I am a second semester senior nursing student at UWEC. Living in Eau Claire, WI some people may call this a large community in the midwest but compared to many larger cities we lack many of the healthcare oppurtonities that a larger city such as milwaukee or chicago may have. Yes I argee that early access to care is an important part in saving someones life in emergent situations. And it is not just the physicians that we would need to put in these rural communities. Even if we could find physicians, there would still be a need for the rest of the health care staff, at the time of a traumatic event and the facilities.At this point I feel that our best option is similar to what Luther Midelfort Mayo has done in Eau Claire; creating community hospitals that can treat many minor problems, but work to diagnose and then transfer the patient via ambulance or helicoptor to eau claire, and possibly rochestor to treat the problem. For example if someone presented at the ER in some small town population 500, 1 hour from Eau Claire with chest pain and STEMI elevation. It would be more cost effective and provide better care to let the physicians diagnose the patient with an MI, and transfer him to Eau Claire where there is a cath lab, and can preform emergency open heart surgery, and have a critical care unit to take care of him, rather than leave him in Barron WI, where the only option is to treat the patient medicaly, not surgicaly.On a side note, Although Eau Claire could be considered a rather large community, Luther Midelfort hospital normally does not keep peds patients in house, rather transfer them to the cites or Mayo, the average daily census for pediatric patients at luther in Eau Claire is .72. At Sacred Heart the other local hospital the cenus is slightly higher.My thought for the best way to provide care is to aim at primary care and secondary prevention in the rural communites, where they can refer to larger hospitals, so there are able to seek more cares, where there is more specialization, and surgical options.
The most important aspect to care is for primary access to care
Friday, April 17, 2009
Monday, April 6, 2009
Reform Proposal 4 - Improving Rural Access Disparities
Our last reform focuses on improving the disparity between access for rural residents versus those in urban areas. At the bottom of the health care marketplace lie rural communities that lack the population base, local economy, or lifestyle benefits to attract and maintain substantial primary health care providers. 20% of the US population lives in rural areas that take up 80% of the land mass, yet 9% of all physicians practice in rural locations (RWHC). In the past two decades some physicians have spread into these low density areas, but the vast majority continue to locate in the areas already with large numbers of primary care providers leaving rural populations at an extreme disadvantage in their access and quality of care. Our health care system is set up with a market based model. Delivery is linked to where people can pay rather than where the care is needed (Shi and Singh).
Rural populations are among medically underserved areas (MUAs) that need the protective benefits of being seen early and treated in outpatient and primary care facilities. But the health problems of these residents are by and large under-diagnosed. Medicare payments to rural physicians are also dramatically lower than urban counterparts for equivalent services (NRHA). Rural populations could use primary care more and are receiving it less. They have less access and thus a poorer quality of overall health. They also experience cost difference as many times they must travel great distances to be seen. Or else they choose not to travel to see a primary care physician and don’t receive treatment early ending up with greater costs and morbidities.
It is understood that medical school graduates want to obtain prestigious, high paying jobs to pay off their debt and live the luxury their education has afforded them. This allows maldistribution by both specialty and location. Primary care rural doctors are hard to recruit and harder retain. Urban areas offer greater prospects for ‘high incomes, professional interaction, access to modern facilities and technology, continuing education and professional growth, higher standards of living’ among others (Shi and Singh). All of these lead to rural areas having to work harder to recruit and try to offset those options and entice doctors to consider their career location. Rural areas offer their own benefits as they have low density populations, cleaner environments, low crime rates, and a value system that embodies neighborliness. Rural primary care physicians also cite better job satisfaction as they are made to feel their services are essential and deeply appreciated by the community (NRHA).
In order to fix this issue it will take a multifaceted approach that is well-tuned to all the problems. First one must consider the desires of graduating primary care physicians. There already are national and state reimbursement packages for practitioners choosing to locate in rural areas which pay back tuition and debt they possess. These reimbursement programs should be expanded to allow more physicians the option of receiving these. They’re extremely effective but funded too modestly. Hospitals and clinics should also consider offering compensation packages which take into consideration pay cuts doctors take when locating rurally. Teaching hospitals producing rural primary care physicians should increase the number of slots available. It’s shown that those with rural experience are more likely to take jobs in rural areas. Training programs should facilitate admission to students coming from rural communities, offer educational experiences use internships for rural exposure (Shi and Singh). The rural communities should also feel empowered to make themselves attractive to potential health care workers and recruit those who will improve their primary care. Access to capital for these rural facilities should also be improved both federally and statewide to allow them the construction and modernization to attract primary care practitioners (National Advisory Committee on Rural Health).
These actions would decrease costs in transportation and residual care to rural residents by increasing primary care personnel to allow them better access and therefore improving their quality of health care.
The National Rural Health Association is a good source of advocacy and policy change that can be implemented to see health care for 62 million rural Americans improved. They’ve been instrumental in some of the recent changes that have taken place. They believe that ‘All Americans are entitled to an equitable level of health and well-being established through health care services regardless of geographic locale, gender, ethnic or racial background, or economic ability or status.’ (NRHA)
Resources:
Shi, L., & Singh, D. A. (2008). Delivering health care in America: A systems approach (4th ed.). Sudbury, MA: Jones and Bartlett Publishers, Inc.
National Rural Health Association. (2009). What's different about rural health care? Retrieved April 2, 2009, from http://www.ruralhealthweb.org/go/left/about-rural-health/what-s-different-about-rural-health-care
The National Advisory Committee on Rural Health and Human Services - U.S. Department of Health and Human Services. (n.d.). Compendium of recommendations by the National Advisory Committee on Rural Health . Retrieved April 2, 2009, from http://ruralcommittee.hrsa.gov/nac_comp.htm
Rural Wisconsin Health Cooperative. (2009, February). Review and commentary on health policy issues for a rural perspective. Retrieved April 2, 2009, from http://www.rwhc.org/eoh09/February.pdf
Oregon Rural Health Association. (n.d.). Rural health disparities. Retrieved April 2, 2009, from http://www.orha.org/disparities.htm
Rural populations are among medically underserved areas (MUAs) that need the protective benefits of being seen early and treated in outpatient and primary care facilities. But the health problems of these residents are by and large under-diagnosed. Medicare payments to rural physicians are also dramatically lower than urban counterparts for equivalent services (NRHA). Rural populations could use primary care more and are receiving it less. They have less access and thus a poorer quality of overall health. They also experience cost difference as many times they must travel great distances to be seen. Or else they choose not to travel to see a primary care physician and don’t receive treatment early ending up with greater costs and morbidities.
It is understood that medical school graduates want to obtain prestigious, high paying jobs to pay off their debt and live the luxury their education has afforded them. This allows maldistribution by both specialty and location. Primary care rural doctors are hard to recruit and harder retain. Urban areas offer greater prospects for ‘high incomes, professional interaction, access to modern facilities and technology, continuing education and professional growth, higher standards of living’ among others (Shi and Singh). All of these lead to rural areas having to work harder to recruit and try to offset those options and entice doctors to consider their career location. Rural areas offer their own benefits as they have low density populations, cleaner environments, low crime rates, and a value system that embodies neighborliness. Rural primary care physicians also cite better job satisfaction as they are made to feel their services are essential and deeply appreciated by the community (NRHA).
In order to fix this issue it will take a multifaceted approach that is well-tuned to all the problems. First one must consider the desires of graduating primary care physicians. There already are national and state reimbursement packages for practitioners choosing to locate in rural areas which pay back tuition and debt they possess. These reimbursement programs should be expanded to allow more physicians the option of receiving these. They’re extremely effective but funded too modestly. Hospitals and clinics should also consider offering compensation packages which take into consideration pay cuts doctors take when locating rurally. Teaching hospitals producing rural primary care physicians should increase the number of slots available. It’s shown that those with rural experience are more likely to take jobs in rural areas. Training programs should facilitate admission to students coming from rural communities, offer educational experiences use internships for rural exposure (Shi and Singh). The rural communities should also feel empowered to make themselves attractive to potential health care workers and recruit those who will improve their primary care. Access to capital for these rural facilities should also be improved both federally and statewide to allow them the construction and modernization to attract primary care practitioners (National Advisory Committee on Rural Health).
These actions would decrease costs in transportation and residual care to rural residents by increasing primary care personnel to allow them better access and therefore improving their quality of health care.
The National Rural Health Association is a good source of advocacy and policy change that can be implemented to see health care for 62 million rural Americans improved. They’ve been instrumental in some of the recent changes that have taken place. They believe that ‘All Americans are entitled to an equitable level of health and well-being established through health care services regardless of geographic locale, gender, ethnic or racial background, or economic ability or status.’ (NRHA)
Resources:
Shi, L., & Singh, D. A. (2008). Delivering health care in America: A systems approach (4th ed.). Sudbury, MA: Jones and Bartlett Publishers, Inc.
National Rural Health Association. (2009). What's different about rural health care? Retrieved April 2, 2009, from http://www.ruralhealthweb.org/go/left/about-rural-health/what-s-different-about-rural-health-care
The National Advisory Committee on Rural Health and Human Services - U.S. Department of Health and Human Services. (n.d.). Compendium of recommendations by the National Advisory Committee on Rural Health . Retrieved April 2, 2009, from http://ruralcommittee.hrsa.gov/nac_comp.htm
Rural Wisconsin Health Cooperative. (2009, February). Review and commentary on health policy issues for a rural perspective. Retrieved April 2, 2009, from http://www.rwhc.org/eoh09/February.pdf
Oregon Rural Health Association. (n.d.). Rural health disparities. Retrieved April 2, 2009, from http://www.orha.org/disparities.htm
Monday, March 30, 2009
Reform #3
Reform #3
Our third reform on outpatient and primary care will focus on increasing the number of community health centers (CHC). CHCs are not free clinics. They are community owned non-profit organizations which are funded by the Public Health Services Act. CHCs provide care to medically underserved areas and provide services for anyone needing care no matter their insurance status or their ability to pay. They provide primary care, preventive care and dental care in 3,650 sites across the United States. They follow a sliding fee schedule based on patient’s income and take direct or third party payments. CHCs improve access to preventive care and health status, provide high quality care and cost effective care, and reduce health disparities within the population. (Shi and Singh, 272)
The health disparities of the underserved population could be reduced with the growth of CHCs. CHCs have been shown to reducing the number of low birth weight babies and hospitalization for patients with chronic conditions, as well as increasing the amount of preventative women’s health services(Taylor). The addition of these clinics will not only increase the access to health care for the medically underserved population, but they will also increase the quality and access of emergency care.
Currently, emergency departments are overused for non-urgent and routine care; fewer than half the visits aren’t emergent conditions (Shi and Singh, 261). The Emergency Medicine Treatment and Active Labor Act (EMTALA) of 1986 is thought to be the key factor of this overuse. EMTALA requires all hospital emergency departments to see all patients and stabilize them if needed without considering their ability to pay. No other part of the healthcare system is required to accept everyone (Healthaffairs.org). Many people who don’t have insurance use emergency departments for their primary care because they can’t be turned away and most clinics won’t treat them. This results in crowding of the emergency departments, causing bed shortages, too few RN’s, and longer waiting periods. The improper use of the facilities and personnel increases the costs because the emergency departments were not set up to provide primary care (Shi and Singh, 272).
Adding more CHCs will allow the uninsured to received primary care without having to go the emergency department. Having fewer patients come into the emergency department will free up RNs and rooms. This will also shorten the waiting period for patients who are in need of emergency care and increase the quality of care given. The quality of care provided by emergency department will increase because the personnel won’t have as many patients to provide care for. The cost of the emergency departments will decrease because the inappropriate use of the equipment won’t be high as less patients use the emergency department for primary and routine care.
From 1988-2001 a study was done in Kansas looking at how CHCs effected care for uninsured patients and the effect on the local hospitals. This study found that within three years after the state started funding CHCs, the number of uninsured patients’ visits to the local hospital emergency departments decreased by around 40%. Ten years after the state funding started the number of uninsured patient visits to the emergency department are still 25% lower than prior to when the funding began. In that ten years the decreased visits of uninsured patients to the emergency department saved almost $14 million dollars (Smith-Campbell).
The use of more CHCs will provide compressive quality medical care for the underserved population in a cost effective manner. Over time, CHCs will not only increase the medically underserved access to quality healthcare but also everyone else’s. This will result from fewer patients using the emergency departments for primary care allowing the remaining patients to receive higher quality care.
References:
Delivering Health Care in America, Shi and Singh.
Healthaffairs.org: (http://content.healthaffairs.org/cgi/reprint/hlthaff.w4.146v1?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=emergency+department&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT ).
Smith-Campbell, B. "Emergency department and community health center visits and costs in an uninsured population." Pubmed. 22 Mar. 2009 <http://www.ncbi.nlm.nih.gov/sites/entrez>.Taylor, Jess. "The Fundmentals of Community Health Centers." National Health Policy Forum (2004). 22 Mar. 2009 http://www.aoa.org/documents/Fundamentals-of-CHC.pdf
Our third reform on outpatient and primary care will focus on increasing the number of community health centers (CHC). CHCs are not free clinics. They are community owned non-profit organizations which are funded by the Public Health Services Act. CHCs provide care to medically underserved areas and provide services for anyone needing care no matter their insurance status or their ability to pay. They provide primary care, preventive care and dental care in 3,650 sites across the United States. They follow a sliding fee schedule based on patient’s income and take direct or third party payments. CHCs improve access to preventive care and health status, provide high quality care and cost effective care, and reduce health disparities within the population. (Shi and Singh, 272)
The health disparities of the underserved population could be reduced with the growth of CHCs. CHCs have been shown to reducing the number of low birth weight babies and hospitalization for patients with chronic conditions, as well as increasing the amount of preventative women’s health services(Taylor). The addition of these clinics will not only increase the access to health care for the medically underserved population, but they will also increase the quality and access of emergency care.
Currently, emergency departments are overused for non-urgent and routine care; fewer than half the visits aren’t emergent conditions (Shi and Singh, 261). The Emergency Medicine Treatment and Active Labor Act (EMTALA) of 1986 is thought to be the key factor of this overuse. EMTALA requires all hospital emergency departments to see all patients and stabilize them if needed without considering their ability to pay. No other part of the healthcare system is required to accept everyone (Healthaffairs.org). Many people who don’t have insurance use emergency departments for their primary care because they can’t be turned away and most clinics won’t treat them. This results in crowding of the emergency departments, causing bed shortages, too few RN’s, and longer waiting periods. The improper use of the facilities and personnel increases the costs because the emergency departments were not set up to provide primary care (Shi and Singh, 272).
Adding more CHCs will allow the uninsured to received primary care without having to go the emergency department. Having fewer patients come into the emergency department will free up RNs and rooms. This will also shorten the waiting period for patients who are in need of emergency care and increase the quality of care given. The quality of care provided by emergency department will increase because the personnel won’t have as many patients to provide care for. The cost of the emergency departments will decrease because the inappropriate use of the equipment won’t be high as less patients use the emergency department for primary and routine care.
From 1988-2001 a study was done in Kansas looking at how CHCs effected care for uninsured patients and the effect on the local hospitals. This study found that within three years after the state started funding CHCs, the number of uninsured patients’ visits to the local hospital emergency departments decreased by around 40%. Ten years after the state funding started the number of uninsured patient visits to the emergency department are still 25% lower than prior to when the funding began. In that ten years the decreased visits of uninsured patients to the emergency department saved almost $14 million dollars (Smith-Campbell).
The use of more CHCs will provide compressive quality medical care for the underserved population in a cost effective manner. Over time, CHCs will not only increase the medically underserved access to quality healthcare but also everyone else’s. This will result from fewer patients using the emergency departments for primary care allowing the remaining patients to receive higher quality care.
References:
Delivering Health Care in America, Shi and Singh.
Healthaffairs.org: (http://content.healthaffairs.org/cgi/reprint/hlthaff.w4.146v1?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=emergency+department&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT ).
Smith-Campbell, B. "Emergency department and community health center visits and costs in an uninsured population." Pubmed. 22 Mar. 2009 <http://www.ncbi.nlm.nih.gov/sites/entrez>.Taylor, Jess. "The Fundmentals of Community Health Centers." National Health Policy Forum (2004). 22 Mar. 2009 http://www.aoa.org/documents/Fundamentals-of-CHC.pdf
Sunday, March 22, 2009
In High School I could have been considered a regular at the local hospital and physical therapy clinics. Tearing both of my ACL's and having various other injuries where medical attention was necessary, my parents couldn't have been happier that I had great health insurance coverage.
My history however, is something that is now slowly creeping up on me as I near college graduation. Once graduated and on my own, no longer covered as a student or under my parents, I will have to search for my own health insurance. But who will want to cover a young girl who's already had more surgeries than her grandparents? My oldest sister, who is now under her own health insurance, recently tore her ACL as well. Residing in California now, in order to get the best coverage she had to fly back to Wisconsin and stay at home while recovering. It may have not been the easiest route, especially traveling both ways on crutches, but it was the cheapest. I witnessed first hand what my surgeries could have been if not covered. Simple luxuries such as the hospital TV were not even covered for her, and the hospital kicked her out almost as soon as they had ripped the IV out of her arm. Now I watch her pay out of pocket just for the minimal care she received.
When comparing two family members that had the exact same injury, doctor, and facility; it's sad to see that our health care system can be so skewed. She is paying more but receiving less care than I did. There is a definite need for an outpatient health care reform and after reading your proposals, I couldn't agree more with your group.
My history however, is something that is now slowly creeping up on me as I near college graduation. Once graduated and on my own, no longer covered as a student or under my parents, I will have to search for my own health insurance. But who will want to cover a young girl who's already had more surgeries than her grandparents? My oldest sister, who is now under her own health insurance, recently tore her ACL as well. Residing in California now, in order to get the best coverage she had to fly back to Wisconsin and stay at home while recovering. It may have not been the easiest route, especially traveling both ways on crutches, but it was the cheapest. I witnessed first hand what my surgeries could have been if not covered. Simple luxuries such as the hospital TV were not even covered for her, and the hospital kicked her out almost as soon as they had ripped the IV out of her arm. Now I watch her pay out of pocket just for the minimal care she received.
When comparing two family members that had the exact same injury, doctor, and facility; it's sad to see that our health care system can be so skewed. She is paying more but receiving less care than I did. There is a definite need for an outpatient health care reform and after reading your proposals, I couldn't agree more with your group.
Sunday, March 15, 2009
Patient Guest Author
I recently started working at my first job after college and now have health insurance. Up to this point in my life I had never had health insurance. The company I now work for has a great insurance program and I do not have to pay anything per month. I have been to both the dentist and eye doctors so far. Both visits went extremely well. I was very pleased with both of the doctors. They were very friendly and helpful being a first time patient with them. I am now working on making appointments to visit a doctor for a physical and an oral surgeon to have my wisdom teeth taken out. These are appointments that I had put off until I could get health insurance.
I read your proposals and I think that you should mention the differences between rural and urban healthcare facilities more in your proposal. I used to live in a very rural area and when I would make dentist appointments, I would have to make them at least 3 months in advance. I now reside in a very urban area and was surprised to find that making appointments with doctors is much easier. On both occasions I called on a Monday morning and was able to get in for an appointment within a week. They were also very flexible with their hours to make it easier for me to get in so it wouldn’t interfere with work. I definitely prefer the doctors and healthcare facilities that I have now compared to the ones that I used to go to.
I read your proposals and I think that you should mention the differences between rural and urban healthcare facilities more in your proposal. I used to live in a very rural area and when I would make dentist appointments, I would have to make them at least 3 months in advance. I now reside in a very urban area and was surprised to find that making appointments with doctors is much easier. On both occasions I called on a Monday morning and was able to get in for an appointment within a week. They were also very flexible with their hours to make it easier for me to get in so it wouldn’t interfere with work. I definitely prefer the doctors and healthcare facilities that I have now compared to the ones that I used to go to.
Saturday, March 14, 2009
Reform Proposal #2-Quality of Primary Care
Not only is the access and availability of needed services important in outpatient care, but also the quality of care received is an absolute priority for citizens of the system. Decades of research have shown that good primary care reduces costs and improves outcomes, yet we have ignored these fundamental facts to our detriment. I will discuss our current quality of primary care in the United States and the reform we propose for our ideal universal health care system.
One of the first problems with our current primary care is the lack of family practitioners throughout the US. This causes increased stress on the clinician to see as many patients as possible, resulting in quick and inefficient visits. “In the United States, approximately 40.8 percent of the physicians work in primary care and the remaining 59.2 percent are specialists, according to 2003 data from the American Medical Association (US Bureau of Labor Statistics 2007).”
“The number of positions filled in family practice residency programs showed an increase during the first few years of the 1990s, but there has been a slow decline since 1998” (Shi, Singh, 133).
This is a very different ratio as compared to other industrialized countries where only about 25 to 50 percent of physicians are specialists (Shi, Singh, 134). Utilizing more specialty services usually includes the most up-to-date technology and services which results in higher expenses.
The need to change this unequal balance is very clear. To do this, we propose an incentive for medical schools to encourage students to practice in the field of primary care. This would be accomplished through increased financial awards and funds towards tuition and also towards schools whose curriculum incorporates concern and training in the areas of outpatient care.
Another way to increase the number of primary care doctors would be to offer a sign-on bonus for those who commit a minimum number of years as a primary doctor before pursuing specialization, if desired. If we had a universal system, these funds would come from the government.
A second problem related to the quality of primary care is the lack of education offered to patients and the over-utilization of ‘doctor’s visits.’ Our country has been so focused on the supply side of health care that the demand side has been ignored. What does this mean? Well, instead of putting all of the focus into the control of services, cost, technology, and other health care supplies, what about putting more effort into decreasing the demand for care.
A piece from a health care reform proposal entitled, ‘Beyond Health Promotion: Reducing Need and Demand for Medical Care, aligns well with the idea that reducing demand for care is ideal. It suggests that “an integrated system of population-based health care delivery would join the tenets of health promotion—self-efficacy, behavior modification, and long-term management of health and disease—with traditional approaches to diagnosis, treatment, and prevention” (Healthaffairs.org, 1).
One way to reduce the demand for care is to provide health education to patients and to promote personal involvement in their health and well-being. This can be done in many ways, two of which we will focus on. The first, is to utilize the vast amount of technological resources available. “E-health refers to all forms of electronic health care delivered over the Internet, ranging from informational, educational, and commercial products to direct services offered by professionals, nonprofessionals, businesses, or consumers themselves” (Shi and Singh, 166).
The amount of time and effort it takes to actually get into a clinic can be minimized or eliminated through email or other educational tools sent via the Internet between doctor and patient. This of course would not be right for every patient, but could definitely be utilized by those who have access to these types of technologies and in events where simple questions and other services can be relayed in this manner. Examples of the efficient use of E-health could include the sending of updates on blood pressures for a patient on a new medication, or for a young diabetic patient to ask a quick question concerning his/her new pump.
Another way to increase education and reduce the dependency on physicians would be to incorporate health educators into clinics and other health care facilities throughout the United States. They would act as buffers before patients see a doctor and could take some of the load off of clinicians. Some of the services they could provide could be training on the use of certain medical devices patients receive to monitor their illnesses and conditions, to providing nutrition education and dietary guidance to newly diagnosed diabetic patients.
References:
Healthaffairs.org
(http://content.healthaffairs.org/cgi/reprint/17/2/70.pdf).
Delivering Health Care in America, Shi and Singh.
One of the first problems with our current primary care is the lack of family practitioners throughout the US. This causes increased stress on the clinician to see as many patients as possible, resulting in quick and inefficient visits. “In the United States, approximately 40.8 percent of the physicians work in primary care and the remaining 59.2 percent are specialists, according to 2003 data from the American Medical Association (US Bureau of Labor Statistics 2007).”
“The number of positions filled in family practice residency programs showed an increase during the first few years of the 1990s, but there has been a slow decline since 1998” (Shi, Singh, 133).
This is a very different ratio as compared to other industrialized countries where only about 25 to 50 percent of physicians are specialists (Shi, Singh, 134). Utilizing more specialty services usually includes the most up-to-date technology and services which results in higher expenses.
The need to change this unequal balance is very clear. To do this, we propose an incentive for medical schools to encourage students to practice in the field of primary care. This would be accomplished through increased financial awards and funds towards tuition and also towards schools whose curriculum incorporates concern and training in the areas of outpatient care.
Another way to increase the number of primary care doctors would be to offer a sign-on bonus for those who commit a minimum number of years as a primary doctor before pursuing specialization, if desired. If we had a universal system, these funds would come from the government.
A second problem related to the quality of primary care is the lack of education offered to patients and the over-utilization of ‘doctor’s visits.’ Our country has been so focused on the supply side of health care that the demand side has been ignored. What does this mean? Well, instead of putting all of the focus into the control of services, cost, technology, and other health care supplies, what about putting more effort into decreasing the demand for care.
A piece from a health care reform proposal entitled, ‘Beyond Health Promotion: Reducing Need and Demand for Medical Care, aligns well with the idea that reducing demand for care is ideal. It suggests that “an integrated system of population-based health care delivery would join the tenets of health promotion—self-efficacy, behavior modification, and long-term management of health and disease—with traditional approaches to diagnosis, treatment, and prevention” (Healthaffairs.org, 1).
One way to reduce the demand for care is to provide health education to patients and to promote personal involvement in their health and well-being. This can be done in many ways, two of which we will focus on. The first, is to utilize the vast amount of technological resources available. “E-health refers to all forms of electronic health care delivered over the Internet, ranging from informational, educational, and commercial products to direct services offered by professionals, nonprofessionals, businesses, or consumers themselves” (Shi and Singh, 166).
The amount of time and effort it takes to actually get into a clinic can be minimized or eliminated through email or other educational tools sent via the Internet between doctor and patient. This of course would not be right for every patient, but could definitely be utilized by those who have access to these types of technologies and in events where simple questions and other services can be relayed in this manner. Examples of the efficient use of E-health could include the sending of updates on blood pressures for a patient on a new medication, or for a young diabetic patient to ask a quick question concerning his/her new pump.
Another way to increase education and reduce the dependency on physicians would be to incorporate health educators into clinics and other health care facilities throughout the United States. They would act as buffers before patients see a doctor and could take some of the load off of clinicians. Some of the services they could provide could be training on the use of certain medical devices patients receive to monitor their illnesses and conditions, to providing nutrition education and dietary guidance to newly diagnosed diabetic patients.
References:
Healthaffairs.org
(http://content.healthaffairs.org/cgi/reprint/17/2/70.pdf).
Delivering Health Care in America, Shi and Singh.
Monday, March 2, 2009
Reform Proposal #1
Our first reform proposal for outpatient and primary care will focus on the integrating of contemplative and alternative methods of care into what is offered for health care services and is covered by insurance companies. According to Medline Plus, complementary and alternative medicine (CAM) is the term for medical products and practices that are not part of standard care. “Alternative medicine means treatments that you use instead of standard ones. Complementary medicine means nonstandard treatments that you use along with standard ones” (Complementary).
Currently, most forms of CAM are not covered under health insurance plans. Individuals have to pay out-of-pocket for these methods of care. Because of this, many individuals don’t even think about taking advantage of the methods because they don’t want to pay full price, even if it would be beneficial to their health. While most of these types of medicine aren’t ridiculously priced, the continuous use of them could rack up the overall price. But, if they were covered under health insurance, the individuals would pay the smaller co-pay price and be able to use more outpatient care, which in the long run, is cheaper.
Some methods of care that should be covered under health insurance are massage therapy and acupuncture, chiropractic care, disease prevention and education, meditative practices, and psychiatric therapy. The benefits of massage therapy have been shown to include the treatment and relief of many chronic conditions along with relieving stress and tension of everyday living. Acupuncture has many benefits and it can be used with many other methods for treatment and relief. Some of the benefits of acupuncture include the treatment and relief of mild to moderate depression and some types of back pain and relief from nausea, arthritis, and some migraines.
Often times, chiropractic care can offer relief from problems that other methods of care are unsuccessful at. Some benefits of chiropractic care are decreased arthritis and joint pain along with pain relief from all areas of the body and greater mobility. When the body is realigned it relieves pressure throughout, allowing the body to begin to heal on its own.
The education and early prevention of disease is beneficial because it works towards catching and treating the issue before it is too late. Individuals need to be better educated when it comes to their health and more needs to be taught so they know what they can do to try and prevent the disease or detect the disease at an early stage.
Although meditative practices are not widely popular in the United States, they have been shown to be beneficial to health. Meditative practices, such as yoga and Tai Chi, enhance the immune system, help lower blood pressure, and lead to extreme relaxation. The types of movement that are involved in these practices are very good for the body, not only because of what has already been stated, but they also can increase mobility in individuals.
Finally, by allowing individuals to visit a psychiatrist that is covered by their health insurance, they are able to talk about their problems and issues, which could benefit the individual’s mental health. Depression is such a huge issue in the United States and many people who suffer from it lack proper treatment for it. By providing health insurance to see a psychiatrist, individuals are able to have their mental health problems diagnosed and treated properly so they can work towards better health as a whole.
The use of these methods will benefit the hospitals and insurance companies in the long run because by using these less expensive methods in the beginning health care providers can prevent or detect a problem early on. This way the patient doesn’t have to wait until a more severe issue arises where their only option is to be admitted to a hospital and go through numerous tests and/or procedures to try and take care of the issue. Once the patient is admitted to the hospital, the expenses that will be accrued could be astronomical depending on the types of testing and procedures that need to be done. But, if the individual would be allowed covered access to complementary and alternative outpatient care, they would have the opportunity to fix the issue early on and end up with less expenses.
Complementary and Alternative Medicine. (2009, February 25). Medline Plus. Retrieved February 26, 2009, from http://www.nlm.nih.gov/medlineplus/complementaryandalternativemedicine.html
Currently, most forms of CAM are not covered under health insurance plans. Individuals have to pay out-of-pocket for these methods of care. Because of this, many individuals don’t even think about taking advantage of the methods because they don’t want to pay full price, even if it would be beneficial to their health. While most of these types of medicine aren’t ridiculously priced, the continuous use of them could rack up the overall price. But, if they were covered under health insurance, the individuals would pay the smaller co-pay price and be able to use more outpatient care, which in the long run, is cheaper.
Some methods of care that should be covered under health insurance are massage therapy and acupuncture, chiropractic care, disease prevention and education, meditative practices, and psychiatric therapy. The benefits of massage therapy have been shown to include the treatment and relief of many chronic conditions along with relieving stress and tension of everyday living. Acupuncture has many benefits and it can be used with many other methods for treatment and relief. Some of the benefits of acupuncture include the treatment and relief of mild to moderate depression and some types of back pain and relief from nausea, arthritis, and some migraines.
Often times, chiropractic care can offer relief from problems that other methods of care are unsuccessful at. Some benefits of chiropractic care are decreased arthritis and joint pain along with pain relief from all areas of the body and greater mobility. When the body is realigned it relieves pressure throughout, allowing the body to begin to heal on its own.
The education and early prevention of disease is beneficial because it works towards catching and treating the issue before it is too late. Individuals need to be better educated when it comes to their health and more needs to be taught so they know what they can do to try and prevent the disease or detect the disease at an early stage.
Although meditative practices are not widely popular in the United States, they have been shown to be beneficial to health. Meditative practices, such as yoga and Tai Chi, enhance the immune system, help lower blood pressure, and lead to extreme relaxation. The types of movement that are involved in these practices are very good for the body, not only because of what has already been stated, but they also can increase mobility in individuals.
Finally, by allowing individuals to visit a psychiatrist that is covered by their health insurance, they are able to talk about their problems and issues, which could benefit the individual’s mental health. Depression is such a huge issue in the United States and many people who suffer from it lack proper treatment for it. By providing health insurance to see a psychiatrist, individuals are able to have their mental health problems diagnosed and treated properly so they can work towards better health as a whole.
The use of these methods will benefit the hospitals and insurance companies in the long run because by using these less expensive methods in the beginning health care providers can prevent or detect a problem early on. This way the patient doesn’t have to wait until a more severe issue arises where their only option is to be admitted to a hospital and go through numerous tests and/or procedures to try and take care of the issue. Once the patient is admitted to the hospital, the expenses that will be accrued could be astronomical depending on the types of testing and procedures that need to be done. But, if the individual would be allowed covered access to complementary and alternative outpatient care, they would have the opportunity to fix the issue early on and end up with less expenses.
Complementary and Alternative Medicine. (2009, February 25). Medline Plus. Retrieved February 26, 2009, from http://www.nlm.nih.gov/medlineplus/complementaryandalternativemedicine.html
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