Healthcare reform.

The United States has one of the most complex healthcare systems in the world, and yet, from an international perspective, the United States can be spending more than any other country on healthcare and still it does not produce the best results. Health insurance is high, and many Americans can not afford health insurance. Vulnerable populations such as the homeless and people suffering from severe psychological disorders may not have access to healthcare at all. Socio-economic and geographic location can even affect outcomes of an individual’s healthcare.

The Department for Professional Employees (DPE) 2016 Fact Sheet shows though the US has the best doctors in the world, but that the treatment in the U.S. is inequitable, overspecialized, and neglects primary and preventative care (DPE, 2016). The result is that American’s health care is poor in comparison to other advanced industrialized nations.

Only three cents of each health care dollar spent in the U.S. goes toward prevention, but 90% of our health care dollars are spent treating chronic diseases such as obesity, diabetes, high blood pressure, heart disease, and cancer, which are largely preventable. Seven in 10 deaths in the U.S. are related to chronic diseases that can be prevented.

Many professionals have tried through the decades to make healthcare more accessible and more affordable, but so far, the goals for America’s healthcare systems have not been met. Both healthcare professionals and healthcare consumers are divided on what policies and reforms should be implemented and how, and politicians that want to help can easily become confused with the policies being presented because the healthcare systems are so complex.  American citizens want quality healthcare at affordable prices. Doctors want to provide healthcare, but they also want to get paid for their services, skills, and knowledge. In March 2021, President Biden signed the American Rescue Act of 2021 (H.R.1319 – 117th Congress, 2021-2022) which is similar to President Obama’s Affordable Care Act. The American Rescue Plan directs healthcare systems to incrementally implement changes.

Affordable Care to American Rescue:

The Affordable Care Act (ACA) is the name of a comprehensive health care reform law and its amendments that was enacted in two parts: The Patient Protection and Affordable Care Act was signed into law on March 23, 2010, and was amended by the Health Care and Education Reconciliation Act on March 30, 2010. The law reduced the number of uninsured but failed to provide insurance for millions and was repealed under the Tax Cuts and Jobs Act of 2017 (HHS.gov, 2021). Now, the United States is implementing the American Rescue Plan. The goals for the outcomes are similar to goals of decades past. The most noticeable change is that rather than “reducing” healthcare disparities, the goal now is to “eliminate” healthcare disparities.

Goals for the United States healthcare systems still include making healthcare coverage affordable and accessible. One goal is to increase the number of Americans with coverage by funding community-based public health and prevention programs, and by supporting research and tracking of key health measures. And this goal is attainable. The problems that prevent people from being able to receive healthcare that they need include insurance being unaffordable, healthcare dollars being misused and overused, the focus on treatment rather than prevention. Geographic locations, and socioeconomic factors.

Like most United States government policies that affect billions of people around the world, changes in our healthcare system will be slow. We are only in the beginning stages and experts have not figured out the answers although they do have promising visions of a better future for healthcare delivery systems. The goal will be to provide high-quality healthcare that is convenient and affordable.

Mental health:

Serious mental illness costs the United States an estimated $193.2 billion in lost earnings annually and only about 41% of persons with a mental disorder ever receive any treatment (Shi & Singh, 2019). Mentally ill patients are at higher risks of becoming homeless, and homeless people do not have access to medical care and experience higher rates of adverse physical and mental health conditions, suicides, substance abuse, and respiratory diseases. SAMSHA’s national mental health statistics show that yearly, about 42.5 million (18.2%) American adults suffer from some mental illness. Approximately 9.3 million adults (4%) experience severe mental illness that interferes with their daily lives. Mood disorders affect about 20.9 million American adults (9.5%) with the median age being around 30 years old.

Socio-economic factors:

Socioeconomic factors prevent many people from receiving both preventative and curative healthcare. Poorer, less educated populations receive less care than educated, more financially stable Americans. Minority group membership is associated with lower overall health care access. Racial or ethnic minorities are less likely than their white counterparts to have a specific source of ongoing care (Shi & Singh, 2019). Blacks and Hispanics are more likely than Caucasians to visit hospitals for healthcare rather than doctor’s offices (36% versus 21%). Emergency rooms end up being overwhelmed with people seeking emergency help that could have been prevented or treated in doctor’s offices. Nonwhite beneficiaries of Medicare have fewer cancer screenings, fewer flu shots, less mental health care, and fewer ambulatory and physician visits than their white counterparts (Shi & Singh, 2019).

Racial profiling:

Racial profiling can traumatize people of color making their daily life experience different from that of Caucasians. Racial and ethnic minorities have less access to medical and mental health services and may not receive the same level of care. Statista shows that as of April 2021, around 25.5% of U.S. black, non-Hispanic public health workers reported having depression in the past 2 weeks, while 32.4% of white, non-Hispanic health workers reported the same. (It should be noted here that these numbers may not be accurate because this is a limited study and other populations were not included, and because some people such as homeless people, do not have access to care. Stigmas surrounding mental health also prevent people from reporting mental health concerns.)

Geographic locations:

Geographic disparities also present barriers to access. It is believed that rural Americans have higher mortality and morbidity rates and shorter life expectancies because they have fewer doctors and because they have to travel to get medical and mental healthcare. Suicide rates in Wyoming are the highest in the U.S. while New Jersey has the lowest rates for suicide. The Pacific Northwest, and the Midwest seem to suffer more from mental illness such as depression, unshakeable feelings of dread, despair, loneliness, and hopelessness that can lead to suicide more so than in other regions.

Mobile teams can greatly benefit low-income rural communities that cannot easily access medical care. Because many people may not have the ability to drive to doctor’s offices or have access to transportation that can get them to a doctor, community health centers are encouraged to team up with mobile teams to improve access to care. Mental and physical health outcomes improve by closing the transportation gap. Other insightful approaches to making healthcare more accessible include “staffing retail outpatient health systems with nurse practitioners and physician assistants in places such as Target, Safeway and Kroger” (Miller, & Peterson, 2021). Expansion for such CHCs is provided for through the ACA (Shi, & Singh, 2019).

“About 3.6 million Americans miss or delay medical appointments every year because they lack a ride to the doctor”, writes Therese McMillan for the U.S. Department of Transportation (Miller, & Peterson, 2021).

Shortage of healthcare providers:

Healthcare costs are rising and there is a critical shortage of healthcare professionals. Serious issues remain in the areas of coverage, quality, administrative costs, access, affordability, and training. One study shows that CNA supervisors were concerned that 16 clinical hours was insufficient to adequately prepare new CNAs for employment in long-term care facilities and that patients in long-term residential treatment do not feel that they are getting the care they deserve (Trinkoff, et. al., 2017). 

A physician workforce shortage was forecasted by a public database that was constructed to predict changing future healthcare needs. As a result, “The Physician Shortage Reduction Act of 2017 (H. R. 2267) was introduced in Congress to increase by 3000 the annual number of residency slots from 2019 to 2023. States such as Arkansas, Kansas, Missouri, and Utah have also passed legislation to provide provisional licenses to some medical school graduates who have not been able to find residency spots. With these provisional licenses, they can practice primary care under the medical license of another physician, but only in medically underserved areas” (Zhang, et. al., 2020). The study also shows how doctors from other countries are filling the gaps in the United States healthcare system.

Challenging colleagues:

Medical mistakes can be deadly. Intervention and the ability to challenge colleagues who are in authority when something does not seem right or is clearly wrong can save lives and create better outcomes. The Royal College of Surgeons of Edinburgh runs popular regular non-technical skills courses for surgeons that teach how to ensure safety through good communication and teamwork (Green, et. al., 2017).

Multidisciplinary teams

Identifying barriers between colleagues helps in the development of tools that can be implemented to create improved future outcomes. Understanding professional roles and being able to communicate with providers is important and trained multidisciplinary teams are showing improved trusts, teamwork, patient benefits, accessibility, convenience, treatment outcomes, patient satisfaction, waiting times, access to care, and that MDTs prevent and reduce complications. On the other hand, the review shows that poor interactions between healthcare professionals can hamper quality patient care (Tan, et. al., 2020). 

Technology:

Americans want the latest technology and although the initial costs of training and implementing new technology may raise the costs of healthcare, it is believed that technology will provide better outcomes and become cheaper over time. In some instances, technology can even make healthcare more accessible. The internet has added a convenience that is making virtual visits possible.

Internet now enables patients and practitioners to access information and facilitates interaction between consumers and providers. Electronic health records (EHRs) have replaced the traditional paper medical records making it easier and faster for medical providers to share information about patients.

Clinical applications support patient care delivery. Administrative information systems are designed to assist in carrying out financial and administrative support activities such as payroll, patient accounting, staff scheduling, materials management, budgeting and cost control, and office automation.

Decision support systems forecast patient volume, project staffing requirements, evaluate financial performance, analyze utilization, conduct clinical research, and improve quality and productivity to provide information and analytical tools to support managerial decision making.

Clinical decision support systems (CDSSs) are interactive software systems designed to help clinicians with decision-making tasks, such as determining a diagnosis or recommending a treatment for a patient.

There are concerns about the use of technology in healthcare delivery. There are ethical and moral issues that have to be decided about the patient’s healthcare such as when a physician should use technology to save a life and what information should be shared. Some Americans are concerned that too much data is being shared and that the internet is not secure enough to keep their personal data private.

The United States spends more than any other country on research and development (R&D) and advances in healthcare technology are changing the way that health care is delivered. Many believe that technology is a major cause of the rising costs of healthcare while others will argue that technology is making healthcare more affordable. The government says that technology improves healthcare delivery systems, makes healthcare more affordable, and that lessons learned from providers, patients, and payers are transforming healthcare by identifying problems and inspiring national models for reform.

Government:

The United States healthcare system is complex and mostly misunderstood because it is financed by both by public funds and by private funds. There are many issues that have to be worked out. The goals of healthcare reform are still to make  healthcare accessible and affordable. The implementation of the Affordable Care Act (ACA) was intended to do that, but it failed to insure millions of Americans and was ultimately repealed in 2017. Recently, it was replaced by the American Rescue Plan.

Besides disagreements among healthcare experts, there are also disagreements among Americans about how healthcare reform should be accomplished. Many Americans do not trust the government to provide for them and believe that healthcare reform will limit the care that they can receive, force American’s to wait in lines or wait for months to see a doctor, and limit a person’s individual choices in their own care. Americans want to be able to choose their doctor and have a choice in treatment options.

MONAHRQ software is a digital software system that is used by state data organizations, chartered value exchanges, and hospital organizations to advance healthcare quality, safety, and effectiveness through the evidence collected from digital healthcare systems research. One way the government measures the quality and outcomes of services provided to patients and accounting for the costs of resources used to produce them is MACRA. The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 which is a health information system that established incentives for clinicians to produce better outcomes. It ended the Sustainable Growth Rate formula that for years resulted in congressional intervention to avoid reductions of payments to physicians. There is a concern though that Incident To Billing Coding can undermine the integrity of MACRA because with incident to billing, accurate measurement of both quality and costs are not possible. A solution may be for Medicare to adjust billing procedures so that payment identifies with the clinician that provides services (Buerhaus, et. al., 2018).

Financing healthcare reform:

“Medicare still faces a substantial financial shortfall that will need to be addressed with further legislation. Such legislation should be enacted sooner rather than later to minimize the impact on beneficiaries, providers, and taxpayers,” The 2020 Annual Report Of The Boards Of Trustees Of The Federal Hospital Insurance And Federal Supplementary Medical Insurance Trust Funds, Associate, Society of Actuaries Member, American Academy of Actuaries, Chief Actuary, Centers for Medicare & Medicaid Services 2020 Federal Trustee Report states (Spitalnic, Paul, 2021).

The financial status of a trust fund can appropriately consider all sources of financing provided for that fund, including the availability of trust fund assets that Medicare or Social Security can use to meet program expenditures. From a budget perspective general fund transfers represent a draw on other Federal resources for which there is no source of revenue from the public. “The budget perspective does not reflect that publicly held debt and interest payments to the public are both lower because the trust funds hold some of the debt.” (Spitalnic, Paul, 2021).  The financial status of the trust funds and financial operations of Medicare and Social Security in the context of the programs’ trust funds or in the context of the overall Federal budget are often misunderstood but are important when considering ways that we can reform healthcare to better meet the needs of populations (Spitalnic, Paul, 2021).

Eliminating disparities:

“If we are going to make improvements, we need to find ways to prevent barriers to care for those with on-exchange and off-exchange individual private insurance plans and Medicaid.” (Alcalá, et. al., 2018). Researchers wanted to know if lower Medicaid reimbursement rates would be associated with poor access to providers.

The odds of being unable to access primary care providers, access specialty care providers and receive a needed doctor’s appointment in a timely manner were assessed and give insight into the effectiveness of the ACA (Relias Media, 2019).  The study concluded that ACA insurance exchange offerings differed from other non-exchange insurance options in terms of access to healthcare. “The results show that poor access to primary care providers was seen among private coverage purchased via exchanges, relative to private coverage purchased on the individual market. Similar trends were seen with employer-based coverage that may not be attributable to reductions in Medicaid fees.

The ACA insured millions of previously uninsured people. However, barriers to quality healthcare persist for some populations (Relias Media, 2019). The study shows that the ACA insurance exchange offerings differed poorly from other non-exchange insurance options in terms of access to healthcare (Alcalá, et. al., 2018).

At the time that the reports of the study were published, Alcalá did not know how his team’s findings would affect hospitals. What he discovered later further suggested “Hospitals can offer financial counseling to help people understand what all this means. But if providers are unwilling to take patient’s health insurance coverage, this is unlikely to help those who are unable to pay for care out of pocket” (Relias Media, 2019).

Conclusion:

In conclusion, America as a whole cannot afford to allow socio-economic and geographic factors to prevent vulnerable populations from receiving care. There are several bipartisan bills on the table that provide hope that America will find solutions to provide affordable quality healthcare to everyone. The money is there. It should not be misused. Surely the best doctors in the world with the help of interested organizations, stakeholders, and technology can find a way to provide equitable, affordable healthcare that does not leave anyone out or neglect primary and preventative care. Internationally, the United States should be leading the world with the best healthcare outcomes, not just filling the gaps with doctors from other countries. Health insurance is high, and many Americans cannot afford health insurance.

Minding Hearts is building advocacy and peer support groups in each state.  The groups are created to raise awareness, educate, and advocate for those that might not otherwise be heard. We are here for encouragement, education, and support. We cannot give legal advice, but we can try and direct you in the right direction with your case. Links to legal services are listed with their states. Please share and let’s grow our groups. We are here to support families and develop resources that maintain family integrity. We look forward to your support. If you would rather become active by donating, then visit the donation page.

References

AHRQ, (2021), Agent for Healthcare Research and Quality, Healthcare systems research, practice improvements, and data analytics, Retrieved From, https://www.ahrq.gov/

AF4Q, (2021), Aligning Forces for Quality, Improving Healthcare in Communities Across America,  Robert Wood Johnson Foundation, Retrieved from http://forces4quality.org/

Alcalá HE, Roby DH, Grande DT, McKenna RM, Ortega AN., (2018) Insurance Type and Access to Health Care Providers and Appointments Under the Affordable Care Act. Med Care. 2018 Feb;56(2):186-192. doi: 10.1097/MLR.0000000000000855. PMID: 29271819, Retrieved From,  https://pubmed.ncbi.nlm.nih.gov/29271819/

APHA, (2021),  Health Reform, American Public Health Association, Topics, and Issues, Retrieved From, https://www.apha.org/topics-and-issues/health-reform

Buerhaus, Peter, Skinner, Jonathan, McMichael, Benjamin J., Auerbach, David,  Perloff,  Jennifer. Staiger, Douglas, Skinner, Lucy, (2018), “The Integrity Of MACRA May Be Undermined By “Incident To Billing” Coding, ” Health Affairs Blog, DOI: 10.1377/hblog20180103.135358, Retrieved From, https://www.healthaffairs.org/do/10.1377/hblog20180103.135358/full/

CDC, (2020), Homelessness as a Public Health Law Issue, Center for Disease Control, Retrieved From, https://www.cdc.gov/phlp/publications/topic/resources/resources-homelessness.html

DPE, (2016), The U.S. Health Care System: An International Perspective; 2016 FACT SHEET, Department for Professional Employees, Retrieved From, https://www.dpeaflcio.org/factsheets/the-us-health-care-system-an-international-perspective

Green, B., Oeppen, R. S., Smith, D. W., & Brennan, P. A. (2017). Challenging hierarchy in healthcare teams – ways to flatten gradients to improve teamwork and patient care. The British journal of oral & maxillofacial surgery, 55(5), 449–453. Retrieved From, https://doi.org/10.1016/j.bjoms.2017.02.010

Health.am, (2015), Mental Health Disorder Statistics, http://www.health.am/psy/more/mental-health-disorder-statistics/

HHS.gov, (2021). About the Affordable Care Act, U.S. Department of Health & Human Services Retrieved from https://www.hhs.gov/healthcare/about-the-aca/index.html

H.R.1319 – 117th Congress (2021-2022): American Rescue Plan Act of 2021. (2021, March 11). https://www.congress.gov/bill/117th-congress/house-bill/1319

Miller, Moly, and Peterson, Tom, (2021), 10 Ways Hospitals Can Improve Healthcare Access, Transforming Health Through Community Partnership, Stakeholders, Retrieved From, https://stakeholderhealth.org/healthcare-access/

Relias Media, (2019), Millions More Are Insured, Relias Media, But Barriers to Care Persist, The trusted source for healthcare information and continuing education, Hospital Access Management, Retrieved From, https://www.reliasmedia.com/articles/144428-millions-more-are-insured-but-barriers-to-care-persist

Shi, L., & Singh, D. A. (2019). Essentials of the U.S. health care system with access (5th ed.). Burlington, MA: Jones & Bartlett Learning. ISBN: 9781284156720.

Spitalnic, Paul, (2021),  2020 Annual Report Of The Boards Of Trustees Of The Federal Hospital Insurance And Federal Supplementary Medical Insurance Trust Funds, Associate, Society of Actuaries Member, American Academy of Actuaries, Chief Actuary, Centers for Medicare & Medicaid Services, Retrieved from, https://www.cms.gov/files/document/2020-medicare-trustees-report.pdf

Statista, (2021), Prevalence of depression, anxiety, PTSD, and suicidal ideation in the past 2 weeks among public health workers in the United States as of April 2021, by race/ethnicity, https://www.statista.com/statistics/1255157/prevalence-select-mental-health-conditions-by-race-in-us/

Tan, H. Q. M., Chin, Y. H., Ng, C. H., Liow, Y., Devi, M. K., Khoo, C. M., & Goh, L. H.  (2020). Multidisciplinary team approach to diabetes. an outlook on providers’ and  patients’ perspectives. Primary Care Diabetes, 14(5), 545-551. Retrieved From, https://doi.org/10.1016/j.pcd.2020.05.012

Trinkoff, Alison M. ScD, RN, FAAN, Storr, Carla L. ScD, Lerner, Nancy B. DNP, RN, Bo Kyum Yang, MSN, RN, Kihye Han, PhD, RN, (2017), CNA Training Requirements and Resident Care Outcomes in Nursing Homes, The Gerontologist, Volume 57, Issue 3, 1 June 2017, Pages 501–508, https://doi.org/10.1093/geront/gnw049

Zhang, X., Lin, D., Pforsich, H. et al. Physician workforce in the United States of America: forecasting nationwide shortages. Hum Resource Health 18, 8 (2020). Retrieved From, https://doi.org/10.1186/s12960-020-0448-3

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