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The tenants of quality healthcare
Organizational structure in the healthcare system
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In healthcare system the highest quality medical care means the greatest benefit to patients at the lowest possible cost The Agency for Healthcare Research and Quality (AHRQ) defines quality health care “as doing the right thing for the right patient, at the right time, in the right way to achieve the best possible results.” (NCQA, n.d.). According to American college of physicians, the single most reason for the health care cost is the high healthcare spending. There are several factors involved in the high health care cost such as inappropriate use of advanced technology, lack of patient involvement in decision making, overuse of payment system, excessive price for healthcare services, high administrative cost, and medical liability are some …show more content…
There are four elements in finance management such as planning where goals, strategies and budgets are established, in controlling, make sure established goals and strategies are followed by comparing report of original value with target values. Organization and directing involves maximum utilization of the available resources for the best advantage such as staff, space supply, and equipment .Finally the decision making involves analysis and evaluation to select the best alternatives .However there is no single entity with any single solution is not available to improve the quality outcome and bring the expenses down instead multi model approach ad efforts are required for the best cost effective practice. However, nation has to ensure spend taxpayer’s money wisely to improve health care quality and control health care cost
The government controls and regulates healthcare somewhat because healthcare organizations are in a position to take advantage of the elderly and sick so there are regulations that protects them. It seems as though healthcare facilities are being paid less for their services today. Some critical measures for the survival of a healthcare organization are to optimize performance and quality. Finding system-wide efficiencies and cost reduction healthcare will help. In order to get better and keep high quality and performance while still raising reimbursements, it is necessary and important to involve doctors with the ideas and plans for any management strategies.
Regardless of technological advancement, life-saving skills and abilities and first-world resources, the outlandish cost of healthcare in the United States far surpasses any other country in the world. From price gouging, to double billing, to overbilling, to inefficient and expensive operations, the United States wastes $750 billion every year through our healthcare system. According to the Institute of Medicine (IOM), $200 billion of that astronomical number is due to nothing more than administrative waste. It is estimated that 15 cents of every dollar spent on healthcare is wasted due to inefficient administrative practices.
Bigalke, J. T. (2009, February). Healthcare Financial Management [Managing Uncertainty to succeed in the new health economy]. , (), . doi: Retrieved from
The interpretation of quality health care varies with each person. Some place emphasis on the ability to access various treatments without interference. Others value the feature of being able to simply select one’s provider. Quality health care, according to the Institute of Medicine (2001), can be defined as care that is “safe, effective, patient-centered, timely, efficient and equitable” (p. 3). Furthermore, it should account for, in detail, a patient’s medical history, and improve overall patient well-being.
The National Healthcare Quality and Disparities Report (NHQDR) (2012) identified three key themes. The themes are health care quality and access are suboptimal, especially for minority and low income groups; overall quality is improving, access is getting worse and disparities are not changing; and urgent attention is warranted to ensure continued improvements in: quality diabetic care, maternal and child health, adverse events, disparities in cancer care and quality care among the states in the south.
In order to make ones’ health care coverage more affordable, the nation needs to address the continually increasing medical care costs. Approximately more than one-sixth of the United States economy is devoted to health care spending, such as: soaring prices for medical services, costly prescription drugs, newly advanced medical technology, and even unhealthy lifestyles. Our system is spending approximately $2.7 trillion annually on health care. According to experts, it is estimated that approximately 20%-30% of that spending (approx. $800 billion a year) appears to go towards wasteful, redundant, or even inefficient care.
Canadian health care system is well developed, highly efficient, and even with drawbacks it provides Canadian resident the best health care they deserve.
The U.S. expends far more on healthcare than any other country in the world, yet we get fewer benefits, less than ideal health outcomes, and a lot of dissatisfaction manifested by unequal access, the significant numbers of uninsured and underinsured Americans, uneven quality, and unconstrained wastes. The financing of healthcare is also complicated, as there is no single payer system and payment schemes vary across payors and providers.
The balance between quality patient care and medical necessity is a top priority and the main concern of many of the healthcare organizations today. Due to the rising cost of healthcare, there has been a change in the focus of reimbursement strategies that are affecting the delivery of patient care. This shift from a fee-for-service towards a value-based system creates a challenge that has shifted many providers’ focus more directly on their revenue. As a result, organizations are forced to take a hard look at the cost of services they are providing patients and then determining if the services and level of care are appropriate for the prescribed patient care.
Rising medical costs are a worldwide problem, but nowhere are they higher than in the U.S. Although Americans with good health insurance coverage may get the best medical treatment in the world, the health of the average American, as measured by life expectancy and infant mortality, is below the average of other major industrial countries. Inefficiency, fraud and the expense of malpractice suits are often blamed for high U.S. costs, but the major reason is overinvestment in technology and personnel.
In today’s healthcare system, there are many characteristics and forces that make up the complex structure. Health care delivery is a complex system that involves many people that navigate it with hopes of a better outcome to the residents of the United States. Many factors affect the system starting from global influences, social values and culture. Further factors include economic conditions, physical environment, technology development, economic conditions, political climate and population characteristics. Furthermore the main characteristics of the Unites States healthcare system includes: no agency governs the whole system, access to healthcare is restricted based on the coverage and third party agencies exist. Unfortunately many people are in power of the healthcare system involving multiple payers. Physicians are pressured to order unnecessary tests to avoid potential legal risks. Quality of care is a major component; therefore it creates a demand for new technology. A more close investigation will review two main characteristics and two external forces that currently affect the healthcare delivery system. Furthermore, what will be the impact of one of the characteristics and one of the external forces in review with the new affordable care act 2010? The review will demonstrate the implications to the healthcare delivery system and the impact on the affordable care act 2010.
There are new challenges every year in the health care field. Research on the future of U.S Healthcare System is of paramount importance to the entire Health care industry as well as the citizens of the U.S. To begin with, the research will discuss how challenges for future healthcare services can be enhanced by reducing the costs of medication. By creating a better quality of health care, Information technology advancements, including future funding, lower rising costs, the Medicare and Medicaid programs. The research will also discuss the challenges of market shares for different ages of populating and maintaining a skilled work place. It will further discuss the tentative solutions to these challenges. The role that the government plays to ensure that these challenges are mitigated and that health care is available to all American citizens is also discussed. Among these problems poor quality of care is perhaps the most visible and troubling, resulting in nearly 100,000 preventable deaths each year (Institute of Medicine, 1999) and reduced quality of life for millions of Americans due to non-fatal yet serious adverse events such as wrong-limb amputation, hospital-acquired infection, and medication errors (Institute of Medicine, 2006; Leape, 1997).
The World Health Organization outlines 6 areas of quality that help shape our definition of what makes quality care. Those areas are; (1) Effective: using evidence bases practice to improve health outcomes based on needs of individuals and communities. (2) Efficient: healthcare that maximizes resources and minimizes waste. (3) Accessible: timely care that is provided in a setting where the skills and resources are appropriate for the medical need and is geographically reasonable. (4) Acceptable/Patient-Centered: healthcare that considers individual needs, preferences, and culture. (5) Equitable: healthcare quality that does not vary because of race, gender, ethnicity, geographical location, or socioeconomically status. (6) Safe: healthcare that minimizes harm and risks to patients. (Bengoa, 2006)
2.2 Relationship between cost, quality and equity Health care is extremely sensitive and cost management tool because of per capita income process. The leadership ranks the indicators of quality and low identification for specific sources.
Nguyen, N. (2009, August). Improving quality and value in the u.s. health care system. Retrieved from http://www.brookings.edu/research/reports/2009/08/21-bpc-qualityreport