Abstract
In the history of the United States healthcare system, major reforms have taken place to improve the state of health care affordability, accessibility, equitability, and quality. Despite all the milestones achieved, numerous gaps still underlie the healthcare system that must be addressed to achieve the desired goals. This project exploits primary data collection by reviewing peer studies to obtain information needed in the discussion. Findings place the high cost of healthcare expenditure in the center of the challenges that burden the healthcare industry in the United States. It further illustrates how health disparities created by past discriminatory policies have greatly contributed to the vulnerability of some populations to the high healthcare costs. Moreover, the study finds the inadequate public health workforce and the declining worker-to-population ratio a challenge that contributes to inefficiency in emergency preparedness and response of the healthcare industry. However, on the other hand, the high cost of workforce development and compensation is found to add to the high cost of healthcare spending. The findings show that despite marked improvements to the healthcare sector in the U.S., there still exist gaps such as social justice issues, the high cost of healthcare, provider reimbursement, policy issues, high out-of-pocket expenditure, for-profit interests, universal coverage, and quality and better outcomes that must be addressed to achieve desired outcomes.
Keywords: out-of-pocket expenditure, high health care spending, health disparities, Healthcare policy, cost containment.
Delegate your assignment to our experts and they will do the rest.
Introduction
Healthcare is an important sector whose level of success reflects any country’s economic growth and development. Due to its distinct nature as a service and its interconnectedness to life, death, and other aspects of the human life of transitions, it is a vital topic in the sphere of public consciousness. The wellness and productivity of a country’s workforce is a measure of the health of her people. In the history of the United States healthcare system, major reforms have taken place to improve the state of health care affordability, accessibility, equitability, and quality. Examples of the recent key reforms include Medicare, Medicaid and the Affordable Care Act of 2010. These reforms have substantively contributed to the improvement of health care delivery in the U.S. Lately, the Patient Protection and Affordable Care Act (2010) has been on the spotlight that despite its remarkable impact in lowering the number of uninsured citizens, several challenges in healthcare still exist that must be addressed in order to ensure the desired healthcare standards and outcomes are achieved. At the center of these challenges is the escalating cost of healthcare expenditure that has drawn the attention of many scholars, the public and other affected parties. This paper examines the cost challenge of the healthcare sector and explores the potential solutions towards ensuring a just and sustainable healthcare system.
In the recent past, budgetary cuts in Medicare and Medicaid have been implemented in efforts to resolve the issue of high costs. Apparently, the impact has negatively affected the whole healthcare system. The U.S. healthcare faces a policy dilemma on whether to address the high cost of health care as an issue of public interest or the for-profit interests that seek to maintain their status quo. Formulation of policy solutions to cut down the healthcare expenditure has been rendered difficult to implement owing to the existence of these conflicting interests (Clarke & French, 2013). The government is to blame for the failure to effectively regulate healthcare markets and properly appropriate healthcare resources through channeling funds and resources towards misaligned interests. It, however, remains unclear how the for-profit interests in healthcare can be eliminated, how the affordability of health care services can be achieved and at the same time taking into account all stakeholders’ interests. In addition, there are policy dilemmas on curbing the escalating cost of health care and whether it is a policy issue or not. The role of research and development in providing solutions is also not clearly known, thus making the whole issue complex.
The escalating cost of health care is one of the greatest challenges facing the industry. In a 2015 study by actuaries of the Centers for Medicare & Medicaid Services, it was established that health care spending cost the U.S. $3.2 trillion which was equivalent to 17.8% of the country’s GDP (Centers for Medicare & Medicaid Services, 2016). Furthermore, in an empirical study by Thornton and Beilfuss (2015), there was a 61% growth in healthcare spending between 1990 and 2009. This growth was associated with growth in incomes, greater provider availability, and other time-dependent factors. Part of this growth in spending is associated with the integration of technology into healthcare. Studies by Branning and Vater (2016) and Baker et al (2005) find high cost of healthcare to be associated with the for-profit motif in the healthcare system. Branning and Vater further state that in 2015, 17.8% of US’ GDP was spent on health care (p. 445). According to Hempstead et al. (2015), healthcare’s out-of-pocket expenses are too high that some populations choose to forgo preventive care services. As a result, providers opt for alternative payment interventions so as to minimize the pressures of negative outcomes such as unsustainable debts.
As a consequence of the high-pocket expenditures, provider debt levels may increase and access to care by low-income patients may be limited owing to the shifts in provider reimbursement and patient obligation (Hempstead et al., 2015). Reinforcing on the effects of high cost of healthcare spending, Mulvany (2014) projects that the escalating healthcare costs may lead the local employers and state Medicaid to shift the pressure onto healthcare providers to minimize vulnerability. He established that high health care spending may prompt employers to adopt value-based strategies for purposes of cost containment. Adding to the literature on healthcare spending challenges, Baker et al. (2005) argue that this state has been worsened by the serious and systematic underfunding of the public health infrastructure (307). State and federal policymakers have played a major role here because of the low priority they have accorded this area. Reports from the media and professional organizations show a reduction of funds meant for routine public health functions (Baker et al., 2005). This is an area that needs more systematic research studies to emphasize these concerns.
Whereas ACA (2010) and the competition in health care promoted by the US capitalist system have been cited as measures in lowering the costs, stakeholder interests and profit motives in healthcare business have been cited as the misaligned incentives that have caused the cost implications witnessed in the sector (Thornton & Beilfuss, 2015). Various stakeholders have distinct profit interests. Health insurers that allocate high profits to medical care expenses and pharmacists collect service charges and benefits managers with part of the savings. Also, healthcare providers want to earn large incomes to pay back their student loans as a justification of their devotion to patient care (Clarke & French, 2013). Profits are also derived from huge research and development costs, while pharmaceutical manufacturers regain from marketing (Querci, 2014). On the other hand, patients are motivated to spend the least of out-of-pocket funds as they look up to third-party payers to cover their healthcare costs. Finally, the government’s interest is to apportion minimal revenue for the provision of care for patients and vulnerable groups. These are among the for-profit motifs that govern the extensive healthcare system.
This state of for-profit has caused the lingering question on why there still are poor medical outcomes when the country spends so much on health care. It should be noted that while other developed countries of America’s economic stature dedicate most of the healthcare budget on patient care, the United States, on the other hand, invests only less than one-third of her healthcare expenditure on patient care. the remaining two-thirds goes to the profits for the players in the industry mirrored in the high cost of hospital care, expensive medical drugs, devices, and procedures, ancillary services, physician fees, high salaries and bonuses, and unnecessary administrative bureaucracy and regulations (Jones & Kantarjian, 2015). In addition, insurance companies and health care providers consume large sums of healthcare funds through their unpopular denial management to make profits at the expense of providing health care. Proper implementation of universal healthcare can, in the long run, be more efficient and affordable despite opponents’ contention that it will be excessively expensive.
Considering the rising challenges facing health in America, it is important to note that there is an inadequate public health workforce. A 2000 enumeration study’s estimates highlighted a decline in public health workforce numbers registering a worker-to-population ratio of 1:635. In another midrange enumeration study conducted in 2013, a worker-to-population ratio ranging from 1:1010 to 1:909 was established, indicating serious erosion in the public health system’s functional capacity (University of Michigan, 2013). These statistics reflect the inadequacies in both formal graduate training and professional certification in the public health industry that further limit a worker’s career development hence lowering the performance capacity of health care organizations and agencies. It is also evident that public health graduates often seek employment elsewhere in relatively high-paying agencies (Baker et al., 2005). This inadequacy in the healthcare workforce is one of the major contributing factors to the challenges in emergency preparedness and response to disasters such as infectious diseases, natural disasters, terrorist attacks, chronic disease, injuries, and high-risk behaviors. Apparently, also, financing high-quality workforce production, compensation and wages, and incentivizing of healthcare professionals are costly interventions which add to the cost burden in the healthcare sector. While human resource development in health care is critical in enhancing the meaningful use of technology and promoting research and development, Walsh (2015) suggest that a balance in managing its supply and demand must be made.
In addition to challenges related to costs, the healthcare sector is flawed with disparities that are as a result of past policies that promoted separatism, social positioning, residential discrimination, differences in access to quality education, and other economic factors in American society. In a qualitative study examining how socio-demographic characteristics influence health outcomes, Jaffee et al. (2005) found that greater urban stress was reported by African-American caregivers with stress factors relating to employment, housing, and finances. The study further found that differences in social structures, institutional and cultural racism, and economic and political gaps are major determinants in the accessibility to quality health care. These disparities have rendered fruitless the efforts dedicated to the achievement of desired reforms and equity in the healthcare system. Relaying emphasis on this issue, Dubowitz et al. (2016) assert that politics play a critical role policy-making process, hence the necessity of considering the political realities such as hyperpolarization, coalition building, and soliciting for public support in policy formulation. Milo (1994) and Berlinger et al. (2014) highlighted that public housing, financing of food and nutrition, accessibility to education, and environmental well-being are the many ways that government policy that affects a population’s health Such unfair past policies led to residential, racial, and socioeconomic discrimination which renders some populations vulnerable to the high costs of healthcare (Dubowitz et al., 2016). Supporting the need for action, Preda and Voigt (2015) argue that addressing income and wealth inequalities are paramount in solving the existing healthcare disparities based on socioeconomic factors.
Owing to the escalating cost of healthcare globally, there are efforts to increase access to care, cut costs, and enhance efficiency whose net effect has several implications for both the general public and nurses. Changes in line with cost-cutting will imply shortened hospital stays and increased need for home health nursing care hence an increased demand for self- and family-care (Parse, 1996, p. 55). On the other hand, these changes will mean fewer nursing positions in health centers, hence decreased demand for degree nurses and increased demand for community-and home-based nurses to provide primary and home care. These changes threaten the status quo of the nursing practice and in effect, there are vital challenges that have been created. First, medical administrators, leaders, and educators who want to preserve the identity of medicine are a great barrier to the integration of the human becoming nursing approach. These administrators and medical leaders advocate for authority-driven practice. In addition, the nursing field is unsettled between preserving the nursing identity and switching to the human becoming approach. Educators, managers, and researchers are redesigning their contribution to the health care delivery system in attempts to maintain the status quo. Moreover, in the contemporary society, people are enlightened about their health and alternatives to care, therefore free to make their care decisions, with others providing their own care (Parse, 1996).
As noted earlier, the inherent weakness in the U.S.’ public health infrastructure in terms of emergency and disaster response and preparedness which puts the public’s health at risk. In their review, Baker et al (2005) emphasize that this increasing state of uncertainty is due to the recent cuts in state healthcare funding which threatens the commitment of the health sector to public health preparedness. In addition, the cutting of the funding threatens to weaken the development of partnerships which is critical especially when it comes to addressing emergencies. Among the highlighted threats in the sector include the said underfunding of the public health sector, inadequate health workforce, uneven and outdated legal foundation, inconsistency in the application of information technology, and organizational deficits (Baker et al., 2005). In a bid to suggest recommendations for bridging the existing gaps in the healthcare industry, in this regard, Baker et al argue that an enhanced and sound financial base, as well as increased investment in public health research, should be considered. Also, the authors believe enhancing and strengthening communications within the healthcare organizations will help facilitate quick response and increase preparedness to emergency situations. Finally, it is not enough to reduce the worker-patient ratio, but more importantly ensuring the organizations operate efficiently through carrying out routine public health agency accreditation, updating old-fashioned public statutes, and fostering competency certification of the public health professionals.
Another problem that looms in healthcare in this advent of globalization is the modern information technologies that are rapidly being integrated into healthcare. IT integration comes with a host of challenges including curbing cyber-security risks that increase with every development, the management of the newly adopted technologies, Health Insurance Portability and Accountability Act (HIPAA) compliance issues, and maintaining efficient operation of the IT systems (Spannbauer, 2018). To start with, the adoption of ‘bring your own device’ (BYOD) approach has brought a number of rewards in healthcare including yielding better staff productivity, reduced hardware costs, and enhanced communication. However, the use of personal smartphones and laptops in healthcare work is bound with serious risks such as data ownership issues, loss, and theft of devices, uncontrolled access and use of sensitive healthcare tools and applications, among other challenges. Use of technological devices across multiple, unknown locations makes it difficult to manage IT network security. This perspective is highlighted by Healthcare in America (2017) that notes “patient privacy issues, including concerns about data breaches, continue to be a challenge for providers, payers, and consumers”. Unlawful access to private patient information under HIPAA standards has huge repercussions including hefty fines and reputational damage. Complying with HIPAA’s stringent security and privacy regulations through data backups, security encryptions, log management, routine risk analysis, etc. is a big challenge for many healthcare organizations that must be always be addressed.
In addition, cyber-insecurity remains an overarching challenge in the use of IT in the healthcare sector. In a survey by Healthcare Information and Management Systems Society (HIMSS), in 2017 alone, 78% of healthcare providers reported malware or ransomware attacks (Spannbauer, 2018). These attacks pose a serious danger to the safety of the highly sensitive healthcare data and information. From a data perspective, the healthcare industry hosts big volumes of data whose management and use require high competency. Often, while some healthcare organizations lack tools and strategies, there are others that do not know the type and amount of data to collect and even if they had the data, it is likely that they do not know what to extract from the data.
Conclusion
The challenges facing the US healthcare industry highlight the policy areas that must be addressed in order to achieve best outcomes desirable to all citizens of the United States. There is a need for awareness and advocacy on the need for controlled health care spending by highlighting the policy dilemma that locks the healthcare system. It is important to emphasize that there exists a conflict between addressing the cost issue as a matter of public interest and maintaining the status quo of the for-profit interests (Clarke & French, 2013). In addition, the disparities inherent in the healthcare industry shouldn’t be existent in such a diverse and civilized society as that of the United States in the 21st century.
Healthcare organizations have a duty to address the multi-dimensional public health disparities through the application of ethical theories and principles into practice. In so doing, Kanekar and Bitto (2012) emphasize that these ethics must be integrated into the public health training curriculum for purposes of developing a competent workforce that observes ethical standards expected of a healthcare setting. In Kanekar and Bitto’s scientific research, the significance of ethics-related training in practitioner and school programs of public health is necessary for informing decision-making, especially in subspecialties such as medical ethics, public health ethics, and bioethics. It is indeed unethical and immoral to have a public health workforce that is ethically untrained in this era when the United States public health is facing disparity challenges and issues in public health research, health promotion and risk reduction (Kanekar & Bitto, 2012). Much as the ethic-based curriculums are developed, strategies must be put in place to facilitate the translation of the competencies into practice in the public health sector.
In addition to ethics-related training, Milo proposes a number of solutions including the provision of sensitive and compassionate care by culturally competent providers, promoting advocacy and community-based participatory research, and advancing education required in the acquisition of skills, knowledge, abilities and fundamental competencies by healthcare professionals. Furthermore, scholars propose the adoption of community health worker interventions to bridge the existing health status gap. And, in order to achieve a health equity system, multi-sectoral and community-based approaches that address the social and structural factors that affect health status and access to care must be sought so as to streamline the connection between public health and medicine.
In order to remain HIPAA compliant and ensure security and safety of private healthcare information, organizations must ensure defense strategies against cyber-attacks are implemented. End users of technological devices and information must be trained on risk identification and safe use of the technology. Also, organizations have a responsibility in ensuring their IT departments keep their systems updated on the latest security software, firewalls, operating systems, and firmware. Automated defense systems and machine learning tools that monitor and analyze suspicious networks and behaviors are being explored for advanced cyber-security protection (Spannbauer, 2018).
Much of the proposed interventions would require policy-making stakeholders’ full support and goodwill to come into effect. The government agencies and departments involved with health care have a responsibility in ensuring proper appropriation of healthcare resources and effective regulation of healthcare markets through heightened advocacy and exposure of credible evidence by influential societal groups and agencies. The whole American society, in particular, those in influential positions in both government and private agencies and organizations must work collaboratively to ensure equity, accessibility, affordability, and quality in health care through implementation of effective policies, procedures, and laws. More importantly, despite the heavy funding on research and development in the healthcare industry, their findings have not been implemented or have been underutilized. This is evidenced by the unmatched quality of care and poor healthcare outcomes.
In the long run, ours is a land of opportunity where while hard work is rewarded, equal opportunity envisaged in the American dream must prevail. Fair access to health care and education for all Americans will no doubt guarantee equal opportunity. A lack thereof disadvantages children right from birth as inequality in both leads to loss of opportunities, poverty, and compromised ethical principles on accessibility to basic necessities (Jones & Kantarjian, 2015). The solution to all other challenges such as cost burden, disparities, entitlements etc. revolve around this equality and living the spirit of human becoming in the healthcare industry.
References
Baker, E. L., Potter, M. A., Jones, D. L., Mercer, S. L., Cioffi, J. P., Green, L. W., … Fleming, D. W. (2005). The public health infrastructure and our nation’s health. Annual Review of Public Health , 26 (1), 303-318. doi:10.1146/annurev.publhealth.26.021304.144647
Berlinger, N., Gusmano, M. K., & Turbiner, E. (2014). Revisiting ‘The Clinic’: ethical and policy challenges in US community health centers. Health Economics, Policy and Law , 9 (04), 425-434. doi:10.1017/s1744133114000140
Branning, G., & Vater, M. (2016). Healthcare spending: Plenty of blame to go around. American Health & Drug Benefits , 9 (8), 445-447.
Centers for Medicare & Medicaid Services. (2016). The nation’s health dollar ($3.2 trillion), calendar year 2015, where it came from, where it went. Retrieved from https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/PieChartSourcesExpenditures2015.pdf
Chernichovsky, D., & Leibowitz, A. A. (2010). Integrating public health and personal care in a reformed US health care system. American Journal of Public Health , 100 (2), 205-211. doi:10.2105/AJPH.2008.156588
Clarke, S. P., & French, S. E. (2013). Healthcare reform in 2013: Enduring and universal challenges. Nursing Management (Springhouse) , 44 (3), 45-47.
Dubowitz, T., Orleans, T., Nelson, C., May, L. W., Sloan, J. C., & Chandra, A. (2016). Creating healthier, more equitable communities by improving governance and policy. Health Affairs , 35 (11), 1970-1975. doi:10.1377/hlthaff.2016.0608
Gold, M. (1999). The changing US health care system: Challenges for responsible public policy. The Milbank Quarterly , 77 (1), 3-37. doi:10.1111/1468-0009.00123
Healthcare in America. (2017, January 10). The top healthcare industry challenges in 2017. Retrieved from https://healthcareinamerica.us/the-top-healthcare-industry-challenges-in-2017-7b4799b8b540
Hempstead, K., Sung, I., Gray, J., & Richardson, S. (2015). Tracking trends in provider reimbursements and patient obligations. Health Affairs , 34 (7), 1220-1224. doi:10.1377/hlthaff.2015.0105
Hughes, J. L., Brannan, D., Cannon, B., Camden, A. A., & Anthenien, A. M. (2017). Conquering APA style: Advice from APA style experts. Psi Chi Journal of Psychological Research , 22 (3), 154-162. doi:10.24839/2325-7342.jn22.3.154
Jaffee, K. D., Liu, G. C., Canty-Mitchell, J., Qi, R. A., Austin, J., & Swigonski, N. (2005). Race, urban community stressors, and behavioral and emotional problems of children with special health care needs. Psychiatric Services , 56 (1), 63-69. doi:10.1176/appi.ps.56.1.63
Jones, G. H., & Kantarjian, H. (2015). Health care in the United States—basic human right or entitlement? Annals of Oncology, 26(10), 2193-2195. doi:10.1093/annonc/mdv321
Milo, N. (1994). Health, health care reform, and the care of health. American Journal of Nursing , 38 (1), 92-107.
Mulvany, C. (2014). Provider payments face short-term local cuts, long-term federal cuts. HFM (Healthcare Financial Management) , 68 (6), 38-40.
Parse, R. R. (1996). The human becoming theory: Challenges in practice and research. Nursing Science Quarterly, 9 (2), 55-60. doi:10.1177/089431849600900205
Preda, A., & Voigt, K. (2015). The social determinants of health: Why should we care? The American Journal of Bioethics , 15 (3), 25-36. doi:10.1080/15265161.2014.998374
Querci, E. (2014). Health spending as a driving force for the growth of a country. The low cost high value health care as a complement to national health systems. Economia Aziendale Online 2000 Web , 5 (4), 263-270. doi:10.4485/ea203-5498.005.0023
Spannbauer, B. (2018, February 5). Four IT challenges facing healthcare organizations in 2018. Retrieved from https://thedoctorweighsin.com/four-it-challenges-facing-healthcare-organizations-in-2018/
Thornton, J. A., & Beilfuss, S. N. (2015). New evidence on factors affecting the level and growth of US health care spending. Applied Economics Letters , 23 (1), 15-18. doi:10.1080/13504851.2015.1044644
University of Michigan Center of Excellence in Public Health Workforce Studies. (2013). Public Health Workforce Enumeration, 2012 . Ann Arbor, MI: University of Michigan.
