced. Most communities, later on, reached a size that required a more formal organization for the better care of the patients. As a result, the first voluntary hospitals in the US were created in in Philadelphia in 1752 as well as in New York in 1771 (Rocher & Smith, 2012). In addition, the first mental hospital was built in Virginia in 1773. 

The nineteenth century 

The advent of this century is regarded as the awakening period about public healthcare. In this century, poor sanitation was viewed as the main cause of diseases. Prevalence of certain diseases in particular regions was not only viewed as an indicator of poor environmental and social conditions but also as an indicator of poor spiritual and moral health (Oliver, 2016). Thus, the authorities began to put a lot of emphasis on cleanliness, isolation, and piety. These measures were seen as the best means of helping members of the public to stay at bay from diseases. Additionally, institutions that were established to treat patients with mental disorders began to direct their focus on moral treatment and cure. Sanitation efforts also changed the way the society interpreted the public responsibility towards citizen’s health. Instead of people being concerned only about their health, protection of health became a social responsibility. In addition, instead of the authorities and the public reacting to outbreaks of diseases, the focus shifted to prevention efforts. 

Development of public activities in health 

Because the US was a colony of the UK, the early development of its healthcare system borrowed heavily from the British system. A London lawyer named Edwin Chadwick was one of the prominent people in the sanitary movement (Howell, 2016). He was also the secretary of the Poor Law Commission. Under the authority of Chadwick, the commission carried out surveys of the health and living conditions of the working class who resided in London in 1938 as well as the whole country in 1842. Through the surveys, it was noted that people were living in dilapidating and deplorable conditions and that the average mortality age was only thirty-six years, especially for the laborers. It was from the analysis of the findings of the survey that Chadwick asserted that foul air emanating from decomposing wastes caused illnesses. It was then seen as best practice to construct drainage systems to remove sewage and wastes. Chadwick also suggested that a national board of health, local boards in every district, as well as medical officers be appointed in every district to accomplish his proposal. 

Seemingly, the US was also influenced by Chadwick’s idea. A Massachusetts bookseller and statistician knew as Lemuel Shattuck also carried out similar studies in several cities (Howell, 2016). Shattuck recorded critical statistics about the population of Massachusetts and documented disparities in mortality and morbidity rates in various places. He then accredited the disparities to urbanization, particularly the foul air created by the decomposition of waste in places that were densely populated as well as to immoral lifestyle. Shattuck argued that the deplorable conditions of living on the city posed a threat to the whole community. He also pointed out that even though a few people attempted to maintain hygiene in their homes, they were still at risk of contracting diseases because of the activities of the majority. 

Shattuck emphasized the need for the government to take a central role in the management of the environment to prevent the spread and contraction of diseases. Perhaps this was the beginning of the recognition of the role of the government in disease control and management. It seemed that a matter as important as health could not be left solely to private individuals to control. Since the government had more authority, it could compel people to follow certain measures to enhance their health and safety. Shattuck’s report, therefore, recommended that the government conduct new census schedules, control of water supplies and disposal of wastes, consistent studies of local health conditions, particular studies on particular diseases (Catlin & Cowan, 2015). Some of the specific diseases that needed to be studied included, tuberculosis and even alcoholism. In addition, Shattuck also proposed that healthcare providers be educated in preventive medicine; local sanitary associations are established to gather and distribute information, and a state and local boards are created to implement the sanitary regulations. 

Late nineteenth century 

Swift development of scientific knowledge regarding causes and prevention of several diseases triggered significant changes in public health. Many contagious illnesses were put under proper management through the application of science to public health. Through identification of bacteria and creation of intervention measures such as water purification techniques and immunization, diseases were better controlled and prevented (Parks, 2012). It was during this time that the germ theory was developed, and proved to provide a better scientific basis for public health. Hence, public health initiatives mainly focused on particular contagious diseases, and the ways of treating and managing the diseases changed dramatically. It was during this time that people began to realize that diseases had specific single causes. 

Development of state and local health department laboratories 

The state and local laboratories began to sprout in the 1890s to develop and apply the new scientific knowledge. For example, the first laboratories were set up in Massachusetts and integrated the Massachusetts Institute of Technology and the State Board of Health (Catlin & Cowan, 2015). Other research laboratories were later developed in other cities such as New York and Michigan. The focus of the laboratories was to improve sanitation by detecting and controlling bacteria in water systems. Public health did become not only a scientific venture but also a province of experts. Reforms in public healthcare began to be guided by professionals such as chemists, engineers, physicians, and biologists. Control of infectious diseases was not left to the public and individuals only, but the state needed the epidemiologists and their laboratories to direct the way. 

Early twentieth century 

The dawn of the twentieth century witnessed the expansion of the role of both the state and the local departments. Because of the increased scientific knowledge, bacteriology became the basis of disease control. The actions of people were seen as the main sources of diseases as opposed to things (Parks, 2012). Although death rates from certain diseases such as typhoid and other contagious diseases had been considerably lowered, it became evident that immunizations and treatment of infectious illnesses did not solve all the health problems. Experts also realized that even in the case of diseases that had treatment, still the urban poor, as well as children, were affected. Because of the opinion that healthier societies could be created by providing health care for individuals, the available health departments expanded into health education and clinical care. 

Modern healthcare 

As it can be seen, the US public healthcare system has gone through several stages to the state it is in currently. Before, the eighteenth century, the healthcare system was considerably disorganized compared to the present state. Currently, each state controls its healthcare facilities. In comparison, most many diseases can be cured and managed than in the past. In addition, more research institutions have been established to train, research, as well as care for the sick. The government has a firmer grip on the public healthcare institutions than in the past. Individuals who cannot afford to pay directly for medical services can get access to insurance services. The introduction of the Medicare and Medicaid programs, which are forms of insurance services provided by the government to cater for the medical needs of the elderly, physically challenged and the poor has changed the healthcare system to be all-inclusive. 

Political influence 

It is common during political debates to hear the different aspirants lay their manifestos about their health policies. Because the federal government is the largest payer of health care in the US, different political leaders always have different impacts on the manner in which health care is provided in the country (Cohen et al., 2015). In addition, most of decisions about provision of state public health care are implemented through the Congress, which is made up of politicians. The US has two major political parties, The Democrat and the Republican. Hence, the president who is in power at a given period may change how the public healthcare system works. In addition, the party that has the majority numbers in both the Congress and the Senate largely dictates the type of changes that can be made to the public healthcare system. If the president has the majority in both the legislative houses, there is a high likelihood that his proposed changes will be implemented. 

Perhaps the most recent political influence on public healthcare was during President Obama’s tenure. Obama’s popular Obamacare has received a lot of criticism. The Obamacare was enacted in 2010, and the act required that American citizens obtain health insurance for a minimum of nine months per year or be subject to a tax (Cohen et al., 2015). The tax rate is placed at 2.5 percent of individuals’ incomes unless other particular conditions apply. The Obama policy arose upon the realization that most people in the US do not have medical insurance hence struggle to pay for medication whenever they suffer from illnesses. Although the Medicaid and Medicare programs were available, they did not cater for everyone. Obama was a Democrat, and with the entry of Donald Trump, a Republican, he has threatened to repeal the Obamacare and introduce another system. Such cases demonstrate that the US public healthcare system is prone to significant changes with the entry and exit of political leaders who have different ideologies. 

Quality, safety, and competition 

Quality and safety are the most important aspects of any healthcare system. The US, in particular, is spearheading efforts to ensure that the services provided in all its public health institution promote the best care for patients especially after the passage of the Affordable Care Act (ACA). Also, the National Strategy for Quality Improvement in Health Care was formed in 2011 by the Agency for Healthcare Research and Quality (AHRQ) to direct efforts of quality improvement at the state, local, and national levels. The three critical aims of the National Strategy were as follows; 

a. Boosting overall quality through ensuring that it is more patient-centered, accessible, reliable, and safe. 

b. Improving population health by supporting interventions that are proven to address, social, environmental, and behavioral determinants of health 

c. Minimizing the cost of care for individuals, employers, families, and the government. 

For instance, in 2013 a lot of focus was directed to the Journal of Patient Safety, which indicated that hospital medical errors caused more than 210,000 deaths every year. The report also stipulated measures that could be used to promote quality care and minimize harm in the public healthcare institutions. Later, an analysis conducted by the NHQDR indicated that approximately half of the patient safety measures improved with an average improvement of about 3.6 percent each year (Goldman & McGlynn, 2013). The NHQDR also revealed that there was approximately a 17 percent reduction in hospital-acquired infections such as pressure ulcers and falls. 

The improvement in the healthcare conditions of the public healthcare institutions translated to almost fifty thousand fewer patient deaths and healthcare saving costs of about $12 billion. It was also established that there was a considerable reduction in adverse drug reactions. 

The US public healthcare institutions encounter competition mainly from private institutions. Majority of the private healthcare institutions offer equally competitive healthcare services if not better. Because the goal of the private institutions is to make as much revenue as possible, they invest many of their resources in purchasing superior equipment as well as hiring some of the best medical professionals (Brekke & Sørgard, 2017). The professionals hired in the private healthcare centers are often motivated by better working conditions, apart from the high salaries. Many experts are of the view that competition between the public and the private sector are healthy because they improve the overall quality of the healthcare industry; that the healthcare industry would not have developed to the current standards if public institutions were to be given the monopoly of providing healthcare (The Economist, 2018). However, a different school of thought argues that the private sector has managed to entice the best professionals, hence leaving public institutions with a deficit of the best medical officers. Awarding of high salaries to specialists in the private sector has contributed to low morale among medical staff in public health facilities. 

Future challenges and issues 

The immediate challenges facing the US public healthcare system are the rising costs of treatment and the increasing number of uninsured individuals. Seemingly, the cost of medication has been left to free market forces to decide. The US, which is commonly regarded as the world’s superpower, does not have a system of providing medical cover for all the citizens while a country like the UK covers everyone. Individuals have to incur huge medical expenses in case of severe illnesses, which means that a considerable amount of their income, as well as savings, cater for their medical expenses (Mariner, 2015). Experts are of the view that if the situation goes on unabated, there will be a high likelihood of social problems. Majority of the people affected are those in the middle-class. When the middle-class draws most of its savings to cater for medical expenses, there is a likelihood of the US having more poor people who will overstretch its resources. 

As earlier mentioned in this working paper, the population of baby-boomers (individuals born between 1940 and early 1960s) is expected to rise. It means that there will be too many elderly people who will need specialized treatment services. Most of the diseases likely to affect the elderly population include chronic ailments and mental disorders. It means that therapeutic facilities, as well as specialists, will be needed to help care for the aging population. With the rising healthcare costs, it will be difficult for the aging population, which will have no employment to cater for medical expenses (Institute of Medicine, 2014). Although specific groups such as the veterans have their medical expenses catered for, it is unclear how the large population of baby boomers will have their healthcare catered for. 

Recommendations 

Most of the challenges that the US faces in the provision of quality, safe and all-inclusive health care services have been addressed by different countries. The UK for instance taxes every citizen a health stipend. All the UK citizens, therefore, have their healthcare needs provided for by the government. Whenever an individual is sick, he or she does not have to worry where financial support will come from because everyone can get treatment at any public facility. It is also important that the government intervenes and controls the medical costs. The cost of treatment should not be left to free market forces as some scrupulous individuals take advantage of the situation to hike the prices. Spending too much on medical costs will strain some families and create social problems. By comparison, the UK citizens look more relaxed and satisfied than the US citizens who are always on the move to seek for satisfaction. US parents have to provide for the medical needs of their children as well as themselves. The projected increase in the aging population as noted is likely to cause strain on the health resources of the country. It would be best if the active and working population were cut a stipend that caters to their medication when they age to remove the strain on the government and medical facilities. Also, the US needs to come up with robust policies that hinder politicians from causing adverse changes in the public healthcare systems. 

Conclusion 

The US public healthcare system has gone through tremendous changes since before the eighteenth century. From the analysis, significant changes began in the nineteenth century especially with the advancement of scientific knowledge. In the past, the society had a primitive approach to health matters, with many communities having the notion that illness arose because of moral or spiritual problems. The healthcare industry was not organized, but with time, it became more organized and specialized. The US spends many resources to provide healthcare for its population, with the most prominent challenge being the soaring costs of healthcare. There is a need for the relevant stakeholders to evaluate the system and guarantee every US citizen of quality and safe healthcare. 

References 

Brekke, K. R., & Sørgard, L. (2017). Public versus private health care in a national health service.  Health economics ,  16 (6), 579-601. 

Catlin, A. C., & Cowan, C. A. (2015). History of health spending in the United States, 1960-2013.  Baltimore, MD: Centers for Medicare and Medicaid Services . 

Cohen, A. B., Colby, D. C., Wailoo, K. A., & Zelizer, J. E. (Eds.). (2015).  Medicare and Medicaid at 50: America's entitlement programs in the age of affordable care . Oxford University Press. 

Goldman, D. P., & McGlynn, E. A. (2013).  US health care: Facts about cost, access, and quality . Rand Corporation. 

Howell, J. D. (2016). A History of Medical Residency.  Reviews in American history ,  44 (1), 126-131. 

Institute of Medicine. (2014).  The Future of Public Health . Washington, DC: The National Academies Press. https://doi.org/10.17226/1091 . 

Irvine, B., Ferguson, S., Cackett, B., Clarke, E., & Bidgood, E. (2013). Healthcare Systems: Canada. 

Mariner, W. K. (2015). The Health Care Mess: How We Got Into It and What It Will Take to Get Out.  DePaul Journal of Health Care Law ,  10 (4), 543. 

Oliver, T. R. (2016). The politics of public health policy.  Annu. Rev. Public Health ,  27 , 195-233. 

Parks, D. (2012). Overview. In  Health Care Reform Simplified (pp. 1-19). Apress, Berkeley, CA. 

Rivers, P. A., & Glover, S. H. (2013). Health care competition, strategic mission, and patient satisfaction: research model and propositions.  Journal of health organization and management ,  22 (6), 627-641. 

Rocher, F., & Smith, M. C. (2012).  Federalism and health care: the impact of political-institutional dynamics on the Canadian health care system . Commission on the Future of Health Care in Canada. 

The Economist . (2018).  Going public, and private . Retrieved 9 March 2018, from https://www.economist.com/news/business/21591858-fuss-over-obamacares-teething-troubles-obscuring-bigger-story-investors-american