The Restructuring of the Current Health Care System


TheRestructuring of the Current Health Care System


The current care system is inundated with various challenges.Nevertheless, the greatest challenge to the U.S. health care is thesystem inefficiencies (Moriates, 2015). Consequently, changes need tobe implemented to ensure that patients are treated usingcost-efficient methods. The debilitating state of health care can beattributed to government bureaucracy. Practitioners have alsomanifested an unwillingness to evolve at the pace of moderntechnology. Therefore, the current health care system needs to berestructured to streamline treatment procedures. In particular,medical practices have to be expedited to prevent patients fromdeveloping worse complications.

The Role ofGovernment

The U.S.government has the primary role of regulating all health caresectors. In fact, the central government fulfills various functions.For example, it is recognized as the purchaser and provider of healthcare (Moriates, 2015). Besides, it sponsors the research of healthservices as it seeks to set high standards for the sector. Thefederal government needs to display decisive leadership that providesclear direction to practitioners and care facilities. It is criticalto enact consistent policies that control practices across all healthcare sections. For example, the Patient Protection and AffordableCare Act (PPACA) was adopted in 2010 to reduce health care costs(Moriates, 2015). The Act also barred insurance companies fromdenying medical cover to individuals with preexisting conditions.Consequently, the government can exploit its lobbying powers toinitiate greater changes in the health care system.

In particular,the government should use regulatory practices to establish clinicalreporting requirements for the sake of health care programs(Moriates, 2015). Furthermore, the government must ensure that allprograms adopt purchasing strategies. Such plans would lead to thewidespread integration of best practices as providers compete forfinancial rewards. Hence, physicians and hospitals that achieveexcellent outcomes could receive higher bonuses, capitation rates,diagnosis-related group (DRG) payments, and fees (Moriates, 2015).Health care delivery systems should be focused on developinginnovative models. Also, the government needs to oversee not only thecreation of public products but also the dissemination of findings(Moriates, 2015). The research of applied health services should begeared towards the development of strategies and tools that enhancequality in a broad variety of health care settings.

The role of thegovernment in restructuring the health care system is depictedthrough quality innovation, improvement, and assurance (Moriates,2015). Granted, some citizens lack access to adequate and competentmedical care. Consequently, the government must establish basichealth care standards for the benefit of impaired and incompetentclinicians. Such measures would also help health care organizationswith severe limitations in processes and capabilities. For example,all clinics and hospitals are required to implement infection controlmechanisms. Nurses and doctors are also needed to attain particularlevels of academic and practical training (Moriates, 2015).Furthermore, all practitioners should maintain valid licenses topractice medicine.

Granted,bureaucratic procedures have been manifested through conflictingobjectives and reporting burdens. Nevertheless, the gradual shiftfrom quality assurance to quality improvement techniques has enhancedthe government’s role as a health care provider (Moriates, 2015).In particular, the federal government has applied regulatorystrategies to programs such as the State Children’s HealthInsurance Program (SCHIP), Medicaid, and Medicare (Moriates, 2015).Such private institutions are required to demonstrate improvements inpatient outcomes and care processes. In this respect, they mustcollect data on particular performance measures. Therefore, thegovernment can adopt similar strategies in public health careorganizations to ensure uniformity.

Furthermore, thegovernment can contribute to the restructuring of the health caresystem through its role as a provider. For example, the federalgovernment can assume responsibility for employing health careworkers, operating comprehensive delivery systems, and buildingmedical facilities (Moriates, 2015). Hence, the government canengineer the testing of new information dissemination, delivery, andfinancing models. It also can test different combinations ofimprovement strategies and quality measurement techniques.Additionally, the federal government could use the Agency forHealthcare Research and Quality (AHRQ) to develop public reportingtools, survey instruments, and quality measures (Moriates, 2015).Consequently, the health care system would benefit from refinementsin delivery and financing.

Current Trendsin Health Care

The currenthealth care industry has witnessed the emergence of several trends.For example, there have been more mergers between industryprofessionals and other stakeholders (Gooch, 2015). Some of thesepartnerships feature clinician groups and independent hospitals.Health insurers also seek to develop collaborations to bolster theirearning power and benefit from competitive advantages such asoptimization of IT infrastructure and diversified revenue streams.Top tier health systems have consolidated their operations to takeadvantage of powerful data analytics (Gooch, 2015). Current trendshave also seen an escalation in drug prices due to the increase ofhigh-deductible plans of health care. Consequently, pharmaceuticalcompanies have shifted their focus to new financing models thatmitigate the cost of drugs using complementary programs (Gooch,2015). Biosimilar drugs have also been produced to serve as cheapersubstitutes for original medications. The Food and DrugAdministration (FDA) is responsible for reviewing the safety ofbiosimilars that are produced from living organisms (Gooch, 2015).

Furthermore,current trends in health care have seen an increased use ofsmartphones and tablets to monitor personal health. Such gadgets havereduced the significance of doctor visits since diagnosis andtreatment can be provided irrespective of the time and place.Developers have created many health-related apps due to shifts intechnology and financial incentives. The phenomenon of ‘bedless’hospitals has also gained prominence such that the majority ofconsumers prefer to visit with a health care professional using theirsmartphones (Gooch, 2015).

Additionally, theadvancement of medical technology has created considerable concernsof cybersecurity. In this regard, medical devices such as pacemakersand insulin pumps have been compromised by unscrupulous hackers(Gooch, 2015). Consequently, health care providers and devicecompanies have enhanced their vigilance with regards to medicalequipment. Protective measures have been adopted in networkarchitecture and design. In the recent past, insurance companies suchas Anthem have been victims of cyberattacks (Gooch, 2015).Corporations that suffer due to security breaches are subjected tolawsuits that not only yield fines but also damage their reputation(Murphy, 2015). Hence, consumers avoid links with organizations thatexperience breaches.

Consumers havealso adopted innovative means of managing their expenditure on healthcare. In this respect, they have endeavored to adopt new methods ofsolving payment issues. Some of these ways include combininginnovative financing models with other beneficial offerings. The needfor expenditure management arose due to co-insurance and higherdeductibles (Gooch, 2015). Many clients acquire pricing informationand payment plans to help them cater for medical expenses. Besides,high-tech databases have been established to conduct an in-depthanalysis of patients’ data. Granted, traditional databases couldstore structured information into rows and columns (Gooch, 2015).However, new databases can store unstructured data such astranscripts and clinician notes. Therefore, health care providerswill be empowered to use the collected data to provide bettertreatment for individual patients.

The increase inthe number of mental health cases has enhanced the significance ofbehavioral health. Mental illnesses have hampered the productivity ofbusinesses due to a reduction in man-hours. Consequently, many healthcare facilities and employers have focused on behavioral health careto reduce costs (Gooch, 2015). The enactment of programs for mentalhealth care also ensures that consumers maintain their good healthwhile businesses sustain their productivity.

The rise ofmedical expenses has led to the adoption of cost-saving measures.Budget pressures have intensified progressively such that manymedical centers have established community hospitals. The pursuit ofcheaper care settings has also contributed to the increase of retailclinics (Gooch, 2015). Other emerging trends include the creation ofvirtual care centers. Gradual elimination of inpatient medical carehas also been fuelled by technological advances and alternativepayment models. Although health systems customarily generate billionsin revenue, they are limited in identifying the number of expensesincurred. However, recent trends have seen the shareholders demandmore value (Gooch, 2015). Hence, health care providers will realizeadditional opportunities to improve care and ensure higherefficiency.

Impact ofVarious Stakeholders

Insurancecompanies have had an indelible mark on health care. Previously,insurance firms would disqualify patients with preexisting conditionsfrom enjoying treatment cover. However, the adoption of theAffordable Care Act made it mandatory for civilians to receiveinsurance coverage regardless of age, race, sex, social status, andcolor. Therefore, insurance firms collect predetermined premiums inexchange for medical cover. The value of premiums is always based onthe policy experience. The tax treatment of health insurance alsocosts the federal government plenty of resources (Moriates, 2015).The employer-sponsored insurance is exempt from tax payments. Hence,employers can provide greater health benefits at lower costs.

Additionally,information technology experts have played a significant role in thetransfer of electronic medical records. Physicians meet many patientsduring the course of practicing medicine. Therefore, maintainingrecords is critical in achieving the outcomes of medical care(Moriates, 2015). In many cases, clients visit different health careorganizations due to existing circumstances or personal preference.In such a situation, the practitioner will get in touch with thepatient`s personal doctor to request for electronic health records(Moriates, 2015). IT experts facilitate the storage and analysis ofpatient information on logs and charts.

Significanceof Education, Workforce, and Human Capital

Inevitably,education contributes to literacy and learning of language. Anilliterate person would have difficulties in adhering to prescribedmedications. In addition, an educated individual has an increasedlikelihood of having insurance coverage. On the other hand, anemployed individual would benefit more from health care than anunemployed person. This is because an employee is liable foremployer-based health insurance (Moriates, 2015). Furthermore, aworker that earns more than the average laborer can afford exclusivetreatments that may be out of reach for lower-income workers. Thegreater the capacity of human capital, the higher the rate ofexposure to health care.

Several factorshamper the growth of the U.S. health care. For example, thefee-for-service (FFS) reimbursement model creates a strong incentiveto conduct more tests and services. The federal government pays forthe tests conducted through the FFS system (Moriates, 2015). Sadly,such a system is maintained regardless of whether the tests improvethe quality of care. Consequently, medical professionals order moretests and procedures, longer inpatient stays, and more frequentoutpatient visits. Furthermore, the costs are ordinarily paid throughthird party insurance schemes. Hence, consumers are forced to payhigh premiums to maintain their insurance cover. Fragmentation ofhealth care delivery has also contributed to fewer instances ofcollaboration and coordination of efforts. The importance ofcoordinated care delivery is manifested through the adult populationthat is encumbered by multiple chronic conditions. Some of theseindividuals are dually eligible for Medicaid and Medicare (Moriates,2015). FFS payments provide little incentive for efficient medicalcare. Therefore, many patients are burdened with overtreatment.

Cost drivers inhealth care can also be attributed to medical errors andadministrative burden. The fragmentation of payment and delivery hasled to increased paperwork. Hence, a higher number of administrativeresources are needed to maintain the system and ensure appropriatechecks and balances. Administrative burden enhances the payer andprovider costs due to an intensified consumption of patient andphysician time. The aging population increases the number of peoplewho depend on the government for social welfare and other benefits.Individuals over 65 years old receive health care courtesy ofMedicare (Moriates, 2015). Consequently, the federal government’sbudget is depleted in caring for the aging population.

There is alsolimited consensus on many medical issues. For example, patients lackthe technology to compare health care outcomes and quality.Consequently, clinicians and patients are limited in identifying themost cost-effective treatment strategies. Health care professionalsusually receive a large quantity of information on ew interventionsand treatments (Moriates, 2015). Nevertheless, the health sectorlacks a mechanism to ensure comparisons of the success of differentstrategies.

Impact ofSocial Determinants and Other External Factors

Socialdeterminants of health include various factors such as education,support networks, employment, and access to health care. They alsoinclude the physical environment and socio-economic conditions of anindividual (ODPHP, 2016). Other social determinants include housing,transportation, safety, community engagement, and health coverage.Some people are born in low-income families (Heiman &amp Artiga,2015). Hence, they have fewer opportunities to benefit from qualitymedical care. Other persons have limited access to health carefacilities due to their unfavorable geographical location. Besides,some people are born into tribal communities that have little regardfor health care facilities. Additionally, individuals with limitededucation would have less appreciation for quality medical care.Consequently, social determinants of health have a great impact onthe restructuring of the health care system.

Also, theincrease in the number of chronic diseases has a direct bearing onthe health care system. The vast majority of Medicare spending isgeared towards the management of chronic conditions in olderpopulations (Mosadeghrad, 2014). In fact, most of the senior peoplein the U.S. experience terminal illnesses. A large percentage ofhealth care dollars are used to care for such individuals.Consequently, it frustrates the government`s plans to build morehospitals and clinics (Mosadeghrad, 2014). It also reduces the amountof funds available to provide treatment discounts through subsidies.

Advancements inmedical technology have also had multiple effects on health care.Such progress has increased the efficiency of the health care system.On the other hand, some physicians have been influenced by FFStreatments to order expensive, unnecessary tests (Mosadeghrad, 2014).In many cases, patients are permitted to have unlimited access tohealth care services. Such treatments are provided with littleincentive to participate in cost-sharing activities (Mosadeghrad,2014). Consequently, some circumstances encourage higher utilizationof medical facilities. The amount of funds spent on medical care alsoincrease.

Roles ofProfessional Obligation and Ethics

Restructuring ofthe health care system must be conducted in harmony with professionalobligations and ethics. The American Medical Association (AMA) hasestablished various ethical guidelines that dictate the conduct ofphysicians and health care organizations. For example, allpractitioners must respect the human dignity of their patients(Medical Assistant Certification, 2016). Physicians are also requiredto build on their scientific and medical knowledge to advance theirpractice (Medical Assistant Certification, 2016). In addition, theyshould respect the law with regards to the rights of patients andother colleagues.

Moreover, allphysician-parent interactions are guided by four ethical principles,namely, autonomy, justice, beneficence, and nonmaleficence.Physicians are expected to respect the patient’s decisionconcerning the acceptance or refusal of particular treatments.However, the practitioner should provide the client with enoughinformation to eliminate the likelihood of ignorance (MedicalAssistant Certification, 2016). Doctors must also be fair in theiruse of time to avoid making wrong diagnoses. Treatments and resourcesmust be dispensed in a reasonable manner. Besides, responsiblepractitioners must understand that no two patients would respondsimilarly to the same course of therapy. Therefore, physicians areobligated to cultivate an awareness of each person’s ability towithstand pain and illness (Medical Assistant Certification, 2016).Subsequently, practitioners would consider their actions to ensurethat unintentional harm does not occur to the patient or any otherparties (Medical Assistant Certification, 2016). Any attempts made inrestructuring the health care system must ensure that physiciansconduct comprehensive assessments of the benefits and risks of alltreatment decisions.

Health care mustadhere to the highest standards of privacy and confidentiality byprotecting the personal information of clients. The Health InsurancePortability and Accountability Act (HIPAA) was enacted to preventhealth care professionals from sharing the patient’s confidentialdetails (Medical Assistant Certification, 2016). Restructuring thehealth care system would require the adoption of other legislativeinstruments to address the ethical dilemmas that physicians encounterduring their practice. Notwithstanding, any amendments must avoidputting practitioners in situations where they may have to compromiseon ethics and professionalism.


Indeed, the current health care system needs to be restructured toaddress bureaucratic inefficiencies. Various stakeholders have animpact on the health care system. The government plays the role ofprovider and purchaser by issuing funds to support different programsand institutions. Besides, the government can enact policies such asthe PPACA to provide affordable health care for all citizens.However, the authorities should improve the models of health caredelivery and financing to make it easier for clients to cater fortheir medical expenses. The rise in medical costs has led to theemergence of trends pertaining to information technology and healthinformatics. Indeed, social determinants have a substantial effect onmedical care. Nevertheless, improvements in health care must considerthe impact on professional obligations and ethics.


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Heiman, H. J. &amp Artiga, S. (2015, Nov. 4). Beyond Health Care:The Role of Social Determinants in Promoting Health and HealthEquity. KFF. Retrieved from

Moriates, C. (2015). Understanding value-based healthcare. NewYork, NY: McGraw-Hill.

Mosadeghrad, A. M. (2014). Factors influencing health care servicequality. International Journal of Health Policy and Management,3(2), 77–89. doi:10.15171/ijhpm.2014.65

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