SOC/HSP 355 

Contemporary Health Care Systems

Name

Institution

Contemporary Health Care Systems

Features of the United States Healthcare System

This part looks at the features of the U.S. healthcare system and creates a better understanding of how it works. Some of these features are changing slowly but surely especially with the introduction of the Affordable Care Act. Ten primary areas distinguish this system (Papanicolas, Woskie, & Jha, 2018). One feature is that the U.S. healthcare system is not governed by one central agency which means there is limited integration and coordination. The government, in contrast to most systems around the world, does not authorize financing, payment and the delivery of services to the public. The privately-owned practices work independently. It is important to note that the lack of coordination results in high costs of healthcare. It would be less complex if the system was coordinated centrally for cheaper healthcare options. The government is only but a subsidiary of the private sector. The government’s financial obligation remains to cover the gaps left by private entities. These gaps include but are not limited to clean water and sanitation, care for vulnerable people and funding for research and training.

The U.S. healthcare system is very technologically focused with a lot of emphasis on critical care. The United States is a center for research and innovation and growth in science and technology results in increased demand for new services without regard to the diminishing resources and stretched finances. The system is also characterized by extreme costs, imbalanced access and mediocre outcomes. Compared to other developed nations, America spends the most when it comes to medical services (Obama, 2016). Despite this much spending, a huge number of U.S. citizens have restricted access even to the most basic medical care. Access is restricted to those that have employment insurance, those covered under the Affordable Care Act, those capable of purchasing private cover, those able to pay the services after every visit, and or those that can access through safety net. Although insurance in this system is primary to obtaining care, it is not necessarily sufficient. This inadequacy and inequality in access to health care mean that residents of the United States do not record desirable health outcomes as compared to other developed nations.

The United States healthcare system operates under imperfect market conditions. Although the system is controlled by private entities, free-market forces to an insignificant extent only govern the market. Patient choice does not determine the prices through the forces of demand and supply. This may be explained by the fact that the patient is not the actual payer for the services as MCO, Medicaid and Medicare pay for the services instead. Agencies that are external to the market set the prices and not the forces of supply and demand as it is in a free market. In certain parts of the country, one giant medical system controls healthcare services restricting competition.

The system is one where the concepts of market justice and social justice are fused together. These two philosophies are contrasting on how healthcare services can be generated and circulated. The concept or theory of market justice put the obligation for the rational distribution of medical services on market forces. This means that health care services are distributed basis on willingness and capacity to pay for them. Contrary to this, social justice puts emphasis on the welfare of the public over that of the individual. For this reason, social justice does not condone the restricted access to medical services because of the inability to pay and considers it unjust. The U.S. healthcare system blends these two principles benefiting from the ideals of each. To put it into context, employed persons bringing home middle-class incomes have healthcare insurance sponsored by their employers. The lower class on the other side are reliant on government-sponsored programs. The theories, however, also create conflict. A good example is that some small employers cannot afford to provide insurance for their employees or when offered, these employees cannot afford to pay for it from their salaries. Yet, they are not eligible to obtain government support owing to their income surpassing the required minimu (Shi & Singh, 2010).

The other feature includes multiple players such as physicians and administrators of institutions that have a direct interest in the system and balance of power. Large companies, insurance providers, hospitals and physicians constitute a set of commanding and civically aggressive special interest groups that are represented in Congress by expensive lobbyists (Shi & Singh, 2010). The pursuit of integration and ability also characterizes the system. The other thing is the access to healthcare services selectively on the basis of insurance coverage. The system provides one of the best medical services in the world. However, these services are available to those that can afford insurance coverage that can offer sufficient coverage or those able to cover the costs of the procedures themselves. The system is also characterized by legal risks that guide applied behaviors. Americans are quick to drag alleged medical offenders to court motivated by the possibility of enormous jury awards. As a result, medical practitioners are becoming increasingly vulnerable to legal process and the risk of malpractice claims influences how they practice medicine.

Comparison with other models in Europe

Germany, Canada and the United Kingdom represent three basic models with which care systems are structured in Western Europe and of course, Canada. Canada uses a model where the government finances health care through using tax revenue while the actual care delivery is left in the hands of private providers. In comparison to the United States quad-function model, which is loosely coordinated, The Canadian arrangement necessitates tighter consolidation of funds, insurance and imbursement functions, which are all harmonized by the Canadian government while distribution is left to disconnected private arrangements. Provinces and territories in Canada have put in place some enterprises to increase incorporation and coordination of care for people with chronic conditions and compound needs. Provincial and territorial governments granted to strengthen healthcare as part of a 10-year plan by providing about 50 percent of their residents with access to prime care teams across all disciplines. The 10-year plan was enacted in 2004, and by 2007, almost three-quarters of primary care physicians operated under physician-led, multi-disciplinary practices. Across the provinces, the use of electronic health records had reached a level where, by 2015, almost 60 percent of primary care physicians were using it.

Canada also has the Federal health transfer where federal funding is dispersed to provinces on a per-capita basis only, which replaced earlier compensation for disparities in taxes bases, which benefited that provinces that were considered less privileged. The aim of this new funding policy is to increase equity. Provinces also put effort to decrease the cost of generic drugs. Primary care reform has been rolling in Canada since 2000 after the government injected CA$800 million over a period of 6 years through what is known as the primary care transition fund (Marchildon, & Mou, 2018). Restructuring of principal care systems continues in each province like provider payment methods and the issue of incentives to shift to a team-based approach from the individual one, management of chronic cases, and the coordination of care with other providers.

In Germany, the government mandates employees and employees to contribute in order to fund healthcare. Delivery of care is left in the hands of private providers. The contributions made by employers and employees are handled by sickness funds which are non-profit insurance entities that reimburse hospitals and pay physicians. This system closely integrates insurance and payment functions. There is also better coordination of the payment functions as compared to those in the U.S. The government controls the overall exercise by the distribution of care is left to private entities.

The General Law on Patient’s Rights was enacted in 2013 citing measures tailored to strengthen the rights of patients most importantly the integration of these rights into the Civil Code of Rights, duties and protocol relating to the relationships between patients and care providers.

Germany also enacted a bill that redefines the way Social Health Insurance is contributed in terms of rates and who they are distributed between company and employee to cater for ancillary labor costs. As of 2015, Germany resolved to maintain the 14.6 percent general contribution rate but abolish the employees’ special contribution rate of 0.9 percent as well as supplementary premiums (Mossialos, Wenzl, Osborn, & Anderson, 2014). In the place of supplementary premiums, there will be a extra income-dependent contribution rate, informed by individual sickness funds.

The United Kingdom healthcare system is such that the government finances an insurance program that is supported by tax revenue and controls the infrastructure required for the delivery of care. The government operates numerous medical institutions and employs the majority of the care providers. The few that do not fall under the government payroll are closely systematized in a publicly managed setup. As compared to the quad-function in America, the British system exerts more close consolidation of these functions, usually by the government.

The Social Care Act of 2012 eliminated primary care trusts and put in place clinical commissioning groups across the country (National Audit Office, 2013). These commissions are mandated to ensure effective use of capitals in making resolutions about the planning and purchase of various services for their local dominions. Overall practices fall under the control of commissioning groups and should be governed by a chairperson who must be a general practitioner alongside other clinicians and managers.

Ethical Guidelines for Medical Research and Practice in the U.S.

The aim of clinical research is to create the general knowledge intended to improve human health and better understanding the human anatomy. The participation of individuals in research programs enables the acquisition of this knowledge. Without ethical guidelines, the rights of volunteers, as well as the integrity of science, may be at risk of abuse. An issue of notable controversy is genetic testing. Genetic testing has been considered the future of medicine, but its implementation has been associated with various challenges to the individuals involved on the basis of their genetic characteristics (Wilson, Miller & Rousseau, 2017). Some genetic discoveries many not go well with insurance providers resulting in genetic discrimination, which may hinder the recruitment of individual for genetic testing.

The ethical argument is that genetic discoveries should not be used for the intent to cause harm. It is integrally prejudicial to discriminate based on genetic characteristics because each genome is inherited from parents, including variants that increase the chance for contracting diseases or those that are protective. Because this is a biological process based on chance, it is clearly beyond the power of individuals meaning that all people should be exempted from discrimination or favoritism based on their personal ancestry or genome.

Employers and insurance companies are notorious for discriminating people because they possess a genetic mutation that increases susceptibility to diseases, inherited disorder or familiar history of a specific health condition. The Genetic Information Nondiscrimination Act protects individuals from insurance discrimination as well as discrimination in title I and title II, respectively. Because of the risk of discrimination, stakeholders have debated whether to inform or not to inform a third party about the genetic features of an individual.

Another controversial research topic is stem cell research. Stem cell research is associated with great promise for increased knowledge on the basics of human growth and differentiation. It also generates hope for new treatments for illnesses such as diabetes, Parkinson’s disease, spinal cord injury and myocardial infarction. Nonetheless, human stem cell research attracts controversies and raises strident ethical questions.

The method of conducting stem cell research that includes the use of aborted fetuses is criticized in terms of the end does not justify the means. Arguments against the methods maintain that life is life, and it should not be compromised for any end. A fertilized egg should be considered as human life and valued in the same manner; it does not matter if it is in its first weeks. There is no ethical ground in destroying human life to save human life. Critics suggest that stem cell research should be put on hold until methods that will enable the use of adult stem cells become available. The scientific value of stem cell research has been exaggerated or include flaws; for example, there is no concrete evidence that stem cells can be used to clone organs that can be transplanted.

The available guidelines for stem cell research do not cover these arguments but instead take a more general view. These guidelines include (International Society for Stem Cell Research, 2016):

The veracity of the research initiative

Primary focus on patient welfare

Respect for volunteers and research subjects

Transparency

Social justice

The advancement of medical technology has resulted in tasks for examining the ethical dilemmas that arise as a result. The principles of bioethics are applied to the field of medicine to investigate and research how various parties arrive at health care decisions. In general, bioethics ensures that medical practices and procedures are beneficial to society.

Ways in Which Contemporary Healthcare Systems May Inform Contemporary Bioethical Guidelines

Contemporary medicine can inform bioethical guidelines for issues such as end-of-life care advancement in treatment allows for the ability to prolong life, although the quality of life may be significantly affected. Elderly people and their loved ones face the dilemma as these individuals become too old and near the end of life. Medical providers overseeing these decisions are also faced with the task of considering the legal, practical, medical and spiritual nature of these decisions (Hussung, 2017). These decisions may be informed by the level of pain management offered the possibility of delivering care at home, the kind of professional or caregiver required, among other issues.

Another aspect of the contemporary health care system that can be used to inform bioethics is the increased availability of medical resources. However, a level of complete sufficiency has not been attained yet, meaning sometimes medical resources require rationing. The availability of resources should inform the patients that should be considered for treatment first and the amount of time and resources to be dedicated. A good example is patients in the ICU that may be transferred out to accommodate more serious patients when they can still benefit from ongoing monitoring.

References

Hussung, T. (2017, June 2). Bioethical Issues in Healthcare Management | CSP Online. Retrieved from https://online.csp.edu/uncategorized/bioethical-issues-in-health-care-managementInternational Society for Stem Cell Research. (2016). Guidelines for stem cell research and clinical translation.

MARCHILDON, G., & MOU, H. (2018, May 11). The funding formula for health care is broken. Alberta’s windfall proves it. Retrieved from https://www.theglobeandmail.com/opinion/the-funding-formula-for-health-care-is-broken-albertas-windfall-proves-it/article14764089/Mossialos E, Wenzl M, Osborn R, Anderson C. (2014) international profiles of health care systems. The Commonwealth Fund. Pub. no. 1802. http:// www.commonwealthfund.org/~/media/files/publications/fund-report/2015/ jan/1802_mossialos_intl_profiles_2014_v7.pdf. Published January 2015. Accessed May 2015.

National Audit Office. (2013). Managing the transition to the reformed health system. Department of Health, United Kingdom, pp. 1–46.

Obama, B. (2016). United States health care reform: progress to date and next steps. Jama, 316(5), 525-532.

Papanicolas, I., Woskie, L. R., & Jha, A. K. (2018). Health care spending in the United States and other high-income countries. Jama, 319(10), 1024-1039.

Shi, L., & Singh, D. (2010). Major characteristics of U.S. health care delivery. Essentials of the U.S. health care system. Sudbury, MA: Jones and Bartlett Publishers, 1-25.

Wilson, B. J., Miller, F. A., & Rousseau, F. (2017). Controversy and debate on clinical genomics sequencing—paper 1: genomics is not exceptional: rigorous evaluations are necessary for clinical applications of genomic sequencing. Journal of clinical epidemiology, 92, 4-6.