Managed Care Philosophy and Initiatives directed at Prevention and Health Maintenance
The health care system of the United States has seen drastic changes in the past decades. One of these changes has been the rapid growth of health maintenance organizations. Health maintenance organizations (HMOs) can make significant contributions to the prevention of illnesses in various ways. First, HMOs are increasingly turning into a key provider of health care services for the recipients whether for employer-based care or government-based programs such as the Medicaid and Medicare. Indeed, the rate of enrollment in HMOs has increased significantly over the last three days. Since their inception, HMOs have always included prevention as part of their initiatives and programs because one of their objectives is to minimize health costs. As part of their preventive initiatives, HMOs have put in place several measures to enhance the quality of their preventive services. These measures include: “internal performance-measurement and quality-improvement systems such as Continuous Quality Improvement (CQI) to monitor, correct, and enhance their services,” (Pope, 1995, p. 71).
Besides internal measures, HMOs also adhere to external measures such as the “report card,” which is a group of indicators used by HMOs to assess the quality of the services they offer. The majority (78%) of these indicators are preventive indicators thus showing the dedication of HMOs to preventive health services. Some of the preventive indicators used by HMOs include “incidence of low-birth-weight infants among the HMOs’ enrolled populations and their utilization of vaccinations, mammography, screening for cervical cancer and cholesterol, prenatal care, and retina examinations for persons with diabetes,” (Pope, 1995, p. 73).
Challenges of Vaccination Programs
Mass vaccination is one of the fundamental aspirations of most health ministries in many countries. This is because of the importance of vaccination in preventing the future occurrence of deadly and highly contagious diseases. In the United States, for instance, there have been significant developments in the vaccine delivery system. Nevertheless, vaccination programs are often faced with numerous challenges, chief of which is the access of the vaccinations to all members of the target population. American Academy of Pediatrics (2003) argues that “the goal for universal immunization set in 1977 has not yet been reached” (p. 993). Close to 25 percent of American are yet to receive at least one of the essential vaccines given during childhood. While this figure is disappointing, the situation is graver in rural and ethnic-minority communities and even worse in developing countries.
Challenges that face access to vaccinations include: low levels of maternal education which is linked to poverty; living in rural or inner-city areas, and being members of racial/ethnic minority. Other challenges include problems inherent in the vaccine delivery mechanism. These problems seem to increase as new vaccines are developed to curb new illnesses. Shortage in certain vaccines is also another challenge which is quite common in developing countries. Lastly, vaccination programs are also hampered by worries among come segments of the population concerning the safety of the vaccines and the possibility that they may be harmful to the recipients. Such a perception may hinder access to vaccines even in the case of easily available vaccines (American Academy of Pediatrics, 2003).
Steps taken to Improve Quality
Improving the quality of immunization programs requires taking into consideration many things. One of the most important considerations is the correctness of immunization records. Accurate data on immunization would enhance not only the health of the target population but also the running of healthcare clinics as well as the decision making process of public health organizations. Immunization records that are of low quality may increase morbidity and mortality among the target population. Quality of immunization records can be assured through the Immunization Information Systems (IIS) and the staffs responsible for submitting the information (American Immunization Registry Association, 2008). For quality assurance of immunization records, the following measures can be taken:
- Principles, rules and models should be developed which form the basis of the input data process
- Key definitions should be developed and re-confirmed
- The pre-qualification of healthcare providers involved in immunization should be described. This would help in “the assessment of the input data quality of new submitters, prior to allowing them to regularly add data to IIS in order to ensure that the data sent are correctly formatted and complete, thereby helping to identify systemic data errors prior to data imports,” (American Immunization Registry Association, 2008, p. 12).
- There ought to be a common source profile for each specific provider (for instance, a common profile for pediatrics or a common profile for geriatrics) and the IIS should show the anticipated allocation of different vaccines.
- There should be a general agreement among the experts as an indication of commonly agreed and used approaches
What Works and What Does Not
To ensure the quality assurance of immunization programs, the data collected should be of high quality. This can only be achieved through a quality data collection procedure. Secondly, quality immunization programs require a standard procedure which can be achieved by laying down of principles and rules to govern the entire program. The experts involved in the immunization programs should also come to an agreement about the strategies that would be used in the process. This is in spite of differences in the vaccination programs, target population, or in opinions of the experts. A big hindrance to quality assurance of immunization programs is poor quality immunization records. Poor quality data would increase the rates of morbidity and mortality among the target population because the objectives of the program would not be achieved.
Recommendation for Further Improvements
It is important to note that many vaccination programs fail to reach some segments of the target population, such as those living in rural or remote areas, internally displaced persons and refugees. In order to ensure quality assurance of any immunization program, all members of the target population must be catered for. However, this can only be achieved by improving the quality of the vaccine delivery process. The process can greatly be improved through the Plan-Do-Check-Act cycle which is an effective process improvement tool. Because the tool is a cycle, it would help the program leaders to know the successes and failures of the program and thus put in measures which would help to address the failures.
Application of the Previous Essay on Breast Cancer Screening to the Issue of Vaccinations
The previous essay on breast cancer screening is similar to the issue of vaccination in one major way. Both mammography and vaccination are health preventative strategies. They help to prevent or detect early the occurrence of the respective illnesses. As a result, they help to uphold the health status of the target populations. Both essays have also focused on quality improvement of the illnesses.
American Academy of Pediatrics. (2003). Increasing immunization coverage. Pediatrics, 112(4), 993-996.
American Immunization Registry Association. (2008). Data quality assurance in immunization information systems: Incoming data. Atlanta, GA: American Immunization Registry Association.
Pope, T. (1995). United Health Plan bridges gap between HMOs and community health centers. HMO Practice, 9, 71-74.