Reforming Health Care in the United States


Health care system in the United States is in need of reformation since it has some obvious flaws. The primary goal of change in healthcare is to improve patient outcomes while improving cost efficiency. However, researchers and stakeholders differ in opinions which elements of the system need reformation the most. The present paper offers an overview of the top five aspects of the healthcare system in the US that are in most need of reform.

Payment System

One of the major aspects of the health care system that requires reformation is the payment system. In the United States, payments are traditionally connected to the provided services. This link causes considerable challenges in improving the cost-efficiency of care since hospitals are encouraged to schedule as many procedures as possible to increase the revenues. Even though the matter is regulated by the policies of insurance companies through standardization, the push for standardized care may be associated with decreased quality of care and increased readmission rates (Catena, Dopson, & Holweg, 2019). Therefore, a radical change is needed in the sphere of payment to address the cost-efficiency of care.

The US may look to adopt the capitated payor system to address the financial issues of the health care system. According to Hackbarth (2009), the ways to refine the cost efficiency of care are through improving payment accuracy, care coordination, and reducing preventable readmissions. By adopting the capitated payment model, care providers will be automatically encouraged to implement these measures. First, payment accuracy will be improved since the proposed system is based on paying per enrolled patient and does not require complicated calculations. Second, clinics will have to use fewer resources on accounting and will be able to use for improving coordination. Third, hospitals will be encouraged to decrease preventative readmission since there would be no financial stimulus behind it. Therefore, capitated payor system may be the correct direction for reforming the payment system.

Medical Malpractice

Medical malpractice reform, or tort reform, may also be named among the top five elements that need reformation. Today the cost of care is partially explained by the risk of paying an unregulated amount of money to patients that experienced malpractice. Introduction of regulations in the sphere, such as a maximum repayment amount for non-economic damage from medical errors, can improve the situation (Viscusi, 2019). Even though there are concerns that the quality of care may deteriorate, the endeavor is still worth considering since it successfully used in many countries with the highly effective healthcare system. In short, one of the approaches to improve the cost-efficiency of health care in the US is to make changes in medical malpractice laws.

Emergency Care

The advancement in technology has led to the emergence of digital solutions for health care provision. Sharma, Fleischut, and Barchi (2017) state that telehealth is a promising alternative for traditional hospital visits. For instance, New York Presbyterian Hospital uses telestroke programs to connect regional hospitals with a neurologist who can evaluate the condition of a patient and propose the best course of action (Sharma et al., 2017). The promotion of such measures through the healthcare system reformations may lead to improve cost-efficiency of care since patients will be able to avoid unnecessary visits. Additionally, the cost is reduced by lower durations of hospital visits, since 40 minutes of the TelehealthExpress Care Service process can be compared to 2.5 hours of stay in the emergency department (Sharma et al., 2017). In brief, the cost of emergency care may be decreased by introducing telehealth.

Patient outcomes may also be improved since it takes less time for the patients to receive care. According to Sharma et al. (2017), telestroke programs reduce the door-to-treatment time improving access to healthcare. However, reforms that address the introduction of the innovate approaches in emergency care are to consider who is to pay for the initiation of new programs. According to Lang and Connell (2017), the implementation costs are usually borne by the clinics causing conflicts of interests. These conflicts may provoke rejections of the changes due to inability to pay for it. However, a well-planned healthcare reform that encourages innovation may be associated with improved quality and cost efficiency of emergency care.

Chronic Condition Management

Healthcare traditionally focuses on delivering acute care rather than providing continuity of care. People who suffer the most from this phenomenon are patients with chronic conditions. Even though the implementation of Affordable Care Act in 2010 was successful in improving access to health care of people with chronic conditions, additional measures are needed (Clarke, Bourn, Skoufalos, Beck, & Castillo, 2017). The strategies should address coordinated care transitions between clinics, unplanned episodic care, and longitudinal high-risk carefor people with multiple chronic conditions (Clarke et al., 2017). These considerations can improve patient outcomes and decrease the cost-efficiency of health care in the long run through reduced readmission rates.

Some of the strategies that may be included in the reform are the promotion of disease management (DM) and mobile integrated healthcare (MIH). DM model provides incentives for care providers to promote self-management to patients. Since the population with multiple chronic diseases is expected to grow, patient education to manage their conditions may become the key to improve patient outcomes. MIH is the system that aims at delivering services directly to patient home or work. Such a model can be beneficial for people with low access to healthcare. In summary, even though ACA has made some relevant provisions to improve the outcomes of patients with a chronic condition, further reforms can be suggested to this element of the healthcare system.

Hospital Management

Quality and cost-efficiency of care can also be improved by utilizing effective hospital management strategies. According to Zuckerman (2014), healthcare reforms can be embraced only through strategic planning. It is true that resources need to be adequately distributed within an organization, which can be done only using a systematic approach. Strategic planning can improve control over the outside environment and make organizations more flexible to adapt to the shifting trends of modern healthcare. Therefore, the US government should create incentives for healthcare providers to shift to efficient management strategies through reformations. Without such improvements, care providers may encounter problems due to wasteful use of resources. Therefore, cost-efficiency of healthcare can be improved through reorganization of the hospital management system.

Conclusion

Healthcare system is a dynamic entity that consists of multiple elements. While some of the aspects of the system function effectively, others require reformation to meet the shifting needs of the US populations. The top five points that require change are the payment system, medical malpractice, hospital management, emergency care, and chronic condition management. Reformations are to encourage innovations in these areas to decrease the cost of care and improve patient outcomes.

References

Catena, R., Dopson, S., & Holweg, M. (2019). On the tension between standardized and customized policies in health care: The case of length‐of‐stay reduction. Journal of Operations Management. Web.

Clarke, J., Bourn, S., Skoufalos, A., Beck, E., & Castillo, D. (2017). An innovative approach to health care delivery for patients with chronic conditions. Population Health Management, 20(1), 23-30. Web.

Hackbarth, G. M. (2009). Reforming America’s health care delivery system. Web.

Lang, J., & Connell, C. (2017). Measuring costs to community-based agencies for implementation of an evidence-based practice. The Journal of Behavioral Health Services & Research, 44(1), 122-134. Web.

Sharma, R., Fleischut, P., & Barchi, D. (2017). Telemedicine and its transformation of emergency care: A case study of one of the largest US integrated healthcare delivery systems. International Journal of Emergency Medicine, 10(1). Web.

Viscusi, W. K. (2019). Medical malpractice reform: What works and what doesn’t. Denver Law Review, Forthcoming, 19(16), 1-17.

Zuckerman, A. M. (2014). Successful strategic planning for a reformed delivery system. Journal of Healthcare Management 59(3), 168-172.