IHP600FinalExam
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Southern New Hampshire University *
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600
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Health Science
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Feb 20, 2024
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1. What are the basic characteristics that differentiate the U.S. health care delivery system from that of other countries?
According to Shi and Sing, there are “ten basic characteristics which differentiates the US health care delivery system from that of other countries:
1.
No central agency governs the system.
2.
Access to health care services is selectively based on insurance coverage.
3.
Healthcare is delivered under imperfect market conditions.
4.
Third-party insurers act as intermediaries between the financing and delivery functions.
5.
Existence of multiple payers makes the system cumbersome.
6.
Balance of power among various players prevents any single entity from dominating the system.
7.
Legal risks influence practice behavior. 8.
Development of new technology creates an automatic demand for it’s use. 9.
New service settings have evolved along a continuum.
10. Quality is no longer accepted as an unachievable goal in the delivery of health care.”
One of the most obvious takeaways from these characteristics is that healthcare ins the U.S. is a business above all else. Be it the patients, insurance companies, or the healthcare professionals offering treatment, in most scenarios, costs trump the overall quality of care. Patients shop for insurance plans and treatment that fits their budget, insurance companies look to maximize profits, and medical providers have to balance their finances and their hypocritic oath. As stated by Sawyer, “in the U.S., healthcare is now strictly a business term. Healthcare organizes doctors and patients into a system where that relationship can be financially exploited and as much money extracted as often as possible by hospitals, clinics, health insurers, the pharmaceutical industry, and medical device manufacturers.” The numbers back up the notion that healthcare has become a business in the United States. According to the Peter G. Peterson Foundation, “in 2018, the United States spent about $3.6 trillion on healthcare, which averages to about $11,000 per person. Relative to the size of the economy, healthcare costs have increased over the past few
decades, from 5 % of gross domestic product (GDP) in 1960 to 18 % in 2018.” Despite spending more on healthcare than any other country, the United States has seen no significant return on its investments. According to Tikkanen and Abrams, “The U.S. spends more on health care as a share of the economy — nearly twice as much as the average Organization for Economic Co-
operation and Development (OECD) country — yet has the lowest life expectancy and highest suicide rates among the 11 nations — and, compared to peer nations, has among the highest number of hospitalizations from preventable causes and the highest rate of avoidable deaths.” Essentially, the most notable characteristics that differentiate the U.S. health care delivery system from that of other countries, is the fact that Americans pay more for their healthcare but ultimately have worse outcomes. Aside from the financial aspect, I believe another differentiating characteristics U.S. health care delivery system when compared to that of other countries, is the overall availability and accessibility of care. Unlike other countries, the U.S. has no universal or standardized healthcare. With over 27 million Americans having no healthcare insurance, and the inflated costs, the deteriorating health of Americans cannot be unexpected. Although some inroads have been made with the Affordable Care Act, we still have a long way to go to make healthcare more
affordable and accessible to all Americans. “We live in an age of medical wonders — transplants, gene therapy, lifesaving drugs and preventive strategies — but the healthcare system remains fantastically expensive, inefficient, bewildering, and inequitable” (Rosenthal, 2017).
2. List the four health determinant categories and provide an example of how the government is supporting improvement in each determinant.
According to Shi and Singh, the four determinant categories of health include environmental, behavior and lifestyle, heredity, and medical care.
Environmental
o
According to the World Health Organization, “environmental determinants of health are the full set of social and physical conditions in which people live and work, including socioeconomic, demographic, environmental and cultural factors,
along with the health system.” This essentially encompasses all physical, chemical, and biological factors external to a person.
o
For example, the Environmental Protection Agency has set the maximum contaminant level goal for lead in drinking water at zero. This was illustrated recently in Flint, Michigan, where the amount of lead in the local water became toxic and caused residents to fall ill with various symptoms and conditions. o
In response, the state of Michigan provided over $350 million and the federal government provided an additional $100 million to Flint, with an overall goal of improving water quality.
Behavior and Lifestyle
o
These include individual behaviors such as diet, physical activity, smoking status, alcohol or drug use, etc. o
Focusing on smoking status specifically, the government has made significant improvements on helping reduce the number of people smoking. According to Sandford, this includes “a total ban on tobacco advertising and promotion; restrictions on smoking in public places and in the workplace; sustained increases in tobacco taxation combined with measures to curb smuggling; large, bold health
warnings on tobacco products; smoking cessation and health education campaigns; and the regulation of tobacco to standards agreed by the health community rather than those set by the tobacco industry.”
o
In terms of healthcare, providers are also reimbursed for offering smoking cessation counseling to their patients.
Heredity
o
According to Physioplus, “some biological and genetic factors affect specific populations more than others. Examples of biological and genetic determinants of
health include age, sex, inherited conditions and genetic make-up.”
o
Since heredity relates to one genetics, and we continue to make efforts to treat many genetic conditions, much of the government assistance has been with preventing discrimination against those with such conditions. For example, in 2008, President Bush enacted the Genetic Information Nondiscrimination Act (GINA), which prohibits insurance companies and employers from discriminating
based on information based on genetic tests. “It forbids insurance companies from
discriminating through reduced coverage or pricing and prohibits employers from making adverse employment decisions based on a person’s genetic code. In addition, insurers and employers are not allowed under the law to request or demand a genetic test” (Human Genome Project Information Archive, N.D.)
Medical care
o
Arguably the most influential determinant, the overall access to healthcare.
o
In a study performed by the National Association of Community Health Centers found that over 55 million Americans have inadequate access to primary care physicians and considered “medically disenfranchised.” However, the federal government is working to combat some of these inequalities in access to healthcare. According to The Commonwealth Fund, “The American Recovery and Reinvestment Act, also known as the stimulus plan, signed into law February 17, 2009, provides significant funds to supplement prior efforts to combat barriers
to health care access, generate new health care jobs, and meet the primary care needs of the growing uninsured and Medicaid populations.” o
Additional government programs include:
Health Center Program – administers grants and technical assistance to health centers serving primarily uninsured and low-income, publicly insured patients.
Rural Health Clinic Program – provides cost-based reimbursement from Medicare and Medicaid to rural health clinics.
Medicare HPSA Bonus Payment – offers extra payments to physicians who serve in primary care HPSAs and to psychiatrists serving in mental health HPSAs.
3. Explain how the United States has both market and social justice aspects of healthcare. The United States is said to have both market and social justice aspects of its healthcare system, in which the market justice aspect allows for fair distribution of healthcare amongst citizens who are able to purchase the services they want/need whereas social justice establishes a
responsibility for society to ensure equal distribution of healthcare services.
Market Justice
o
For the market justice aspect, according to Shi and Singh, the responsibility for distribution of healthcare on the market forces in a free economy. Market justice allows patients to seek treatment more easily, as they are able to get the care they need, when they need, and at a price point they can afford. As stated by Budetti, individual resources and choices determine the distribution of health care, with little sense of collective obligation or a role for government. This approach derives from principles of individualism, self-interest, personal effort, and voluntary behavior.
o
Shi and Singh also state that market justice in healthcare is based on five core assumptions.
1.
Healthcare functions as any other economic good or service, rendering it subject to market forces of supply and demand.
2.
Individuals are held responsible for their own economic and financial achievements.
3.
People tend to make rational decisions in their choice to purchase healthcare services that promote individual health. 4.
People informed by physicians know what is best for their own health, implying that people place a great deal of trust in their physicians.
5.
A free market, rather than the government, can distribute healthcare efficiently and equitably.
Social Justice
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o
For social justice, the emphasis is on the greater good for the community, as opposed to the individual. In social justice, distribution of healthcare becomes a responsibility of the government or other central governing body and services would be available to everyone, regardless of their ability to pay. As stated by Regis College, social justice in healthcare “health care administrators should be aware of individuals and groups that have been historically marginalized and are currently vulnerable to inequality in health care. Administrators can advocate for these individuals and groups by designing strategic models of social justice in health care. Health care administrators can effectively incorporate the following models for promotion of social justice into their health care strategies.”
o
The Affordable Care Act, and associated legislation, is aiming to push the U.S. healthcare industry to have a larger emphasis on social justice. “The Affordable Care Act (ACA) created a state Medicaid Expansion Initiative to provide health insurance coverage for the remaining population of uninsured adults who suffer from poverty. The program was designed as a primary tool to promote social justice. The population of poor persons has worse health status and worse health care access than do other Americans. The Medicaid Expansion seeks to redress these disparities by promoting equity through expanded health insurance coverage” (Behavioral Healthcare Executive, 2013). However, I believe we need a balance of both market justice and social justice in healthcare, which allows for individuals to seek care they can afford while also expanding treatment who may otherwise be disenfranchised. 4. Discuss reasons why national health insurance has not developed in the United States.
There are many reasons that have contributed to United States’ lack of a national health insurance system, however in my opinion, the main reason boils down to politics. Like with anything else in the U.S. Beginning with lobbyist and special interest groups, these entities essentially have the insurance companies in mind, as opposed to the citizens of this country. As stated by Eaton, “a Center for Public Integrity analysis of Senate lobbying disclosure forms shows that more than 1,750 companies and organizations hired about 4,525 lobbyists — eight for
each member of Congress — to influence health reform bills in 2009.” Of these lobbyists, over 100 worked for insurance companies and additional 85 worked for manufacturing companies. As
stated, numerous times throughout this course, healthcare has become a business and, as such, is being exploited for profit by lawmakers. However, lobbyist cannot formally make laws or pass legislation, this is the role of politicians – the next level of politics preventing a national health insurance system. A wise man once told me; a politician’s job is to get re-elected not help their constituents. As a result, the process to pass such legislation that would allow for universal healthcare often comes difficult. As stated by Callaghan, “the political system is prone to inertia and any attempt at comprehensive reform must pass through the obstacle course of congressional
committees, budget estimates, conference committees, amendments and a potential veto while opponents of reform publicly bash the bill.” Even if a more robust form of legislation is passed calling for universal healthcare, given the partisanship, it is unlikely to pass fully. Lastly, and arguably most importantly, it may just not be what the American people want. Callaghan explains “Americans, and conservatives in particular, have a strong belief in classical liberalism and the idea that the government should play a limited role in society. Given that universal coverage inherently clashes with this belief in individualism and limited government, it is
perhaps not surprising that it has never been enacted in America even as it has been enacted elsewhere.” However, this notion and public opinion may be changing. According to a study performed by PEW Research Center, 63% of U.S. adults say the government has the responsibility to provide health care coverage for all (Jones, 2020). However, until healthcare can be removed from the political forum, it is unlikely a national health insurance system is unlikely to be adopted in the United States. 5. Explain how interest groups affect health care policymaking in the United States
Special interest groups are able to affect healthcare policy making in the United States through four core methods: lobbying, grassroots mobilization, electoral influence, and litigation.
Lobbying
o
This process involves bringing pressure on law makers to gain favorable policy outcomes. As with any interest groups, those in healthcare will send representatives to various state capitols and congress, with the hopes of influencing legislation in their favor. Depending on the interest group, this can be for interest of patients, medical providers, insurance companies, etc. According to
Duffin, “n 2020, the pharmaceuticals and health products industry in the United States spent the most on lobbying efforts, totaling to about 306.23 million U.S. dollars. In the same year, the insurance industry spent about 151.85 million U.S. dollars on lobbying.”
Grassroots Mobilization
o
Similar to lobbying but uses more collective and localized resources to influence change at the local, regional, or international level. Special interest groups who utilize grassroots mobilization will organize protests, rallies, or other forms of activism to help influence change. In terms of healthcare, this was evident in various protests for the single payer Medicare for all movement. As stated by Ravi, “large scale social change has almost always had grassroots support behind it. It takes broad political support coming in line with a set of other political factors.”
Electoral Influence
o
As stated by Warner, “electoral influence can be considered the “primary prevention” of policymaking because it is important activity that precedes policy work. It determines who is elected to the policymaking table in the first place to debate and shape future policies.” Interest groups will work to have their candidate elected, thus allowing for policies to be created to their liking. On example of this was the American Nurses Association (ANA), who formed the ANA-PAC “to support candidates for federal office who match the ANA agenda and values, with the ultimate intent of improving the health care system” (Warner,
2002). This PAC donates upwards of $15,000 annually to candidates who support their cause(s).
Litigation
o
More so a tool used by interest groups, in which they use legal action against policies that may not align with their interests. Litigation may be used to delay and/or revert new legislation that the special interest disagrees with. Depending
on the severity of the new legislation, litigation may be taken up to the Supreme Court, as seen with cases involving the Affordable Care Act.
Essentially, special interest groups for healthcare policy making are no different than interest groups for various other sectors or industries. These groups will work to influence policies that are aligned with their interests and repeal those that they are against. Unfortunately, since healthcare remains a business, not all healthcare interest groups advocate for patients and/or medical providers.
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