Health care reform - why so slow?

Article Abstract:

Americans are uneasy about the health care system in the US. However, even with growing criticism, reform has been slow. For the past 20 years government policies have focused on reversing the escalation in health care costs. The federal government's steps to cut costs have included: federal controls on Medicare reimbursements; federal subsidies for the growth of health maintenance organizations; planning initiatives to reduce redundant expansion of hospitals and equipment; the shift in reimbursement by Medicare from cost to prospective; and a resource-based relative-value scale, which moderates the payments from Medicare patients to physicians. State governments have also wanted to limit their health care spending. These changes have made fewer people, especially among the poor, eligible for Medicaid. Programs have been designed to limit the numbers of reimbursable visits to doctors, prescriptions, hospital admissions, and time spent in the hospital. Many states have low levels of allowable fees for physicians treating Medicaid patients, require certificates-of-need and have low-reimbursement rates for nursing home care. Industries have also wanted to lower the costs of heath care, as there have been annual increases of 10 to 20 percent in costs for employee health care benefits. Although federal and state governments and industries have taken action to lower health care costs, they have failed to do so. The second major problem in the health care system is the growing number of Americans who are uninsured. Attempts to provide coverage for the uninsured have been only modest. There are no easy solutions to the problems of increased health care costs and the growing number of uninsured individuals. The move to broader and deeper reforms, such as national health insurance, have not occurred because the nation prefers modest rather than substantial government intervention. Our health care system contains many different facets, and offers many advantages to the public, such as broad consumer choice, adaptation of care to various regional and local conditions, and the division of decision-making power. This contributes to high costs. Major reform has not occurred because the public feels that cost control will bring less care. Therefore, without the commitment for major reform, it is not surprising that solutions have not been achieved. (Consumer Summary produced by Reliance Medical Information, Inc.)

United States, Reports, Medicaid, National health insurance

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Health care rationing through inconvenience: the third party's secret weapon

Article Abstract:

The inefficiency, slowness, and confusion created by third-party providers of medical insurance, including insurance companies, HMOs, and especially government agencies, has created a bureaucracy so dense and impenetrable that the result has been to limit the effectiveness of health care services in the United States. The dysfunctional bureaucracy created by these third-party carriers works to their own financial advantage. Stemming the outflow of payments and reimbursements to the insured benefits the cash flow of the carriers. No incentive exists for these companies to improve their services and, in fact, this inefficiency is profitable to them. Simple and routine procedures have been turned into lengthy and complex ones. It was observed that a routine visit by a patient to a physician's office generates, on average, 10 pieces of paper. An exotic vocabulary of obscure terms has been created by these carriers and agencies which is substituted for simple and straightforward language. Communications are continuously delayed in the bureaucratic process and authorizations for care and the disbursement of funds are constantly and unaccountably delayed. Elaborate procedures for approval of treatment often compromises patient care and threatens the physicians' autonomy in handling their cases. Carrier procedures are frequently changed, or functions shifted, causing additional slowdowns. The result of this abuse is diminished health care for Americans, especially those with low incomes. Reluctance of the patient to initiate a visit to the doctor when he is ill and a similar hesitancy on the part of physicians to take on new clients if it means involvement with third parties, especially government agencies such as Medicare, has been created. Perhaps a system of reward for good service and penalties for poor service may be effective in modifying the carriers' response and mode of operation. Overall, the American health care system is in desperate need of re-organization and, above all, simplification.

Medical policy, Health policy, column

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Pandemonium in the modern hospital

Article Abstract:

Health care professionals should take it upon themselves to create a quieter hospital environment conducive to healing and scholarly exchanges. Modern hospitals are characterized by the noise of pagers, intercom systems, call buttons, monitoring systems, electronic intravenous machines and computer printers. The recommended noise levels for hospitals are 45 decibels (dB) during the day and 35 dB at night. Actual noise levels in hospitals range between 50 dB and 70 dB during the day, and the average nighttime level is 67 dB. Noise-induced sleep disturbances among hospital patients are frequent, and, in one survey, 50% of hospital patients complained of noise. In addition to sleep loss, noise impairs cognition and promotes anti-social behavior. To lower hospital noise levels, staff should try to avoid shouting and handle equipment carefully and quietly. Other noise control measures include designing hospitals with better sound absorption properties, creating quiet areas and developing quieter equipment and modified alarm systems.

Health aspects, Hospitals, Environmental aspects, Noise, Noise (Sound)

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