The emerging trends in health care include:
- Electronic health records
- Individualized medicine
- Integrative medicine
- Medical home, and
- Telehealth.
The two pertinent trends in health care delivery are integrative medicine and electronic health records. The former trends are gaining popularity because conventional medicine may fail to meet the patient’s expectations. These alternative interventions do not have or have mild adverse effect.
Electronic health records are gaining popularity because they improve patient’s safety. This technique keeps the patients’ records at physician’s disposal, thereby allowing him/her to make appropriate decisions on patient care.
Containing the growth in cost of health care in the United States needs a succinct understanding of the factors responsible for the situation. There is a great controversy on the exact elements that drive this trend of health care expenditure. However, I have described some of the key factors below.
Expenditures on new medical technology and prescription drugs contribute to the current increase in cost of health care. The availability of relatively expensive technological services and novice drugs drive health care spending because the concerned industry must recoup development expenditures of the products. Second is the increase in lifespan and prevalence of chronic diseases. This conditions increase the demand for existing illnesses and nursing home care. Lastly, administrative cost has been accounted for the increase in health care expenditures.
Care providers are able to serve the uninsured on a pro bono (for the public good) basis as far as other revenues wrap fixed costs and afford sufficient margin to engulf the additional expenses of caring for nonpaying patients. Rural providers on contract with managed care agencies adapt cost-cutting strategies like discounting from fees. In addition, providers use public grants to help in underwriting the cost of providing care for the uninsured.
According to Edward J. Schumacher and Philip Nathanson, the key factors in recruitment and retention of nurses are:
- Nursing Leadership development and effectiveness
- Empowerment and collaboration in decision-making
- Work plan and service delivery innovation
- Recognition and reward scheme
- Professional growth and accountability
In order to implement indispensable success factors effectively, health care facilities should:
- Carry out a gap analysis assessing the facility’s performance in every critical success factor
- Design a comprehensive plan to address those gaps
- Make sure that recognition and reimbursement systems throughout the facility attach performance to the comprehensive plan, and
- Make commitment to achieve the objective on a daily basis and as the organization culture.
Private organizations play a key role in health promotion and disease prevention. They, in collaboration with government agencies, participate in organization, delivery, and financing of health care delivery systems. This collaboration effects the development of a broad span of databases useful for monitoring the health of a nation.
Data plays a very important role in provision of health care in America. Private organizations of health professionals in conjunction with health-care providers and health insurance providers among others have a significant interest in the collection and use of health data. Moreover, the private health insurance alongside other sectors has contributed to the growth of health information system.
The garnering market share trend in the United States is important. Possessing a strong market share puts an ambulatory care at a better chance for negotiating with managed care payers. This in turn enables a facility to grow rapidly and secure its future in the progressively competitive healthcare services. In their effort to gain market share, many ambulatory centers have too many sites and are seeking economies to scale. Gains on Ambulatory Surgery Centers (ASC) by managed care players are increasing. This translates to reduced reimbursement for the ASCs. Thus, ASCs are forced to lower cost by various ways, prominently by reducing initial capital cost through reducing smaller and efficient rooms for ASCs. Another measure involves inventory reduction of bulk storage to alleviate storage problems. Architecture of OR is being revised to downsize the operating room. The operating table is position in an angle to allow safe storage of equipments out of staffs’ way.
The current important issues with regard to hospitals in health system remain unknown by many Americans. First, the number of uninsured millions is overwhelming and hospitals are struggling to provide quality care. Indeed, approximately 46 millions Americans are currently uninsured. Second, a rise in prevalence of obesity is taking a large portion of government’s medical expenditure. 64.5% of American adults are obese. Third, pharmaceutical companies regulate more than what Americans care to know. Increased cost of prescription drugs, which has incurred devastating challenges on Medicaid and Medicare programs, has caused physicians to turn down patients with that coverage. Fourth, hospital staff shortages account for high mortality in hospitals, which leaves staff overworked and exhausted to give appropriate care. Lastly, veteran neglect is currently on the rise. Millions of veterans are lacking medical insurance or cannot access regular health care from Veterans Health Administration (VHA) hospitals.
Organization of long-term care is based not the following standards:
- Cost-based reimbursement helps increase the number of registered nurses (RN), but decreases the number of practical nurses relative to flat-rate reimbursement. Higher reimbursement levels, on the other hand, encourage the recruitment of practical nurses.
- Increased professional nursing staff and lower staff turnover improve long-term care.
- Nursing homes with minimal private pay residents produce undesirable outcomes;
- For-profit nursing facilities have reduced operating cost but increased hospitalization rates compared to the nonprofits facilities;
- Case management decreases cost for each participant and sustain quality if the organization has the power to approve public payments, maintains a mean expenditure cap, and offers the case management services.
The recent mental health policies involve soldiers who have returned from peacekeeping missions in politically unstable countries. This policy gives priority to soldiers’ wellbeing. It calls for commanders to encourage soldiers to seek guidance and counseling against stigma or negative consequences.
The federal government through the Food and Drug Administration (FDA) protects and promotes public health through the regulation of over-the-counter pharmaceutical drugs, blood transfusion, biopharmaceuticals vaccines, medical services, and electromagnetic radiation among others. New drugs receive comprehensive scrutiny prior to FDA approval. The drug is approved through New Drug Application (NDA). Moreover, the FDA upholds and regulates advertisement and promotion of prescription drugs. The FDA requires the drug sponsors to review and report every adverse drug outcome amongst patient.
Managed care affects health professional mainly because it leads to understaffing of health facilities. This translates to overworking and exhaustion of professionals. This situation further leads to less time spent on patients. In addition, managed care has increased job dissatisfaction. In addition, increased medical errors raises mortality rate.
Policy making in the United States takes many dimensions including government, care receivers, providers, and cost of medical procedures. The United States emphasizes on costly and high-tech solutions to complicated health events because medical facilities do not pay for this medical bills. Powerful lobbies involving the elderly, hospitals, and physicians want Medicare to cover for novice procedures. In addition, business groups also have impact on health policies. For instance, insurance companies have rested efforts of physicians and hospitals to pass cost of unpaid bills to them.
Managed care helps to improve quality of care; therefore, ethical issues concerning quality of care directly touches on managed care. Ethical issues arise because of conflicting principles and responsibilities in circumstances of competing interest. Three ethical issues are especially associated with managed care. First, the fairness of the protocol with which health outcomes is achieved. Second, changes in the point of decision-making, changes in standard of appropriate care, and physician-patient relationship will elicit commutative justice concern. Third, given that managed care general justice concerns patients and other plan members, unbalanced use of health care may arise leading to few members overusing the available resources at the expense of others.