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Quality in the U.S. Health Care System


Health care system is a vital element in any country assuring improvement of people’s health. Provision of high quality health care services is crucial in this process. Performance of the health care system depends on various factors, including funding of the health care organizations, provision of skilled and experienced doctors and staff, and supply with necessary technical devices and appliances, etc. Sources of funding of the health care institutions, either private or public resources, often determine quality and efficiency of the health care system. Efficiency of the U.S. health care system is extensively discussed and studied at various levels and groups of interest, including, economists, policy makers, health care practitioners, etc. Quality of the health care system in the United States is widely studied and researched. Enhancement of the health care information technologies, improvement in the existing legislation and defining the legal role and loyalty of physicians in the health care settings, role of the independent health care organizations are essential instruments to affect performance of the health care system in the U.S. Therefore, study of the factors affecting performance of health care system is essential in order to assure improvement of the quality of the U.S. health care system.


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Comparison of Qualities of the Health Care System across Countries

Quality of health care across countries is measured worldwide by means of the population health status, patient safety, and experience within health care services and other factors. In this regard, the comparison of these indicators allows observing how each country performs compared to other countries. According to some studies into the quality of health care among industrialized nations, the U.S. health care system performs relatively better in consideration of the life expectancy and infant mortality rates. Under the analysis, it relates to the costs incurred in health care and the medical care quality. Despite the fact that most industrialized nations offer uniform health systems, the U.S. does well with regard to insured people and the delivery of medical services (Harrington, 2008).

Currently, majority of the industrialized countries face the problem of  considerable increase in the health care expenditures. At the same time, there is evidence that substantial share of health spending in the national budgets is not always proportionate to the quality and efficiency of the health care system. Particularly, the question of overspending on health care is becoming more urgent in the situation when demand for funding in education and social spheres is increasing as well. The U.S. economy is considered to be one of those spending the largest amounts of financial resources on the health care.

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In this respect, there is evidence in the literature that the U.S. health care outcomes are not always ranking as high as its expenditures. In particular, . within the health care system in the States, compared to other industrialized countries, there are fewer physicians and hospital beds, and, therefore, less physician and hospital visits. At the same time, prices and prescription drug utilization are shown to be the highest in the U.S., as well as the utilization, supply, and cost of diagnostic imaging. Therefore, the U.S. health care performance is variable on a limited set of quality measures. It ranks high on preventive care, five-year cancer survival, is adequate on in-hospital case-specific mortality. However, it performs poorly on hospital admissions for chronic conditions and amputations due to diabetes compared to other industrialized countries (Squires, 2011).

Provision of Quality Health Care

For the provision of acceptable and quality  health care to all, the government must invest heavily in the health care system. This entails everyone’s accessibility to health insurance coverage and best medical services. In this regard, the government should allocate adequate funds for the industry and adopt standardized regulation in provision of the medical care. In addition, the country should engage in research and development that leads its health system to optimum levels (Schneider, 2011).

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Provision of the quality health care in the United Stated for every individual in the country can be attained with the improvements in the health care workforce as well as health care governance and leadership. It also requires improved individual access to quality health care services as well as affordable health care coverage. It needs transfer emphasis and focus on the community engagement and social determinants of the public health. Finally it should have an improved data system that ensures comprehensive capacity and accountability within the health care system.

The improvement of  health care workforce that would be representative of the communities  they serve is very important for the enhancement of the health care system performance and ensuring its coverage serves diverse and increasing minority population. This will also promote creation of a reasonably priced and sustainable health care system that produces good health outcomes (Schneider, 2011).

Setting up a diverse executive governance bodies and health care leadership is vital for implementing successful health care reform that would meet the needs of population, including diverse minority groups. It will also ensure the elimination of health disparities and inequities within the American population.

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Moreover, health care professional schools and universities should be inexpensive and must represent the diverse communities that they serve.  Curricula of the schools should promote transdisciplinary as well as multidisciplinary teaching methods, be team-oriented and community-responsive. This will ensure the availability of health care providers of the primary health care with necessary means of assuring equal access to health care of all citizens (Schneider, 2011).

There is a need to enhance the availability of a wide range of community-based interventions and programs that are designed to outreach diverse groups of the population, including vulnerable groups of people and minority communities. Organization of the patient-centered, linguistically and culturally experienced care across health care institutions must be encouraged through the financing system. Improvement of the health care infrastructure and health care facilities is another element and means of assuring nation wide coverage of the health care system in the United States.

Provision of Data

Health care delivery outcomes can be measured with the help of various indicators. Patient outcomes, comparative costs of health care, compliance with national standards for preventive and chronic care are acceptable measures of the healthcare delivery. They highlight the quality of the medical care provided to patients. In this regard, comparison of the above mentioned indicators can help in distinguishing a benchmark country with the best healthcare system. In addition, it allows policymakers and clinicians to identify areas that require improvement. Development of the health information technologies will support the delivery of a variety of patient-oriented care measures that are flawless and coordinated. Health information technologies data collection will assure quality and improvement of the health care system.

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Strategies of data collection should be designed to distinguish, measure, estimate, and address the social determinants of health within the framework of the health care system, as well as strategies to advance health care outcomes, encourage quality assurance, and eradicate health disparities and inequities. Developed strategies of the data collection and provision should be consistent and transparent.

Role of Physicians in the Health Care System Quality Analysis

Despite the argument that physicians are vital for the rating of the quality of hospital medical care, the concern was dismissed based on the lack of validity to the desired objective. The main reason in this regard included the fact that physicians measure medical care quality based on the medication facilities available in the hospital and the successes in medical treatment (Shi, 2010). In this regard, some of the factors that related to patients needs included insurance covers, the satisfaction of medical services received and uniform access to quality healthcare by everyone. In addition, physicians feared being subject to law due to malpractices.

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Bearing specialized knowledge, jointly with obtained medical judgment and approval of the needs of the individual patients, physicians carry out a function that is legally recognized unique. All over the country, physicians are granted with a legal status that is distinct from the status of other practitioners. They are certified to execute the functions that can be also performed by other practitioners, e.g. optometrists, podiatrists, nurses, physical therapists, and even psychologists. Physicians are not only legally allotted with wider scope of practice compared to other clinicians, but also sanctioned and even anticipated to manage others’ performance.

Consideration of these values is essential to appreciate and estimate physicians’ work in bearing the basic issues of clinical accountability and quality of health care. These values symbolize the key difference that physicians can bid. Therefore, accountable health care institutions have to take into account and solidify physicians’ credibility ((Shi, 2010)).

Moreover, in the relationships between a doctor and a patient, physician exercises a legal, clinical and also ethical responsibility for the patient  requiring a medical care.  This responsibility is principal and vital for effective work of the health care institution. Currently, physicians consider that primary loyalty has altered since physicians have been assigned with accountability for outcomes of the populations’ health, as well as they are considered to be responsible for the appropriate consumption of resources.

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However, the legal responsibility imposed on the physicians for their incapability of delivering good health outcomes and provision of effective health care services to the patients  creates additional pressure on them.

National Committee on Quality Assurance

The National Committee for Quality Assurance is a non profitable private organization that is developed with a purpose to improve the quality of the health care system delivery. It was founded in 1990 and since that time, National Committee for Quality Assurance has been a fundamental body in the process of health care system improvement throughout the country.

The seal of the National Committee for Quality Assurance is an extensively accepted symbol of health care quality. Health care organizations that incorporate the seal of the Committee should first pass a thorough and comprehensive review. Also, they need to submit annual reports about their performance. With respect to consumers of the health care services, the seal of the Committee is a trustworthy indicator that a health care institution is well-managed and that it delivers medical services of high quality.

National Committee for Quality Assurance has helped to create mutual understanding regarding relevant health care quality issues. It incorporates in its organizational structure policymakers, large employers, patients, and health plans. All  stakeholders are responsible for making decisions regarding measures of the health care quality and ways of its improvement.

Contribution of the National Committee for the Quality Assurance to the quality improvement of the health care system is crucial and considerable. For the last five years, measures of the health care quality in the United States have improved. However, it constantly sets new goals for further improvement. Currently, accredited health plans have to follow thorough set of more than sixty standards. Also, in order to receive approval of the Committee, they should report on their performance in more than forty areas. New standards will support the implementation of strategies that will advance care, improve services and cut costs.

The National committee for Quality Assurance evolved from a managed care organization credentialing to an independent organization credentialing. With this change, many pros emerged.

Pros and Cons of Credentialing by an Independent Organization

Initially, the independent organizations provide a cost-effective plan accessible to the majority of people who demand the maintenance of services. In this case, citizens’ accessibility to healthcare improves the health care systems standards (Merino, 2011). Similarly, the independent organizations would assist physicians by participating fully in the provision of services without the risk of being subject to lawsuits based on selective discrimination or  uncompetitive behavior. In addition, the independent organizations allow even distribution of medical practitioners, which facilitates the delivery of services in all parts of the country.

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On the contrary, one of the demerits of the independent organizations credentialing involves the physicians influence on service delivery. Additionally, it does not address fully the patients’ needs.

Medical Technology

Medical technology plays a significant role in the communication between healthcare providers and patients. With the advancement in the technology utilized in hospitals, there has been considerable improvement in healthcare services delivery. In this regard, healthcare providers can keep and refer to the data relating to patients’ medical details. This will facilitate the improvement of service delivery. In addition, technology improves the manner in which patients can communicate with health providers regarding any of their concerns (Shortliffe, 2006).

As a result, the utilization of technology improves the level of services delivery through increased efficiencies. In this regard, resources and the time used to conduct communication significantly declines. This minimizes the healthcare operation costs while improving its quality. Generally, all citizens will have equal accessibility to quality services.

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To sum up, quality of health care across countries can be measured with various indicators, including health status of people (e.g. life expectancy, infant mortality, crude mortality, morbidity, etc.), indicators of patients’ safety. Application of these indicators to the analysis of health care system performance in various countries allows comparing quality of health care systems worldwide. Statistical data indicate that a lot of industrialized countries are spending considerable amounts of financial resources on health care. However,  a lot of studies have shown that excessive expenditures in the health care sphere are not always associated with effective and quality health care services. Health care system in the United States is not an exception. In particular, evidence shows that even though USA ranks to be the top country in the health care expenditures among other industrialized countries,  its efficiency in the preventive and primary medical care is rather limited.

Currently, U.S. government is implementing a series of reforms in order to increase efficiency of American health care system. In 1990 with this purpose the National Committee for Quality Assurance has been created with the purpose to improve the quality of the health care system delivery. Since it was developed from a managed care organization to an independent organization credentialing it has considerable improved quality monitoring and control.

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Medical technology and information has improved considerably over the course of the last two decades. This has enables health care system to improve its performance and quality of services. Therefore, resources and the time used to conduct communication significantly decline with the extensive application of new and enhanced medical technologies. Hence, it minimizes the costs of the healthcare operation costs. However, at the same time it provides health care system with possibility to improve health care services quality and efficiency. 



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