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It is crucial for a new health care legislation to address the sensitive and relevant problems that exist in health care, namely accessibility and disparity, the rapidly rising cost of health coverage, and patient safety. In this paper, a plan based on evidence and research studies will be presented to understand how these major concerns can be covered in the draft of the future bill.
Accessibility and Disparity
The problem of health care accessibility for representatives of different races and ethnic minorities, as well as citizens with different incomes and financial statuses, is a crucial one because both spatial (i.e. location, transportability) and nonspatial factors (demographics, socioeconomic status, conditions in dwelling units) have a direct impact on the general accessibility of health care services (Wang, 2012). Moreover, nonspatial factors can interact with the spatial ones: different populations have different health care needs (Wang, 2012). For example, individuals with high health care needs such as chronically ill, citizens with disabilities, older adults, children, and ethnic minorities can be negatively influenced by unavailable health care services because they live in rural areas or have difficulties when being transported (Wang, 2012). Thus, the first proposed step would be to enhance health care accessibility for patients from rural areas or with lower levels of transportability by developing TeleMed services and providing them to distant areas.
Another problem is physical accessibility in primary care settings. Mudrick, Breslin, Liang, and Yee (2012) examined physical barriers for people with disabilities that can influence the quality of care. According to them, although most of the medical facilities examined in the study fit (at least partially) intro the developed criteria, the problem of a height-adjustable table for examination remained unresolved by many. Examination of patients who sit in a wheelchair can result in a false diagnosis (Mudrick et al., 2012). The study was conducted in California, but the authors presume that the problem with physical barriers is no different from other states; what is more, access in California can be better compared to other cities with older buildings and more complex infrastructure (Mudrick et al., 2012). Therefore, the next step is to draft nationwide accessibility criteria that will be followed by all medical facilities to ensure that patients with disabilities have access to health care facilities. The lack of a unified approach towards physical accessibility directly affects the quality of care, which results in additional costly treatments, lawsuits, or even fatal outcomes.
In the study conducted by Shi, Zhao, Fonseca, and Krousel-Wood (2014), the problem of disparity and inequality is addressed by using the example of racial disparities in eye examinations. The authors observed an increase in eye examination among non-Hispanic whites since the year 2004, while a decrease in the same rate among minorities was documented (Shi et al., 2014). The impact of insurance was also marked as significant because many of the respondents either had no insurance or had one that could not cover the expensive procedure (Shi et al., 2014). The authors concluded that the recession in 2007 could be the cause of this inequality. Minorities had worse performances on eye examination ; geographical distribution also had an impact on eye examination because a little number of professionals agreed to perform nonmetropolitan practice (Shi et al., 2014, p. 1325). Therefore, the problem of disparity is directly linked to accessibility and racial issues. This needs to be taken into consideration: making health insurance more affordable for ethnic minorities and other affected populations might not have the desired effect (Shi et al., 2014). The lack of medical professionals in rural areas is another issue that influences the disparity. Preventive screening is also more accessible for non-Hispanic whites and citizens living in a metropolitan area. A nationwide screening program could be implemented to address this problem; such a program exists in the UK and provides free screening for patients with diabetes regardless of their financial status and ethnicity (Shi et al., 2014).
Another factor that negatively influences disparity and inequality is the socioeconomic status of patients. Lower socioeconomic status is linked to poor quality of health care or no access to it, as well as a higher risk of infection, development of diseases, mortality even. The problem that lies within is the inability of patients to receive treatment in time. Patients who experience financial difficulties often have to seek help in hospitals with less professional clinical practice and worse clinical outcomes. Ethnic minorities often have to face poverty and inequalities based on the racial difference, and lack of affordable health care can threaten their life, as well as the life of their family. Although these issues are addressed on the administrative level, additional policies and acts need to be drafted and go into action.
In acute care, physicians often have to make quick decisions about the treatment of patients. Here, previous stereotypes of marginalized groups can influence ones opinion on treatment and provoke possible neglect of an underprivileged patient. Thus, to fully address this problem the government needs to work on the elimination of stigmas that surround patients with lower socioeconomic status, as well as address the problem of racial disparities in health care insurance. The program implemented in the UK can serve as an example of such an intervention.
Cost of Health Coverage
The rising cost of health care coverage is another major concern that can cause further complexities in health care access and treatment. Although the USA spends more money on health care per capita than any other industrialized country, the outcomes are still far from perfect. The experience of countries can vary, but one of the proposals has been discussed by the media and the public: universal health care. Universal health care was chosen by many countries as the only option because other approaches to health care were not socially efficient (Savedoff, de Ferranti, Smith, & Fan, 2012). The way to universal health care was supported by numerous public policies that were not perfect but ensured the further implementation of the idea. However, citizens cannot adopt universal health care without the governments involvement because such serious financial investments and special regulations are taken into action only on the national level. Savedoff et al. (2012) point out that it is crucial to shift from out-of-pocket spending to pooled funding (p. 924). Social pressures are often one of the causes of why governments agree to implement universal health care. In the USA where health care costs are rising every year, and not everyone can afford full insurance that would cover complicated surgeries and other procedures, the need for universal health care is evident. However, it is also clear the path to its adoption will be based on public policies, conflicts, negotiations, debates, and other forms of social-governmental interaction. Nevertheless, it is impossible to neglect the fact that health spending grows faster than income (Savedoff et al. 2012).
Patients expect quality care and convenience; however, due to the rising health care costs, not all patients are capable of obtaining these services, even if they are highly needed. Those patients with chronic illnesses or rare diseases who need complicated care often do not have the money to cover provided treatment. The quality of care is often perceived as poor, although its costs are high. Some of the patients with chronic conditions or chronic pain cannot earn money to cover their treatment, which can lead them to alternative practices or neglect. This approach, in return, can result in a higher rate of fatal outcomes or serious complications. Thus, the rapidly rising cost of health care services negatively influences access to care and its outcomes.
Another issue directly linked to this problem is the price of services that is never clearly established before the treatment. Such lack of transparency aims to reduce competition among insurers and providers but ultimately does not allow patients to choose between high-cost and low-cost providers. If customers are given this opportunity, it might make high-cost providers lower their prices. Prices and costs should be transparent to patients so that they can estimate the cost of needed treatment and ensure that they can afford it. Such a transformation is impossible without significant public engagement; therefore, public policies that target the policy of prices and their transparency in health care need to be seen as primary when drafting the new bill.
Patient Safety
Patient safety and strategies focused on its promotion can help health care services reduce the rates of hospital-acquired diseases and fatal outcomes related to clinical errors and mistakes. Shekelle et al. (2013) point out that to evaluate the implemented strategies of patient safety, these practices need to be described in detail to be replicated. It is also essential to measure the effectiveness of the strategy on outcomes, unexpected effects, and costs (Shekelle et al., 2013). The authors also mention management tools (leadership practices, promotion of patient safety culture, training resources) as contexts that need to be included in reports on patient safety (Shekelle et al., 2013).
Shekelle et al. (2013) develop their framework with highly encouraged practices that can reduce the negative outcomes of neglected patient safety, such as preoperative checklists to prevent postoperative interventions, intervention strategies to reduce urinary catheter use, hand hygiene, precautions to reduce the high rates of healthcare-associated infections, etc. (p. 366). As can be seen from this list, many factors that hurt patient safety are linked to neglected safety practices in the clinical environment. Therefore, a unified framework or a set of rules needs to be developed that will define which safety practices are obligatory in different units at health facilities.
Another problem related to patient safety is discussed by Middleton et al. (2013), namely the positive correlation between electronic medical record systems (or EHRs) and patient harm. The authors point out that standardized use cases need to be in priority to ensure patient safety; if all documentation is aligned and correct, they should be used for selected EHR functionalities to measure them (Middleton et al., 2013). Research of best practices in EHR can help assess their effectiveness and understand what training requirements or technology infrastructure affect their safety. Middleton et al. (2013) also suggest that standardization and interoperability among different EHR systems would provide more efficient data processing and enhance patient safety at health facilities.
One of the key points addressed by Middleton et al. (2013) is the significance of the adverse event reporting system. Any medical errors or other adverse events related to the usability of EHR systems need to be reported and reviewed by end-users (Middleton et al., 2013). At last, they also propose to launch an education campaign that will teach users how to operate it effectively and provide the necessary guidelines. The EHR systems are quite new to health care, and the negative events linked to it might be the cause of lacking education program.
It should be noted that the use of electronic tools and systems to gather data about patients is sometimes perceived by patients as surveillance; patients need to be assured that all their data remains confidential and will only be used for particular purposes. Some patients might refuse to provide additional data about them or their health (such as former/present drug or alcohol addiction, other stigmatized factors), which can also result in unintended patient harm. Therefore, education programs need to target patients as well; making patients aware of the influence of shared data on treatment can positively affect patient safety culture and reduce the number of adverse events related to missing information. End-user information can also be very helpful when reviewing the efficiency of EHR systems; that is why health care facilities need to receive reports and information from clinicians who operate the systems to understand what practices are the most relevant to patient safety.
Plan Summary
As can be seen from the gathered evidence, the bill will have to rely on many identified concerns and issues in the three major topics discussed above. First, the bill will need to address the accessibility of health care services that are both influenced by spatial and nonspatial factors. Socioeconomic factors such as conditions of dwelling units, financial status, and occupation also influence the accessibility of these services. Physical accessibility needs to be addressed as well because it is critical for patients with disabilities or those who have difficulties in being transported to health care facilities.
When drafting the bill, legislators need to pay attention to racial disparities that directly influence inequality in health care. In this paper, a program launched in the UK was proposed as an example of the opportunity to reduce this disparity; a national-wide free examination for all citizens with no regard to race, financial status, and gender need to be conducted to make health care services more available for everyone.
Universal health care was also proposed as a possible solution for the problem of rising health care costs. Although quite complicated, this approach directly addresses the expensiveness of health care services. It cannot be implemented quickly and without debates; public opinion and discussion are needed to understand how it will influence costs in the future.
Transparency in prices is another concern that needs to be discussed; legislators should address the problem on the national level and draft regulations that will make prices for health care services more transparent.
At last, education programs can serve as tools for enhancing patient safety. The promotion of patient safety culture and the implementation of practices that will reduce the risk of adverse events will gradually improve the state of affairs in this domain.
References
Middleton, B., Bloomrosen, M., Dente, M. A., Hashmat, B., Koppel, R., Overhage, J. M., & Zhang, J. (2013). Enhancing patient safety and quality of care by improving the usability of electronic health record systems: Recommendations from AMIA. Journal of the American Medical Informatics Association, 20(1), 2-8.
Mudrick, N. R., Breslin, M. L., Liang, M., & Yee, S. (2012). Physical accessibility in primary health care settings: Results from California on-site reviews. Disability and Health Journal, 5(3), 159-167.
Savedoff, W. D., de Ferranti, D., Smith, A. L., & Fan, V. (2012). Political and economic aspects of the transition to universal health coverage. The Lancet, 380(9845), 924-932.
Shekelle, P. G., Pronovost, P. J., Wachter, R. M., McDonald, K. M., Schoelles, K., Dy, S. M., & Bates, D. W. (2013). The top patient safety strategies that can be encouraged for adoption now. Annals of Internal Medicine, 158(5), 365-368.
Shi, Q., Zhao, Y., Fonseca, V., Krousel-Wood, M., & Shi, L. (2014). Racial disparity of eye examinations among the US working-age population with diabetes: 20022009. Diabetes Care, 37(5), 1321-1328.
Wang, F. (2012). Measurement, optimization, and impact of health care accessibility: A methodological review. Annals of the Association of American Geographers, 102(5), 1104-1112.
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