Essay on "Health Care System Evolution Organizational Analysis and Continuum"

Essay 14 pages (3702 words) Sources: 6 Style: APA

[EXCERPT] . . . .

Health Care System Evolution, Organizational Analysis and Continuum of Care

The objective of this work is to examine the evolution of the health care system and how health care delivery systems have influenced the current health care system in regards to Medicare/Medicaid. This work will conduct an organizational analysis for the Centers for Disease Control and Prevention including the stakeholders impacted by this component and how they are affected. Finally, this work will examine the continuum of care for Diabetes care program in the United States including the services provided and how these fit in the continuum of care. This work will examine how the equity contributes or fails to contribute to the overall management of healthcare resources and will examine the future trends of health care and discuss how these services will be impacted or the need to change to meet these future trends.

EVOLUTION of HEALTH CARE SYSTEM: MEDICARE & MEDICAID

The work entitled: "Evolution of Health Care, from 19th Century Till Today" states that Medicaid was created in 1965 as was Medicare. In 1983 changes were made and prospective payment for hospital admissions are stated to have been added. In 1992 a fee schedule for physicians was implemented and in 1993 there was a failed proposal for universal insurance coverage. In 1996 the health Insurance Portability of Insurance for job to job transitions was developed. In 1997 the Balanced Budget Act was enacted which expanded choices in Medicare. Finally, in 2003, Medicare and Medicaid reimbursement of drug costs were expanded. (European Observatory on Health Care Systems in Transition, WHO nd)

The work entitled: "Significance of Medicare and Medicaid Programs for the Practice of Medicine" states: "...1965, the Medicare and Medicaid Programs have enormous influence over the practice of medicine. The evolution of medical care, its' financing, and the expectations of the American population for high-quality care and rational use of public funds have linked, irreversibly, CMS to clinical medicine. CMS finances health care for more Americans than any other single entity; the agency has responsibility to its beneficiaries to ensure that they receive quality, effective, and efficient health care." (Health Care Financing Review, 2005) it is noted that CMS answers to not only beneficiaries but also to investors and taxpayers as well as addressing "the concerns of an array of political constituents, including Congress, presidential administrations, and groups representing the health care industry" (Health Care Financing Review, 2005)

II. INFLUENCE of HEALTH CARE DELIVERY SYSTEMS on CURRENT SYSTEM

In order that CMS effectively balance what are "competing interests" in its pursuit of "evolving policy goals" stated is that CMS "...has had no choice but to become engaged in the practice of medicine and the delivery of health care services." (Health Care Financing Review, 2005) Clinical medicine is stated to have become "intertwined with CMS" in four areas:

1) the end-stage renal disease (ESRD) program;

2) the quality improvement organizations and the effectiveness initiative;

3) Financing of graduate medical education, and 4) State Medicaid activities. (Health Care Financing Review, 2005)

The work entitled: "The Health Care Delivery System: A Blueprint for Reform:" (2008) relates that six goals that have been identified for reform of the health care system include the following goals:

Safety - Avoiding injury and harm from care that is meant to aid patients;

Effectiveness - Assuring that "evidence-based" care is actually delivered by avoiding overuse of medically unproven care and underuse of medically sound care;

Patient-centeredness - Involving patients thoroughly in their care decision-making process, thereby respecting their culture, social circumstances, and needs;

Timeliness - Avoiding unwanted delays in treatment

Efficiency - Seeking to reduce waste -- low-value-added processes and products -- in all its forms, including supplies, equipment, capital, and space;

Equity - Closing racial, ethnic, gender, and socioeconomic gaps in care and outcomes. (Center for American Progress and the Institute on Medicine as a Profession, 2008)

Policy recommendations are stated to include:

Investing in federal scholarship and loan repayment programs - including the National Health Service Corps and the nursing scholarship and loan repayment programs -- to ease the burden of educational expenses and encourage newly trained providers to practice in underserved areas or in primary care;

Creating a federal, long-term investment in comparative effectiveness research that will guide clinical practice and payment systems, increasing effective and efficient health care delivery; and Providing federal funds to support the acquisition of federally certified electronic health records, their maintenance, and the technical assistance needed to implement and use them effectively. This could include providing matching grants to safety net providers. (Center for American Progress and the Institute on Medicine as a Profession, 2008)

III. CENTERS for DISEASE CONTROL & PREVENTION

In a February 25, 2008, United States Government Accountability Office report it is related that the Centers for Disease Control & Prevention (CDC)'s new structure is of the nature that the agency's organization consists of:

1) the CDC Office of the Director;

2) Coordinating centers; and 3) National centers." (USGAO, 2008)

The USGAO states that the coordinating centers are inclusive of:

1) the Coordinating Office for Global Health;

2) the Coordinating Office for Terrorism Preparedness and Emergency Response;

3) the Coordinating Center for Environmental Health and Injury Prevention;

4) the Coordinating Center for Health Information and Service

5) the Coordinating Center for Health Promotion; and 6) the Coordinating Center for Infectious Diseases. (USGAO, 2008)

The coordinating centers are stated to be "intended to allow CDC's scientists to collaborate and innovate across organizational boundaries, improve efficiency, and improve the internal services that support and develop CDC staff." (USGAO, 2008) Four of these coordinating centers are stated to be that which oversee "...the activities at multiple national centers." (USGAO, 2008)

Additionally the CDC is stated to have added "two new national centers, the National Center for Public Health Informatics and the National Center for Health Marketing." (USGAO, 2008) the CDC employs in excess of 8,500 individual in the U.S. with approximately 65% of these living in the Atlanta, Georgia area and only 20% of employees located at CDC's primary headquarters. The CDC has seven National Centers include:

The National Center on Birth Defects and Developmental Disabilities;

The National Center for Chronic Disease Prevention and Health Promotion;

The National Center for Environmental Health;

The National Center for Health Statistics;

The National Center for HIV, STD, and TB Prevention;

The National Center for Infectious Diseases; and the National Center for Injury Prevention and Control works to prevent death and disability from injuries that are not work-related, including both acts of violence and unintentional causes. (Thomson Gale, 2006)

IV. DIABETES CONTINUUM of CARE PROGRAM in the U.S.

The work of Homer, et al. (2004) entitled: "The CDC's Diabetes Systems Modeling Project: Developing a New Tool for Chronic Disease Prevention and Control" relates the facts as follows: "Diabetes mellitus is a complex metabolic disorder marked by abnormally high blood glucose levels. If left untreated, the complications of diabetes can be disabling and ultimately fatal. Diabetes affects at least 18 million people in the U.S., a number that has been growing more rapidly than the general population since 1990. The rapid growth has occurred among those who have the non-insulin dependent Type 2 variety of the disease (formerly known as adult onset diabetes), as opposed to among the one million or so who have insulin-dependent Type 1 diabetes (which almost always strikes in childhood). Total costs of diabetes in the U.S. In 2002 were estimated to be $132 billion, with $92 billion of that in direct medical expenditures and the other $40 billion in indirect costs due to disability and premature mortality." (Worcestershire Diabetes: a New Model of care Stakeholder event, 2007)

The CDC reports that it decided to "employ a system dynamics modeling as a tool for enhancing both learning and action." (Worcestershire Diabetes: a New model of care Stakeholder event, 2007) the CDC reports having sought to create a structure with the following components:

1) Generic enough to be adaptable for other chronic diseases;

2) Realistic enough to reproduce national-level historical data on the prevalence of diabetes, prediabetes, and obesity;

3) Comprehensible enough to test practical policies without disaggregating the population into demographic categories of age, sex, race/ethnicity, or other individual attributes;

4) Broad enough to encompass a spectrum of policy measures that are being considered; and 5) Grounded enough in empirical experience that it does not require speculation beyond what the project participants themselves could agree upon or what credible evidence could support.(Worcestershire Diabetes: a New model of care Stakeholder event, 2007)

However, the CDC did not address the continuum of care for Diabetes. Common components in the diabetes continuum of care programs at various institutions include those as follows:

1) Diabetes care will ensure the patient is at the center of care and empower them to self-manage their condition;

2) Services will be responsive and flexible to meet the needs of individual patient;

3) Diabetic care should mainly be delivered in primary care/community settings;

4) Consultant led care should be easily and quickly accessible for patients with the… READ MORE

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