Health care system has a complicated structure with many stakeholders that have different and sometimes competing views on healthcare administration. The health care costs are increasing due to various factors pushing health care system stakeholders to search for strategies to improve cost-efficiency. The government and insurance companies advocate the concept of standardized care to enhance the performance of healthcare providers. Additionally, the adoption of principles of evidence-based practice (EBP) is associated with improved patient outcomes and reduced costs. However, it is unclear whether the changes will be effective in the long run and who is to carry the financial burden of the innovations. The present paper discusses the views on the issues described above to provide a holistic picture of the matter.
The current focus on patient-centered care promotes the notion that the key figure of the healthcare system is the patient. The primary concern of patients is to receive appropriate care for a fair price. They also expect the system to provide continues care with aiming at health promotion and disease prevention rather than receiving acute care. In other words, according to Batbaatar, Dorjdagva, Luvsannyam, Savino, and Amenta (2016), patients’ satisfaction rests on the quality of care. Patients have different access to care services, depending on their level of income. People with low income expect the government to support them in acquiring health insurance. In brief, patients call for quality care that is affordable at the same time.
The central objective of care providers if to promote quality care while remaining financially sustainable. The organizations expect adequate and timely reimbursements from patients or health insurance companies for the provided services. Even though clinics are interested in improving the quality of care, they are not always ready to embrace the costs associated with the implementation of new practices (Lang & Connell, 2017). In short, care providers need to stay financially prosperous in order to offer high-quality services.
Insurance companies are for-profit organizations, and their primary goal is to make money. Their interest lies in not letting care providers perform unnecessary procedures to decrease the payments to clinics. At the same time, these organizations aim at selling to patients as many insurance plans as possible. Insurance companies are also promoting the idea of government subsidies for patients who cannot afford it to increase the profit. Therefore, while being a crucial stakeholder of the health care system, insurance companies are interested mostly in the financial aspect of the matter.
The US government is interested in the nation’s health level and having a sustainable healthcare system. It aims at improving the numbers concerning insurance coverage and the cost of care. The government implements policies, such as the Affordable Care Act (ACA), evaluates the outcomes, and makes necessary corrections, as described by Glied and Jackson (2017). While caring for the population in general, individual outcomes seem to be less of a concern. In summary, the US government is ready to offer limited financial help in maintaining a balanced healthcare system.
While all the key stakeholders described above have competing views in some areas, all of them agree that implementing the principles of EBP is imperative for healthcare management. According to Spruce (2015), EBP benefits everyone since it elaborates cost-efficient solutions for health issues and improves the quality of care. As mentioned above, all the stakeholders are interested in reducing the cost of care, and almost everyone aims at improving patient outcomes. EBP allows hospitals to stay accountable for their actions by implementing the best strategies according to the latest evidence. At the same, patients are provided with justification for the care they receive, improving patient satisfaction (Batbaatar et al., 2016). EBP also promotes standardized care making all the procedures performed by hospital transparent for the insurance companies. Therefore, healthcare managers who use the fundamentals of EBP are more likely to be successful.
Even though all the stakeholders agree that EBP is cost-efficient in the long run, it is unclear who is to carry the burden of the initial implementation cost. It has been confirmed by multiple researchers that interventions proposed by EBP can reduce future healthcare costs, lost work productivity, and other social costs (Lang & Connell, 2017). The government pays for the research and dissemination of findings through grants. At the same time, the implementation costs are usually borne by clinics (Lang & Connell, 2017). Therefore, it may be concluded that all the stakeholders experience financial benefits except for the healthcare providers. Even though according to Spruce (2015), hospitals can experience financial benefits through decreased turnover rates, the implementation costs seem to be higher than the expected reimbursements. In practice, this conflict of interests may be seen as the rejection of hospitals to embrace EBP due to the inability to pay for it. This may lead to problems with patient satisfaction and decreased payments from insurance companies. In summary, all the stakeholders are to find ways to share the implementation costs to avoid conflicts.
The adoption of standard policies is known to be an effective way to reduce healthcare costs. According to Catena, Dopson, and Holweg (2019), “hospital managers have been increasingly using process improvement methodologies from the manufacturing context” (1). The government is in favor of standardized care as it improves overall statistics of patient outcomes and decreases the cost of care. As stated above, standardized care also supports the transparency of procedures for health insurance companies.
Care providers and patients, however, do not always agree with the principles of standardized care. As stated by Catena et al. (2019), universal solutions may have a negative impact on individual patient outcomes. In practice, the conflict may be experienced in cases where customized care is needed. For instance, a patient needs to stay for two extra days in the hospital to prevent complications. The patient and the hospital is interested in allowing the person to stay. However, the decision may lead to increased paperwork to provide a rationale for the decision. Additionally, insurance companies may refuse to cover additional expenses. Therefore, doctors and healthcare managers will have to make a difficult choice, whether between accountability and financial sustainability.
Healthcare system is a complex entity with multiple stakeholders, including patients, care providers, insurance companies, and the US government. While everyone agrees, that EBP is the key to improving cost-efficiency and quality of care, strategies to share implementation costs need to be elaborated. Moreover, further research is required to find a balance between standardized and customized care. In conclusion, while the four major stakeholders have competing visions of health care administration, they all serve a common cause and harmony should be achieved.
Batbaatar, E., Dorjdagva, J., Luvsannyam, A., Savino, M., & Amenta, P. (2016). Determinants of patient satisfaction: a systematic review. Perspectives in Public Health, 137(2), 89-101. Web.
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.
Glied, S., & Jackson, A. (2017). The future of the Affordable Care Act and insurance coverage. American Journal of Public Health, 107(4), 538–540. 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.
Spruce, L. (2015). Back to basics: Implementing evidence-based practice. AORN Journal, 101(1), 106-114. Web.