I. Incremental Versus Comprehensive Reform
The present health care system can not continue. There are so many citizens without basic services. The costs continue to escalate, and the level of quality care keeps going down. The approach; to continue with incremental strategies versus a comprehensive overhaul of the system, remains the controversial question. We need to determine what level of resources should be allocated to health care, and how they will be distributed to the people. The “standard” health quality of life for each person would need to be established. The acceptable quality of life is based on each person's subjective interpretation of this concept. The other determinate factors that may influence this standard include: the patients' environment, his acceptance of poor quality care, or the naivety that better quality care possibilities exist.
The attempt to achieve universal coverage with a health care voucher program would support the idea that health care is a basic right. This monumental undertaking would require a total restructuring of the health care system. The vouchers would eliminate employer based insurance in the more than half of this nations insured (2005, Fuchs and Emanuel). The purchase of health care would become mandatory for all citizens. The control of the health care market would shift to the hands of the government. This loss of control over one's free choice of health care and a non-competitive market may not support the individual's quality of life. It will, however, attempt to support the basic right of health care to all citizens.
The goal with incremental reform is to provide more of the uninsured with a basic health plan, thereby increasing their quality of care. The two major components are mandates that would require more employers to offer workers health insurance, and the subsidies for the uninsured to off set the purchase of plans. The basic health plans would more affordable but they would make use of larger deductibles. The expansion of health savings accounts and transparency pricing would encourage patients to make more cost effective choices with their purchases of health care.
II. Allocation For Public Versus Private Health Services
Quality of life measurements can be used to allocate health resources from the private to the public sector. The management of finite resources to achieve maximum health benefit for both the individual and the entire population require the recognition of limits on the availability of these benefits. Many areas of public health provide more value for the overall health of the public. The allocation of resources for immunizations is one such example that increases the overall health of the public. The outcomes are not always so easy to evaluate and compare objectively.
The economic evaluation of health services can assess the costs and savings realized from a particular alternative as compared to the current treatment. It can provide answers to questions such as, “Does the benefits of the alternate treatment out weight the increased costs?” The cost-effective analysis between treatments does not take into account the level of overall health that would be gained by the intervention. Alternately, the cost-utility analysis has the ability to measure this improvement in quality care. This evaluation requires the conversion of outcomes to common units of measure, such as, the quality adjusted life years (QALYs) or the EQ-5D instrument that measure quality of life (2005, Douglas and Normand).
The QALY formula produces a quality of life index that can assist in health care allocation decisions. The index assists the provider in prioritizing patients to the available benefits. Tool limitations include: the emphasis on efficiency rather than care, and the treatment of the young versus the old. The incorporation of a health professional with any application of the QALYs system ensures respect for the patients. The publics' needs can be addressed with the application of the QALY formula if care is taken to consider their values. The key to the system is to use a true representative sample of all segments of the population for each index calculation.
III. Ethical Underpinnings Of Resource Allocation
The ethical predicament associated with the allocation of health care is rooted in the fair distribution of these limited resources. The values of health care professionals dictate that they provide all necessary care to patients. It is not possible to provide all services to all patients with the existing scarcity of resources. The dilemma becomes, “Who will receive treatment and who will not?” The health care system must adapt to a systematic process and determine priorities without imposing on the providers' professional obligations.
The responsibility of health professionals is to promote the best health care interests of their patients. They must become true advocates to their patients by enlisting all possible resources to attain a prescribed level of care. The allocation of resources places limits on this level of care, thereby establishing a more universal standard.
The application of the QALY can be used to assist the health care professional in providing ethical and fare allocations of these resources. The approach considers both the quantity and quality of life associated with a specific treatment. However, the added value a person receives from an intervention is based on their own perception of its added benefits. Systems that focus merely on efficiency run the risk of diminishing the quality of life of patients with intractable diseases. The assumption that patients with cancer are not able to attain long lives, with the correct treatment, would be incorrect. The tendency to treat the younger versus the elderly because they have more years of life left to live lacks foresight. These actions would not be reflective of the values that our society places on each citizen. The goal should be to distribute the resources to the patients based on the public's moral values.
IV. Business Development Opportunities For Health Providers
The opportunity to solve the health care industry quality and safety issues could be the single most significant area. The establishment of a universal standard of quality would force providers to change how they practice. This would require mandates of transparency within their practice settings. Each health care system would be forced to provide research based care rather than all possible care regardless of the impact. One of the key components would be a root cause analysis to determine required process improvements. The elimination of poor quality providers would be the direct result of increased competition.
There is a need to develop a measure for quality of life similar to the QALY. The national application of a quality of life measure would establish a standard of care for the population. This formula could offer the provider additional practice knowledge in providing value to their patients' health. They would be able to effectively compare multiple interventions with this “factor.” The ability to match the appropriate therapy to each patient that affords the highest quality gain would become the focus.
The opportunity to integrate lean management techniques in the major health care facilities would significantly decrease health care costs and increase quality. The application of lean management principles within the health care industry has the potential to save this country one trillion dollars (2009, Toussaint). The success of this venture would require a change in the current payment system. For example, Medicare pays ThedaCare Center on average $2,000.00 less per patient for operating more efficient system of care (2009, Toussaint). The shift of reimbursement payments based on quality rather than inefficacies would increase the incentive for providers. The facilities would then engage in the lean principles by making essential systematic changes. The result would be a higher level of quality at a lower cost.
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