Authors

  1. Porter-O'Grady, Tim APRN, EdD, ScD, FAAN, Senior Partner

Article Content

Almost everyone understands that healthcare in America is both unjust and inefficient.1 It inadequately covers those who can pay, excludes those who can't, and costs too much in light of what it actually delivers.2 The business intent of the vast majority of payers, whether public or private, is to reduce or eliminate their own costs in the name of efficiency.3 The only way they can do this is to limit access and minimize service and payment in the interest of maximizing financial benefit.

  
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A classic example of the current approach is consumer-driven or consumer choice insurance plans. These plans shift more of the cost burden for service to individuals, reduce or eliminate historic shared corporate responsibility, limit what's covered, and increase the per-unit cost of coverage.4 Many insurance plans have determined what drugs and services, classification of drugs and services, or kinds of drugs and services will be covered in their insurance plans irrespective of subscriber needs.5

 

Different treatment

There are tens of millions of poor uninsured and underinsured in the United States. The poor as well as ethnic communities endure the major impact of access disparity and receive treatment different from those who can pay. In an American democracy whose economic standard is the envy of the world, it's unfathomable that these conditions of limited healthcare access exist.

 

It's crucial to specifically address the fundamental issues of access and availability of healthcare for all Americans. Three basic questions call out for comprehensive answers as a part of conceiving a meaningful and viable healthcare system to which all Americans have access:

 

1. Can everyone access the healthcare system?

 

2. Do Americans obtain what they need from the system?

 

3. Does it make a difference?

 

 

Address issues

To effectively address issues of public and private access, leadership in the United States needs to explore the resolution of basic issues essential to creating a fair and equitable health system. The basic elements of access for leadership deliberation are:

 

* universal definition of rights and enumeration of the services accessible to all

 

* standardization of health administration, documentation, reporting, and information management

 

* consistency and continuity of services across the healthcare continuum

 

* a focus on public health, prevention, and early intervention

 

* elimination of disparities in access to a common set of services

 

* clear delineation of the quality expectations for services provided

 

* freedom of choice with regard to healthcare providers and practitioners

 

* adequate and broad distribution of a variety of prepared qualified healthcare practitioners and providers

 

* evidence-based and safe foundations for clinical practice and patient care.

 

 

These universal elements for deliberation aren't exceptional, unusual, or unacceptable. Every first-world country other than the United States has addressed these issues, not for just some of its population, but for all of its citizens.

 

Change is important

As a nation that's contributed significantly to the increasing global standard of living and quality of life, the United States has been unmatched. As successful as the United States has been in meeting the many challenges of becoming the number one economy in the world, it shouldn't be impossible to address the basic health needs of all of its citizens and further facilitate its continuing success as a nation preeminent on the global stage. If it doesn't, its preeminence can't be sustained.

 

References

 

1. Quadagno JS. One Nation, Uninsured: Why the U.S. Has No National Health Insurance. New York, NY: Oxford University Press; 2005:6-26. [Context Link]

 

2. Lewin ME, Altman SH. America's Health Care Safety Net: Intact but Endangered. Institute of Medicine. Washington, DC: National Academy Press; 2000. [Context Link]

 

3. Loewy EH, Loewy RS. Changing Health Care Systems from Ethical, Economic, and Cross Cultural Perspectives. New York, NY: Kluwer Academic/Plenum Publishers; 2001:1-7. [Context Link]

 

4. United States Congress. House Committee on Education and the Workforce. Subcommittee on Employer-Employee Relations. Examining Pay-for-Performance Measures and Other Trends in Employer-Sponsored Healthcare: Hearing before the Subcommittee on Employer-Employee Relations of the Committee on Education and the Workforce. U.S. House of Representatives, One Hundred Ninth Congress, first session, May 17, 2005. Washington, DC: U.S. GPO; 2005. [Context Link]

 

5. United States Congress. House Committee on Energy and Commerce. Subcommittee on Health. The Health Care Choice Act: Hearing before the Subcommittee on Health of the Committee on Energy and Commerce. U.S. House of Representatives, One Hundred Ninth Congress, first session on H.R. 2335, June 28, 2005. Washington, DC: U.S. GPO; 2005. [Context Link]