Annotated Bibliography 1
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Feb 20, 2024
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Annotated Bibliography
Brielle West
Bentley, Tanya G.K., Rachel Effros, Kartika Palar, and Emmett B. Keeler. “Waste in the U.S. Health Care System: A Conceptual Framework.” Milibank Quarterly 86, no. 4 (December
1, 2008): 629-59. https://doi.org/10.111/j.1468-0009.2008.00537.x
.
The purpose of this article was to identify waste within the US healthcare system and build a conceptual framework to guide policymakers and researchers in evaluating waste within the system and strategies to lower waste. Healthcare waste is divided into three sections: administrative, operational, and clinical. The first waste tackled is administrative waste which is described as spending that is not necessary to achieve the goals of the organization, in other words, overspending. The second is operational waste which refers to unnecessary and inefficient use of resources in the production and delivery of medical services. The final is clinical waste which refers to spending money to produce services that have little to no health benefits over more affordable alternatives.
The main consensus found is that waste in the US healthcare system greatly contributes to the high costs of medical services which in turn takes funds away from other resources that can be used for the betterment of society. The fact that incentives are not aligned creates a problem of wasteful spending, which affects individuals and households by increasing the fees to receive medical care, and affects insurance rates and premiums. What these authors suggest is that there needs to be policy proposals in financing or quality improvement to improve the market for health insurance, which would create an incentive for better efficiency, which in turn would limit waste.
Bush, Melanie. “Addressing the Root Cause.” North Carolina Medical Journal 79, no. 1 (January 1, 2018): 26-29. https://doi.org/10.18043/ncm.79.1.26
In “Addressing the Root Cause: Rising Health Care Costs and Social Determinants of Health” author Melanie Bush discusses that one of the major root causes for the rising health care costs is systemic disparities and social determinants that lead to health inequalities and poorer health by lower income homes throughout the country. She begins
the article by illustrating that although the United States spends more money on health care than other high-income countries around the world, the US has some of the worst health outcomes. Pointing out that even though the United States has annual expenditures
of over $3 trillion it has the highest mortality rate among infants, and a higher prevalence of chronic diseases compared to other countries around the world. One reason Bush gives
for these disparities is higher out-of-pocket spending, higher consumption of medical technology like imaging, and pharmaceuticals, as well as higher pricing altogether. She later in the articles discusses the social determinants, the social and environmental factors
that impact the direct behavior of individuals, and how they directly correlate to an individual having access to health care, and how healthy an individual is. She uses North Carolina as an example of this. Counties with the worst overall ranking of health mirrors the counties with the most poverty. Dickman, Samuel, David U. Himmelstein, and Steffie Woodhandler. “Inequality and the Health-
Care System in the USA.” The Lancet
389, no. 1077 (April 1, 2017): 1432-41. https://doi.org/10.1016/s0140-6736(17)30398-7
.
“Inequality and the Health Care System in the USA” by Dickman, Himmelstein, and Woodhandler is a report that focuses on how the United States health care system could reduce income-based inequalities but instead usually does the opposite and exacerbates
them. The report pays direct attention to inequality and focuses on inequality in health care as it relates to access to care, quality of care, and financial inequality. The main reason suggested for such inequalities ties to economic disparities and inequalities seen throughout the country. The latter part of the report focuses on health reform. Some key takeaways from this report are that over the past decades, economic inequality has been increasing in the United States and is among the highest in developed countries, despite the implementation of the Affordable Care Act (ACA) in 2010, roughly 27 million people
remain uninsured. Despite government spending in the US is higher than its international counterparts like the UK and Canada, access to health care is restricted by poor insurance
coverage and geographical location. Simply put, patients who cannot afford adequate insurance, or insurance altogether, or are bound by geographical barriers are more likely to forego medical treatment altogether, which in turn brings down health. What is suggested at the end of this report is that in order to achieve healthcare equality in the US,
viewing healthcare as a human right is essential. Douthit, Nathan T, Sakal Kiv, Tzvi Dwalotzky, and Sk Biswas. “Exposing Some Important Barriers to Health Care Access in the Rural USA.” Public Health
129, no. 6 (June 1, 2015): 611-20. https://doi.org/10.1016/j.puhe.2015.04.001
This report focuses on the barriers faced by those living in rural populations of the US, paying close attention to what it was like before and after the passing of the Affordable Care Act (ACA) in 2010. What this literature review found is that there are disparities that affect all patient groups in rural areas regardless of age, race, gender, or sexual orientation. However, it was worth noting that although all groups were affected, “vulnerable” populations were those that were most affected. Using Pubmed, Proquest
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Allied Nursing and Health Literature, and the NRHA Resource Center Database from 2005 to 2015 they found there are five primary reasons individuals who live in rural areas
throughout the United States have poorer health. The first reason is the cultural perceptions that affect access to health care. In smaller communities, healthcare providers
are regarded as friends and neighbors and patients are concerned about the discrimination, stigma, and the extent to which their private information is kept confidential. The struggle to get to the doctor is the second reason; patients are less likely to see a doctor if they have to travel far. The third reason is the absence of services that are accessible and the lack of online services. In smaller rural areas there is a scarcity of hospitals and clinics, as well as a lack of infrastructure to support online medical services like Zoom appointments. The final reason is the financial burden as there is greater poverty in rural areas compared to urban areas. Rural areas are also subject to receiving lower quality health advice as it does not attract the best doctors due to lack of opportunity, and staffing shortages. The major theme found in this literature review is that
geographic barriers can greatly impact the health outcomes of rural patients. He, Xinhe. “Why is Healthcare so Expensive: A Discussion about the Future of Healthcare Reform.” Journal of Undergraduate Research at Ohio State 4 (n.d.).
Xinhe He in “Why is Healthcare so Expensive: A Discussion about the Future of Healthcare Reform” says the healthcare system in the US could be summed up in one word: overpriced. He postulates that the major causes and problems in the US healthcare system are the unnecessary use of advanced technology, a lack of preventative treatments available, and an overly complex pricing system. He takes on the obsession with
technology by offering a solution in the form of encouraging social entrepreneurship innovation, which focuses on the use of innovation to bring down the prices of healthcare
products. However, He acknowledges that a major limitation of this model is the low profitability. Another challenge he lists that the US healthcare system faces is its overly complex pricing system. One reason He cites for this is the products in the US are more expensive and services are charged at a higher price compared to other countries. One reason for this is that medical personnel prescribe more services than are actually needed in order to compensate for their time and investment. This in turn raises medical bills. His
solution to the complexity of the pricing system is that the price level should be set based on the demand for the service and the supply, not the suppliers’ profit. The final major leading issue of the US healthcare system is the lack of insurance coverage. Under the current system high premiums are imposed on buyers and subsequently discriminate those of a lower income. His solution to this is more government involvement in both the public and private sectors of insurance. Summary
While all these articles differ slightly, they all focus on the inequalities within the US healthcare system, where there is waste, and what can possibly be done. Not only makes health insurance more affordable for those already insured but makes it more possible for those who are
uninsured to become insured. The first article “Waste in the U.S. Health Care System: A Conceptual Framework” focuses on waste in the US healthcare system by looking at it from three perspectives, administrative waste, operational waste, and clinical waste. The second article
“Addressing the Root Cause: Rising Health Care Costs and Social Determinants of Health” focuses on some of the root causes for rising healthcare costs, her thought is systemic disparities.
The primary reason for these disparities is higher out-of-pocket spending, higher consumption of technology, and higher pricing altogether. The third article “Inequality and the Health-Care System in the USA” also looks at healthcare costs but focuses primarily on insurance coverage, and why certain people cannot afford medical insurance and how that affects overall rates and overall health in the country. Similar to the previous article the fourth article “Exposing Some Important Barriers to Health Care Access in the Rural USA” looks at the overall health of those living in rural areas throughout the US and how it greatly affects their access to quality healthcare. The final article “Why is Healthcare so Expensive: A Discussion about the Future of Healthcare Reform” looks at the possible reasons why healthcare in the United States is so expensive compared to its international counterparts. This article also gives alternatives to lower the cost of services and medical treatments.
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