Health care
Health care in America has a long and complicated
history. Health care originated with the industrial revolution as a mean to
protect workers from financial and job losses due to injuries and illnesses. However,
this form of illness protection was not an organized structure; in fact, the
decision on protection was made on a trial and error basis.
Health care system became organized in
the early 1900s not through government efforts but organizations such as
American Medical Association. Similarly, labor organizations became involved
with advancing health care through legislations targeting working class and
low-income citizens including children. However, their efforts were objected by
some medical societies, despite initial support of the AMA, who were concerned
about compensation for doctors. The opposition forced the AMA to pull their
support of the bill, and soon after union leaders and private insurance industries
followed suit.
Post World War I and the Great
Depression, health care debate heightened. As the governments worked on health
insurance bills, the medical organizations opposed national health systems.
World War II brought the notion of employer-sponsored health insurance, however,
left the unemployed, retired and disabled out and vulnerable. This lead to a
push from some government official for a national health care system. Once
again, the bill was met with opposition and was rejected.
The evolution of health care throughout
the 20th and into the 21st century has resulted in a
fragmented and profit-driven system that largely ignores its consumers. A
paradigm shift in health care is urgently needed that puts the consumers of the
health care at its core as the main stakeholders and in the center of the ongoing
debate.
Shift in Focus
|
|
Taken from: PublicDomainPictures.net
In addition to changes and shifts in the focus of health care reform from the cost and access standpoint, there is a crucial need to shift the healthcare focus from disease-centered to patient-centered and value-based care. This shift in focus will benefit all segments of the population who have varied and differing, yet value-driven, needs and will result in personalized and precision care beyond the genetics and medicine.
Patient-centered care is a model where
patients and families’ preferences and wishes are taken into consideration and
addressed. Patient centered care allows patients to have an active engagement
in the decisions about their own care, and therefore, will result in patients’
satisfaction with overall health and wellbeing regardless of illness
trajectory.
A research conducted by
the Picker Institute and Harvard Medical School emphasizes that patient-centered care should encompass the
following eight elements:
1. Respect for patient’s values, preferences and
needs: involving patients in all aspects of decision making and emphasizing the
uniqueness and cultural values of individual patients
2. Coordination and integration of care:
recognize and alleviate patient vulnerability and powerlessness during illness
by coordinating patient and clinical care, as well as supportive services
3. Information and Education: on illness status,
process and progression as well as pertinent information on self-care and
health promotion
4. Physical comfort: pain management, assessment
and assistance with ADLs
5. Emotional support: alleviating anxiety
associated with illness and its sequel
6. Social Support: identification, recognition,
involvement and support of family and friends
7. Continuity and transition: information about
and continuity of health care needs such as treatments, medication and services
as well as preventive care such as nutrition and physical activity, and
financial support
8. Access to care: access and availability of
routine and specialized care as well as instrumental assistance and access,
such as ease of scheduling, referral and transportation
IOM Report of PCC
Institute of medicine (IOM) defines
PCC as “Providing care that is
respectful of, and responsive to, individual patient preferences, needs and
values, and ensuring that patient values guide all clinical decisions.” IOM has emphasized that in order to change the
health care system, the health care must be:
1. Safe: care should not harm or injure people;
“first do no harm”
2. Effective: care should be based on scientific
knowledge, beneficial and avoid under- or over-use of treatments
3. Patient-centered (human dimension of health
care): care that is respectful, responsive and takes into account preferences,
needs and values to guide clinical decisions
4. Timely: care that avoids delays and barriers
to patient care
5. Efficient: care that eliminates waste in all
forms
6. Equitable: care and services that is accessible,
and of quality, to all
What is Value-Based Health care?
Value-based health care is a model
where health care entities and providers are paid based on patient outcome and
improvements in their health while reducing cost and chronic disease incidence.
In this model, maximizing the care value for patients and families is at the
core of strategies to reform health care delivery.
Where do we go
from here?
The future of health care should
incorporate the shift in vision of health and well-being to incorporate value
and quality as it is defined by individual patients and those who are affected.
With the increase in chronic illness and the aging of the Americans, the need
for value-based health care is more crucial than ever. It is an empowering
agenda and a “herd immunity” for the rising cost of health care.
Links and sources:
Committee on Quality of Health
Care in America, & Institute of Medicine Staff. (2001). Crossing
the quality chasm: A new health system for the 21st century. National
Academies Press.
Griffin, Jeff. “The History of
Healthcare in America.” Employee Benefits Consultants - JP Griffin Group,
7 Mar. 2017,
www.griffinbenefits.com/employeebenefitsblog/history_of_healthcare.
“What Is Patient-Centered Care?” NEJM
Catalyst, 18 Apr. 2019, catalyst.nejm.org/what-is-patient-centered-care/.
“What Is Value-Based Healthcare?” NEJM
Catalyst, 17 Apr. 2019, catalyst.nejm.org/what-is-value-based-healthcare/.
No comments:
Post a Comment