Question

SIX MAJOR CHALLENGES FACING THE U.S. HEALTHCARE SYSTEM TODAY six major challenges that face the American healthcare system today: quality and safety, access and coverage, growth of heathcare costs, healthy behaviors, public health services, and the coordination and accountability of healthcare services. Discuss the current state of each of these challenges and what improvements are needed. How will these improvements impact the future of American healthcare?

Answer 1

Ans) The Structure of the U.S. health care system is changing rapidly, primarily in response to concerns about the increased costs of health services.

- Many of these changes create disruptions in the way health care professionals are allowed to provide care and the way in which patients may seek care.

- Although these disruptions may inconvenience clinicians and patients in the short run, ultimately we want to know the longer-term effect of these new strategies on the health of the population.

- Quality assessment offers one method for evaluating the impact of changes in the organization and financing of health services on health. If there were a precise relationship between price and quality, we would only need to know how to translate premium prices and other charges into quality units.

- However, because there is no such direct relationship, a separate set of quality measures is essential.

1 Expanding the information available on quality requires the development of valid measurement tools and routine access to the right data. The purpose of this paper is to discuss some of the challenges that must be met to achieve this goal.

The Institute of Medicine (IOM) has defined quality as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.”

2 The definition suggests that:

(1) quality performance occurs on a continuum, theoretically ranging from unacceptable to excellent;

(2) the focus is on services provided by the health care delivery system;

(3) quality may be evaluated from the perspective of individuals or populations;

(4) research evidence must be used to identify the services that improve health outcomes; and

(5) in the absence of scientific evidence regarding effectiveness, professional consensus can be used to develop criteria.

- The definition of quality illustrates the complexity of the concept and its evaluation. In designing a coordinated national strategy, we must ensure that the complex dynamics of health care delivery, the varying levels at which care might be evaluated, and the different perspectives of the key stakeholders in the system are adequately represented.

- To realize these objectives, six challenges must be addressed:

(1) Identify and balance the competing perspectives of the major participants in the health care delivery system;

(2) develop an accountability framework;

(3) establish the explicit criteria by which health system performance will be judged;

(4) select a subset of indicators for routine reporting;

(5) minimize the conflict between financial and nonfinancial incentives and quality-of-care objectives; and

(6) facilitate the development of information systems necessary to support quality monitoring.

The first two challenges address the framework within which quality assessment should be conducted.

The third and fourth challenges define the quality measurement work plan.

The fifth and sixth challenges identify factors that now inhibit progress in improving and assessing performance.

A public/private partnership will be essential to solving these challenges.