Analysis of the Workforce in France and the US

Introduction

There is an important paradox that is facing the contemporary health systems; on one side there has been a gradual increase over the past decade on health care developments and investments, through these advances steps have been made towards extraordinary expansion of technologies, knowledge, skills, techniques and resources on biomedical research and this means that it is now possible to effectively tackle many major health problems than ever before. On the other hand the many attempts of trying to reform health care sector have all been met with little to no success in their quest of trying to develop a more efficient, effective and equitable safe delivery system that embodies all the population health fundamental goals (Institute of Medicine, ,2010).

One of the most overlooked but a major factor in the failure or success of such efforts is the care workforce configuration. The current health care inability to reap full benefits results in many instances, from the challenges of maintaining and creating an efficient, effective and motivated workforce. To other wide array of problems ranging from accelerating labor migrations, looming shortages of some types of health care workers, qualitative imbalances (mis-qualification or under-qualification of health care workers), and distributional imbalances of various types of (gender, geographic, Institutional and occupational) have all added to the undermining of the health care system capacity for effective response to challenges being currently faced. This has led to the centrality of human resources bleatingly recognizing health as a major backbone for all major health related actions (Cunningham, Peter J., 2010).

As part of this articles focus it seeks to analyze the health care systems in France and the USA, it reviews the management and the differences between the gaps in the health care workforce in the two countries, it also aims to bring out the urgency of addressing the divergent barriers that hinder the performance of achieving of improved and proper population health. The article also examines the current and would be implemented policies that would effectively help highlight the main areas that interventions would be necessary for policies harmonization of practices and policies that directly relate to the growth of human resources for health and intended national workforce health goals (Dower,et al 2011).

The supply and demand of the France health care workforce description can better be understood through the understanding that the country offers a unique context to their workforce through their mixture of government role with liberal elements that ensure universal regulation, coverage of managing a national network of public health care organizations and the health system. The French health system provides a particular workforce management context that mixes liberal elements with a strong government role in assuring universal coverage, regulating the health system and management of a national network of public health care organizations. France had an approximately 1675,000 jobs that were accounted to professional health professionals in 2001(Durieux P, Ravaud P ,1997).

An overview of the general distribution of health and human care resources mainly in their health care system reveals that there is a recorded 30.6% increase of France health care workers as compared to 1985.In the 40 years the number of physicians has tripled, as seen from the beginning of 2001 to 332 per 100, 000, and the physicians supply grew on 3.8% average per year as compared to the 1980’s, and by the 1990’s it grew by 1.6%. The many policy clauses implemented by the government have gradually continued to lessen the allowed number of students that can enroll in the medical training from its establishment in 1971.Not withstanding this policy however, on the current physician retirement patterns it is estimated that the practicing physicians number will still manage to remain stable at around 196,000 for a little longer. If the many clauses remain fixed at their current rates of an annual 47000 students, then there will be a reduction of the workforce by 158 000 by 2020, with this in mind the currently aging health workforce becomes a key characteristic to take note of during planning. There has been a recent successful implemented effort on the equal geographical distribution of physicians in France, however there is still large difference in the physicians availability especially for specialists, mainly between the north of the country (lowest density), the southern regions (highest density and Paris. In addition there has not yet been a significantly recorded migration of health professionals into France (Jason Fodeman and Robert Book, 2010).

There is a powerful presence of government role in the French health care system that characterizes its main objective of regulating the health care system and assuring universal coverage, cost sharing, la medecine liberale and a private/public mix in both services provision and financing. These grounding characteristics of France health systems are mainly rooted in three principals namely; pluralism, liberalism and solidarity. This implementation that has a strong control by the government is in direct contrast to the American HHS that mainly uses the implemented Affordable Care acts a main characteristic of the American HHS is that it focuses majorly on offering loans programs and scholarships as a means of increase the number of primary care nurses, dentists, physicians, mental health providers and physician assistants at specific parts of the country that urgently needs them. The HHS also has a comprehensive approach that focuses on enhanced education opportunities and retention; they also want collaborations with the tribal governments that are working with the locals and state to develop the health workforce training, retention, and recruitment strategies and timely access to care by funding the expansion, operation of Health Centers throughout the United States and construction. Through the above analysis of the two systems it is clear that there are two major differences mainly on management and the policies that have been enacted by the two countries. (Wilsford D ,1991).

Theories of knowledge management practices have to be reviewed and viewed in the local cultures context the managers in an organization often bring, experiences, values and beliefs that are rooted profoundly in the specific nations culture, and these add up to form a personal frame for reference. There is a wide variation of what actually the management entails due to the divergence of the national cultures. In this understanding through appreciation and understanding of local cultures, its knowledge management and epistemology perception are however necessary for the adaption of the existing practices. Therefore initiatives that address knowledge management that are aimed and designed to improve performance of organizations should incorporate cultural factors as a way of preventing mistakes due to lack of awareness and lack of cultural understanding (Bodenheimer, Thomas, et, al ,2010).

Through, this understanding the analysis of information management approaches for France and America would be better understood from the concept of Hofstede framework which shows that In America the approach for information management is focused and emphasizes on the implementation and development of ICT systems for manipulation, collection, transportation, storage, deployment and transmission of most of the explicit knowledge. This is in contrast to the perspective of France that shows that initiatives for knowledge management are focused on social processes and new knowledge is shared through the tactical knowledge is shared (Lancry P, Sandier S, 1999).

The knowledge management perspective of France can be seen as a society that is filled and accepts inequalities in their systems. There is need for hierarchies in order to achieve any data and in most cases there are specific privileges that are awarded to the superiors making the information mostly inaccessible to the ordinary citizens. France has a characteristic of centralizing power and this is evident in management practices as seen with the formal attitudes and the hierarchical flow of information which signifies unequal distribution within the systems.

My proposed health care plan would mostly be centralized around a financing system that is mainly hinged on a philosophy of promoting social harmony, while creating an adequate safeguard against encouraging personal responsibility and over-reliance. In this regard my suggestions would go a long way into providing strategies and concepts that would directly help improve and reform the current American health system.

One of the changes that would need to be implemented would be on effecting higher patient’s co-payments, this would be strategic since by them contributing slightly higher for significant portion of the health care, would help with the clients or patients make better choices on the treatments, tests and other procedures that they actually need. The level of need payments would mainly be based on income scale and means test. In that those with more would pay more while those without pay les (Rodwin VG, 2003).

Another change would be on the provider’s bundled payments as of now the medical professionals standard means of payment is that one of fee-for-services; the more treating and testing they perform on their patients the more they get paid. Now by changing this fee-for-service system to a bundled payment system would be more effective towards the reforms. In this proposed system a specific reasonable amount of money should be directed to the care provider mainly due to his diagnosis on the patient as a way of covering the patients associated with the patient’s diagnosis and medical treatment. Through this implementation the care givers would receive reasonable and adequate payment for the treatment and would remove the current trend of having to provide incentives to the doctors to receive quality treatment (Reid, Robert J., et al., 2009).

Another proposed change would be on the implementation of price transparency by providing published cost for hospital stays and common medical procedures. Through knowing what the patients need to pay would make it more competitive for the hospitals and force adjustments of costs (Wilson, Jennifer F, 2008).

Another review would be on the addressing of the collective actions in the grassroots and this dictates that the reform efforts need to start from the city, local, state level and region. In this manner the unity of responsible interest groups and stakeholders coming together to solve the issue that are affecting, labor, payment, education and attraction of professional health care providers, which have already been addressed under the PPACA regulations. The reason i think this is important is that if al the people get involved and share a common goal the review of the care system would be faster and more effective (John G R Howie et al,2009).

Conclusion

As addressed in the article it is clear that the care system in America is failing as compared to other European nation systems, the main reason for this has been articulated to the ever spiraling costs of the health services the outcome of this problem to the clients is that they don’t get efficiency in the services they are offered which still cost high. According to the Centers for Medicaid Services and the Centers for Medicare, they estimate that by 2021 years the spending of the American health will reach almost 5 trillion if a lasting solution is not found. If such extremes are left unchecked they could entirely cripple the nation and American economy. This would eventually threaten the ability to improve, maintain or fund the countries military infrastructure. This would also keep the poor in poverty, increase income disparity and preventing the middle class from ever rising higher on the income scale. Personally I believe that even though the above painted picture seems dire it can be avoided and the costs be reduced concurrently and as a result improve the rate of the health care.Reference

Bodenheimer, Thomas, and Hoangmai H. Pham, (2010) “Primary Care: Current Problems and Proposed Solutions,” Health Affairs, Vol. 29, No. 5.

Cunningham, Peter J., (2010) State Variation in Primary Care Physician Supply: Implications for Health Reform Medicaid Expansions, Research Brief No. 19, Center for Studying Health System Change, Washington, D.C.

Dower, Catherine, and Edward O’Neill, (2011)Primary Care Health Workforce in the United States, Robert Wood Johnson Foundation, Princeton, N.J.

Durieux P, Ravaud P (1997). From clinical guidelines to quality assurance: the experience of Assistance Publique Hôpitaux de Paris. International Journal for Quality in Health Care

Institute of Medicine, (2010) The Future of Nursing: Leading Change, Advancing Health, National Academies Press, Washington, D.C.

Jason Fodeman and Robert Book, (2010) Bending the Curve: What Really Drives Health Care Spending, The Heritage Foundation,

Retrieved from

http://www.heritage. org/research/reports/2010/02/bending-the-curve-what-really-drives-health-

John G R Howie, David J. Heaney, Margaret Maxwell, Jeremy J Walker, George K Freeman, Harbinder Rai, (2009)“Quality at general practice consultations: cross sectional survey,” British Medical Journal, Vol. 319,

Lancry P, Sandier S (1999). Rationing health care in France. Health Policy, 50(1–2): 23–38.

Reid, Robert J., et al., (2009) Patient-Centered Medical Home Demonstration: A Prospective, Quasi-Experimental, Before and After Evaluation,” American Journal of Managed Care, Vol. 15, No. 9

Rodwin VG (2003). The health care system under French national health insurance: lessons for health reform in the United States. American Journal of Public Health, 93(1): 31–37.

Wilsford D (1991). Doctors and the state: the politics of health care in France and the United States .Durham, NC, Duke University Press

Wilson, Jennifer F., (2008) Primary Care Delivery Changes as Non-Physician Clinicians Gain Independence,” Annals of Internal Medicine,