Today, there is a fierce debate regarding how to operate the US healthcare system. There are calls from the Trump administration for the Obamacare program to be replaced. The government seeks to introduce an alternative program that will deliver insurance to the American public. The efforts to replace Obamacare highlight the complex nature of the American healthcare system. Despite spending billions of dollars every year on healthcare, the United States still lags behind other developed nations (Fox, 2016). Millions die from diseases that can easily be prevented, treated or managed. It is clear that there is need for reform in the US healthcare system. The nursing community should be at the forefront of the implementation of the reform. In this paper, the current state and the future of nursing and healthcare in the United States are explored.
Cost and comparative value of US healthcare system
The US is known to have one of the highest costs of healthcare in the developed world. Every year, the government sets aside huge amounts for the purposes of providing medical services to the American people. In 2016, a total of $3.2 trillion was spent on healthcare (Sahadi, 2016). This figure represents a significant increase over the amounts spent in previous years. To gain clearer insights into the cost of healthcare in the country, it is important to consider the per-capita cost of healthcare. In 2016, it stood at $10,345 (Alonso-Zaldivar, 2016). This is a 4.8% rise over the cost for 2015. There is no doubt that the US spends huge amounts on healthcare and this is not reflected in the quality of medical services delivered to the American people. Compared to the systems of other developed countries, the value of the American healthcare system is rather low. It is for this reason that there are some Americans who opt to undergo certain procedures in other countries where medical services cost less.
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Payers of healthcare
Given the high cost of healthcare in the US, it is reasonable to expect that the American people receive support from their government to pay for medical expenses. This expectation is true. The American government covers most of the healthcare costs (“Government Funds Nearly”, 2016). The government has set up health insurance programs such as Medicaid which attend to the medical needs of the American people. About two thirds of the cost of healthcare is paid for using tax-payer funds. Apart from the government, the private sector also helps to meet the cost of healthcare (“Government Funds Nearly”, 2016). There are private insurers who provide medical coverage. Employers also help to pay for healthcare as they either establish insurance schemes or pay into schemes that private insurers have already set up. There is no clear answer regarding the party responsible for paying for healthcare. However, it is generally held that the government should pay for healthcare.
Individual access to healthcare
One of the contentious issues surrounding healthcare in the US regards whether individual Americans have the right to access healthcare or this is a privilege. This issue is difficult to settle. However, it can be argued that individual access is a right and not a privilege (Bauchner, 2017). Since they pay taxes on way or another, all Americans should be able to access health services freely. If healthcare access is a privilege, it means that only those with the financial means can easily access healthcare and poor Americans are left at the mercy of the system. It is only when the government understands that individual access is a privilege that it will commit to providing all Americans with adequate, affordable and quality care.
Shortfalls in US healthcare system
The flawed design of the US healthcare system is partly to blame for the challenges that Americans encounter in their efforts to access medical services. One of the shortfalls in the system is fragmentation (McKethan et al., 2009). There is little coordination and collaboration among practitioners. This makes it difficult for Americans with chronic illnesses to receive treatment. The lack of effective oversight is another shortfall. There have been cases where practitioners offer treatment that is necessary. They are able to do this because their actions are not closely monitored. The fact that many Americans lack health insurance is another shortfall that plagues the US healthcare system (McKethan et al., 2009). Millions of Americans lack health insurance and this hinders access to medical services. The shortfalls discussed here can easily be solved through an overhaul of the healthcare system. The issues that make it difficult for practitioners to collaborate should be addressed and they should also be scrutinized closely to ensure that they offer quality and proper care. There is also need for universal coverage to be provided. This will ensure that all Americans are able to receive treatment. The medical community should spearhead the redesign and reform of the healthcare system. The government and other stakeholders should also be involved.
PPACA
In 2010, the Patient Protection and Affordable Care Act (PPACA) became law. There are a number of key provisions in the Act that have redefined the delivery of medical services in the country. One of these provisions is that all Americans should have some level of health insurance (Manchikanti et al., 2011). Businesses are also required to provide their employees with a certain level of health insurance. Those who fail to meet this requirement face a penalty. The PPACA also mandated the federal government to pay for the health insurance of the millions of Americans who are not covered (Manchikanti et al., 2011). This is done in the form of subsidies in Medicaid and insurance exchanges. There are the core provisions of PPACA. This Act has had tremendous impact on the American healthcare system. Thanks to this Act, patient privacy and confidentiality has become a key component of the system (Rosenbaum, 2011). Now, practitioners strive to ensure that all information that patients share remains confidential and private. Quality and efficiency in the delivery of care have also resulted from this Act (Rosenbaum, 2011). As a result of the Act, medical facilities and practitioners are now more committed to providing quality and cost-effective treatment. It is predicted that the PPACA will place strains on the medical community which will be required to provide care to the millions of Americans who gained insurance coverage thanks to the Act (“The Impact of the Affordable”, 2014). The Act has also affected the American economy. It was believed that when the PPACA came into force, the economy would suffer. The Act would decrease economic production and discourage investment (Nell & Campbell, 2010). Americans would pay higher taxes to fund insurance programs. Higher premiums would also need to be paid. Some of these predictions have been realized while others are yet to be witnessed. For example, it is true that PPACA has increased premiums that Americans pay for medical insurance.
Accountable care organizations
Accountable care organizations are an initiative of the American government. Their primary purpose is to enhance the delivery of quality care. These organizations attend primarily to Medicare beneficiaries. They seek to solve some problems that had plagued the American healthcare system for years. One of these problems is poor access to healthcare for elderly Medicare beneficiaries. The ACOs strive to ensure that practitioners and organizations join forces to provide the beneficiaries with the best possible quality of care (“Accountable Care Organizations”, 2010). The second problem that the ACOs seek to solve is the high cost of medical services in the US. These organizations endeavor to lower the cost of healthcare by initiating cost-saving measures and only providing services that are absolutely necessary (“Accountable Care Organizations”, 2010). These organizations have been effective at addressing these problems. Thanks to their effort, thousands of Medicare beneficiaries now enjoy access to healthcare and significant cost savings have been made.
Role of RNs
The US healthcare system relies heavily on the input of registered nurses (RNs). Currently, RNs are mostly involved. The provision of care to patients is among these roles (Sharon, 2014). Nurses also make decisions for patients and enhance effective communication within the healthcare system. Advocating for the rights of patients is another role that nurses play. Teaching patients and their families is yet another mandate that registered nurses are charged with (Sharon, 2014). This discussion is not exhaustive. Nurses play numerous other roles depending on circumstances. Registered nurses should continue to play the roles that they do. However, it is felt that promoting evidence-based research and practice should be the key mandate of RNs. It is believed that evidence-based practice holds the key to transforming nursing practice and enhancing patient outcomes. For the most part, the nursing profession is effective. However, there are numerous challenges that hinder its effectiveness. These challenges include biting shortages and heavy workloads. These challenges make it difficult for nurses to offer their best effort. As a result, patients suffer. It is felt that the nurses in the United States fail to speak with a common voice. There is no consensus regarding the best approach to delivering care. Additionally, nurses in the US have been accused of failing to advocate for certain patient populations. For example, immigrants suffer poor access to medical services. Nurses have been blamed for compounding the challenges that the immigrants face as they stand by and witness injustices perpetrated against immigrants (Fitzgerald, Myers & Clark, 2016).
Themes in the Institute of Medicine report
The Institute of Medicine (IOM) released a report in which it outlined its vision for the nursing profession. IOM believes that there is need for nursing education to be transformed and for nurses to collaborate with another and with other stakeholders in the healthcare profession (“IOM Releases Report”, 2015). The other themes in the report include nurse leadership and diversity. Data management is another element that the report focused on. IOM clearly understands the current state of the nursing profession. The findings are accurate since they capture the challenges that plague the profession. For example, poor coordination among nurses is one of the problems that the profession faces. If this and other problems are to be solved, the IOM report should be integrated into nursing practice.
In conclusion, significant improvements have been made in the delivery of care in the US. Nurses have played a vital role in ensuring that the American people receive quality and affordable care. The nurses have been aided by numerous policies that the government has developed. The Patient Protection and Affordable Care Act is among these policies. Affordable care organizations have also been instrumental in transforming healthcare delivery. The US healthcare system still faces challenges. These challenges will only be addressed successfully when the different stakeholders join forces and pull in the same direction.
References
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