Improving the Quality of Healthcare: Policies and Reforms

Abstract

This paper explores the various policies that have been implemented to improve the quality of healthcare given to people. It also outlines the stakeholders in the health sector, and their roles as far as quality healthcare is concerned. Though major steps have been made by the state and various stakeholders to ensure improvement in quality of healthcare, some areas need further improvement. Consequently, this paper suggests reforms which are needed in the healthcare sector to ensure that quality healthcare is accessible to all.

Introduction

Human capital is an important resource in the development of every nation, because people run virtually everything in each sector of the economy. However, people are prone to various kinds of infections and accidents while performing their day-to-day activities, either at their places of work or at home. Resumption to duty depends on how quick sick people can get better and swing back to normalcy. In this regard, many nations are highly concerned about the quality of health offered to their citizens, because productivity of a nation directly depends on good health. Different policies and programs have been instituted to put into check the quality of healthcare by different states, as well as the federal government. Despite the efforts that have been put in place to ensure that the quality of healthcare is up to standard, there are still some areas which require scrutiny.

Importance of Quality Healthcare

With improved healthcare, the chances of patients recovering whenever they visit a medical facility are increased. In addition, medical accidents which have led to the loss of lives in some health facilities have been avoided, making healthcare safe for everybody (Pozgar, 2007). Besides increasing the confidence of people in healthcare facilities, a safe healthcare system ensures that people take minimal time to recover hence reducing the effects suffered by other economic sectors.

Moreover, quality healthcare means that effective drugs are prescribed to patients whenever they visit a health facility. Drugs with dire side effects are therefore not allowed in the market, let alone in any health facility. Consequently, patients will not have to visit doctors time and again to be treated for the side effects caused by use of generic substandard drugs. On the same note, citizens will always have high standards of health and will therefore be more productive.

Moreover, affordable medical plans that result from quality healthcare enable people to take up insurance policies. Therefore, many citizens will be able to afford high standard healthcare and conveniently pay for their hospital bills making the nation healthier (Ehiri, 2009). Additionally, good medical covers by insurance firms have been proved to lead to the establishment of good healthcare facilities which are well equipped, further improving the services that people receive. Similarly, with good and affordable medical insurance which results from quality healthcare, more people are bound to be insured. As a result, the number of people who are able to access healthcare whenever need arises is increased.

It is also important to note that when quality healthcare is insisted upon by all stakeholders, research into the field of health will be enhanced. Advanced technology as well as state-of-the-art equipment which enable quick and accurate diagnosis, will result from the research. On the same note, the government will also increase its budgetary allocation to the health sector, leading to provision of exemplary services in both private and public health institutions. In addition, quality healthcare ensures that health personnel are qualified in their field. Strict policies are put in place to guide the training of health personnel in a move that aims at eliminating half-baked professionals, who end up making acute mistakes that cause deaths or permanent disability (Berkman & Harootyan, 2003). At the same time, regulations that are usually implemented to ensure that all qualified health professionals are registered by recognized bodies go along way in ensuring that patients receive proper treatment.

Characteristics of Quality Healthcare

On several occasions, people have lost their lives under circumstances which were preventable if due diligence had been applied by the medical practitioners who were offering medication. In such conditions, the quality of healthcare is compromised by the very people who are supposed to ensure care is upheld. In this regard, quality healthcare should be safe in the sense that when patients seek medical care they are assured of maximum chances of survival (Lloyd, 2004). On the same note, a quality healthcare system is characterized by timely assistance whenever needed. The logical implication is that any patient can easily get the required medical services, which are basic for life support.

Additionally, quality healthcare must ensure that the right prescription as well as diagnosis is given to each patient. However, it is sad to note that only half of the cases reported to medical centers are correctly prescribed, implying that there are instances where medics fail in their duties. Furthermore, it is paramount that all citizens equally access healthcare from every part of the country whether rural or urban. It has been a norm in most areas to find that good hospitals with well trained and experienced doctors are found in established cities, while rural areas are forgotten. This kind of healthcare system is not what can be defined as quality healthcare, because it does not serve all the citizens (Lloyd, 2004). Finally, it is paramount for any quality healthcare to focus more on the patient than any other stakeholder, because healthcare is all about the patient.

Policies and Programs Addressing Quality of Healthcare

Over the years, several policies have been implemented which endeavor to advance quality healthcare. To begin with, there is the McCarran-Ferguson Act which stipulates that the federal government take the basic responsibility in healthcare provision. The main aim of this Act is to ensure that the federal government protects citizens from substandard and usually ineffective health services, which could result from unregulated healthcare systems (Liu, 2003). To achieve this, the Act requires the government to license all providers of healthcare services and ensure that they are fully qualified, before allowing them to offer services to citizens. In addition, all pharmaceuticals and medical devices are supposed to bear the quality assurance mark from the Food and Drug Administration department, so that only quality products find their way to health facilities.

On the same note, in a move to ensure that at least every citizen has means of accessing better health care, in 2010 the Patient Protection and Affordable Care Act (PPACA) was implemented. According to this Act, each citizen is required by law to purchase health insurance to ensure that whenever one falls sick, medical care is guaranteed. When a family member or a child falls sick, they usually need somebody to take care of them. In this regard, the Family and Medical Leave Act was implemented to help protect the employment of people who may find themselves compelled to stay at home and take care of their relatives (Pozgar, 2007). As a result, the Act ensures that at least every person is able to get the basic care at all times.

In the past, patients who needed emergency treatment in various hospitals was sent away whenever they were unable to show proof of ability to pay for the services. On the same note, cases of patient dumping were rampant in the United States. Funnily enough, as late as 1980s some hospitals could not even provide the life saving healthcare to patients indiscriminately. Reacting to frustrations of citizens who had fallen victim to this problem, the congress then passed the Emergency Medical Treatment and Active Labor Act (EMTALA) in 1986. This act helped patients by decreeing that all hospitals in the U.S. which receive Medicare funds, should give the basic medical care to all patients seeking help in emergency rooms (Williams, 2011).

With the advancement in technology, the medical field has come up with new ways of diagnosis and improved drugs. Unfortunately, this has also led to increased financial obligations on the part of consumers, who now have to pay more for the same services they were receiving earlier. However, the federal state enacted the Medicare Prescription Drug Improvement and Modernization Act in the year 2003 to keep this under control. Besides providing subsidies to employers thus preventing them from eliminating retired employees from their medical covers, the Act also bars the government from reaching agreements with drug companies on discounts.

Additionally, partiality had been reported regarding application of the Mental Health Parity Act of 1996. It was observed that insurance firms were using the leeway in the law to set limits on the maximum payment they could cater for, using number of days spent in health facilities. Consequently, in 2008 the Paul Wellstone Mental Health and Addiction Equity Act was enacted. The Act harmonized the benefits received by people suffering from mental illness with those suffering from other illnesses. Moreover, it is the role of any government to protect its citizens from the effects of ever rising prices of drugs and consultation fees, to ensure that basic healthcare is affordable (Ehiri, 2009). In this regard, the federal government of the United States passed the Health Maintenance Organization Act, which provides subsidies in a move to reduce costs of healthcare.

Successes of the Programs and Policies

Several achievements have been made as far as the offering of quality healthcare is concerned due to the various policies that have been enacted. Since the passing of the EMTALA, patients in the United States whether insured or not have been able to receive life saving health care in hospitals’ emergence rooms. Besides conforming to the right of every citizen accessing basic healthcare, the Act increases the chances of survival for the patients. On the same note, regulation of the healthcare system has gone a long way in instilling discipline in the health sector. Nowadays, counterfeit drugs as well as substandard medical care are rare cases in the United States (Berkman & Harootyan, 2003). Moreover, since only highly qualified medical personnel are registered and allowed into the healthcare system, deaths and fatal injuries, due to medical accidents or cases of negligence have been minimized.

In many states in the United States, California being one of them, workers’ healthcare quality has been improved significantly. In this regard, the healthcare system has been enhanced and nowadays workers’ compensation healthcare system is of high standard and all inclusive. On the same note, managed healthcare has really reduced the costs of access to healthcare facilities and increased its quality. In this regard, health maintenance organizations as well as other collaboration institutions have gained popularity, because of their affordability both in the private and public insurance sector.

Failures of Healthcare Policies

Unfortunately, despite all the efforts that have been directed towards ensuring that quality healthcare is accessible and affordable to all, there are still some impediments that hinder success in this field. Firstly, quality healthcare is very expensive in the United States of America. In order to receive up to standard healthcare, one has to part with a huge amount of money which makes the healthcare services unaffordable to majority of the people, especially the uninsured ones (Williams, 2011). Sometimes, even the ones who are insured find it difficult to meet the healthcare costs.

While the main aim of quality healthcare policies is to reduce as much as possible or totally eliminate preventable deaths in the United States, this has not been achieved. Instead of reducing, preventable deaths due to either lack of insurance or inaccessibility of healthcare facilities have been increasing in the United States. In addition, not all patients are able to access proper diagnosis, advanced therapeutic services or even illness prevention services. Citizens who lack good and effective insurance or those who are uninsured most of the time lack the essential healthcare services, yet it has been the aim of the government to make healthcare accessible to all (Lloyd, 2004).

Furthermore, the EMTALA has not achieved it objectives of ensuring life is saved in cases of emergency. On the contrary, it has succeeded in poisoning the minds of people who now wait until it is too late to seek medical attention. Besides the long queues that are witnessed at hospitals’ emergence rooms nowadays, the Act has also led to deaths when people try to seek medical attention too late for their lives to be saved.

Stakeholders and their Roles in Ensuring Quality of Health Care

The health sector is composed of state and non-state actors, who need to work in tandem for efficiency in the provision of health services to be realized. The state particularly through its health docket has to ensure that it regulates medical practice in all hospitals both private and public. First off, it must ensure that medical practitioners seeking licenses meet the stringent requirements that precede certificate issuance. Moreover, the health department should ensure that medical instruments used in hospitals are safe to both the patients and operators. On the same note, laboratory equipment should produce adequate and accurate results for correct inferential analysis by doctors (Liu, 2003). Furthermore, The Food and Drug Administration department must ensure that pharmaceutical companies, only supply to the market drugs that have been tested and found to be suitable for human use. Another perspective of state involvement in promoting quality healthcare is in ensuring that medical personnel are taken through rigorous training in college. Subsequently, the federal government guarantees that universities only churn out competent doctors, nurses and laboratory technologists. To ease the burden of paying for medical services, the federal government usually comes up with different policies and programs. An example is the Patient Protection and Affordable Care Act (PPACA) of 2010, which is aimed at encouraging all citizens to take up medical insurance.

Incidentally, the United States government has continued to offer Medicare which is medical insurance offered to the disabled and elderly, and Medicaid which is medical insurance for low income earners and the poor. Therefore, it is incumbent upon the state to ensure that medical providers who serve patients with Medicare and Medicaid, are timely and adequately reimbursed (Ehiri, 2009). In the same regard, the state should ensure that all medical insurance companies include the basic medical services in their policies. By and large, the Emergency Medical Treatment and Active Labor Act ensures that all citizens are accorded emergency room services when they are in critical condition, before demand for payment is made.

Employers in the private sector should also partly contribute to the payment of premiums made by their staff, as part of welfare services to employees. It is easier for a firm to negotiate for lower premiums for health insurance since it brings on board a huge clientele, compared to individual bargaining. Charitable organizations that are funded by Corporate Social Responsibility (CSR) initiatives of companies should also continue to pay for health services for people in abject poverty (Pozgar, 2007).

Social and Ethical Issues

Inflation might be perceived as an economic problem, but it is nowadays becoming a social worry. The cost of production has exponentially increased and the health sector has not been spared, because drugs are becoming exceedingly expensive. This has prompted the upward revision of premiums payable to medical insurance companies (Klugman & Dalinis, 2008). Sadly enough, people still grapple with unemployment and sticky wage prices that make medical insurance unaffordable.

Doctors and other hospital staff like other human beings are vulnerable to challenges in life like depression, due to divorce or loss of loved ones. When medical practitioners report to work despite the personal problems they grapple with, they put the lives of their patients at risk. They can end up making wrong diagnosis or making grievous errors during surgery. It is therefore imperative that all medical personnel undergo mental check-ups every once in a while, to avert cases of medical malpractice.

Admittedly, if all medical staff were to go on strike, they would paralyze the health sector and lead to loss of lives. It is quite crucial that all medical personnel are adequately paid despite the harsh economic times we are in. Governments should accord medical staff preferential treatment, because of the risk that their jobs come with and the rigorous training that they are put through (klugman & Dalinis, 2008). Typically, the lives of all citizens are at the mercy of medical personnel because people run to them whenever they fall sick.

Crucial Health Reforms Needed

Undoubtedly, medical insurance companies are indispensible players in the health sector. The major downside to medical insurance companies is that they tend to restrict patients to certain hospitals and clinics, which are under their cover. Medical insurance companies need to come up with plans to make their coverage available to all medical institutions, to avoid inconveniencing patients during emergency cases (Williams, 2011). Medical institutions should also ensure that they fully embrace computerized record keeping of patients’ health details, to help medical insurance companies charge the appropriate premiums to their clients.

The desire of every country particularly the developed ones, is to have universal medical insurance coverage. This can only be achieved if there is collaboration between the private sector and the public sector in the financing of premiums. Incidentally, federal government employees are usually accorded state paid medical insurance, and are therefore well-off compared to the struggling private sector middle class. In the same light, the under-privileged and the elderly are usually accorded Medicaid and Medicare respectively (Williams, 2011). The state and employers should come up with a policy to assist the middle class in supplementing their medical insurance premiums, so that they are not over-burdened by payments.

In order to improve the quality of healthcare, a country not only needs state-of-the-art medical devices, but also quality, non-discriminatory and efficient services. Therefore, it is imperative that health workers are adequately motivated in order to offer impeccable services to patients. It is noteworthy to mention that motivation should not be monetary per se, but should encompass psychological motivation and room for career growth and development within the organization (Klugman & Dalinis, 2008). Additionally, in view of the fact that the United States is a multi-cultural society, doctors and nurses need to be trained in sociology and desirable public relation skills. In this regard, doctors will effectively communicate with their patients, enabling the making of accurate diagnosis despite communication barriers that may crop up.

Unfortunately, politics always impedes development in certain areas of the economy and the health sector has on countless occasions been victimized. Republicans and Democrats always lock horns over the amount of funding that should be allocated to the health sector in every fiscal year. There are usually unscrupulous politicians with ulterior motives who serve the interests of private medical insurance companies. The prime agenda of these politicians and the colluding medical insurance companies is to ensure that public health funding is kept at a bare minimum (Williams, 2011). The end result is that more and more citizens are forced to take up private medical insurance, which enables these service providers make supernormal profits. It is the prerogative of the state to prevail upon the legislature and ensure that congress passes fiscal budgets that do not forsake the health sector, for other sectors of the economy. On the same note, the funding should also be continuously extended to the Center for Disease Control and Prevention, so as to foster research in new ways of combating diseases.

Another facet of health sector reforms is the regulation of self medication and use of over- the-counter drugs. It is unfortunate that most of these drugs are usually abused by patients who superfluously engage in self medication, and put their lives in jeopardy (Lloyd, 2004). The health department should step in to ensure that only basic drugs are dispensed by pharmacies. Consequently, stronger drugs should be administered only with a doctor’s prescription.

Conclusion

Good health is the most invaluable wealth a human being can ever acquire. Much as prevention is better than cure, we occasionally fall victim to one form of ailment or another that requires medical intervention. Confidence in a health sector that provides accurate diagnosis of maladies, meticulous treatment and monitoring of patients is what every government seeks to build in its citizens. A working health sector is therefore dependent on goodwill and cooperation between the state, employers, medical institutions and medical insurance companies. Patients also have a pivotal role to play in ensuring that they pay their premiums timely and follow doctors’ advice religiously. Medical insurance is the nucleus of medical service in the health sector. As long as the state will continue providing partial coverage to every citizen, the burden of paying hefty premiums to private medical companies will be greatly reduced. Consequently, patients will get quality health care that is very elusive in most countries.

References

Berkman, B., & Harootyan, L. (2003). Social Work and Health Care in an Aging Society: Education, Policy, Practice, and Research. New York: Springer.

Ehiri, J. (2009). Maternal and Child Health: Global Challenges, Programs, and Policies. New York: Springer.

Klugman, C. M., & Dalinis, P. M. (2008). Ethical Issues in Rural Health Care. Baltimore: JHU Press.

Liu, X. (2003). Policy Tools for Allocative Efficiency of Health Services. City: World Health Organization.

Lloyd, R. C. (2004). Quality Health Care: A guide to Developing and Using Indicators. Sudbury: Jones & Bartlett Learning.

Pozgar, G. D. (2007). Legal Aspects of Health Care Administration. Sudbury: Jones & Bartlett Learning.

Williams, R. A. (2011). Healthcare Disparities and the Crossroads with Healthcare Reform. New York: Springer.

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