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U.S.Health Care System

TheUnited States expenditureonhealthcare is theexcessof $2.4 trillion per yearandnootherstatein theglobesplurges moreamountthan that.In 2013 United States healthcare expenditureincreasedby 3.6percent andreached$2.9 trillion, which translatesto $9,255 per everyperson(Jules&amp Wendy 7). Theproportionof theeconomycommittedto thiscrucialsectorhas remainedat 17.4 percent since 2009. Healthcare expenditurein theU.S is widelyconsideredto be growingto an unsustainable level andpolicymakersare constantlylookingforwaysto reducethe cost to amanageablelevel (Arnold&amp Helen 1). Overthelastone decade,ithas beenquiteevidentthat theskyrocketing costof healthcare ismainlycausedby wastefulandinefficientuseandprovisionof medicalservices.Therefore,ithas becomeimportantto eliminatethewastage soas to reduceexpenditurewithout compromisingthequalityof careAmericans receive.Unnecessaryhealthcare encompassesovertreatment, overutilizationandoveruse of medicalservicesprovidedin thehealthcare system(Arnold&amp Helen 1). In theU.Sthecostof healthcare in relationto thegrossdomesticproductis thehighestin theglobe,andunnecessaryhealthcareis theprimaryfactorbehind thisphenomenon.Factorsthatimpel overutilizationincludethe fee-for-servicemodelof compensatinghealthcare providers andcoveringof patient’shealthexpensesby a thirdpartypayer (privateandpublicinsurance).Theseelementsleaveboththepatientsandphysicianswith noinducementto controlhealthcarepricesandutilization (Arnold&amp Helen 1).

Wasteprovision of medical services encompassesspendingon servicesthat lackevidenceof producinganymeaningfulandbetteroutcomes,comparedto alternativeavailable.Italsoincludesunnecessaryprovisionof medicalservices.Nationalhealthexpenditureis projectedto increaseto 20percent of thegrossdomesticproductby2015 (Jules&amp Wendy 7). Manyhealthexpertsconcurthata considerableproportionof themedicalcaredollarsare wasted,with projectionsindicatingthatup to 30 percent of thetotalspending could besavedwithout reducingthequalityof medicalhealthdelivered(Arnold&amp Helen 1).Wasteexistwithin three distinctspheresof thehealthcaresystemhealthcarefinanceandadministration,clinical careanddruganddevicedevelopmentandregulation.

Categoriesof Waste

Researchersin themedicalfieldhaveidentifieda numberof categoriesof wastein theUnited States healthcare system:

AdministrativeComplexities

Thisis themaincauseof inefficiencyandwastefulpracticesin thehealthcare systemin theUnited States. Thisemanates from excessiveexpending that takesplacebecausethegovernment,privatehealthinsurancecompanies,andaccreditation agenciescreateinefficientandunsoundrulesandexceedinglybureaucratic procedures(Berwick&amp Hackbarth 2). Forexample,absenceof uniformformsandstandardizedprocedurescan leadto unnecessarycompoundandcumbersome billing workforphysiciansandtheir personnel.AstudycarriedoutattheUniversity of Toronto in 2011 comparingtheadministrativecostsborneby smallmedicalpractitioners in theUnited States, andwhoin their dailyoperationsinteract with numerousinsuranceplans,to similarphysiciansin Canada whointeractonlywith singlepayer agencyidentifiedmassivedifferencesthat makesU.S systema lessefficientsystem(Berwick&amp Hackbarth 2).Thestudyrevealedthaton averagedoctorsin theUnited States of America incurjustabout four timesmoreadministrativecoststhan their Canadian counterparts.Succinctcalculationindicatesthatifphysiciansin theUnited States incurredsimilaradministrativecostslike thosein Canada, a whopping$27.6 billion dollarswould besavedeveryyear.I total,andadministrativebottlenecks andcomplexities added$107 billion to $389 billion in wastefulexpenditurein thatyearalone(Berwick&amp Hackbarth 2).

Failureof Coordination

Thethirdcategoryis failureof coordination, which is a problemthat happenswhenever patientsare forcedby prevailinginstitutional systemto experiencehealthcare that is fragmented. Forinstance,In theUnited States healthcare of a patientthat switchesfrom one healthcaresettingis feebly managed(Berwick&amp Hackbarth 2).

Thelackof propercoordination andmanagementof healthcare environmentin differentpartsof thecountrycausesproblemssuchas unnecessaryadmissions,avoidable hospitalization anddeclinein functionalcondition,particularlyof patientswith chronicailments(Berwick&amp Hackbarth 2). Closeto a fifth of fee-for-service Medicare recipientsdischargedfrom healthcare facilitiesare readmitted within a spanof lessthan one month,three quartersof all thereadmission andthatcostmore$12 billion everyyearare in a classof diagnosisthat can be avoided.Itis evidentthatpoorcarecoordination can amplifycostsby $25 billion to$45 billion everyyear(Berwick&amp Hackbarth 2).

Overtreatment

Thisclassof wasteemanates from executionof practicesandcarethat is peggedon outmodedhabits,which is propelledby provider’s preferencesinsteadof carethat is informedby patients,carethattotallydisregardscientificknowledgeandthatis inspiredby otheraspectsotherthan provisionof optimal careforpatients(Berwick&amp Hackbarth 2).Suchpracticessignificantly increasetests,proceduresandtreatmentsthat are not clinically necessary,butthat are meantto attaintheobjectiveof thehealthcaregiver.In totalthiscategoryifwasteisestimatedto addup to $200 billion in wastefulexpenditurein thehealthcare sector.An excellentexampleof overtreatment is defensivedrugs,in which medicalproviders prescribeunnecessarydiagnosticprocessesandteststo shield themselves from legalresponsibilityin malpracticecomplaintsandlawsuits.Astudyby Michele Mello (2010) projectedthatabout 2.4 percent of theoverall United States expenditureon healthcare wasattributedto medical,legalresponsibilitysystemscostsencompassingbutlimitedto defensivemedicine(Berwick&amp Hackbarth 2).

Overtreatmentcan alsooccurwhenthere is overdiagnosisthatemanatesforendeavorsto identifyandmanagemaladyin its initialstageswhenin actualsensetheailmentmay neverprogress.In sucha scenariowatchfulwaiting,mightturnout to be theaptstrategybutis seldomfollowed.Forexamplein 2012 a taskforceconstitutedto studyandgiverecommendationon diagnosisof prostate cancer,advisedagainst prostate-specific antigen-basedscreening as a diagnosticmeasurein patientwith prostate cancerbecauseitalmostresultedto ‘overdiagnosis’of cancer,manyof which werenot malignant.Overtreatment alsoconsists of intensivecareto a patientwhois terminally illwhenotheroptionsarechosenbyfamily members orexcessiveuseof antibiotics(Berwick&amp Hackbarth 2).

DefensiveMedicine

Defensivemedicineis theothercauseof unnecessarytreatmentanddiagnosisin thehealthcare system.Itrefersto thepracticeof prescribingdiagnostictreatmentandteststhatin realityare not theaptoptionsforthepatientbutthat are doneas a meansto protectthecaregiveragainst lawsuitwagedby a patient(Stanzak2005).Theseare actionsthat serveas a rejoinderto theincreasingcostsof misconductby insurancethrough charginghighpremiums.In theU.S. healthcaregiverssuchas physicianare at thegreatestthreatof beingsuedfordelayeddiagnosis.To avert legalliabilitymostdoctorsendup overtreatingpatients.Itis important to mentionthatthenumberoflegalproceedingsagainsta physicianin United States of America has beenon theincreasein thelastone decade (Stanzak2005). Thishas hada significanteffecton their behaviorandmedicalpractice.Manyphysiciansordertestsandsteerclearof treatingchronically illorhigh-risk patientsin a bidto reducetheir riskto litigationby patients.In theUnited States,physiciansmay be coercedto discontinuetheir medicalpracticedueto overly highinsurancepremiums.Itis a formof defensivemechanisms(Stanzak2005).

LegalAspects of Healthcare Administration in United States

Toimprovetheperformanceof healthcareindustryin United States andto significantly reducewastefuluseof resourcesandfacilitieswhich has enormousimpactson thecoffers of thenations,a comprehensivepolicyguideline andrulesandregulationmust be formulated(Arnold&amp Helen 1).Thisbringsus to thelegalandadministrativefunctionof thefederalandlocalgovernmentwhich has powersto shapetheplatformon which healthcaregivers bothin thepublicandprivatedelivertheir services.To builda healthcarestructurethat can conveyvaluableservicesto Americans,andthatis not wasteful a concertedeffortby allstakeholders in thehealthcare sectorto redresstheissuesbedevilingthiscrucialarea.In thepastnumerouspolicieshavebeensetacross a rangeof front,someof thepoliciesfoundfertilesoilhavebeenimplementedbutmostremainunimplemented (Arnold&amp Helen 1). Three unemployedbroadpolicyoptionsare fundamental.

First,nationalgovernmentin consultationwith physicianscan strengthenantitrust policies.Thiswould goa longwayin ensuringthatnohealthcare provider would be in a positionto opt fornoncompetitive priceincreasesandtepidyearlygainsin costefficiencyandqualityof care.Strongantitrust policiesare alsocrucialto promotecomprehensivehealthcareservicesrelevantto themyriad of changestakingplacein thesociety(Arnold&amp Helen 1). Theseentailsbutis not limitedto enablingcritically illpatientsto accessconditionsfitfortheir treatment,an aspectthat eliminateovertreatment. Nonetheless,thegreatestprospectto improveefficiencyin healthcare systemsliesin thepassageof federalpoliciesthat are meantto harmonizetheimpactsthatthecountry’shealthcare payers haveon healthcaredecisionsof sickpeopleandtheir physicians.There are five keyfacades of harmonization that are of particularlyimperativein creatingan efficienthealthcare systemin United States of America (Arnold&amp Helen 1).

Thefirstpolicyshould begearedtowards standardizingmeasurementof comparativeperformance.There are severalessentials that can beusedfortherelativecomparison,includinghospitals,treatmentoptions,healthcaresystems,groupsof physiciansandtreatmentdeliveryschemes.On theotherhand,measurementeffortshould encompasspatientexperienceof availablecare,treatmentoutcomes,andthe annualpayer expenditureper treatmentepisodeof patientwith chronicailments(Arnold&amp Helen 1). Forexample,Sweden has successfullyappliedthisharmonization policysuchthatthenationalgovernmentcanknowthenumberof citizenswhoare in a positionto without painfive yearsafter surgeryof hip-joint replacement. There is evenrecordin eachhospital,physicianandsurgeonin thecountry.Suchinformationcan beaccessedin theUnited States forthe majorityof thehealthcare thatthefederalgovernmentis buying.

Providentially,there is a widespreadimpetusto standardizedclinical performancemeasurementacross payers in theUnited States. There isa needformutualeffortsby allstakeholders in thehealthcare industryto homogenize performancemeasurementforpublictreatmentandrecitalenhancement.Oncea functionalperformancemeasurementmethodsareestablishedandstandardizedallpayers would be encouragedevaluateproviders’ performance(Arnold&amp Helen 1).

Inthesamethispolicyshould makeita generalrequirementthatallplayersmust truthfullyandopenlydiscloseto consumersof healthandtheir healthcareproviders allthespecificationof measurementbeingevaluated,theunderlying principlebehind themodeof measurementandtheanticipateddurationof thetest.In thisnewdispensation,healthcareproviders would be compelledto gatherdata whilethepayers should be expectedto providea formof incentiveas a provisionalbridging step.ThecenterforMedicaid andMedicare servicescanputin placea systemof publicqualityreportingtiedtogetherto its hospitalpayment(Arnold&amp Helen 1). Thiswould playanenormous part inadvancingstandardizedassessmentof hospitalperformance.

Thesecondharmonization elementis standardizingpayer methodsforadministrativeinteractionwith healthcare providers. Thiswould begearedtowards simplifyingadministrativeprocessesandcreatinga strongbackgroundforhomogenizing payer relationswith thehealthcare givers.Asaforementioned administrativecomplexities are theprincipalcauseof inefficiencyandwastefulpracticesin thehealthcare systemin theUnited States (Arnold&amp Helen 1). An aspectthat originatesfrom excessiveexpending that takesplacebecausethegovernment,privatehealthinsurancecompanies,andaccreditation agenciescreateinefficientandunsoundrulesandexceedinglybureaucratic procedures.In thisvein,standardizingpayer methodswould not onlyfacilitateservicedeliverybutwould alsogoalongwayin reducingadministrativeburdens,which is an excellentwayof loweringandreducingwastage (Arnold&amp Helen 1).

Thethirdharmonization processentailsstandardizingpaymentmethodsthat accordhealthcare providers a vibrantincentiveto improvethevalueof thehealthcare servicesdelivered.Expertsandscholarsin themedicalfieldconcurthatfeeforservicepaymentsthat are generallyacceptedto be blindto qualityare responsibleforactionsandpracticesin healthcare that may havelittleornochancesof improvingtheconditionof a patientandthatcan evenleadto harm.Privateinsurancecompaniessometimestryto withholdpaymentforsuchservices,buttheir actionshaverarelyyieldedtheexpectedresults(Arnold&amp Helen 1). Thisconundrumcan onlybe solvedby offeringhigherpaymentsfornecessarycare,bundling paymentinto a solitaryall-inclusivefee,formulatingpoliciesthat will callforcostsharingbetween healthcareprovidersandpatientsandconditioning healthcare providers.In addition,soas to averta healthcarebacklashthatwhich occurredin the1990s provider paymentsreformsshould encompassmethodsof safeguarding andimprovingthequalityof care(Arnold&amp Helen 1).

Overuseof medicalcarehas becomea nagging problemwithin themedicineandprofessionalsocieties.Mostof thesegroupshas calledupon thefederalgovernmentto passlegislationandformulatepoliciesthat would encouragehealthcare providers to avoidofferingunnecessarycare.

Uniformcatastrophic Insurance

Auniformcatastrophic insurancehas thepotential of reducingthebottlenecks that may emanatefrom thirdpartypayer. Thisis a solutionthat has beenfrontedby expertssuchas Friedman andthecouncilof economicadvisors. Thispolicyfunctionslike thiseveryfamilyin theUnited States would be compelledto takea catastrophic insurancethat would caterforalltheir healthexpenditureabove a certainproportion,andwhich consumea givenpercentageof thefamily’sincome(RobbinsGary, Robbins Aldona &amp Goodman 19).Inthe caseof a healthconditionthat surpassessetlevel, costsnot coveredby insurancewould be cateredforby thefamilywithout anyassistancefrom thegovernment.In thesameveiniffamilyout-of-pocketexpendituressurpassthelevel thatisestablished,publicandprivatehealthcareinsurancewould caterfortherestof theexpenses.Thisis a doubleedged swordthat solvestwo tribulationsat thesimultaneouslyfirstitentirelyeliminatesbothover insuranceandthedistorted incentives(RobbinsGary, Robbins Aldona &amp Goodman 19). Insuchan arrangementwhenindividualsfrom such a familywishesto covera medicalbills,theywould haveto sacrificea dollar’sworthof othercommoditiesandservices,everymomenttheyspenda dollaron medicalcare.Thiswould not onlydiscourageexcessiveuseof healthservices,butfamilieswould havethe incentivenot to spenda dollarin themedicalmarketplaceexcept inthe circumstancewheretheyfeeltheywill receivea valueoftheir dollar.In addition,whenchoosingamong therapies,patientswould be compelledto paytheprevailingmarketpriceforeachchoicemade.Giventhattheprivatecostincurredby everyindividualwould be equalto thesocialcostof deliveringtheservice,everypersonwould haveidealincentivesto opt forthelowestcosttherapies(RobbinsGary, Robbins Aldona &amp Goodman 19).

MedicalSavings Accounts

Thisproposalwould providean opportunityforemployeesandindividualsto makeregulartax-free depositsto a medicalsavingaccount.Likeanyotheraccount,thesemedicalsavingsaccountswould be privatepropertyof theconcerned personandwould be portable(RobbinsGary, Robbins Aldona &amp Goodman 19). Incase,fundsare not spentwould consequently be rolledover tothe pensionplanat thetimeof whena personretires.Therationaleis thatbecausethesesavingswould be usedto covera patient’smedicalexpensesthat arenot coveredbyprivateinsurance,individualswould not overuseorexcessivelyvisithealthcareproviders. Medicalsavingsaccountsoffera formof self-insurancefordiminutivemedicalexpensesandprotectionfrom catastrophic events,yettheydefendincentivesto sensibleconsumptionof healthcareservices(RobbinsGary, Robbins Aldona &amp Goodman 20).

HealthMaintenance Organizations

Agovernmentcan passlegislationforthecreationof healthmaintenanceorganizationwhich are prepaid medicalplanspeggedon theprinciplesthattheinsurancepremiumshould be an individual’sonlyout-of-pocket expenses.Thismeansthatat thetimethatan individual’sconsumeshealthservicesin ahealthmaintenanceorganizations,theywould not haveto payanything (RobbinsGary, Robbins Aldona &amp Goodman 20). Thismeansthatallhealthserviceshavea priceof zero, as in ahealthmaintenanceorganizationthentheproblemof overconsumption andovertreatment is solved.Individualswill nolonger haveto facedistorted incentivesin relationto thechoicestheymakeabout healthcare programsandtherapies.In thesamevein,dueto thefactthathealthmaintenanceorganizationphysiciansareoftenrewardedformaintainingcostsdown,theywould be encouragedto choosetheleastcostlytreatmentprogramanddiagnosticprocedures,ceteris Paribas . Underthispolicypatientswould haveincentivesto over consumeupto thepointwherethevalueof thecareandservicestheygetis zero, buthealthmaintenanceorganizationphysicianwould havefinancialincentiveto under -provide.Therefore,theyshall be two forcespullinginoppositedirection,andstudieshaverevealedthathealthmaintenanceorganizationpatientsusefewermedicalandhospitalservices.Consequently,generaloverconsumption is inclinedto offsetsomeof thegainsof replacinglesscostlyformoredeardiagnosticproceduresandtreatment(RobbinsGary, Robbins Aldona &amp Goodman 20).

Globalbudgets

Inoperationglobal budgetcomplementtheHMO. Ascan be observedina healthmaintenanceorganization,itis not possibleforindividualsto consumemedicalservicesup to theextentthattheyhavezero value.Suchan endeavorwould resultininsolvencysince healthmaintenanceorganizationdoesnot allowmembersto makeunrestrainedalternatives(RobbinsGary, Robbins Aldona &amp Goodman 21). Butin a situationwherethere are constraints,theproblemthatemanates is whoshould be responsiblefor imposingthem. Should thedecisionbe madeby thegovernment,physiciansorthehealthmaintenanceorganizationadministratoron theamountof healthservicesthata patientis goingto consume?

Globalbudgetsstipulatea limiton thequantityof resourcesavailableto healthcare providers andphysicians,localhealthauthoritiesandhealthcare institutionssuchas hospitals,andcompelthem to rationhealthcare. Mostof thedecisionsconcerningrationing areleftin thehandsof healthcare providers andareaadministrators(RobbinsGary, Robbins Aldona &amp Goodman 19). Nonetheless,thecentralgovernmentandin thecaseof United States t6he federalgovernmentlimitsthetotalamountto be spentandregularlyrevisesthebudgeteachyear.Thisis a measureadoptedby centralgovernmentto exertpressureon healthcare systemto usecost-benefit analyzesto thedeliveryof medicalcare.Thissystemhas beenverysuccessfulin developedstatessuchas Britain andCanada (RobbinsGary, Robbins Aldona &amp Goodman 19).

Conclusion

Excessiveprovision of medical services existwithin three distinctspheresof thehealthcaresystemhealthcarefinanceandadministration,clinical careanddruganddevicedevelopmentandregulation.To improvetheperformanceof healthcareindustryin United States andto significantly reducewastefuluseof resourcesandfacilitieswhich has enormousimpactson thecoffers of thenations,a comprehensivepolicyguideline, rulesandregulationmust be formulated.This can be achieved through standardizedclinical performancemeasurementacross payers in theUnited States, byestablishing a uniformcatastrophic insurancethat has thepotential of reducingthebottlenecks that may emanatefrom thirdpartypayer, portable Medical Savings Accounts, passinglegislationforthecreationof healthmaintenanceorganizationwhich are prepaid medicalplanspeggedon theprinciplesthattheinsurancepremiumshould be an individual’sonlyout-of-pocket expensesand use of globalbudgetsthat stipulatea limiton thequantityof resourcesavailableto healthcare providers andphysicians,localhealthauthoritiesandhealthcare institutionssuchas hospitals,andthat compelthem to rationhealthcare.

WorksCited

Arnold,Milstein and Helen, Darling. Better U.S. Health Care at LowerCost.University of Texas, Dallas.2013. Retrieved from:http://issues.org/26-2/milstein/.

Berwick,M.Donald and Hackbarth. EliminatingWaste in US Health Care.Duke University. 2013. Retrieved from:http://news.medicine.duke.edu/wp-content/uploads/2013/08/Eliminating-Waste-in-US-Healthcare-Berwick.pdf.

Jules,Delaune and Wendy, Everett. Wasteand Inefficiency in the U.S. Health Care System. Clinical Care: AComprehensive Analysis in Support of System-wide Improvements.New England Healthcare Institute.2008. Retrieved from:http://www.nehi.net/writable/publication_files/file/waste_clinical_care_report_final.pdf

Robbins,Gary., Robbins, Aldona and Goodman,John. Inefficiency in the U.S.Health Care System: What Can We Do? NCPA Policy Report No.182.National Center for Policy Analysis. Dallas, Txas.

Stanzak,Richard K. BottomLine Medicine: A Layman`s Guide to Evidence-Based Medicine.New York: Algora Pub, 2007. Internet resource.