Question

Describe and explain why the USA health system is considered to be neither a decentralized health market nor a centralized health system and what is the impact on health care reform of the combined federal-state responsibility with substantial federal oversight and funding, imbued with state innovation and implementation?

Answer 1

Answer:

It's that we at Health Catalyst believe in a concept that Reed Hastings, co-founder and CEO of Netflix, refers to as “highly aligned, loosely coupled.” Highly aligned means everyone in the organization shares the same specific strategic goals, and that team interactions are focused on strategies rather than tactics.

The Pros of Centralized Health Care

1. Cheaper Health Care Costs.

Centralized health care reduces the cost of health care for everyone. It can be a great way to make health care affordable for everyone including the government that subsidizes most of the health care under a centralized health care plan.

People do not realize that a big part of their health care is already subsidized by the government. They think that centralized health care will actually drive costs up but the reality is that it will actually bring health care costs down.

2. Connected Care.

Centralized care makes getting the right care easier and also can make diagnosis more accurate. When every doctor that you see has immediate access to your health records it means that a lot less time has to be wasted by the doctor or nurse collecting your health history.

It can also help improve upon the accuracy of diagnosis which in turn not only gives you better health care but it also saves money on costly tests that may not be necessary.

3. Equal Health Care Opportunities.

Equal health care is available to all the different socioeconomic groups regardless of standing or finances. A centralized health care system would mean that money would be a lot less important in seeking top medical treatment.

The Cons of Centralized Health Care

1. Long Waits.

One of the biggest problems in countries that use a centralized health care system are the waits for non emergency services. For example if you have a health condition that requires surgery but it is not a life threatening situation is Wales you can spend up to 6 months waiting to be able to have the surgery.

For people that DO NOT have health conditions that need continued treatment getting an appointment can also be met with long waits.

2. A Decline in Capitalism.

Capitalism is built on the idea that the harder you work the more successful you will be. Centralized health care systems typically set cap off prices on what a doctor or health provider can charge. By setting these limits you remove the need for health care providers to compete and excel. It can actually back fire and make health care providers lack a desire to achieve.

3. Over Sharing of Information.

A centralized health care system would leave a lot of “cooks in the kitchen”. There would be a great deal of people that would be able to see health records in direct violation of hard won HIPPA laws. Some opponents fear that health information could be used to create a bias.

Decentralization of health systems

Decentralization of health systems is a common pillar of health sector reform initiatives and is often viewed as a means to improve efficiency and quality of services as well as promoting accountability and local governance of the health system. Despite many years of health decentralization initiatives in many countries worldwide, our knowledge of the relationships between particular forms of decentralization and performance of health systems remains limited. For instance, does decentralization help, hinder or have no impact on equity in resource allocation? Or are there relationships between decentralization of logistics systems and health sector performance? Part of the difficulty in addressing such questions lies in the inherently contextual relationship between decentralization and health systems performance, as well as the difficulty in untwine decentralization from other health sector reforms

The Promise of Decentralization

Health sector decentralization has become appealing to many because of it has several theoretical advantages.

• a more rational and unified health service that caters to local preferences
• improved implementation of health programs
• decrease in duplication of services as the target populations are more specifically defined
• reduction of inequalities between rural and urban areas
• cost containment from moving to streamlined targeted programs
• greater community financing and involvement of local communities
• greater integration of activities of different public and private agencies
• improved intersectoral coordination, particularly in local government and rural development activities.

Health Care Reform

The efficiency of our complex and fragmented patient-care effort. With more than 17.6% of our gross domestic product (GDP) devoted to medical care and approximately $1 trillion of that cost borne by taxpayers, the ACA represents a structural change that will challenge both public and private insurance programs to meet these stated goals. The changes inherent in this reform initiative offer stakeholders numerous opportunities, but they also present challenges to many aspects of their current business model.

Although a number of ACA provisions will not be implemented until 2014, several components of the law that encourage risk sharing among providers and the CMS will become a reality in the next 2 years. Final rules for Accountable Care Organizations were released in October 2011 with the intent of providing guidance for organizations willing to assume financial responsibility for the total care of Medicare beneficiaries. If the Medicare experiment with ACOs is successful, a fundamental shift to this form of performance-based care is likely. The ability of pharmacy providers and managers to demonstrate and document value to these ACOs represents a significant opportunity to expand the current scope of practice and to begin formulating models of pharmacist-service reimbursement. The value that medication therapy managers bring to patients in these ACOs could radically transform pharmacy practice from a product-reimbursed profession to a service-reimbursed one

Conclusion:

Market forces in the health care delivery system continue to evolve, as do legal and regulatory changes resulting from health reform legislation. Health care organizations need to maintain their diligence in gauging, as well as following, emerging regulatory guidance and rules in addition to federal and state laws. This complexity of the health care regulatory environment is not likely to abate soon; therefore, it is expected that professionals who are responsible for health care administration will need to direct their attention to the legal environment as part of their duties.

As changes occur, this column will keep readers abreast of policy and legal updates that affect health care professionals.