HSM 410 Week 2 Discussion Question 1 – U.S. Healthcare System Organization (RATED A+)

HSM 410 Week 2 Discussion Question 1 – U.S. Healthcare System Organization What have been some of the forces driving the organization of U.S. healthcare? Bodenheimer states that there are sever al reasons for the forces driving the organization of U.S. healthcare: 1.) The biomedical model - basically in a nutshell, as diseases have grown or developed, like different strains of the flu, cancers, and etc., the needs for more than just family practice has moved to needing more specialty disciplines, plus the 1-year general practice internship was replaced by a 3-year residency program and specialty board certifications. 2.)Financial incentives - to be more exact, financial incentives for physician specialization and hospital expansion began. 3.)Professionalism - The last thing is the nature of control over health planning. "The U.S., unlike other nations, is unique in its relative laxity of public regulation of health care resources." So the professional status that comes with being a physician has given them a special authority to guide the development of the U.S. healthcare system. (Chapter 5, 2012) Bodenheimer states, “People in the United States rightfully take pride in the technological accomplishments of their healthcare system.” (Chapter 5, 2012) The need for Family Practitioners and General Practitioners for the U.S. population has been a subject of debate and legislative concern for a couple of decades. It will reach a critical concern with the Baby Boomers turning senior and healthcare reform. (Chapter 5, 2012) Class, why has the U.S. seen more focus on the specialist versus the general practitioner? The U.S. seen more focus on the specialist versus the general practitioner because the fees are higher for a specialist. The figure shows trends over time in the average income of primary care physicians relative to specialist physicians in the U.S. and in the percentage of graduating medical students in the U.S. planning on entering careers in primary care. The average primary care physician income was about half that of specialist. (chapter 5, 2012) "Generalists earn lower incomes than specialists". Due to education costs more specialized medicine leads a higher salary verses the salary of a generalists. "Generalists appear to practice less resource-intensive style of medicine and generate lower overall healthcare expenditures, including less use of hospital and laboratory services". General practitioners treat acute diseases, the rise of chronic disease in the U.S has raised the demand of specialists. Bodenheimer states, “Critics of the US health care system find fault with its “top-heavy” specialist and tertiary care orientation and lack of organizational coherence. Analyses of health care in the United States over the past half century abound with such descriptions as “a nonsystem with millions of independent, uncoordinated, separately motivated moving parts,” “fragmentation, chaos, and disarray,” and “uncontrolled growth and pluralism verging on anarchy.” (Chapter 5, 2012) Class, do you agree? Does this affect the driving forces? I agree, the American health system is a mixture of independent moving parts with individual agendas which is an extensive contributor factor guiding the organization of healthcare within the U.S. The specialist’s oriented and chaotic health care structure has added to the rising cost of care. Moreover, this type of format deteriorates quality of care. For instance, when many hospitals each perform small numbers of surgical procedures such as coronary artery bypass grafts, mortality rates are higher than when such procedures are regionalized in a few higher-volume centers (Bodenheimer & Grumbach, 2012). Some of the driving forces of the organization of U.S. healthcare is from the economy and the patients. The recession has reduced their employment, their benefits, and now other costs for families are rising gas being the most recent. As state and local government frantically reduce services to balance their budgets, health care simply has to deliver more value. The government is trying to focus on better performance and bedside manner from all healthcare professionals and ThDIcfetwhaesydoawrneloaabdeldebtyo10m00e0e0t82t9h9e57s1t2a5nfrdomarCdosurtsheHreonqu03i-r0e2d-20t2h2e2n3:t1h7:e2i8rGpMaTy -c0a6:n00increase. This can also be referred to as an incentive to have the health care professionals work harder to manage the proper patient care. Our hospital is always doing the HCAHPS and NCR pickers to see how were doing and what need to be improved. In our office we do Oswestry per and post op scoring which helps with reimbursement for the office. Pay for performance is the wave of the future and honestly the topic of much debate in the health care realm. CMS has initiatives that are directed at not only paying for the services but also basing this payment on patient outcomes. I know from personal experience as an Inpatient case manager for an insurance company CMS has a re-admission policy that if the person is re-admitted for similar symptoms and has not remained in the community for 24 hours post discharge then the hospital will not receive another DRG payment. This was one of the beginning steps to having providers be responsible for positive outcomes. The Affordable Care Act has also addressed many of these areas such as the "Hospital Readmissions Reduction Program and the Hospital-Acquired Condition (HAC) Reduction program" All of this is the beginning of the shift. I know at my company we are discussing metrics and outcome incentives to be implemented and added to our providers. This is not only for the inpatient facilities but for all service providers. References: