Table of Contents
Lesson 5. Three main forces that have led to hospital downsizing are influence of managed care, economic constraints faced by rural hospitals, and changes in reimbursement. The influence of managed care had a significant impact on reducing of inpatient utilization as hospitals started focusing on efficient use of resources (Shi & Singh, 2014). Considering that the inpatient care is expensive, hospitals prefer providing care in alternative settings. For example, some services were moved from hospitals to communities. Besides, hospitals started developing initiatives to keep the community healthy, which allowed reducing the inpatient utilization. Another way of effective utilization of resources is more careful observation of patients after discharge. It helps reduce the number of readmissions.
Economic constraints have led to closing of some small rural hospitals. The distinctive feature of rural population is that they tend to have lower income, worse health, older age, and higher proportions of uninsured patients than urban population. Medicare payments are also lower to rural hospitals than to urban ones (National Rural Association, n.d.). Therefore, rural hospitals do not have enough resources to address all healthcare issues of their patients. In addition, rural hospitals, as well as urban ones, receive financial incentives for reducing the length of patients stay, which also motivates them to move patients to other settings. The common feature of all three forces affecting the hospitals downsizing is minimizing the costs.
Lesson 6. Long-term care services must be individualized as the patients experiencing some chronic health issues and functional disabilities have various needs (Shi & Singh, 2014). For example, some individuals need more time for recovery due to the fact that their bodies respond slower to treatment. Therefore, healthcare professionals should consider patients’ individual needs during choosing services for them. Such individual needs are determined in the result of patients’ functional assessment. Long-term services must be integrated as they are followed by providing primary care, acute care, and mental health care. The interaction of services should be done accordingly to the needs of patients. Delivering only some type of services will not solve the patient’s health problems. In addition, the level of services changes from time to time due to the fact that the patient’s health condition also modifies. Integration helps facilitate the transition between the different types of long-term services and between long-term and other kinds of health care services. Finally, long-term services must be coordinated as the modern healthcare system offers a significant number of various services to patients. As a result, one person cannot manage everything alone. It is much more reasonable to coordinate long-term services through efficient case management. Such approach not only accelerates the recovery of a patient but also reduces the costs of hospitals considering the fact that each person receives only long-term services, which he/she really needs. Therefore, individualized, integrated, and coordinated long-term services are beneficial for both patients and healthcare providers.
Lesson 7. The United States needs to regulate growing of healthcare costs due to several reasons. To begin with, increasing healthcare costs mean that American people need to spend less on other goods and services to be able to cover their healthcare expenses. It is negative for American economy due to the fact that other industries will receive fewer resources compared to health care industry. Rising healthcare costs might also have negative impact on the competition position of the country’s business in foreign markets (Shi & Singh, 2014). Moreover, further active growth of healthcare costs might lead to bankruptcy of Medicare or other social insurance programs due to their inability to cover all patients’ needs.
Another part of the problem is that healthcare organizations sometimes act in their own interests rather than in interests of patients. For example, the development of technology has led to appearing of unnecessary services, which is proved by the current policies of hospitals. In addition, pharmacology companies have been developing numerous expensive drugs, which could be replaced by cheaper treatment options. Therefore, the U.S. should control the feasibility of the used costs. For example, some health organizations managed to reduce readmissions through more careful following of patients after their discharge. Moreover, hospitals have become more active in delivering preventive services and searching for alternative settings. Earlier, the control of health costs was weaker, so healthcare organizations were not interested in effective use of their resources.
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Lesson 8. Social and demographic force of future change means that the U.S. is becoming older and more culturally diverse, which leads to raising of healthcare costs (Shi & Singh, 2014). However, the future of Medicare, Medicaid, and other social programs will depend on the development of U.S. economy. In addition, the national debts, economic development, the unemployment rate, and household income will affect spending on healthcare services. Political force involves different policies in education and immigration, which have impact on the availability of healthcare labor forces and their qualifications. The technological innovations also have an outstanding impact on healthcare as they increase the variety and costs of services provided. The potential of informational force is still advancing but it has a significant amount of applications even today. Ecological force includes the appearing of new diseases or cases of bioterrorism. In its turn, bioterrorism becomes possible as a result of new diseases appearance due to interactions between humans and ecosystem. Natural disasters can also lead to outstanding health risks. Global forces involve such factors as medical tourism, standardization towards qualifications of healthcare workers, development of global telemedicine, volunteer work of healthcare staff, and producing of genetic medicine in Asian countries. Manufacturing drugs in Asia is cheaper but less secure due to absence of proper control. Finally, anthro-cultural force comprises of such aspects as the impact of society’s beliefs, customs, and ethos. In particular, Americans have always been opposed to drastic changes in providing funding for healthcare.
The Impact on the Government on the Development of Hospitals
The government’s policies have caused both reduction and increase of number of hospitals in the U.S. Thus, the Hill Burnton Act of 1946 led to appearing of more community hospital beds in the 1950s and 1960s. According to the law, nursing homes, hospitals, and some other healthcare organizations received loans and grants for building and modernizing of their resources (HRSA Data Warehouse, n.d.). At the same time, the given health facilities had to assist in increasing the number of services for people, who could not pay for them. Such requirement made the health services available to everybody living in the hospital’s area. Although the program has not been offering funds since 1997. Consequently, 150 healthcare organizations across the United States still have to deliver free or reduced-cost services (HRSA Data Warehouse, n.d.). Overall, the cost of uncompensated services to eligible patients through Hill-Burton has reached approximately $ 6 billion since 1980 (HRSA Data Warehouse, n.d.). Therefore, the Hill Burnton Act not only helped hospitals to grow but also improved the access of low-income Americans to healthcare services.
In addition, the government has also developed Medicaid and Medicare programs, which also caused the growth of hospitals due to the fact that health insurance became available to more people. Consequently, the hospitals received more patients. On the other hand, the government has raised its control over healthcare costs. Therefore, health facilities had to reduce the number of patients in their settings, which caused downsizing of hospitals. Today, it is more beneficial for hospitals to improve the community health or provide better care after patients’ discharge.
Utilization Review Methods
Utilization review is the evaluation process, which is used for determining whether services are appropriate or not. The main aim of utilization review is to ensure that patients receive the proper level of services. Such mechanism also helps control the efficiency of costs use and availability of subsequent care. There are three utilization review methods, such as prospective, concurrent & discharge planning, and retrospective.
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Prospective utilization review indentifies the appropriateness of health care prior to its providing. For example, the primary care professional decides whether the patient needs the help of other healthcare specialists or not. This method has a number of benefits. First, it helps avoid of costs and time misuse. Second, the method helps inform concurrent review systems about a new patient, so they could be able to make discharge planning. Moreover, if the case is complicated, prospective utilization review informs case management about it.
Concurrent & discharge planning is conducted daily. This method is used to determine the duration of stay in a hospital. It also helps in observing whether ancillary services and treatment are appropriate. For example, when the patient is hospitalized, he/she has to stay a fixed number of days in the health facility. Then, healthcare specialists evaluate the patient’s condition to determine how many days he/she should stay in the hospital.
Retrospective utilization review is a method, which is used after delivering of services. It presupposes a careful analysis of records. For example, observers check the appropriateness of services provided. The benefit of this method is that it helps monitor the work of providers and see the whole case. If some excessive utilization is detected, healthcare specialists can lose their bonuses. Therefore, such utilization methods allow to evaluate the appropriateness of services before, during, and after their delivering. This fact maximizes the accuracy of evaluation process.
Challenges in Rural Health
Rural health faces a wide of range of challenges, which have led to closing of some small rural hospitals. First, there is a lack of healthcare staff in rural areas. In 2014, sixty percent of areas having lack of basic medical health professionals were non-urban (National Rural Health Association, n.d.). A shortage of healthcare staff means that health of rural citizens can be negatively influenced due to a restricted supply of services. Second, many rural inhabitants do not have health insurances, which also reduces their access to healthcare. Nevertheless, these people could potentially receive some health coverage with the help of Affordable Care Act. However, two-thirds of rural people without health insurance are from a state, which has not expanded Medicaid (Newkirk & Damico, 2014). It means that uninsured rural residents have fewer opportunities to receive help using social insurance programs. Another challenge is transportation and distance. Sometimes, rural inhabitants have to deal with long distances to reach some health care facilities. It is particularly problematic, if a person needs specialist services. Moreover, rural patients sometimes have lower health literacy, which means that they have a lack of knowledge about preventive services, the proper use of medicine, and managing their health condition. Finally, rural health involves privacy issues. For example, rural people are afraid of visiting some health specialists as they think that their health information will be revealed to others.
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New Technology and Delivery of Health Care
The research and development of new technology is associated with high costs. However, it can significantly improve the quality and speed of delivering healthcare services. For example, technology helps put diagnosis and treat patients, and even improve staff communication. For example, electronic SBAR protocols reduce the time nurses spend on shift reports and interdisciplinary rounds, so health specialists could have more time for patient reviews (Cornell et al, 2014). Some patients do not need to travel to a hospital to obtain the healthcare. For example, it is possible to receive some services thorough telehealth. Therefore, the technology has many benefits for patients but it is necessary to control the appropriateness of technologies’ use in a hospital due to their high costs.