Radiation Therapy in the United States

This is a very interesting blog. Certainly there are many discrepancies in the US Health Care System. In the field of radiation therapy, I noticed that at times it is difficult for patients to receive approval from their insurance companies for the recommended treatment especially if it uses the newer technologies. Often insurance companies will pay for sub-standard therapy treatments that either cause greater morbidities to the patient or are not as effective in killing the tumor. While I agree that technology is advancing rapidly and all technologies are not needed, it is important for all patients to be able to receive the most advanced care possible. I fear that if health care is universalized that it might actually inhibit the advancement of technology and cancer research because the newly found technologies would not be approved by the government. Therefore, if there is going to be universal health care, the government needs to see to it that they stay on top of the technologies in various field in order to continue to provide the very best treatment possible to patients in their fight against cancer. It would be a large disservice to cancer patients if they were only able to receive sub-standard treatment because of universal health care regulations.

Access to Health Care

The term access refers to availability and ease of attaining health care. Access to health care means that when you are in need of medical attention, it is there for you anywhere you are. Access is there for you with a reasonable price, good service, accurate information, and appropriate actions. Currently there are about 46 million Americans without access to health care. You might ask how that is possible when the United States, out of all the countries in the world, spends the most on health care. United States is currently spending 16% of its GDP on health care. How then is the United States lacking in the number of citizens with health care plans?

We believe that access to health care is a right to every resident in the United States. United States is behind every other developed county in the world in number of people covered by health care plans and yet somehow spends the most money on health care. Many other nations like Germany, Japan, and UK have universal coverage. Universal coverage means that every resident in those countries is covered. Also, according to the total health care expenditures chart above, all those countries providing universal health care spend half as much as the United States to do so. The Organization for Economic Cooperation and Development (OECD), compares many trends among 30 industrialized countries. Some of these trends include spending per GDP, supply, number of physicians per certain size population, etc. The OECD has determined that Americans don’t have access to a greater supply of health care resources than most other OECD countries, even though America spends the most. OECD determined that the United States has fewer per capita hospital beds, physicians, nurses, and CT scanners than the OECD median. The U.S also had more malpractice claims than Canada, UK, and Australia. In 2001 alone, the number of malpractice claims cost the U.S and estimated $6.5 billion dollars, which is only 0.46% of total health care spending.

The United States government needs to act on the access portion of health care quickly. They fall behind every other developed nation in the world. As we stated in out political stance, the United States needs to push towards universal health care. There are many small steps that can be taken to do so. Laws can be passed to control the amount of money physicians can charge per visit. Physician costs per visit and for the procedures they perform rise every year. Laws can be passed to get rid of independent health insurance companies. The government can slowly begin to take control over health care expenditures for every resident. Like Canada for example, their taxes are a little higher but the government pays for every single health care need for every resident. The higher taxes makes up for not having to deal with insurance companies and being covered for health care at all time, no matter what the need, anywhere in Canada.

The changes that need to occur to improve access include: changes with the government policies, changes with insurance companies, changes in taxes, and changes in the residents of the U.S with attitudes towards a little higher taxes. Many things will need changing, the residents of the U.S will need to adapt to the change because the changes should ultimately lead to universal health care access. The quality of health care in the United States is one of the best in the world. The education is exceeding expectation, and the technology is like in no other country. There are a few defects in quality with a few things such as the U.S life expectancy is not as high as other countries, obesity is greater in the U.S, and the number of babies dying each year is a little high.

The cost of health care, is done correctly, should essentially decrease. Currently everything in the United States works as a competition, who can make the most money. Physicians increase their prices periodically along with insurance companies. The prescription drug expenditures has been seeing the greatest rise in recent years. Government needs to take control over the salaries of health care workers and needs to take control over all hospitals. Controlling both salaries and hospitals, the government can make a set cost of health care and the usage of hospitals. This way there is no competition, everyone makes the same amount of money, which will still be plentiful, and coverage will be provided to all.

Access to health care is a right that every resident should have, and currently 46 million do not. Changes need to occur to provide every resident health care along with a reasonable and affordable price. Changes should be made to improve to universal health coverage. By controlling the salaries of physicians and hospitals, the U.S can place physicians and hospitals in rural areas where the population is not as high, providing access to those people.

Resources

Gerard F. Anderson, Ph.D., Peter S. Hussey, Ph.D., Bianca K. The Commonwealth Fund (2005), “Health Spending in the United States and the rest of the Industrialized World.” Retrieved March 30, 2009 from http://www.commonwealthfund.org/Content/Publications/In-the-Literature/2005/Jul/Health-Spending-in-the-United-States-and-the-Rest-of-the-Industrialized-World.aspx

Health Care Marketplace Project. The Kaiser Family Foundation (2007), “Health Care Spending in the United States and OECD countries.” Retrieved March 30, 2009 from http://www.kff.org/insurance/snapshot/chcm010307oth.cfm

Samuel D. Uretsky. Med Hunters (2008), “Health Care in the United States.” Retrieved March 30, 2009 from http://usworkforce-mg.blogspot.com/?zx=3ae89a99a49f8670

National Coalition on Health Care (2009), “Health Insurance Costs”. Retrieved March 30, 2009 from http://www.nchc.org/facts/cost.shtml

National Center for Health Statistics. Center for Disease control and Prevention (2008), “NCHS Data on Health Insurance and Access to Care”. Retrieved March 30, 2009 from http://www.cdc.gov/nchs/data/infosheets/infosheet_hiac.htm

Addressing the Issue of Quality

Authored By Shawn Morgan

For quality, health care focuses on the outcome of services provided rather than individual behaviors. Therefore, the health care community should start to pay more attention to developing standards of quality. The U.S. has become obsessed with developing state of the art technology. However, this can be beneficial and also harmful. At least to a small degree, we need to try to overcome our obsession with technology and focus on achieving the standards of care that are currently being overlooked. Essentially, we need to build a strong quality base for our new procedures to stand upon. In return, millions of dollars should be saved by not pouring as much money into new technology.

Currently, hospitals monitor quality using HEDIS (hospital report cards), but many things still go wrong. According to the Joint Commission for Safety in 2005, 88 cases were reported of wrong side procedures.1 This statistic is obviously staggering and completely avoidable with better assurance of quality. HEDIS are a good start, but we need to also get the opinion of people who do not have access to healthcare.2 Unfortunately, Americans without access to health care consists of almost 46 million people.3 For this reason, some may argue that access is possibly a more pressing matter. However, quality and access truly go hand in hand. Once all Americans gain access, quality will be most important because it measures the services provided.

Maybe the best way to insure quality would be to turn it over to the government to be monitored. The government could establish protocols for all hospitals and clinics for specific procedures. These protocols could be published for each individual profession and created by operational management or a cabinet concerned with quality. Failure to comply with such protocols could result in legal action, which would thereby insure quality.

Quality is also a duty that should be monitored by the professionals who provide care. Professionals need to lobby to the government to ensure quality of services. For instance, a study found that radiologic professionals committed seven times more medical errors than any other area of healthcare.4 Because of this; radiologic professionals are now lobbying and trying to pass “The Care Bill” to congress to require licensure for radiologic professionals. This would improve quality because licensure would require all to achieve the same educational standards and competency testing. The Care Bill is a current example of enforcing better standards of quality through the passing of a law.


1. The Joint Commission. "Performance of Correct Procedure at Correct Body Site." Patient Safety Solutions May 2007 1-4. 10 Mar 2009 .

2. Bureau of Labor Education. World Health Report 2000:World Health Organization Assesses World's Health Systems. 21 June 2000. World Health Organization. 10 Mar 2009 .

3. Shi, Leiyu, and Douglas A. Singh. Developing Health Care in America. 4th ed. Boston, MA: Jones and Bartlett Publishers, 2008.

4. Giddings, Sharon. "First, Do No Harm." Advance: for Imaging and Radiation Therapy Professionals 21(2008): 16.

Addressing the Issue of Cost and Payment

“Human right” is a rather ambiguous term in heath care arena. Some believe that a human right is only applicable on an individual basis, while others believe it can be applied to a large cohesive group of people. Being supporters of the later means that we believe health care should be equally accessible, equally coordinated, equally executed, and equally affordable for every US citizen.

If we were to take the amount of money that was spent on healthcare in 2002 and divide it amongst the entire US population, every person would have to shell out $5,267.1 Albeit an equal contribution, this sum of money (depending on your income and lifestyle) could equate to an entire year’s worth of food and rent for your family or a one night’s stay at the Jumeirah Emirates Towers in Dubai. This being said, we need to seriously reevaluate the definition of “equal”. Many reform proposals focus on equal contributions by all US citizens – either to the government or to private insurance companies through an employer in order to cover the cost of healthcare. Instead, what is needed is a system that is truly equal.

Currently, the US has a largely fragmented system that relies heavily upon intermediates and paying them to make the healthcare system more complicated than it needs to be – through separation of allocation and redistribution.2 A stronger foundation could be created through the establishment of non-governmental agencies the collection of “ailment funds”. The government would need to intervene by introducing 3 or 4 main insurers for the entire nation. The insurers would need to guarantee coverage to every employed person in the United States. The private insurers would have to guarantee unconditional coverage through all 50 states for trauma, emergency care, and acute care. All other health care and maintenance care would have to be provided within the person’s geographic vicinity. The private insurers would directly collect financial resources through the establishment of “ailment funds” which would be financed through payroll contribution based on the following schedule:

Gross income per year: Below $28,000
Employee’s percent contribution to ailment funds: 2.5%
Employer’s percent contribution to ailment funds: 4.5%

Gross income per year:$28,000 – $35,999
Employee’s percent contribution to ailment funds: 3.0%
Employer’s percent contribution to ailment funds: 4.0%

Gross income per year: $36,000 – $43,999
Employee’s percent contribution to ailment funds: 3.5%
Employer’s percent contribution to ailment funds: 3.5%

Gross income per year: $44,000 – $51,999
Employee’s percent contribution to ailment funds: 4.0%
Employer’s percent contribution to ailment funds: 3.0%

Gross income per year: $52,000 – $59,999
Employee’s percent contribution to ailment funds: 4.5%
Employer’s percent contribution to ailment funds: 2.5%

Gross income per year: $60,000 – $67,999
Employee’s percent contribution to ailment funds: 5.0%
Employer’s percent contribution to ailment funds: 2.0%

Gross income per year: $76,000 – $83,999
Employee’s percent contribution to ailment funds: 6.0%
Employer’s percent contribution to ailment funds: 2.0%

Gross income per year: $84,000 – $91,999
Employee’s percent contribution to ailment funds: 6.5%
Employer’s percent contribution to ailment funds: 2.0%

Gross income per year: above $92,000
Employee’s percent contribution to ailment funds: 7.0%
Employer’s percent contribution to ailment funds: 2.0%

Using this schedule of contribution would essentially create enough funds on a yearly basis to cover the “equal” yearly contribution of $5,267 per person for the same quality of care as previously established. The private insurers would compete with each other based on the types of services they provide and all citizens would have the option of choosing which insurer their ailment funds would go to. This would essentially create more of a free market and would result in lower, more competitive payment on therapeutically equivalent services that could lower overall costs.

The concept of “sickness funds” or an “ailment fund” system has been utilized in both Germany and France.3 In both countries, the government has the power to regulate the insurers. Through regulation, standardization of payment, and expenditure caps – a higher level of cost containment can be achieved.4 Although the government will have more involvement than some would like, its participation in healthcare reform is absolutely necessary to guarantee its success. This system obviously focuses on an “equal” contribution on the part of high-income citizens. But our liberal philosophy stresses the importance of being able to provide care to all if it means making a select few unhappy. As a country, we need to move away from individualistic thinking and aim for population-centered solutions.

1. Anderson GF, Hussey PS, Frogner BK, Waters HR. Health spending in the United States and the rest of the industrialized world. Health Aff (Millwood). 2005;24:903-14. [PMID: 16136632].

2. Claxton G. How Private Insurance Works: A Primer. Menlo Park, CA: Kaiser Family Foundation; 2002. Accessed at www.kff.org/insurance/upload/How-Private-Insurance-Works-A-Primer-Report.pdf on 26 February 2009

3. Anderson GF, Reinhardt UE, Hussey PS, Petrosyan V. It's the prices, stupid: why the United States is so different from other countries. Health Aff (Millwood). 2003;22:89-105. [PMID: 12757275].

4. White J. Competing Solutions: American Health Care Proposals and International Experience. Washington, DC: Brookings Institution; 1995.

Overview

Examples of current employment opportunities in the U.S. health care workforce range from more traditional providers, such as physicians and dentists, to alternative or specialty providers, such as radiation therapists and chiropractors. Workforce in the U.S. health care system can be described as strong among the specialties and slightly weak among physicians and nurse practitioners.

Since much of the baby-boomer population is approaching becoming part of the older and elderly populations, many physicians and nurse practitioners are considering retirement. If most of these workers are to retire, our country will endure a major physician shortage. Prior to the idea of baby-boomers retiring, less students than usual were admitted into medical schools due to the surplus of physicians across the country. However, now that the need for such students is quickly increasing, many schools are beginning to open their doors to more students in an attempt to cushion the blow of the number of physicians that will retire simultaneously.

With the concern of having a major physician shortage in the near future, health care administrators are doing their best to encourage more enrollment into physician studies rather than into specialty studies. In doing so, the U.S. is reaching out to neighboring countries for prospective students. Other countries, such as Canada, are doing the same because they are experiencing a similar dilemma. The current administration in the U.S. is also concerned about the objectives of the next generation of providers. The next generation of providers have the intention to uphold normal business hours, but not as many of the long, on-call hours that current providers uphold. The reasoning for this is so that they may spend less time away from their families.

Needless to say, workforce is a very important topic because inpatient and outpatient care would not be available without providers of care. Some people may deem workforce less important than other topics because some believe the structure and environment are more influential on the overall outcome of health care. Without providers there would be limited services, and therefore limited health care. With the help of reform in the workforce system, we may be able to make quality adjustments while taking in consideration issues pertaining to health care costs and access.

References:

Busing, N. Managing physician shortages: We are not doing enough. Canadian Medical Association Journal. 2007; 176: 1057.

Girion, L. Needs of patients outpace doctors. [Los Angeles Times Business]. June 4, 2006. Available at: http://articles.latimes.com/2006/jun/04/business/fi-doctors4. Accessed February 12, 2009.

Shi,L., Singh, D. Delivering health care in America: A systems approach. 4th Edition. Sudbury, MA: Jones and Bartlett Publishers; 2008: 128-136, 139-140.

WordNet 3.0 © Princeton University 2006. http://wordnet.princeton.edu/

Political/Philosophical Stance

Our group believes health care is a right, not just a privilege. In America, we should be pushing toward a more universal health care plan. Our current system is inefficient and failing and we are in need of reform. Other countries with similar health care systems have changed over to a universal coverage with excellent results. We believe the U.S. can do this too.

A universal health care plan would increase the workforce dramatically because more providers will be needed. This will be beneficial to our economy because it will create many jobs within the health field. However, numerous challenges still remain.

• The workforce needs to be distributed evenly per capita.


• Education should be cost effective.


• With cheaper education we can lower salaries of providers.


• Providers should be more concerned with patients' needs than with their salaries.


• More providers means they can see less patients but for longer periods of time.

Our stance on the US health care workforce is also affected by the distribution of health care professionals across the nation. The demand for health care professionals exists in every state, but health care professionals are undoubtedly more concentrated in certain areas of the country. Different states and different areas require more or less health care attention. An uneven distribution of services in varying areas could result in an overall increase in health care costs based on the prices that are reflective of the cost of living in those areas.