Understanding the U.S. Healthcare system can be very challenging due to the system is constantly changing from new technology; manage care, health care reforms, aging populations and other economic factors that have a significant impact in the service provided. This paper will focus on the stakeholders involved in health care today. Who are these stakeholders? What are their roles in the healthcare industries? Understanding the public, payers, providers, and the suppliers may explain why the healthcare system continues to be challenge.
Today U.S. Health Care System is facing many challenges. According to Sultz & Young (2011), this because the growing concern that the Health Care is a large and difficult to manage and that consume over 17% of the U.S. Gross domestic product and exceeds $ 1.5 trillion in cost (p.1). Who are these major stakeholders that sometimes share and often cause conflicting concerns, interest and influence the major component on the health care system? They are the public, payers, providers, and the suppliers. The public is the major consumers of the service provided by the health system. The insured and the uninsured are both major contributors. The public is truly not aware of the real cost of healthcare services because of the third party payers or the government’s Medicare/ Medicaid program. The insured is only concern is the amount of deductible and co-pay due. The uninsured relies on the government aid and with the lack of understanding prefer ER visit instead of primary doctor visit. The public also assumes that healthcare is just like other inherits right (such as protection from the police, fire department or public education) and should be accessible to all U.S. citizens. Currently, the number of uninsured is rising, and that’s why Affordable Care Act was implemented by President Obama.
The question is “How many uninsured will actually gain coverages, and whether the reform law will keep healthcare spending growth down are the two many uncertainties in the year ahead?” (Meyer & Evans, 2014, p.15). The consumers also have an organization that lobbies legislation and protection for the public. Such organizations are the American Association of Retired Person, labor organization and a disease specific group (ACS-American Cancer Society, The American Heart Association). Traditionally, patient’s behavior is very dependent upon the provider (physician), and the possibility of excessive services such as diagnostic testing can be done. Currently, internet has empowers people to seek health information. Internet plays a larger role in their diagnosis and treatment. A survey done by Pew Research Center’s Internet & American Life Project (2013), 1 in 3 American adults have gone online to figure out a medical condition, and 35 % of U.S. adults say that, at one time, or another, they have gone online specifically to try to figure out what medical condition they or someone else might have (p.1). Internet use is becoming more popular due to easy access to the internet with smartphones. There are reliable and not reliable website that patients’ needs to be aware when searching the interment. According to Sultz & Young (2011), internet users are becoming more educated and participatory in clinical decision-making (p.59).
These just challenge the doctors on how to deal with a more knowledgeable and involved patients. I see more and more patient dictating their treatment options versus before just doing what the doctor says. The payers in the U.S. health system are very influential group of stakeholders because they are the one paying for the high percentage of the cost. The payers are the public sector which includes the federal government, state and local government. The private sectors are the private insurers and business. According to the article Understanding the U.S. Healthcare System (2010), 47% of the expenditures comes from the public sources and 53% from private sources (p.4). They are also the one the currently taking an active role in determining what those costs should be. The government is considered a dominant stakeholder since the implementation of Medicare and Medicaid. The government is the taxing authority that generates the funds to support the healthcare system. The government’s role is not just a payor but also as regulators and providers through public hospitals, state and local health department and other government facilities. Many regulators were formed over the years to control over various areas in the healthcare system. Most common regulators are the HHS- U.S. Department of Health and Human Services, CMS- the Center of Medicare and Medicaid, and the FDA- the Food and Drug Administration.
These organizations are created to make sure everyone is compliant with the current law of U.S. The current healthcare situation has created a significant dilemma in our country. Problems such as the rising uninsured, the advancement of technology and the rising cost and healthcare system emphasis on cure and fail prevention are just few of the example of why the president implemented the Affordable Care Act (ACA). The Affordable Care Act will help millions of Americans who currently lack insurance, working-aged men and women and their children, access to Medicaid. It will help small business and individuals with modest means purchase reasonably priced plans. Shaw et al. (2014) mentioned by 2019, the law will bring health coverage and the health benefits of insurance-to an estimated 25 million more Americans (p. 75). It has already restrained discriminatory insurance practices, made coverage more affordable, and realized new provisions to curb costs (including tests of new health-care delivery models) (Shaw et al., 2014). The ACA has positive and negative points, but our troubled healthcare system needs to emerge in these issues and challenges in order to improve our healthcare system.
The providers in the U.S. Healthcare System include all individuals and organization that provide healthcare services to the consumers. Individuals include; physicians, nurse practitioners, nurses, dentist and any allied health providers. Organization include; hospitals, nursing homes, community-based ambulatory services and other similar entities. Although health professional is the one that provides actual care, hospitals in particular offer the environment in which care can be provided and are compensated by the payers for the service provided. As an employee in the healthcare, I have seen a physician that provides extra service or chargeable item in order to increase revenue. This assumption is hard to prove because of documentation provided by a physician and conflicting opinions. Physicians and organization that emphasis on cure can fail to lead prevention. Healthcare professional can steer and influence public opinion especially when it comes to health. According to Sultz & Young (2011), Professional Association has considerable influence over legislation proposals, regulation, quality issues, and other political matters (p.16). A good example is the lobbying effectiveness of the American Medical Association plays an important role.
It also includes the American Hospital Association, and The American Nurses Associations are just a few of the powerful organization that has a role in the health policy decisions. Another important issue is the long term care in the aging population is also creating challenges in our healthcare system. The increase of senior citizen (baby boomers) will create higher cost deficit and it’s important to create a seamless process of care to avoid duplication of services. Currently, healthcare providers are experiencing budget constraints and strict regulation. Providers are asked to have EMR (electronic medical record) system implemented. According to CMS.gov, as required by law, President Obama issued a sequestration order on March 1, 2013. Under these mandatory reductions, Medicare EHR incentive payments made to eligible professionals and eligible hospitals will be reduced by 2%. This 2% reduction has been applied to any Medicare EHR incentive payment for a reporting period that ended on or after April 1, 2013 (“EHR incentive programs,” 2014).
Continuous quality improvement (CQI) should be included in gathering data quality in the organization, since it focuses on processes rather than the individual; reorganized both external and internal customers, and promotes the need for objective data to analyze and improve processes (Green & Bowie, 2011, p. 258). A more patient-centered care and prevention could cause impact on how the providers handle business. The suppliers in the healthcare system include medical equipment companies and drug companies. These suppliers have grown immensely due to the search of greater efficiency in the delivery of health care services. These companies are for profit and strive for competition in the market just like the insurance companies. New drugs, technology and new creative surgical procedures have made it possible to treat diseases that have a bad prognosis. New technologies have created a life enhancing and life-extending medical accomplishment (Sultz & Young, 2011, p.44). Strategies have change in the delivery of care due to the advancement of technology and brought new problems.
New medical and technological advancement came with new financial and ethical dilemmas. Financial aspect is whatever it’s beneficial or not the use of new technology has contributed to the higher healthcare cost. The ethical dilemmas are greater ability to prolong the life can likely cause poor quality of life and the right to die. The AMA (American Medical Association) and the federal government have developed programs to examine these issues and provide information to the public and to the providers. In the Technology Assessment Act of 1972, “it is essential that, to the fullest extent possible, the consequences of the technological applications be anticipated, understood, in the determination of public policy on existing and emerging national problems” (Shultz & Young, 2011,p.45). The Agency of Health Care Policy and Quality has a challenging mission to adhere and sort out the complicated health care system and determine what is reasonable to whom, when and at what cost.
In conclusion, the U.S. Health Care system is changing economically and socially. Healthcare organizations are challenge in providing high quality, affordable care, and healthcare services are an increasingly difficult challenge. The reported outcomes are critical components of evaluating whether clinicians are improving the health of the patient, safety, reducing cost and encouraging preventive care. Containing the cost will affect the quality of care; that will raise the question to quality and access. In addition, there are strong pressures on providers to examine and document the outcomes and effectiveness of their health care actions. All stakeholders must change in order to resolve the complex issues such as treatment options, domain of laws, politics, journalism, administration, public and providers. There are still a lot of issues that need improvements, but I believe that our government and society will find a middle ground to solve these issues.
Courtney from Study Moose
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