The United States Health Care System

This article is focused on describing what is wrong with the United States Health Care system and how it can best be reformed.  The current system is described as being inefficient and expensive, with poor outcomes and many people who are denied access.  The authors advocate a health trust system that would provide core medical benefits to every American, while improving efficiency and reducing redundancy.  In this country we have the most technologically intensive medical practice in the world, yet our country also spends more money than any other nation on medical care, with outcomes inferior to those in other developed nations.  Lack of access to health care leads to major disparities in health.  A fragmented delivery system also leads to cost shifting, which is the practice of insurer's transferring costs to other payers, administrative waste, and an imbalance between spending on medical care and spending on population health initiatives.  Most proposals for reforming the health care system call for universal coverage independent of employment status, disability status, or age.  Also essential to integrate is personal prevention programs and therapeutic care with public health.  A reformed system should also be organized and funded to take advantage of new knowledge about medical and nonmedical determinants of health.  This new health trust system, would assess the cost of health care insurance equitably, promote efficiency by reducing fragmentation and relying on competitive markets, allow coordination of spending on population health and personal medical care, accommodate heterogenous preferences, and build on existing American health insurance and provider institutions, informed by international experience.  The current financing structure and organization of care in the U.S. provide strong incentives to treat illness after it occurs rather than focus on preventative care.  This is extremely troublesome because it would be a great way to reduce costs by preventing illnesses before they happen. But since our system is more concerned about treating visible illnesses, physicians and other health care professionals may be likely to just let a disease come about so they can make money by treating the disease or condition.  According the authors of the article, a reformed health care system would also foster coordination of public, population, and private health care at the local level, impose financial discipline and encourage choice for and responsiveness to, clients.  The first level would be the national health trust, which would use risk-adjusted capitations to allocate funding to regional health trusts, which would direct funding to the appropriate areas in their regions.  Doing this would ensure that funding for health services would be responsive to the needs of the different populations in different locations.  Also needed to be taken into account is the costs of delivering medical care in various areas throughout the country, through mechanisms similar to Centers for Medicare and Medicaid services developed for Medicare inpatient and outpatient services.  Another responsibility of the NHT is developing uniform national policies to promote information technology, define criteria for high-quality care for particular diseases, conduct comparative effectiveness analyses, and forecast future health manpower needs.  The Regional Health Trusts would be responsible for the organizing, managing, and overseeing the delivery of the core benefits: personal care combined with population health interventions.  Something important to remember is that RHT's would not directly provide care, they would contract for services either directly with providers or indirectly through integrated plans and would also finance population and public health initiatives.  RHT's would employ quality standards developed by the NHT to evaluate the quality of care and make this information available to consumers to facilitate the selection of providers or care plans.  They could also monitor quality of care at the patient level, tracking patients by their unique insurance identifier.
        This plan sounds good on paper,  but I am questioning its practicality, even though I believe that a change in the health care system has been long overdue.  I am of the opinion that perhaps this method could be proposed to Congress, and perhaps they would be able to make a working model of the plan that would be better suited to dealing with the problems that we face in this country.  One problem I have with this article is that it seems to be biased towards those who favor health care reform.  I feel that the authors of this paper may not have looked carefully enough at the other side of the debate before they wrote their article.  Even so, they still have some very good points that I feel warrant a closer look at by the National government as they attempt to determine the best way to go about reforming the health care system, because it is inevitable that change will happen, what will be variable in the equation is how much change do we want?  That's that most important question that we all have to ask ourselves before we form our own opinions about what should be done.













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