Term Paper on "Health Care Financing"

Term Paper 8 pages (2286 words) Sources: 7 Style: APA

[EXCERPT] . . . .

Health Care Financing ISSUE ANALYSIS

In the past decade, the increasing financial crisis faced by the medical profession has emerged as a significant concern among medical professionals, student residents, patients, and health care researchers. In recent years hospitals have faced doctor shortages, the result of the combination of a lack of medical residency funding and the poor financial state of Medicare, which is the primary health care provider of seniors, as well as the primary agency that controls the supply of doctors. Congress controls the supply of physicians by how much federal funding it provides for medical residencies. To become a physician, students spend four years in medical school, and graduates then spend three to seven years training as residents, usually treating patients under supervision at a hospital (Cauchon, 2005). Residents work long hours for $35,000 to $50,000 a year, and even doctors trained in other countries must serve medical residencies in the United States to practice in the U.S. (Cauchon, 2005). Also acerbating the medical profession financing problem is Medicare, the federal program which reimburses hospitals for the cost of training medical residents. Medicare, which faces enormous financial pressure in coming decades, already spends 3% of its budget training physicians and may not have the resources to spend more (Cauchon, 2005).

The government spends about $11 billion annually on 100,000 medical residents, or roughly $110,000 per resident (Cauchon, 2005). A review of the literature indicates that the medical profession does not appear to have adequate funding to provide the necessary amount of doctors, even in a clinical setting comparable to a small rural hospital consisting of approximately 200 beds. According to a USA Today Report, the U.S. needs 200,000 more physicians because aging and wealthy countries demand more health care. In addition, the portion of U.S. income spent on health care rose from 8.8% in 1980 to 15.4% in 2004 and will reach 18.7% in 2014, according to Medicare estimates (Cauchon, 2005). Furthermore, demographic changes in the medical profession also contribute to the need for more physicians; nearly half of new physicians are women, and studies show they work an average of 25% fewer hours than male physicians (Cauchon, 2005).

As a result of the lack of resources to fund the medical profession, hospitals are faced with an increasing number of doctor shortages. Smaller rural hospitals are in desperate need of more doctors, and the next closest facility may be over 60 miles away. In an attempt to make up for these shortages, many small rural hospitals are turning to the use of medical resident interns to provide a wide range of medical services. This will not change the supply of physicians in the United States, since the number of resident slots will stay capped at the 1996 level of 98,000; however, it should ease the pressure some hospitals are experiencing and bring more doctors to underserved regions (Croasdale, 2004). Unfortunately, the use of student residents to make up for the doctor shortages has resulted in an increase in the already long hours worked by medical student interns. As a result, the health and safety of medical student interns is at risk. This problem is an important one for the health care industry and related financing concerns because it is an issue that directly affects medical interns while pursuing their career as professionals in the medical field.

Analysis & Explanation of Complex Situation review of the literature indicates that the health and safety of medical residents is placed at risk as a result of substituting residents for doctors as a potential solution to the lack of funding for doctors. Research by Barger et.al. (2005 was conducted as a result of the increasingly reported problem of motor crashes and near-miss accidents experienced by interns after working an extended work shift. These findings are of particular concern because motor vehicle crashes are the leading cause of death in the age group most represented by medical interns. Furthermore, research indicates that 69% of interns travel by car, and the study results indicate that implementation of a work schedule for interns without any extended shifts could prevent a substantial number of crashes. The purpose of the Barger (2005) study and similar studies was to validate long-standing concerns regarding the association between validated work hours, extended work shifts, and driving safety among postgraduate physicians. Long shifts such as those required by interns are currently sanctioned by the Accreditation Council for Graduate Medical Education. The Barger (2005) utilized a survey in which questions were emailed to participants. The study design was an appropriate one to use given the busy schedules of the participants, and the nature of the questions were questions that could be answered in electronic format.

The Barger study sample was very large, consisting of a total of 3,429 interns, where 2,737 (80%) completed the survey, and were deemed the study cohort. 93% of the study cohort completed at least one monthly survey and were eligible for the analysis of crashes and near-miss incidents. Extraneous variables included the additional hours that medical interns spent working or studying outside the hospital, classroom or workplace related to their program. Other extraneous variables included hours per week working at a job outside their program, and days off including weekends, holidays and allocated time off. The study did not mention the appropriate measures that were used to control for the influence of the extraneous variables. Interns are on-call during extended shifts, and the study did not appear to address this extraneous variable. The study did not monitor work hours for every participant; rather only 7% of the study completed daily work diaries in which direct observation was used for continuous monitoring of work hours.

Application

The Barger (2005) study can be applied to evaluate the current state of the risks posed to medical student interns. In the study, the Mantel-Haenszel test was used to calculate the odds ratio for crashes and near-miss incidents that had occurred after an extended work shift, as compared with a non-extended hour work shift. The support provided for the reliability of the study instruments was adequate for their use in the study because the researchers also assessed whether the mean monthly number of scheduled extended shifts was associated with the subsequent occurrence of motor vehicle crashes as reported on the monthly surveys. This means was used to address the potential reporting bias in the surveys. The instruments used were appropriate for this study because the surveys assessed the number and proportion of crashes and near crashes that had occurred after an extended work shift, as compared to a shift that was not extended, for each participant. Advertisements announcing the study and its' monetary incentive were sent via email to interns matched to a residency by the National Resident Matching Program and to graduates of United States medical schools. Responses to questions regarding work hours, extended duration shifts, motor vehicle crashes, near-miss accidents, and incidents of involuntary sleeping behind the wheel were collected.

However, a limitation of the Barger (2005) and other related studies involves the data collection. Since data was collected on a monthly basis, there is the chance that the data could have crossed-over, for example if a participant completed the questionnaire once, and then completed it a month later after having experienced a vehicle crash. The study does not mention what steps were specifically taken to make sure that the rights of the subjects were protected, but does state that the Human Research Committee of Brigham and Women's Hospital and Partners HealthCare approved all the study procedures, and all the participants provided electronic written informed consent.

Even with that limitation, the data analysis procedures were appropriate for the data collected because the data analysis revealed the odds ratios for reporting a motor vehicle crash and reporting a near-miss accident after an extended work shift, as compared to a shift that was not of extended duration. For example, in a prospective analysis, every extended work shift that was scheduled in a month increased the monthly risk of a motor vehicle crash by 91%. The type of data collected allowed the researchers to analyze how many hours were worked in comparison to the reported number of accidents and allowed the researchers to see correlations between the hours worked and unsafe driving occurrences.

In the Barger (2005) research, the data analysis procedures were appropriate for answering the research question and proving the hypothesis because the data collected directly corresponds to what the researchers are trying to prove. The study also allowed the researchers to collect such data as police reports and insurance claims to support the reported vehicle accidents. However, there was nothing collected to report a near-miss incident or falling asleep in traffic, only word of mouth by the participant. Other studies building on this research could implement another method of collecting this data, such as videotape surveillance or another means of collecting this difficult-to-prove type of data. The two major strengths of the scientific merit of these studies are: the data… READ MORE

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