Medical services expenditures in the U.S. continue to increase, deeply cutting into the GDP more and more each year. The majority of these expenditures are due to diagnosis and treatment of chronic diseases and conditions such as diabetes, obesity, cardiovascular disease and asthma (U.S. Department of Health and Human Services, 2003).  The problem with these expenditures is that these disorders are preventable by a change in lifestyle. An overwhelming flow of resources are used in treatment of easily preventable disorders, so why is there not a push for preventative measures. One could conclude that there is a break in the communication chain. Alternatively, is there a direct link to key economical factors that inhibit healthier lifestyles?

            Perhaps inadvertently the economic structure has cohesively linked itself to a lifestyle of Big Mac’s and supper size fries. Morgan Spurlock, in a witty and satirical documentary, says that this nation is well into a “fast food epidemic” (Utichi, 2004). The film goes on to build a theory that the nation is in a crisis brought on by a fast food era. Conditions such as diabetes, obesity, and cardiovascular disease can be linked to a fast food lifestyle. Furthermore, the fast-paced American culture encourages fast food consumption over more healthier and nutritious food choices. 

The four food groups have been a staple in nutrition education for years. The underlining problem is that while children are receiving this well-meant education, they are at the same time inundated with commercial after commercial on the pleasures of fast food. With more single parent families and two household income families, time is hard to come by. These and many other factors play a role in the fast food craze culture of the United States. Why, then, does the government knowingly expend so much resource on treating fast food junkie fallout? 

The fact is, it is often harder to change a lifestyle than to find cheaper ways to treat conditions such as diabetes, obesity, cardiovascular disease and asthma (Longest, 2002). Moreover, there are large amounts of revenue generated from both the medical treatment and the fast food industry. Forcing adults to change their lifestyles would be like, as the cliché’ goes, “biting the hand that feeds you.” Educating children on how to live a fit and active life with proper exercise and a well-balanced diet will break this cycle of dependence.  Research has always shown that it is cheaper and more effective to motivate people when they are young and before bad habits form rather than to try to change them when they are older and set in their ways. 

References

Longest, B. B. (2002). Health policymaking in the United States, 3rd ed. Chicago: Health

            Administration Press.

U.S. Department of Health and Human Services. (2003). Prevention makes common “cents”.

Retrieved June 15, 2005 from http://aspe.hhs.gov/health/prevention/

Utichi, J. (2004). Review - Super size me. Retrieved June 15, 2005 from

            http://www.filmfocus.co.uk/review.asp?ReviewID=114

Though the healthcare systems of the Military, Veteran’s, and the private sectors are very different, the mission is the same:  to provide quality healthcare to its patients.  However, there are key fundamental factors that set these systems apart from each other. Factors such as budget, billing, type of care given, and political influence serve to outline the types of polices that these very different systems have. Though the mission is the same at each facility, there are political and economic factors that dictate, direct, and limit the policy-making procedures of each. 

In the private sector, factors that limit growth are the number of patients within the system and the ability to remain competitive. In the Military and Veteran’s Health systems (MHS and VHS, respectively), congress and the national budget limit growth. The budget granted to Military and Veteran’s Health systems is also directly proportional to the volume of care given. One very important factor in the both the MHS and VHS is that the care is given free of charge to their patients. Therefore, the capital used for a healthcare system is truly a powerful force that drives a system’s policies. 

The cost of healthcare in the Military, the Veteran’s, and the private sector is on the rise and is expected to continue to rise without slowing (House Affairs, 2005). Take for instance the pharmaceutical needs of patients. This high cost service has put a great deal of pressure on Military and Veteran systems as well as private sectors. The medications given to the 9.1 million beneficiaries within the MHS are all free of charge to the patient. This is also true for VHS patients and their medications needs. This service is costly to these systems, and due to this, policies ensure that medications are only prescribed when there is a clear need. Moreover, as these costs are rising, the systems are changing policies in order to control costs. An example of this is reclassifying key medications to a non-formulary category (House Affairs, 2005).

In conclusion, the Military, Veterans, and private sectors are very different but the goals of quality care are the same. All three of these systems provide quality care to their patients with respect to the mission and policies mandated by the system. Furthermore, while one system may often face factors that the others do not, political and economic pressures are faced by each these organizations.   The pressures on one system can cause another to transition its policies to accommodate fluid reform.   Regardless of the type of organization, all these factors cause the systems to constantly form new policies and change current policies.   

References

House Affairs. (2005). TRICARE moves three medications to non-formulary status. Retrieved

June 30, 2005 from http://www.ha.osd.mil/asd/20050425.cfm

 

In these difficult economic times, healthcare must come to the front. From a socio-economic burden influenza has left its mark throughout known history. The massive death tolls and economic hardship is felt greatest in what world poorest countries but not limited to them. The 1918 flu that battered the world for a year left a wake of dead and a world scrambling to understand how and why. The burden that is thrust upon the world with each outbreak of influenza in deaths alone is unimaginable but the economic burden is all too clear. In the United States influenza accounts for 1-3 billion of the nations direct medical cost (Szucs, 1999). Losses due from lost earnings and future lost earnings due to death are a staggering 10-15 billion a year (Szucs, 1999). In a rough estimate about 9% of the world’s population will contract influenza infections each years with the greatest burden falling on children and elderly (Szucs, 1999). Moreover, as an investigation into the factors that make flu such a world issue it gets more and more complicated with more and more underlining social and economic burdens that the world faces as a whole. Influenza has become the equalizer of nations and no one nation is safe from the clandestine ever changing virulence. The burden is great and just how great will depend on the ability of our leaders to see this danger and plan for the next pandemic. Our economic systems growing pains in recent weeks should be a call to action to improve or nation’s healthcare system. Moreover, how flawed is our healthcare system will it fail when we need it most?

Szucs, (1999), The socio-economic burden of influenza, Journal of Antimicrobial Chemotherapy, 44, Topic B, 11-15

With the growing cost of medical care a great burden is put upon the world’s resources to treat and prevent chronic diseases. Primarily due to advances in medical science and an overwhelming number of poor life choices, chronic disease has become the world’s leading cause of death (Yach, 2004). Cardiovascular disease rose to become the leading chronic disease in 2002, with cancer; chronic respiratory disease; and diabetes following closely behind (Yach, 2004). Worldwide, these mostly preventable chronic diseases caused the deaths of 29 million people. The staggering burden on society due to lost productivity and rising healthcare costs leaves many nations clamoring to find a solution. 

One would think that a preventable chronic disease would be easily be extinguished through preventative measures such as educations and governmental policy. However, as billions are spent in the hopes of preventing chronic disease, barely a dent has been made in this growing global problem. This is due to a world of fearless smokers and binge eaters who want the government to bail them out after decades of poor life choices. Clearly the damage is done for the current aging generation, but there is hope for the next. For, educating youth on good life choices will lead to greater quality of life and better health. The hope is to reduce chronic disease through prevention, surveillance, and control.  

There is a great task ahead for chronic disease treatment and prevention. One generation requires acute and long-term care and another generation truly needs to understand the implications of poor life choices. The World Health Organization (WHO) has worked to set prevention, surveillance, and control measures to aid in the chronic disease crisis the world faces. Unfortunately, people will not change overnight. However, through social marketing and cognitive dissonance changes can occur in individual minds and hopefully cause them to make wise life choices.

Reference:

Yach. (20040. The Global Burden of Chronic Diseases,

            Overcoming Impediments to Prevention and Control

            JAMA. 291:2616-2622.

Fragmentation of the healthcare system is not a new problem and has been around for some time. The soaring need for healthcare and high-costs care has caused such proliferations in recent years. Is quality health care at risk due to the due to the rise of specializations in the health industry? What are the desirable and undesirable aspects of this fragmentation?   Should actions be taken to slow or stop this trend? These are questions will be examined in this report, Health Care at Risk. 

There are three factors that affect the overall quality of healthcare, according to a US Primary Care Policy Fellowship in 1994. “Three barriers to healthcare are shared by all vulnerable populations: inaccessibility of care, fragmentation of care, and cultural insensitivity on the part of care providers”. (Campos-Outcalt D, Fernandez R, Hollow W, paragraph #3, 1994) In looking at health care fragmentations, it is also important to consider inaccessibility and cultural insensitivity as a whole in assessing this healthcare disability. Each populations has it own set of vulnerabilities that set in motion a chain of fragmentation in the healthcare system. Populations such as patients with physical disabilities, mental disabilities, cultural differences, geographic separation, or limited economic resources due to system limitation are unable to enter the health care system efficiently. (Campos-Outcalt D, Fernandez R, Hollow W, paragraph #2, 1994)   Extenuating factors that are meant to improve the overall care of the patient soon become barriers to quality health care.

For example, a 19-year-old female with a 2-year-old son is presented at an urgent care center with strong case of depression and the inability to keep food down. Upon testing she is found to be 2 months pregnant. She is promptly referred to the Welfare department to apply for Medicaid. She has not finished school and is unable to fill out all the forms needed to get adequate care. About two weeks after her visit to the ER she is informed that Medicaid will cover her. With some difficulty she is finally able to locate a provider that will take Medicaid. At the same time her two year old has had no well-baby check ups and is behind on all vaccinations. The system becomes more fragmented when she is found to have complications that if caught earlier in the pregnancy could have been treated. 

Due to the complication, her current provider will no longer see her out of fear that it is outside the scope of his practice. This then forces her to search for another provider that will see her with the complication.  Three weeks have gone by and she is able to get a referral to a specialized OB practice that will take on her care. Problems arise when Medicaid will only pay for two ultrasounds, leaving her with the choice to pay for the additional ultrasounds herself or forego the needed care. Late in her pregnancy she is referred to the WIC office to monitor her and her toddler’s dietary needs. Again more paper work is required, and to complicate things further the WIC office is across town and due to a lack of transportation she is unable to make all her appointments. 

As she gets closer to the delivery date she become so frustrated with the system that she considers abortion, which in her case is easer to get than to have the baby and care for it. The problem with the system is that the fragmentation is subtle and while important to the healthcare system is cumbersome and cryptic to the patient. Is quality healthcare at risk due to the due to the rise of specializations in the health industry? Yes, the system set in place to organize and develop the flow of care often obstructs and inhibits quality patient care. Patients are often faced with difficult decisions on whether or not to receive care and even at times where to go to get the necessary care. Notable care issues quickly arise in vulnerable populations that are unable to adapt to the fragmented complexities of the healthcare system. Fragmentation of healthcare soon leads to poorer patient outcomes. (Linda Mann, paragraph #1, 2004)

What are the desirable and undesirable aspects of this fragmentation?   Notable desirable aspects of fragmentation are better long-term care within specialized fields such as mental health, cardiology and diabetic care. In some healthcare systems, patients can be diagnosed with special need such as Coumadin therapyand Pneumonia without even entering the healthcare system. (Linda Mann, paragraph #10, 2004)

 Undesirable effects are mostly due to a lack of communication within and outside the healthcare system. Patient records are not freely released to providers, not affording providers with key information with respect to patient care. Should actions be taken to slow or stop this trend? Action should be made on a consolidated effort to streamline the health care system with an effort to reduce fragmenting. The more the system fragments the farther it isolates itself from the patient. By working to reduce communication problems and by opening the system between specialized care and routine care there will be a greater opportunity to homogenize the care given regardless of the source. 

In time there will be benefits from fragmentation but it will come more fluidly as the levels of information flow are streamlined and patients are given greater freedom in choice of care. Patients do benefit from knowledge and the patient’s choice of specialized care or general care should be a right. Moreover, the health care system should focus on the needs and rights of its patient base, giving a great range of latitude to vulnerable populations most affected by system-wide fragmentation. The rewards of opening and specializing are to the great benefit of both the patient and the healthcare system. However, this should never come at the expense of the overall quality of patient care.

References:

Campos-Outcalt D, Fernandez R, Hollow W, et al. (1994). Providing quality health care to vulnerable populations. US Public Health Service Primary Care Policy Fellowship. Retrieved 05/05/05 1600 from, www.primarycaresociety.org/1994d.htm

Griffith, J. R. & White, K.R. (2002).  The well managed healthcare organization(5^th ed.). Chicago, IL: Health Administration Press.

Linda Mann. (2004). From “silos” to seamless healthcare: bringing hospitals and GPs

back together again. Retrieved 05/04/05 1500 from, http://www.mja.com.au/public/issues/182_01_030105/man10274_fm.html

Community-based intervention (CB) strategies are often used to prevent disease in low income communities. Recently community-based interventions have been primarily employed for the prevention of diabetes in rural development and urban planning. Diabetes is a growing nationwide health concern, yet in many cases it can be prevented or controlled through diet. The uses of community-based interventions are concentrated in many areas. Areas such as behavior modification and social, cultural, community, and environmental factors that contribute to health disparities are primarily used to aid in the prevention and control of diabetes (Goodman, 2006).

It is important to target community-based interventions of diabetes due to its strong link to cultural views on health. For instance, many people are predisposed to diabetes due to their cultural attitudes about diet and exercise. It is important to note the values and perceptions of a particular culture or ethnic group as this will be a significant factor leading to preventable chronic disease. Therefore, it is critical to target scocial change stemming from the cultural base; in this manner there will be lasting community-based interventions. Moreover, as cultural awareness is a leading part of interventions there will be greater progress in chronic disease prevention. The move to encourage healthful living requires systematic understanding of cultural norms and values that serve to form the community’s perceptions on what is healthy and what is not. 

Reference:

Goodman, (2006), Applying Comprehensive Community-based Approaches in    Diabetes Prevention: Rationale, Principles, and Models.

             Journal of Public Health Management & Practice; Nov/Dec2006, Vol. 12 Issue 6, p545-555

 In looking back at the aftermath of 911 there is one strong resounding fact:  America is strong. A great nation and a great people were cut and cut deep. The trembling foundations of the trade towers resonated throughout the American and world economic structure. How is it that with this charge from an enemy bent on the destruction of American economic power that in 2003 there was 2.4% growth? (Free Republic,03). 

I would have to say that the dot.com bubble, Enron hysteria, WorldCom lies, AOL lies, Tyco stealing, and the overall lack of ethical practices were far more destructive to the over economic health of the United States. (Free Republic,03). People know that they can not trust a murdering highjacker but they should have peace of mind in their retirement and their nest egg investments. The problem lies somewhere in the minds of some of the world’s most powerful executives; they lost touch with the little guy. When people lose their trust in the market due to untrustworthy CEO’s, it will not come back quickly. 

I do not agree with the comment of an anemic economy. It is what we make of it and America has overcome greater than this. Moreover, while the attacks of 911 did cause the economy to weaken and people did lose trust, it was mostly due to the lack of truthfulness of top level CEO’s.  I would also have to say that the CEO is looking at two buckets, one with truth and the other with puffed-up lies. There are those who chose to lie to the public about their earnings and those who told the truth. Tell the truth and loose investors, or lie really well and keep them--perhaps even add new investors. The bullish truth about the average person’s perception of CEOs today is that they are as trustworthy as politicians.

I find it hard for the economic leader to feed the human spirit when they have none of their own. The goal of honesty and loyalty to the consumer should be the basis of their strategy. Peace of mind starts with knowing the truth so that one can overcome the negative and capitalize on the positive. I agree that deeper communication is the key, but it must be the truth in order to hold the trust of the investor and the spirit of the company. “Effective leaders in tough times can actually do a great deal to impact the economy and keep our country on its feet.” (Villeneuve,01). This holds true and it is key to the economic power of this great nation. Because of this leaders should be held accountable for any actions that may cause harm to the economy. These are hard times, but I believe that it is primarily due to the greed and lack of ethical leadership of some of today’s top leadership. Most of all employees are investors in the company and they need to both trust the leadership and the economy. I fond the article of Villeneuve to be clear on one point leadership has the power to make changes good or bad. 

Sources:

Free Republic. (2003). Blue Chip economists trim U.S. growth forecast. Retrieved 03/15/05 from, www.feerepublic.com/focus/f-news/908995/posts

 When looking at the service of Medicare created in 1965, one can only hope there was the best of intentions behind its lofty goals. The truth is Medicare created jobs and has served to provide healthcare to more than 40 million older and disabled Americans. The goal of providing healthcare in 1965 to older and disabled Americans was both idealistic and well received. Nevertheless, as with any other “benefit”, problems arose by both poor quality of service and inadequate funding. Moreover, through the years Medicare became a political tool of power.   Finally, every administration since its conception has dabbled with the policies and services Medicare provides. For example, in Nov. 25, 2003, the Bush administration included a new prescription drug benefit (CBS News, 2003).

The changes to Medicare where deemed necessary due to the rising costs of medications and the debilitating burden that soaring costs put on the beneficiaries of Medicare. In 2002, the United States spent $162.4 billion on prescriptiondrugs with only about 22% of this paid for by the Government and 44% by personal healthcare prescriptions (Frank, 2002). The root of the problem lies in the inability of elderly and disabled Americans to be able to cover the rising price of prescription care. Each year the costs of prescription care are on the move up and out of the reach of most people on Medicare. This growing problem has forced many elderly and disabled people to choose between good health and paying one’s bills.

Beginning in 2006, the main provisions of the new legislation would allow seniors to purchase coverage for their prescription drugs as well as require higher-income seniors to pay more for Medicare Part B coverage (CBS News, 2003).  Estimates under this new program would have drug insurance premiums of about $35 a month and a deductible of $250 (CBS News, 2003). Seventy-five percent of costs would be covered until the recipient’s drug costs reach $2,250, after which there would be no drug coverage until drug costs reach $3,600, or approximately $5,100 in overall expenses (CBS News, 2003). After $5,100 in expenses, the plan would cover about 95% of prescription costs (CBS News, 2003). Even with political and special interest influences directing the policy, the Medicare reform goal was reached.   

Congressman Charles Grassley, R-Iowa, an architect of the bill, and many insurance and pharmaceutical companies were involved in setting the agenda for this policy reform to Medicare (CBS News, 2003). Together, with the support of the President, these parties and many special interest groups worked to set the formulation of change. Grassley stated that, “now was the time to act for it may be years before another opportunity comes along (CBS News, 2003).” The role of interest groups such as the nation’s various elderly and disabled groups served to display the needs and values hoped for in future reforms. Governmental leaders in both the Senate and the current administration worked to provide a service to beneficiaries that fell within current and future budgets. At times, the lofty $395 billion legislation was ignored and caused a great deal of political and public unrest.

This legislation was very controversial and in many cases proved to be more of a detriment than an improvement to Medicare.   Senate Democratic Leader Tom Daschle called the bill a "bailout for the HMOs and insurance companies (CBS News, 2003).” The administration stated that the change to modernize Medicare would have savings of between 15 percent and 25 percent off retail prices. The caused the many out-spoken critics to argue that White House estimates were inflated (CBS News, 2003). Many critics even stated that the pharmaceutical companies were the winners of this bill at the expense of low income Americans.

The stated goal of the administration was that it was time to modernize Medicare.  One factor that contributed to reaching this goal was the addition of electronic medical informatics. This electronically stored data is invaluable to evaluating both the financial viability and the practicality of medical procedures. The ability to evaluate patient data with respect to cost analysis was a crucial factor leading up to reform (Longest, 2002).   

In conclusion, the need to reform Medicare was clear and certain. The leadership at the time took decisive advantage of timing and resources in order to advance their goals and ideals. Moreover, the parties of interest and influence worked to motivate and render change. Even with all the political balancing acts, President Bush signed the bill, and it will take effect in 2006.  And while the initial goals were not entirely reached, the concept and practical value of the change can, in the future, prove to be of great value. The question to ask is whether people will appreciate it or cause it to become even more of a burden on society and political power tool.

References

CBS News. (2003). Medicare drug bill nears passage. Retrieved July 1, 2005

from http://www.cbsnews.com/stories /2003/11/25/politics/main585478.shtml

Frank, R. (2002). Prescription-drug prices. New England Journal of

Medicine. Retrieved July 1, 2005 from http://content.nejm.org/cgi/content/full/351/14/1375

Longest, B. B. (2002). Health policymaking in the United States, 3rd ed. Chicago:

Health Administration Press.