The United States is known as a country with the best and most properly developed healthcare system. The relationship between private and public agencies and non-profit and for-profit organizations defines the quality of the progress of healthcare services. Much attention is currently paid to the role of government and the importance of legislative efforts in analyzing healthcare costs, access, and quality. However, in addition to multiple benefits related to the work of private and public facilities, certain concerns and shortages cannot be ignored. Americans need to be sure about the contributions made by the US government and the steps taken in the clinical medicine sector. In this paper, the review of Chapter 11 of the book Health Care USA by Young and Kroth will be given. The goals are to discuss the conflicts between public health and clinical medicine, identify governmental responsibilities in monitoring high-risk situations, and study the worth of legislative proposals for the Iron Triangle. Despite the existing controversies and debates, the federal government should respect the activities of private stakeholders and vice versa to ensure high-quality care, equal access, and negotiable costs within the US healthcare system.
Public and Private Health Efforts
The impact of public and private health efforts on promoting human well-being is one of the key issues in the chapter. According to Young and Kroth (2018), public health is based on social justice and applies the principles of multiple disciplines, including medicine, statistics, environmental science, and epidemiology. This approach creates healthy living circumstances and improves life quality through education, screening, and cooperation. Thus, public health focuses on entire populations, while clinical or private medicine addresses individuals’ needs and local clinicians’ responsibilities. On the one hand, Young and Kroth (2018) admit that private and public efforts complement each other because of the necessity to deal with similar health problems and resources. On the other hand, the authors underline the distinction of these efforts concerning the stages of diseases and the required measures (Young & Kroth, 2018). Public health should concentrate on prevention, education, and selection of interventions for promoting healthy behaviors and reducing care barriers. Private clinicians, in their turn, are responsible for diagnoses, treatment, and positive patient outcomes. Such purposes explain the contentious relationship between private and public efforts.
Private and public health representatives cannot find the required agreement in several areas, including economics, politics, and social interactions. For example, private clinicians admit that public health significantly damages the physician-patient relationship, defining income services and political motivation of many interventions (Young & Kroth, 2018). At the same time, public health experts think doctors and nurses are concerned about their financial gains and neglect the importance of preventing diseases and health problems (Young & Kroth, 2018). In other words, private medicine is more interested in treating people than following public health regulations and predicting disease progress early. Still, private-public health cooperation affects populations’ health by promoting immunization activities, educational campaigns, and skill improvement initiatives, specifying the federal government’s role and policy-making.
Medical Errors as a Leading Cause of Death and Disability and the Role of Federal Government in Monitoring High-Risk Situations
There are many ways to promote healthy lifestyles and enhance population well-being in the country, and one of them is the analysis and prediction of medical errors. According to the report introduced by the Institute of Medicine in 1999 (as cited in Mohajan, 2018), about 98,000 deaths were due to medical errors each year. The publication of these fundings provoked multiple debates and questions about the quality of health providers’ work and their education level. Medical errors might have different roots and causes, including poor communication, the complexity of the healthcare system, time pressure, and low medical knowledge levels (Mohajan, 2018). State and federal governments affect healthcare delivery by regulating the activities of health professionals, insurance companies, and financial analytics (Young & Kroth, 2018). There is no specific requirement for the federal government to minimize the number of medical errors, and much responsibility lies on healthcare providers. It is hard to imagine how the US government might directly affect this particular problem, and the continuation of indirect initiatives seems to be the only viable option.
Financial outcomes of medical errors depend on several factors: the type of errors, the level of responsibility, and the patient’s condition. Mohajan (2018) identifies medication errors as the most common mistake (about $3.5 billion annually), surgical errors as a life-saving component, diagnostic errors as an element of primary care, blood transfusion problems, and postoperative infections. The federal government has to take several monitoring steps and examine high-risk situations similar to epidemic assessments. The implementation of new safety systems should strengthen the quality of reporting activities. Public health agencies are responsible for administrating federal initiatives, promoting technical assistance, enhancing laboratory services, and developing regulation and inspection activities to ensure patient safety and protect human health (Young & Kroth, 2018). It is wrong to believe that medical errors become the single responsibility of healthcare providers, leading to deaths or disabilities. The federal government should improve its strategies not only to reduce the number of medical errors but help other stakeholders understand their possible contributions.
Legislative Attempts and the Iron Triangle of Health Care
When the federal government and other public or private health agencies are involved in developing care policies and regulations, they need to solve the problems of rising costs, lack of universal access, and low care quality. In the face of limited resources and poor awareness of healthcare problems, researchers introduce the concept of the Iron Triangle, where three major goals should be achieved: increased access, low costs, and high quality (Moleman et al., 2022). This triple aim determines financial, organizational, and educational factors in health care delivery. According to Moleman et al. (2022), the value of this framework is the possibility of solving emerging problems as soon as possible. Thus, when some legislative attempts are taken to solve just one of the problems, and the other two elements remain neglected, no satisfactory results can be achieved.
Private and public organizations should focus on different aspects of care: quality, communication, support, diagnosis, treatment, monitoring, and prevention. In their discussion, Young and Kroth (2018) mention several agencies that promote the health and well-being of the population. For example, The Administration for Community Living works with older adults and people with disabilities; the Centers for Disease Control and Prevention identifies and assesses safety and health threats and promotes life quality (Young & Kroth, 2018). These facilities do not differentiate between the policies to control cost changes or improve care quality. They work hard to ensure that no threats exist in the healthcare system and that all stakeholders know their tasks and responsibilities. As the cost factor is improved, it provokes additional shifts in care quality and access.
Another situation may be related to patient satisfaction as a basic criterion of healthcare activities. Young and Kroth (2018) state that long-term professional doctor-patient relationships induce improved preventive care, high-level services, and cost savings. It is impossible to accept the success of such relationships if any of these characteristics are absent. Care should be cost-conscious and available to all individuals to confirm the principles of public health and clinical medicine (Moleman et al., 2022; Young & Kroth, 2018). Thus, all legislative attempts directed to only one component of the Iron Triangle will negatively affect the remaining two and lead to no positive results in the future.
In general, the review of the chosen chapter contributes to a better understanding of how the government affects public health and defines the responsibilities of different agencies in the US healthcare system. The federal government’s inputs usually include policy-making and decisions to develop new preventive strategies, educational campaigns, and screening interventions. Public and private efforts must serve the same purpose – well-being promotion and health stabilization. Still, the representatives of different fields continue arguing about their interferences with each other’s activities. Although there is no direct impact on medical error prevention, legal attempts are constantly made to strengthen the responsibilities of healthcare providers and other profit and non-profit organizations. Therefore, it is not enough to identify the role of the government in health service delivery but to analyze the connection between all elements of the existing system. Care quality, cost, and access depend on how well the government cooperates with healthcare facilities and creates the background for new improvements and organizational shifts.
Mohajan, H. (2018). Medical errors must be reduced for the welfare of the global health sector. International Journal of Public Health and Health Systems, 3(5), 91-101.
Moleman, M., Zuiderent-Jerak, T., Lageweg, M., van den Braak, G. L., & Schuitmaker-Warnaar, T. J. (2022). Doctors as resource stewards? Translating high-value, cost-conscious care to the consulting room. Health Care Analysis.
Young, K. M., & Kroth, P. J. (2018). Sultz & Young’s health care USA: Understanding its organization and delivery (9th ed.). Jones & Bartlett Learning.