G.Mills-N502-6

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1 Role of the Government in Healthcare Giselle R. Mills Masters of Science in nursing education, Aspen University N502 – Health Care Systems Dr. Patrica McAfee July 7, 2021

2 Role of the Government in Healthcare Throughout history the government has contributed to the best of its ability strategies, dynamic adaptations and interdisciplinary approach to the success of the health care system; one of the government main roles is to guarantee that its citizens can receive quality medical care they need with little to no financial hardship (Young et al., 2018). Yet, while the government contributes to the development of the health care system along with private sectors, tension still arises. The people of the country should be able to trust the health care system and not be fearful of being harmed by medical errors and access, quality and cost of healthcare should coincide together to balance affordability of quality health care. This paper will discuss the relationship between public health and private medicine and identify causes for tension between both. Medical errors in healthcare will also be identified and responsibility of same will be explored. Lastly, the quality of healthcare cannot be overlooked; addressing only one of the trios in the iron triangle of healthcare will be analysed. Public Health and Private Medicine Relationship According to the Centers for Disease Control and Prevention (CDC, 2021), Public Health is defined as a science and art of preventing diseases, prolonging lives and promoting healthy lifestyles through an organized approach. Public health within a community creates a method of controlling communicable disease transmission, providing safe water and food as well as keeping a clean and safe environment. It also sheds light on issues including laws/polices about smoking indoors, seatbelts, immunizations and aids in research of diseases to determine who is likely to be more affected and why. The governmental efforts in public health consist of providing health insurance plans for low- income families and the elderly such as: Children’s Health Insurance Program (CHIP),

3 Medicaid and Medicare (Young et al., 2018). According to Heaton et al., (2021) public health insurance is more affordable due to little or no co-pays or deductibles. However, it is less flexible, provides limited choices in medical services and also some health facilities do not accept government insurance or may not be reimbursed for services provided. Private sector contribution in providing health care is not a new phenomenon and is also complex (Hallo et al., 2016). It is offered through “for profit” hospitals, self-employed health practitioners and not for profit non-government providers; usually paid for out of pocket or by long term care policies (Basu et al., 2012). According to Slipicevic et al., (2012) health care providers within the private sectors are mainly focused in urban areas and those of wealthier backgrounds. Private sector includes dentists, pharmacies, specialists and radiology facilities. Their roles are to provide direct health care, manage health care facilities, development and manufacturing of goods (pharmaceutical products and medical supplies) and financing health care such as private insurance companies (Hallo et al., 2016). Private medicine offers private health insurance plans that are provided by private companies through an employer or organization and can be purchased individually or as a group. It is more flexible and offers a variety of options when it comes to choosing a doctor or medical facility; however, these plans tend to have a more burdensome price attached which may not be affordable to everyone. According to Slipicevic (2012), due to the increase in burdens on health care services, the public sector is unable to address all the needs by itself. Hence, public and private medicine must work together to achieve a successful health system; they have the potential to complement each other’s efforts to improve care. Unfortunately, public health care facilities are unevenly distributed and offer little specialists in comparison to urban facilities. There is also longer waiting periods and quality of care is considered to be poor. Public health and private medicine can be likened to taking separate busses to arrive at the

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4 same destination. While they contribute separate efforts to health care, their relationship is often times hindered by lack of communication and coordination (Lurie et al., 2009). Basu et al., (2012) suggests that the recent economic recession that began in 2007 had placed great constraints on the government budgets causing disputes between private and public systems to escalate. This caused recommendation of the International Monetary Fund to countries thereby increasing private sector provision in health care to reduce government debt. Medical Errors in Healthcare Carver et al., (2021) defines medical errors as a preventable adverse effect of medical care, whether or not it is obvious or causes harm to the patient. Medical errors are serious public health issues that pose a threat to patient safety. Some common medical errors include: Mistaken patient identity, misdiagnosis, improper blood transfusions, wrong site surgeries, incorrect or improper dosage of medications (oral or intravenous), poor tube feedings/shift change communication and restraint related injuries. According to the Institute of Medicine (2000), health care is not as safe as it should be and has sufficient evidence that points to medical errors being the leading cause of death and injury. In a 1984 New York study reported by the Institute of Medicine (2000), reports that 58 percent of hospital admissions experienced some form of medical error or adverse effects. They also report that approximately 98,000 Americans die each year in hospitals as a result of medical errors. Decreasing the country’s leading cause of medical death and injury due to medical errors will require changes with those involved within the health care system as well as government contribution. To effectively achieve prevention of medical error both clinical and evidenced based actions can be implemented. This includes proper communication between team members, standardizing handoff communication reports, participating in

5 multidisciplinary team training as well as being receptive to constructive criticisms about medical errors and near misses (Donladson, 2008). The government plays a large role in the public health system in the country; it is responsible for protecting the public’s health by providing safe and quality services free from errors. The government should contribute to making sure its citizens are safe and care provided is free from errors. After the Institute of Medicine released the report on medical errors, the government, under Clinton’s presidency, developed a plan of action to reduce the incidence of medical errors; this was led by the Quality Interagency Coordination Task Force (QuIC) who ensured the efforts of 12 federal agencies were involved in regulating health care services to improve health care quality. The federal government also worked to determine effective measures to present the public with information on medical error incidents. The institute of medicine committee also believed that the government should incorporate and establish interdisciplinary team training programs (Schulman, 2000). Iron Triangle of Healthcare The three components of the iron triangle are cost, quality and access. They are a part of the primary concerns of the health care systems and operate in a complex yet dynamic relationship. Often times when of the component is addressed the remaining two components weakens (Carroll, 2012). Cost is the simplest component to understand and address. The goal is to allow more individuals to be able to afford healthcare by reducing health care costs. Blendon et al., (2006), reports that some experts have concerns about the exorbitant level of spending on healthcare in the United States. Costs require compromise from all the other components (quality and access). However, the public does not share the same concerns as the experts. In a survey conducted by Blendon et al., (2006), Americans believe that the government is spending too little on health care. Most Americans are satisfied with the ability to access and receive quality care for themselves and their families, and do

6 not see the issue as a top tier problem; their main concern is the cost and affordability. Carroll (2012) states that health care system can be more cost effective, however access and quality will be reduced; and the same will go for the other two components. However, all three components must work together and should compromise with each other when necessary in order to make health care affordable, accessible and of good quality. Conclusion Though the United States healthcare system is not perfect and is faced with a few dents and bumps, the government’s contribution to healthcare is highly needed. It will take dynamic adaptations and interdisciplinary approach to achieve a successful health care system. History has proven that the health care services provided cannot be the sole responsibility of the public sector, but should also include private medicine. Despite any contented event that may arise between the two, their relationship should work together for the good of the health care system. While medical errors can happen at anytime, anywhere and involving any patient, it may not be harmful. However, with strategies placed to improve patient safety and the government’s contributions; medical errors should decrease and no longer be on top of the list for deaths and injuries among the people it serves. We can conclude that the trio of rising costs co-relates with the other components (access and quality). High costs of health care will lead to people having little to no access to health care due to affordability which therefore leads to poor health care quality outcome.

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7 References Basu, S., Andrews, J., Kishore, S., Panjabi, R., & Stuckler, D. (2012). Comparative performance of private and public healthcare systems in low- and middle-income countries: A systematic review. PLoS medicine , 9 (6). https://doi.org/10.1371/journal.pmed.1001244 Carroll, A. (2012). The “iron triangle” of health care: access, cost, and quality. American Medical Association. JAMA Health Forum 1(1) . https://jamanetwork.com/channels/health-forum/fullarticle/2760240 Carver, N., Gupta, V. and Hipskind, JE. (2021) Medical error. Retrieved on July 3, 2021 f rom: https://www.ncbi.nlm.nih.gov/books/NBK430763/ Centers for Disease Control and Prevention. (2021). Introduction to public health. Retrieved on June 29, 2021 from: https://www.cdc.gov/training/publichealth101/public-health.html Donaldson, M. (2008). An overview of “to err is human: re-emphasizing the message of patient Safety”. Patient safety and quality: an evidence-based handbook for nurses. Available from: https://www.ncbi.nlm.nih.gov/books/NBK2673/ Hallo, A., & Toebes, B. (2016). Assessing private sector involvement in health care and universal health coverage in light of the right to health. Health and human rights , 18 (2). 79–92. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5394993/ Heaton, J. and Tadi, P. (2021). Managed Care Organization: In statpearls treasure island (FL). Available from: https://www.ncbi.nlm.nih.gov/books/NBK557797/

8 Institute of Medicine. (2000). Errors in health care: A leading cause of death and injury. To err is human: Building a safer health system. Retrieved from: https://www.nap.edu/read/9728/chapter/4 Lurie, N., and Fremont, A. (2009). Building bridges between medical care and public health. JAMA , 302 (1), 84–86. https://doi.org/10.1001/jama.2009.959 Schulman, K. A., & Kim, J. J. (2000). Medical errors: how the US government is addressing the problem. Current controlled trials in cardiovascular medicine , 1 (1), 35–37. https://doi.org/10.1186/cvm-1-1-035 Slipicevic, O., and Malicbegovic, A. (2012). Public and private sector in the health care system of the federation bosnia and herzegovina: Policy and strategy. Materia socio- medica , 24 (1), 54–57. https://doi.org/10.5455/msm.2012.24.54-57 Young, K. and Kroth, P. (2018). Sultz & Young’s Health Care USA: understanding its organization and delivery . Jones & Bartlett Learning.

G.Mills-N502-6

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