The main purpose of any health care system in the world is to provide health services to the people with an aim of ensuring the entire population remains in a healthy state. As simple as it may sound, the United States’ health care system is a conglomerate of several players, with each providing distinct services at different stages. The major stakeholders within the system include the patients, health care providers, the government, pharmaceutical companies, insurance companies, and employers. All these stakeholders contribute towards one or more of the basic components within the system, that is, delivery, financing, insurance, and payment (DeNisco & Barker, 2016).
However, DeNisco and Barker (2016) pointed out that most of these stakeholders in the U.S health care delivery system only care to serve their own interests at the expense of the bigger picture that could have otherwise ensured universal access to affordable and quality healthcare services. These competing visions among stakeholders need to be looked into in order know exactly how they impact on the delivery of health care services.
Conflicts Amongst Stakeholders
To fully understand how the conflicts arise, it is vital to first get a foothold of what the positions and aims of the different stakeholders are. Insurance companies thrive on their ability to sell health coverage policies to individuals, either directly or indirectly. This can either be achieved through contracted government intermediaries or through the employers who purchase health insurance for their workers.
These programs by employers are facilitated by deductibles and co-payments that include the employees, all with an aim of ensuring their employees remain in healthy conditions for an optimal output at work. Similar to the insurance companies, pharmaceutical organizations are also money-oriented when it comes to developing and marketing of medications that are meant to be used by the patients. This is by virtue of these corporations being privately owned or publicly listed companies whose shareholders expect return on their investments. For the pharmaceutical companies, they gain from government drug benefit plans or when individuals purchase medical insurance.
According to the American Nurses Association (2015), physicians have an ethical responsibility of ensuring patients get access to proper medical care and are obligated to do everything possible within their abilities to ensure this is achieved. From this, it is assumed that the physicians are at the service of the patients who should expect services that would lead to the best health outcomes at all times.
Still on the delivery, health care facilities provide necessary resources that physicians can make use of as they attend to the patients. Finally, the government is obliged to ensure the citizens get access to affordable quality health care services and would, therefore, come up with and enforce policies to facilitate the same. Clearly, as noted by Edwards (2010), the visions of these stakeholders are not in line with each and are the source of the conflicts that exist within the system.
One of the major sources of conflict in the health care delivery system are the policies that are intended at reforming the health insurance sector. In its old state, the health insurance sector had high levels of uncompensated Medicaid expenses as well as charity care in many hospitals (Edwards, 2010). Moreover, such reforms were aimed at expanding the government subsidy programs to incorporate more individuals who were previously locked out. The challenge, however, comes in at two different levels.
In Massachusetts, hospitals came to the realization that the behavior of individuals could not simply be altered by government legislations when they encountered low enrollments into the new health programs that offered insurance to millions who were previously uninsured (Edwards, 2010). This required the hospitals in the area to incur extra costs by employing fulltime staff who would explain and enroll clients into the programs.
Secondly, according to Edwards (2010), health facilities were faced with uncertainties over the possibility of an influx of patients who would overwhelm the health facilities following the increased insurance coverage. This meant that hospital administrators were unsure of whether to increase the capacity of their facilities or not.
An efficient and effective health care delivery system is as good as the availability of qualified physicians to provide the health care delivery services. Following the policy offering millions of previously uninsured cover a medical insurance, more individuals are expected to seek medical attention in a proper health facility.
This gives the hospital administrators a staffing problem as there is an unprecedented shortage of qualified physicians. The conflict arises from the fact that, unlike the government policy that can be passed in a short time, training of doctors takes quite some time. This means that the available physicians will have to shoulder the weight of the extra duties that come their way.
Birk (2010) noted that evidence-based decision making has become prevalent in the healthcare delivery system in the U.S. Despite health being a basic need, health care costs are very high, mainly as a result of the increased costs of medication and tests using the latest technologies. In the recent years, the government enforced a policy that required all medical practitioners and health care organizations to fully document all the procedures and care that they provide patients with, and provide reasons for these actions. This is aimed at reducing medical costs by eliminating unnecessary procedures and tests. This causes a conflict between the visions of the pharmaceutical agencies and hospitals, and the payers. Additionally, physicians prefer to have minimal interference with their work (DeNisco & Barker, 2016) but the evidence-based practice serves as a scrutiny to how they conduct themselves.
In most cases, the high medical costs have meant that individuals would prefer to look out for an employer who will cover most of their medical expenses. Besides, it is their desire that the employer will provide several options to an individual so that they can select the most suitable insurance cover that suits their needs.
However, this view is hardly shared by the employers whose aim is minimizing the cost so as to increase their profit levels. Thus, employers mostly go for plans that only serve the basic medical care of the employees.
The U.S health care system is clearly a fragmented sector whose stakeholders are working towards their individual goals instead of aiming towards proper medical care. For some like the insurance companies and pharmaceutical agencies, money is their driving force, whereas the government and patients focus on affordable and quality medical care. Clearly, to achieve the best outcomes, the visions of the various administrators ought to be streamlined.
American Nurses Association. (2015). Code of ethics for nurses with interpretive statements (2nd ed.). Silver Springs, MD: Author.
Birk, S. (2010). The evidence-based road: Available data can drive successful community benefit programs. Healthcare Executive, 25(4), 28-36.
DeNisco, S. M., & Barker, A. M. (2016). Advanced practice nursing: Essential knowledge for the profession (3rd ed.). Boston: Jones & Bartlett.
Dinkin, S., Filner, B., & Maxwell, L. (2013). The exchange strategy for managing conflict in healthcare: How to defuse emotions and create solutions when the stakes are high. Maidenhead: McGraw-Hill.
Edwards, R. (2010). Access. Hospitals & Health Networks, 84(8), 16-19.
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