Several Push of Health Care Systems


There has been continuous development in the delivery of health care because of the evolution of different disease patterns, which calls for modified forms of treatments. Some of the radical changes that have occurred over the years include a decline in global spending by the government on health care services as well as the transfer of hospital care to community settings. Consequently, the number of hospitals as well as their size has significantly been reduced, therefore allowing only the most seriously ill patients to be admitted.

Moreover, the transition from close-range care to looser managed care has impacted heavily on the cost of providing health care services; and in effect, the government has invented various strategies to curb the rising costs, which include employer contribution methods, competition among health maintenance organizations, behavioral managed care, cost-sharing, hospital mergers, etc. However, some of these cost-effective measures have resulted in inaccessibility to quality health care. Several pushes and pulls of health care systems will be highlighted in the questions discussed below.

The changes in health care delivery that have led to the decline of in-patient hospital days

Some changes have been embraced in health care delivery, leading to a reduction of in-patient hospital days; firstly, there is the use of entitlements and private insurance. This is a program where individuals are encouraged to make certain contributions in form of premiums regularly before seeking medical attention. It has been observed that patients who subscribe to the medical policies with private insurers enjoy negotiated discounts thus Medicare cost is lowered.

Secondly, the health care medical providers have embraced a lifestyle of working longer hours than the regular business hours from 9.00 am to 5.00 pm. This allows them to serve more patients early enough before the ailment culminates to a serious illness. This also ensures that the customer (patient) who is working is not left out and is able to access the service at his/her own convenience.

Thirdly, accessibility to medical health care has been made more available. More clinics have been established near or next to grocery store as well as utilization of ambulatory visits where there is poor infrastructure like rugged terrain impassable roads. Other employers invite physicians and other licensed independent practitioners to hold ‘in-house clinics’ for their employees (Shi and Singh, 2008).

Traditional hospital governance and major sources of authority

There are two major models of governance each of which is distinct to the other namely, philanthropic and corporate mode; with the former being involved in health care centers and the latter being involved in commercial area.

The philanthropic model tends to incorporate rather than refute the existence of culture and beliefs about health and health care. The philanthropic model puts emphasis on asset preservation and constituent representation. It is known to be of significant importance and requires only minor alteration to become adaptive to the current environmental conditions that pose a challenge to the hospitals (Griffith, 1999).

The three major sources of authority consist of the national laws and regulations, the state and local regulators where the contributors include the highly trained professionals, the health care providers/hospital administrators and the policy makers. The policy makers provide stringent rules and regulations that govern quality health care provision ranging from primary care, acute hospital care, home health care, long-term care, etc. The role of these authorities is to ensure that all the rules stipulated are adhered to regardless of the setting in of the service provided (Kaiser Permanente Institute for Health Policy, 2010).

How managed care has changed the role of physicians in medical care decision-making

During their practice, physicians are mandated by the professional ethics to establish proper relationships with the patients as well as with other practitioners. In addition, all the physicians have a duty to take care of both the patient and the organization despite there being conflict or contradiction in the two roles.

Prior to managed care, there was criticism that the managed care represents a complete departure from the ancient physician/patient relationship, wherein the physician is taken as a patient advocate. Moreover, most of the physician’s deep commitment was the patient’s welfare. However, current findings reveal that the decision made by the physicians is influenced by other factors like conflict of interest, biasness, and conflict of obligation. As a result of conflicts of interest, self-referral practices have emerged or relationships with pharmaceutical firms have arisen with the aim of personal material gain. Moreover, there is biasness based on gender, religion, race, against the aged, those living with AIDS, etc. Some of the obligatory conflicting issues include pursuing research projects of a patient without observing the required level of competence at the expense of the patient (Kaiser Permanente Institute for Health Policy, 2010).

Major categories of long-term care

The five major categories of long term are includes: Community-based services, Home health care, Housing for the disabled and the elderly, Board and care homes, and Continuing care retirement.

All these categories of long term care deal with provision of activities of daily living care needs and additional services. Palliative care is provided in all settings at the end of life care with the aim of maintaining comfort for quality of life (McKenzie, Pinger and Kotecki, 2008).

Strengths & shortfalls of our health care system for individuals living with AIDS

Some of the strengths of the health care in caring for those living with AIDS include provision of free medication, voluntary counseling, and testing as well as provision of community home-based care. However, there are some setbacks that are experienced like lack of qualified medical personnel to offer the patients’ special needs, inadequate equipments and instruments due to lack of funds, compromising of the set control standards that ensure quality services.

Should the treatment of mental illness be separate from the treatment of physical illness?

Subjectively, the mentally challenged people should be separated from the rest of the patients. This is because they require special attention in order for the physician to effectively monitor their improvement. Furthermore, the mentally ill patients can be a menace if combined with the other suffering from physical illness.

I would advocate for a monitoring program to be developed to check the progress of the patient. This program should be done as frequently as possible to ensure the patient is in good health. In addition, I would also recommend that the government provide incentives such as home care services and free medication for the mentally challenged.


Conclusively, it is observed that hospital boards are more accurately characterized as “hybrids” rather than as corporate or philanthropic in form, hence the complex and varied ways of health care governance and provision. Further, evidence that hospital boards are confronted by multiple, competing demands may be seen in the relatively loose coupling of structure and activity demonstrated by several dominant governance configurations.


Griffith, J. R. (1999). The well-managed healthcare organization. NY: Health Administration Press.

Kaiser Permanente Institute for Health Policy. (2010). Partners in Health: How Physicians and Hospitals Can be Accountable Together. NY: John Wiley and Sons.

McKenzie, J., Pinger, R. and Kotecki, J. E. (2008). An introduction to community health. MA: Jones and Bartlett Learning Press. Web.

Shi, L. and Singh, D. (2008). Delivering health care in America: a systems approach. MA: Jones & Bartlett Learning.

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