Health Care Reform

I had to go to the emergency room a few years ago because I had been sick for days and eventually reached a fever of 102 degrees. I was still in high school so my parents took me and I was covered under their insurance. I ended up being tested for mono and strep throat, had to undergo x-rays, a physical and a gynecological exam, even though I was not sexually active at the time. In the end, I was diagnosed with a mono-like virus and sent home with directions to stay in bed, drink a lot of orange juice and take ibuprofen for my fever and aches and pains. Thankfully the insurance paid for most of this. But all the testing was not what my parents and I were upset about. We stayed in the ER for over four hours because there were only two nurses on duty and had to call in an off duty doctor to examine me. Because of this, I just wanted to go home instead of having to undergo all of those unnecessary tests but the nurse insisted that I stay and wait for the doctor because there could have been something terribly wrong with me. But even after an hour of waiting and my fever decreasing, we were still waiting for the doctor and encouraged to wait. I do not know if this was solely because they want to make money or need a certain number of tests to run or patients to evaluate each day. The amount of workers, however, were definitely a problem and if there were more, I could have been treated and tested quicker and possibly not subjected to the expensive bill.

The health care system around the country is obviously lacking in the worker department. And something to think about it how necessary it is to actually admit someone to the hospital; this increases the patient to nurse ratio and ultimately results in medical mistakes and sometimes death. The heart of the matter really lies in how well people are educated about health, preventative medicine, and insurance coverage. People will wait until they absolutely have to go to the hospital, which can increase capacity and doctors and nurses have too many patients to properly care for. It’s definitely something for our government to think about changing.

Katy Lawrence

US Health Care System

I am currently a junior studying abroad in Argentina, with a double major in CHE and Spanish, so I still have much to learn about the US Healthcare system but...

The need for a reform in the US healthcare system has become more and more evident within the last several years. Much of the American population is without health insurance or do not have enough health insurance to cover their expenses. Many people then attempt to pay for these costs out of pocket only to fail and in turn, end up missing preventative measures, treatments or follow-up appointments, and ruining their lives and credit in the mean time. In the long run, this ends up costing much more than if preventative action was taken in the first place!

Precisely because of this, I feel that the US should turn to Universal coverage. Currently, the US is one of the only industrialized nations without universal coverage. Instead of focusing on treatment, the US needs to be more prevention-oriented, so illness and disease don’t occur in the first place (ideally). Patients would consult with doctors, nurses and other allied health professionals by means of primary and secondary prevention, which would help keep costs down as well as being able to provide health care for all Americans. With lower costs, more services would be available to larger populations of people, which would improve access. It really is a cycle, in which effort for reform really will pay off in the end. Hopefully those in the position to make a big change see this opportunity and take advantage of it before more people lost the coverage they have.

Health Care Workforce
Maggie Butterfield

My journey into health care has taken many different paths. I am a director of a large family support entity. I am an early fifty woman who in the world of health care employees, I am not unusual. Health care is comprised of over 70% women. The health care workforce is aging as the economic view of our communities continues to be challenged. Many people similar to me have thought of retiring, retired and returned or are frightened at the prospect of retiring, due to the economy and often times due to a loss of a sense of purpose. My experience has totaled 27 years with the same organization, watching as it has grown, and being allowed to grow right along with it. I have a varied background of early childhood education, therapeutic intervention for hospitalized children, parent education, adult learning and leadership development. I relate to this environment, as it is the culture in many ways of which I have grown up since my early twenties.

I am this workforce in many ways and my experience as an educator, as a learner, as a leader and as a parent has all contributed to a greater understanding of what the employees of today and the future need to do to continue to build a greater health care environment of the future. Critical to the success of health care is the continued efforts of science to better understand how to successfully cure those that it can, and to successfully heal to the best of their ability those they cannot cure. Innate to this clinical greatness is an understanding of people, where they are in their lives and what impact their healthcare situation is thrusting upon them. Relevant to that is the impact not only on them, but their family and the family’s ability to survive. Every member plays an important part of the healing and wholeness. Health care workers of today and the future need to understand this, work collaboratively with all who can make a difference and to create the choreography of healing for each and every patient they may work with. The world of health care is about the strategic alignment of skills and to come together to play their part in the healing of one individual, in the prevention of long term health issues, in the provision of key resources to live an sustain within a community and in the overall wellness of people.

There are many players in the world of health care. I am not of the belief that more is better, what is better is a rich wealth of skills that can come together to make a difference in the health of another. The world of health care in the future will have to be diverse in the creation of how many, and the skill basket needed for success. One obviously is not enough…1000 not working together is not acceptable. A health care workforce of the future will need to play upon the complimentary skills of each other to make a difference. That is how we decide how many.

The hospital that I work at has recently received the very first National Database for Nursing Quality Indicators (NDNQI) Quality Award for Academic Medical Centers. This means nurses at this hospital have been recognized for prioritizing and achieving the highest quality, safety and patient-centered care. This particular hospital is striving for higher patient care outcomes, and has achieved its goals. It's refreshing for a nursing student who will be entering the field in January, to see a hospital so committed to excellence. It's a place any nurse would be lucky to work at. As far as changes, I believe more hospitals should be striving for outstanding nursing quality. This reflects higher on the profession and the hospital, and leads to higher patient care outcomes. With higher nursing quality it will also limit the amount of days that patients will have to spend in the hospital, therefore cutting down on cost. Working in the hospital environment I see several patients with health problems that could have been prevented with preventative medicine. In order to achieve health care reform, there will have to be a shift of focus from tertiary care to preventative health care.

Health Care Workforce

Health Care Reform-Workforce
Abby Butterfield
It is obvious to me that there are major changes that need to be made in today’s world of health care. In today’s economy, I seriously believe that some sort of a universal coverage system should be made available, with the option to have additional coverage if you wish to pay for it. Having care available to everyone is just the first step, though. We also have to build care delivery systems to get care to the populations that need it the most. In today’s age, doctors have been put on a pedestal, and I think that we need to seriously consider how much we are paying doctors and maybe try to re-delegate that money in a way that will benefit not only doctors but the general population as well. We need to offer quality care at an affordable price. Second to economic recovery, health care reform is the most important topic discussed in Washington. The reform we are looking for has to be a balancing act between being affordable without losing the quality of care people need.
In order to create a quality care, we need to spend money in order to produce quality physicians and surgeons. There is no compromise when it comes to surgical care especially, seeing as their training and expertise are unmatched by anyone else. I also think we need to better allocate how money is spent. For instance, instead of opting right for surgery, which could be very expensive, we should spend more money paying physical therapists, child life specialists, art therapy aides, or pet therapy aides in order to decrease the amount of money spent paying for pharmaceuticals, as well as decreasing the money spent on unnecessary surgeries.
According to Shi and Singh, the baby boomer population between 2000 and 2010 will require 1.9 million more health care workers, seeing as they will all be reaching retirement age. Another issue that must be addressed is more health care workers need to be trained in geriatric care, seeing as we have an aging population that will require special care. Also, as more women and minorities enter the workforce, there needs to be cultural competencies that people working in health care need to understand.

Citations
http://www.oshpd.state.ca.us/ April 5th, 2009
http://www.workforce.com/wpmu/washington/2009/03/20/health-care-reform-pitfalls-may-test-bipartisanship/ April 5, 2009
http://www.facs.org/ahp/hcreform08.pdf April 5th, 2009
Shi and Singh. Delivering Health Care in America: A systems approach.

Reform Proposal 3

I recently viewed the documentary "Sicko" by left-winged Michael Moore. Many feel this movie is unfair, biased and lacks a lot of beneficial facts about the health care system in America. However, I felt it truly represented what a lot of middle to low class families experience every day with their medical bills and hospital visits: frustration and overwhelming sadness. Much needs to be done to reform our health care system, including push from our new president. However, as much as President Obama wants to see new proposals and change in our system, he said that most of the legislation and ideas will need to come from Congress.

But what can be done within the health care workforce? For one, those that currently work in health care, and those, like myself, and many of my peers are going to school for right now, need to maintain an open mind about a health care overhaul that needs to take place immediately. A proposal that most likely will be introduced is that workers in the health care system may need to take a pay cut in order to accomodate all of those who need care, yet keep the care at a high quality rate. This is a small price to pay so that people can receive equal health care around the clock and not have to worry about going bankrupt. This is also something that can happen while still being able to use the great technology that our country has. However, if you examine the current programs in countries such as Canada, Switzerland, Great Britain and Germany, the U.S. clearly does not need the latest and greatest technology right away.

Another thing that workers can do is model after the British in preventive medicine and care. As documnted in the PBS Frontline special, "Sick Around the World," Great Britain is leading the world in preventive care. Not only would an increase in this kind of care reduce hospital visits and cost for medications, but it would allow workers to build better relationships with the patients. By thoroughly communicating with patients about proper hygiene, safe sex and drug use, dental care, and other daily health activities, workers will be doing their job, and not feel the consequences of overcrowded clinics and hospitals. This will ultimately result is less stress, overtime hours and worker and patient dissatisfaction.

Citations:
Reinhardt, Uwe E. Defining ‘Health Care Reform’. 27 March 2009. Economix Blog. The New York Times. Retrieved online 30 March 2009. <http://economix.blogs.nytimes.com/2009/03/27/defining-health-care-reform/>.
Moore, Michael. Sicko. Dog Eat Dog Films. 2007. Retrieved online 30 March 2009. <http://video.google.co.uk/videoplay?docid=6646340600856118396&ei=-ybRSdfeJ5DQ-AGZ1J2SAg&q=sicko>.
Sick Around the World. Frontline. 15 April 2008. PBS. Retrieved online 30 March 2009. <http://www.pbs.org/wgbh/pages/frontline/video/flv/generic.html?s=frol02p101&continuous=1>.

Health Care Reform Proposal 2

“Overall reform needs to begin by encouraging all health care providers, purchasers, consumers, and policy makers to think in terms of health agenda rather than a healthcare financing agenda”, Wisconsin Nurses Association. The United States is home to the best medical technology and best doctors in the world. Unfortunately, their services are a luxury that many Americans cannot afford. It is the responsibility of not only President Obama and Congress, but anyone that feels they can contribute their knowledge, time, or money to this long awaited change in American society. It is important to remember that when reforming the health care system that it will take some give and take from everyone. We will not be able to move forward without cooperation from everyone involved. As stated in reform 1, preventive care is the key to a successful health care reform. But, there many other actions that must be taken to have a successful health care reform.
The insurance and drug companies need to realize that making a profit and doing what is best for their companies is not what is best for the American population as a whole. Legislation should prevent insurers from overcharging doctors for their malpractice insurance and invest in proven strategies to reduce preventable medical errors. By reducing these preventable medical errors patients will have more confidence in their health system and money will be saved over time by preventing such errors.
In 2006 Massachusetts enacted a law that required all residents of the state to carry health insurance which dramatically dropped their total number of uninsured residents. The Massachusetts Health Care Reform Plan addresses one critical component of health care reform -- insurance coverage. Without an adequate supply of primary care physicians, however, the plan cannot guarantee timely access to care, creating a gap between coverage and actual provision of services. As a result, waiting times to see a primary care physician can amount to weeks and even months in some instances. It is clear to see that if our entire nation adopted a similar plan that our need for more primary care physicians would increase significantly. The government would need to put in place more scholarships and incentives to attract people to this field.
While all of the topics are important we feel that it is especially important to focus on the reform of the health care system paying close attention to the health care workforce. Physicians have an insight to the health care system like nobody else. It is crucial that we listen to their needs and ideas to improve the health care system inside and out. Administration should also be closely looked at to promote cost awareness in billing and reimbursement systems.


(2005). The Wisconsin Nursing Community Agenda for Health Care Reform. Retrieved March 16, 2009, from Nursing's Agenda For Health Care Reform Web site: http://www.wisconsinnurses.org/docs/WI%20Nursing%20Community%20AgendaFINAL.pdf
The Agenda-Health Care. Retrieved March 14, 2009, from The White House Web site: http://www.whitehouse.gov/agenda/health_care/
Arvantes, J (2008). Lack of Primary Care Physicians May Derail Health Care Reform Initiative . Retrieved March 16, 2009, from AAFP Web site: http://www.aafp.org/online/en/home/publications/news/news-now/professional-issues/20080130massachusettsreform.html
Gov. Doyle, J (March 11, 2009). Washington Should Look to Wisconsin for Answer to Health Care Reform. Retrieved March 16, 2009, from The Huffington Post Web site: http://www.huffingtonpost.com/gov-jim-doyle/washington-should-look-to_b_174107.html
Hatwell, K (2009, March 10). AMA Physicians Work for Health Care Reform. Retrieved March 16, 2009, from AMA Web site: http://www.ama-assn.org/ama/no-index/news-events/physicians-health-care-reform.shtml

Health Care Reform Proposal

In today’s world, the economic downturn has been a top priority, but health care reform will remain one of the most controversial issues facing the country. While a total health care overhaul is unlikely, we must give a sense of urgency to small changes capable of making a great impact.
A new reform should improve access and be cost effective, while providing exceptional quality. Ideally, congress would pass legislation requiring all employers to provide health coverage to their employees. This would provide coverage to people who work part time and people whose position or wage status may not qualify them for coverage. This would reduce the amount of uninsured people and also the amount of people dependent solely on tax funded care, for example, Badger Care. This would also increase access, since people who had no coverage could utilize health services without worrying about paying out of pocket. This would reduce the amount of people using emergency care as their primary care.
Although passing costs on to companies and employers may be difficult in a struggling economy, it would serve as motivation for companies to take interest in the health and well-being of their employees, since their profitability now depends upon it. Similarly, an employee whose wages depend on his health and efficient use of health care might begin to take more responsibility for his well-being, and would promote preventative care as opposed to reactive care. To give employees an idea of how much money their employers are spending on their health care, a new piece of legislation was introduced in October that would require employers to report the annual health insurance expenditures on their employees W-2 tax forms.
. The current trend of wastefulness contributes to soaring costs. To reduce this waste, efforts should focus on simplifying administration, researching cost/benefit comparisons in treatment, and eliminate unnecessary procedures and tests, and providing incentives to do so. Increased cost effectiveness would allow for better treatment and payment of the health care workforce, more efficient care, and lower premiums for businesses and employees alike.
If congress passed legislation passing responsibility for health to the individual, and if companies are motivated to reduce waste and become cost effective while maintaining quality, we would be well on our way to having one of the best health care systems in the world, without risking all the problems that could come from a massive system overhaul.

Citations:

“American College of Surgeons: Statement on Health Care Reform”. 31 October 2008. Accessed 2 March 2009. http://www.facs.org-ahp-hcreform08.pdf.url

Schoeff, Mark Jr. “Health Care Reform to Be a Top Priority of Congress”. 21 October, 2008. Accessed 2 March 2008. http://www.workforce.com/section/00/article/25/85/98.php

Leaning slightly to the left, our group believes physicians, nurses and other health care providers need to take a more proactive approach to treating patients. With approximately half of all chronic diseases being linked to preventable problems including smoking, obesity, and physical inactivity and 70% of health care spending being put toward these diseases, this requires more attention to primary prevention of disease (www.healthcareproblems.org). Primary prevention is the future health of all Americans. By preventing diseases before they begin opens a door to the right direction on the issue of health care reform.
Education is another responsibility of these individuals. Many studies have shown that when patients with chronic diseases focus on their health and get involved in their own care, their overall health improves and health expenses decrease (www.pbs.org). Through education, health care providers empower their patients to take on a healthier lifestyle and proceed on a path of changing high risk behaviors.
Although education may encourage individuals to live a healthier lifestyle, access, quality, and affordability of health care are crucial to paving the way for a healthier America. Both individual and population health are closely related to having access to adequate preventive and curative health care is a key determinant of health (Shi, Shing pg. 52). About 44 million people in the United States have no health insurance, and another 38 million have inadequate health insurance. These staggering numbers create a gap in the ability to seek preventive care. A quote from Sherry Glied, PhD, Associate Professor of Public Health, Columbia University explains these three important dimensions of health care reform,
“The people who are most at risk today are those who have no health insurance at all. They’re at risk of not getting regular care when they need it. They’re at risk of not getting regular care when they need it. They’re at risk of not catching real problems before they get serous enough to not be treatable. They’re at risk of not getting the best treatment when they actually do get sick. And they’re at tremendous financial risk. They could lose everything that they’ve saved in their lives because of some even fairly minor health problem www.columbiauniversity.edu.”
As the members of our group continue on our journey of the health education program, we realize the importance of the three dimensions, access, quality, and affordability. Without having equal emphasis put on all three, the system doesn’t run as it is needed to. If one dimension of the triangle is unattainable, the other two will not be able to compensate and the system will fail.
As a member and employee of a health care facility, our group feels it is those individuals responsibility to address issues that are concerning to the public. According to Commonwealth Fund President Karen Davis, “fraud in health care is rampant” (www.hospicepatients.org). There are a few issues such as intentionally understaffing facilities, making decisions which harm to patients is known, and assigning more cases than capacity to maximize profits. These are issues that are harming the quality of care patients are getting and we feel it would have beneficial value to change the attitude from money to patient care.
The Shi and Shing text states, that “the American public’s attitudes toward improving health are based on more medical research, development of new medical technology, and spending more on high-tech medical care” (pg. 52). As our group was reading this statement we realized the shocking truth to it. As American citizens we have gone away from the belief of living a healthy lifestyle. Most feel too busy to incorporate daily exercise or even a daily intake of fruits and vegetables. This has had serious consequences to our society and it is our responsibility to have our voices heard and shift the emphasis of health care to primary prevention.
As health educators and potential health care workers, these are serious issues that we need to be educated about in order to have a positive influence. Health care reform is a high on the priority list of our influential leaders and it is important for them to know how we feel and what we, as educators and providers need to make health care affordable, accessible, and effective.

Overview/History of Workforce

“In many healthcare occupations, we face labor shortages. Yet these are also opportunities for quality jobs and rewarding careers.”
-Governor Jim Doyle
This statement issued by Wisconsin Governor Jim Doyle in the Wisconsin Healthcare Workforce Annual Report 2007 emphasizes a major problem the United States faces: a shortage of healthcare workers. According to this report healthcare is the quickest growing workforce area in the country and is expected to create 3 of every 10 jobs nationally through 2014. The healthcare workforce can include professionals ranging from physicians, registered nurses, dental hygienists, and health information technicians. With this much demand for healthcare positions, how can the shortage be solved?

The Select Committee on Healthcare Workforce Development in the group who is responsible for coming up with ideas that will help solve this massive problem. One proposed solution is working to increase clinical site capacity. Another proposal is to create an online database that will help prospective workers with position placement. The initial focus of this program would be with Registered Nurses as, according to the report, it is the career with the most projected openings through 2014. Yet another possible solution is the implementation of the tracking of employee retention rates. If hospitals work harder to keep their staff, they may not have as many issues with shortages.

Accompanying the shortage of healthcare workers is the decrease in the quality of healthcare. According to an article from the American Medical Association, the average office visit in the United States last for about 16 minutes. With this being an unofficial standard of healthcare, it is hard for patients to receive quality care when they only have access to their physician for a fraction of the time needed to discuss all of their problems. Such a short visit will almost guarantee that a discussion about prevention, possible side effects of medication, and psychosocial issues (things essential to quality healthcare) will be forgotten.

This article published by the American Medical Association and titled “So Much to Do, So Little Time” by Kevin Fiscella, MD presents an extremely comprehensive overview of a typical visit to the doctor’s office. There are many charts that present issues such as tasks and challenges for caring for patients and how our current system treats patients. Also in the article Fiscella discusses how patient treatment can be improved including physician and staff training, patient training, providing resources, and physician leadership. With three pages of outside references this is a strong article that presents a well-built case for better physician care.

In 2006 healthcare expenditures were projected to consume 16.2% of the United State’s GDP which is more spending per capita and any other nation (McKenzie, 414). The spending on healthcare is projected to increase and with that will come an increased demand for services. More services will require more healthcare workers including health service administrators (Shi and Singh, 489). Because of the increased demand for healthcare workers, it is imperative to reverse the current shortage as soon as possible.

With a shortage of healthcare workers all around, one area in particular is feeling the effects the most. In metropolitan areas the number of physicians increased by 74% while in nonmetropolitan and rural areas the number only increased by 61% with a ratio of generalists to population of 5 per 10,000 (Shi and Singh, 131). These numbers show you that it is hard for people living outside of major cities to receive access to medical care.

The issue of the healthcare workforce shortage is incredibly important. With the economy in its current state many hospital administrators may be forced to cut programs that help improve the quality of healthcare delivery and the safety of patients (Hamby, 23). With the loss of these programs not only are patients put a risk but the shortage of healthcare workers only gets worse. If this issue is not addressed and dealt with in a timely manner, many people’s health may be put in extreme jeopardy.

Many people may think that the workforce is not as important as other issues in healthcare. They may think that improving medical technology to improve the chances of patient survival is more important or they may believe that increasing primary care as opposed to secondary and tertiary is critical to the improvement of healthcare. However, without a healthcare workforce, not one of these could be put to use. It would be great to have improved technology or primary care, but without a workforce, neither could exist.


References:
Fiscella, Kevin, and Ronald M. Epstein. "So Much to Do, So Little Time." So Much to Do, So Little Time 168 (2008): 1843-852. Archives of International Medicine. 22 Sept. 2008. 15 Feb. 2009 .
Hamby, Leigh. "Beyond the Current Crisis." Modern Healthcare 39 (2009): 23-23. 02 Feb. 2009. 15 Feb. 2009 .
McKenzie, James F., Robert R. Pinger, and Jerome E. Kotecki. An Introduction to Community Health. 6th ed. New York: Jones & Bartlett, Incorporated, 2007.
Shi, Leiyu, and Douglas A. Singh. Delivering Healthcare in America : A Systems Approach.
4th ed. New York: Jones & Bartlett, Incorporated, 2007.
Wisconsin Department of Workforce Development. 15 Feb. 2009 .

Posted by Alyssa Buchman