Who controls health care? As you have learned, the U.S. does not have a central agency to manage and govern health care delivery. Rather, multiple parties have varying responsibilities for and interests in health care delivery. Therefore, this question deserves thoughtful consideration and raises many additional questions about healthcare in the United States.
To prepare for this assignment:
You will consider how the control of health care delivery has shifted over time from the preindustrial era until today.
Think about the changing roles and responsibilities of various individuals and institutions, such as:
Government payers (Medicare and Medicaid)
Also, consider how the issue provides opportunities and challenges for healthcare administrators.
To complete this assignment, address the following questions:
What are the historical forces on the healthcare delivery system, or who controls health care in the United States today? Why?
How has this changed over time?
What insights does this topic give you with regard to opportunities and challenges for health care administrators in today’s organizations?
Recommended 3 pages APA formatting is required. Minimum of 2 academic resources are required.
The U.S. Healthcare System
The healthcare system in the United States of America today is not under the control of any single agency or body. The control of the system, which is deemed very expensive, falls under various different agencies. According to Austin & Wetle (2016), the private sector business largely owns and operates healthcare facilities in the US. The percentage composition of community hospitals in the country is as follows: 21% for-profit, 21% government-owned and 58% non-profit. In comparison to other countries, the US incurred more expenditure on healthcare per capita in the year 2011, the actual expenditure being $8,608 (Austin & Wetle, 2016). This is according to the World Health Organization (WHO). In the same report, WHO indicates that in the same year, the country spent the most on healthcare as percentage of its GDP. 17.2% of the country’s GDP went to the provision of healthcare services. In the year 2013, the government paid for 64.3% of health spending. This funding was done through such programs as the Veterans Health Administration, the Children’s Health Insurance Program, Medicaid, and Medicare. Insurance cover is made available to people who fall under the age of 67 years through an employer of a member of their family or their own employer. They may achieve this by buying health insurance on their own failure to which they would remain uninsured. The government primarily provides public sector employees with health insurance.
Various factors have led to the healthcare system in the US being under the control of various agencies and players. One of the factors, as explained by Niles (2014), is that the number of payers for healthcare in the country is large and each payer has their own coverage rules. Another factor is perverse or distorted incentives for payment. For instance, it is a general rule that ready and generous compensation to healthcare providers is based more on the medical procedures they perform than on any other work, involving such cognitive and communication work as preventive care or diagnosis. The US healthcare system is also plagued by the problem of a fragmented healthcare organizations environment. Both healthcare providers and patients are subjected to having to put up with a confusing environment of varied information sources, health plans, payers, specialist and primary doctors, community hospitals, and tertiary care centers. In addition, the healthcare labor market is experiencing an increasing demand for certain specialties including informatics-trained clinicians, health care paraprofessionals, primary care physicians, and nurses.
From the time spanning the colonial era to the early years of the 20th century, little scientific research was done on medicine in the US. This is because during that time, the country was generally lagging behind in medical education, experimental research, and medical science as was compared to such countries as Germany, France, and Britain. Additionally, the attitudes of Americans towards medical treatment were based on conservative common sense and natural history (Loker, 2012). This then meant that medical practice in the country was based less on professional character and more on domestic character. A consumer would purchase medical services out of their own private funds if and when they deemed the services appropriate. This practice was encouraged by the absence of health insurance then. The healthcare market had a situation whereby the providers competed amongst themselves. It was thus upon the consumer to decide the provider whose services they would go for (Loker, 2012). This paints a picture of healthcare being controlled by the competition amongst the providers such that the provider with the best services would have the highest percentage of clients. As such, the delivery of healthcare was done under free market conditions and consumer sovereignty reigned supreme in the market.
The postindustrial era saw American physicians registering remarkable success in the retention of private medical practice unlike physicians from other parts of the world. They thus successfully resisted national health care. The trend was supported by the fact that physicians culminated into an organized medical profession. Insured patients would access technically and scientifically advanced services as were provided by the physicians. According to Loker (2012), the US healthcare system in the 20th century was majorly characterized by the following: patients depended on physicians who were autonomous to act as their agents; independent nonprofit hospitals provided complex care to patients; and, insurers never made interventions in the making of medical decisions and made reimbursements to such providers as hospitals and physicians on the basis of fee-for-service. During this time therefore, the major players in the healthcare system were physicians and nonprofit hospitals.
One of the insights I get from this topic regarding opportunities for health care administrators in today’s organizations is that since performing medical procedures attracts significant payment, the administrators may utilize this to ensure that they conduct accurate diagnosis on their patients. With an accurate diagnosis, the medical procedures conducted by the organizations would most likely be effective. The administrators also have an opportunity of enhancing their communication procedures with their patients. When a patient is adequately informed about their diagnosis and the medical procedures they are subjected to, they would develop unquestionable trust in a healthcare facility and entrust it with their healthcare. Another opportunity is that healthcare providers can now provide specialized treatment to patients as informed by the patients’ insurance coverage rules. On the other hand, healthcare administrators face various challenges such as: non-transparent and complex workflow; having to make critical decisions of healthcare in the face of uncertainty whose sources may be things such as missing medical records or biological variability; and, provision of complex care in an environment that is time-pressured.
Austin, A. & Wetle, V. (2016). United States Health Care System: The Combining Business, Health, and Delivery. Upper Saddle River, New Jersey: Prentice Hall.
Loker, T. W. (2012). The History and Evolution of Healthcare in America: The Untold Backstory of Where We’ve Been, Where We Are, and Why Healthcare Needs Reform. Bloomington, Indiana: iUniverse.
Niles, J. (2014). Basics of the U.S. Health Care System. Burlington, Massachusetts: Jones & Bartlett Publishers.