Literature Review Chapter: United States Has the Most Expensive Healthcare

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¶ … United States "has the most expensive healthcare system in the world, [yet] 47 million Americans have no health insurance. Healthcare is the country's largest economic sector…. Four times larger than national defense… yet millions cannot afford to take care of their health needs" (Farrell, 2009, 1). Despite being an international leader in science and technology, what has happened to the entire healthcare system in America? Fifteen years ago the subject was at the forefront of the new Clinton Administrator, but now, despite technological advances and increased modernization, America finds hospital emergency rooms stretched far beyond any reasonable capacity, the inability for many doctors to afford adequate malpractice insurance, costs for procedures escalating, and even those with insurance unable to afford the basic standards of healthcare. Indeed, even with the nation spending 20% of the total budget on healthcare, there seems no end in sight ("What's Wrong With America's Healthcare? 2006; Newman, 2008). Scholars, pundits, politicians, and business executives, as well as consumers all agree that there is something wrong with America's healthcare system. Of course, everyone has a different view of causes and solutions, but two major themes arise when discussing the ills of healthcare in modern America. First, costs are skyrocketing without the response of either governmental or private insurance. Second, the demographics and needs of the population have dramatically changed which causes greater pressure placed upon both the private and public sectors of healthcare, as well as companies who do offer insurance to their workforce (Klein, 2007). Although everyone agrees there is something very wrong with American's healthcare, there are polarized views about the solution. Many look to the European system of socialized medicine -- perhaps not always as modern in every case, but certainly available to everyone. However, putting government in charge of a broken program in a relatively litigious society may not be the answer either (Saad, 2007).

Costs seem to be one of the predominant issues, yet one asks if costs are far out of line in America and not in the rest of the developed world? In much of Europe, for instance, socialized medicine seems to provide adequate care (debated, yes), but does have a waiting list for certain non-emergency procedures. Costs in the United States are tied with rising costs of technology and prescription drugs, as well as the unbelievable amount of money that is spent on the administration of both the HMO, Medicare, and Medicaid system -- fully 1/3 of all healthcare dollars not even on care, but on paperwork! Add to this the additional 10% of costs called "defensive medicine" -- tests and costs done so that a doctor or clinic protects itself from malpractice, and we see almost 1/2 of the average healthcare dollar not even being utilized for the purpose of real healthcare (Farrell, 2009; Fineout-Overholt, E., et.al. 2011).

As America changed, healthcare has not necessarily followed. Individuals are living longer, and as they age, require different healthcare solutions. In the 1940s, when the average age of death was far lower, many of the cancers and other illnesses of modernity and age had not yet become epidemic (Saad, 2007). So too, with the advances in technology that can discover disease and cure prior to it becoming debilitating have increased as well. Instead, the system has built layer upon layer of bureaucracy that, instead of streamlining the system, causes more bureaucracy and backlog. So, instead of simply establishing a set of universal care that is part of an even bigger bureaucracy, perhaps it is time to set into practice money spent on preventative care and education at the earliest levels, so that as the population continues to age, at least some of the issues might be mitigated. Providing greater access to medical care, too, with the appropriate economic impetus, should reduce costs and increase the ability of the individual to find appropriate levels of care -- that being the key -- appropriate levels of care (e.g. It is relatively unnecessary to order a full panel of x-rays or scans "just to be sure" if there is a lack of symptoms necessitating said procedures) (Orient, 2007). The changes in the population, then, coupled with the changes in methods of delivery and underlying social transformations have also significantly contributed to both a challenge and a potential for solution within the system (Kovner, et.al., 2008).

In the United States, medical care is provided by not just one institution, but by a number of entities and programs typically both owned and operated by the private sector. Health insurance is also provided by the private sector, the larger entities called Health Maintenance Organizations (HMO's) increasing their market hold over the last several years. There are exceptions to this are national programs such as Medicare, Medicaid, Children's Health Insurance Program and Veteran's Health Administration, all of which are part of the governmental bureaucracy ("Americans at Risk," 2009).

Healthcare in the U.S. is in a critical state, with each successive administration working with a new plan to try to patch the dike.. Currently, between 15 and 20% of the total population has either no insurance or is underinsured for their level of risk -- the highest in the developed world. This is concerning, since more government dollars are also spent per capita than in any global nation. Also, a larger percentage of total income is directed towards healthcare in the United States than in any other U.N. member. Finally, healthcare issues for the single largest cause for personal bankruptcy in the nation ("Underinsured in America," 2002; DeNavas-Walt, et.al., 2008).

Case Study -- the American Emergency Room

One particularly egregious example of costs accelerating and affecting care is that of the whole paradigm of Emergency Medicine. Research shows that the number one reason for Emergency Room overcrowding in the United States is the healthcare system as a whole -- lack of insurance for so much of the population, inadequate insurance for others, and lack of accessibility to healthcare for much of the population. This is particularly true when one analyzes that many older adults, despite Medicare, are often the predominant population in the Emergency Room (Cutugno, 2011). There are segments of the scholarly arena that disagree about the statistics presented regarding the insured vs. The uninsured in the United States. One claim is that the portion of the population that is totally uninsured means that they are not eligible for any government plan, which, according to the census figures, would mean roughly 16% of U.S. citizens. However, one might conclude that with the economic crisis, more individuals have lost their benefits, or assigned reduced benefits, are not eligible for any government plan, and thus there are likely over 50 million Americans without any form of insurance. What do these individuals do when they are sick or have an emergency? They are forced to go to the Emergency Rooms of their closest hospital, wait hours for care that, because of the very nature, costs 3-4 times more than it would in a clinic or office setting (Santoro, 2009).

Particularly in the past two decades, critical care constitutes a significant proportion of many organization's emergency healthcare components. Emergency room overcrowding represents a serious threat to both patient safety and an impact on those individuals who require critical care. The overcrowding seen in most emergency areas is associated with exceeding nurse/patient ratios, providing quick turnaround in medical care, overuse of makeshift patient care areas (triage and hallways) and needing to divert ambulances to other institutions. Overcrowding typically results in extremely long wait times, particularly for those patients who are not critically ill. This leads to patient dissatisfaction, compromised medical care, and the healthcare institution needing to divert care from the extremely critical to other patients during peak use times. This escalating strain on emergency resources is felt throughout the system -- managed care has reduced bed capacity, many more people are without insurance, and budget cuts often result in inadequate staff even in major healthcare emergency rooms (Cowan & Trzeciak, 2004).

How do patients perceive the Emergency Room? The modern healthcare consumer believes they will see a doctor when they come to the ER and are often (about 80 per cent of the time) resistant to nurses or nurse PR actioners even for such things as minor cuts, bruises, and sprains. While this study was rather narrow in its demographic scope, it does point to additional issues that patient's tend to have when going to the ER -- they are usually quite ill and uncomfortable, and lengthy wait times becomes even more frustrating for them. Often, then the consumer frustration becomes more focused at the nurse than the system -- more of a convenience (Patient Perceptions, 2010). This is in contrast too with the Nurses' perception of the workforce and how they are continually being placed into a situation in which they are expected to be effective in both he healthcare/clinical role, and the medical/managerial role. Staffing and lack of control over procedures seem to be the largest issue… [END OF PREVIEW]

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